ADDICTION 101 An Introduction to Substance Use THE PROCESS OF ADDICTION & RECOVERY Presented by: Tim Dueck, MSW, RSW

What is a Drug? A drug is any substance other than food which changes the way the body or mind functions. Drugs may or may not have medicinal properties or purposes. Drugs can come from plants or be made in labs. Drugs can be legal, illegal, helpful or harmful.

Substance Use - Appropriate Use To get better if you are ill (doctor’s prescription). To reduce pain from illness or injury. To prevent illness (inoculation). To manage mental illness by balancing brain chemistry. To help the body do things it can’t do on its own (e.g. make insulin).

Psychoactive Drugs Caffeine Marijuana Nicotine LSD Ritalin Xanax Definition: Drugs that work on the mind or on behaviour. Psychoactive drugs alter your mood and the way you think and act. Caffeine Marijuana Nicotine LSD Ritalin Xanax Cocaine Valium Alcohol Heroin

Why Do People Use Drugs? Forget problems Get high Lose or gain weight Relax, energize Go to sleep, stay awake Boredom, depression Gain confidence Be cool, socialize, friends Experience altered states

Why Do People Use Drugs? Symbol of rebellion Sex Sports cont’d Symbol of rebellion Sex Sports Religious ritual Have fun, excitement Reduce anxiety Experiment Avoid withdrawal if dependant Reduce pain (i.e. physical, emotional, etc.)

Substance Abuse / Misuse Misuse or Abuse - any use of a drug that causes personal problems such as health, work, relationship, legal, financial emotional. Frequent forms of abuse: Too much - taking too much at one time or taking smaller doses more often. Too long - taking the drug after it is no longer needed; extending the prescription. Improper Use - taking the drug for a different illness / complaint. Taking another person’s prescription.

Substance Abuse / Misuse cont’d Frequent forms of abuse: Improper Combination - Combinations of drugs can produce unwanted, dangerous effects - even death (e.g. alcohol and tranquilizers). You do not have to be an addict / alcoholic to have a problem with substances.

DSM IV - Definition of Substance Dependence Criteria: A person demonstrates 3 or more of the following, occurring at any time in a 12 month period: Tolerance as defined by either, a) a need for markedly increased amounts to achieve intoxication, or b) a markedly diminished effect with continued use of the same amount. Withdrawal as manifested by either, a) the characteristic withdrawal syndrome for the substance. b) the same (or closely related) substances are taken to relieve or avoid symptoms. Amount / Duration: The substance is taken in larger amounts or over a longer period than was intended.

DSM IV - Definition of Substance Dependence cont’d Control: There is a persistent desire or unsuccessful efforts to cut down or control substance use. Time: A great deal of time is spent in activities necessary to obtain the substance (e.g. visiting doctors); use the substance (chain smoking); or recover from its effects. Activities / Commitments: Important social, occupational and recreational activities are given up due to substance use. Negative Consequences: The substance use is continued despite persistent or recurrent physical or psychological problems that are likely to have been caused or exacerbated by the substance (e.g. current cocaine use despite depression that is induced by the drug).

Addiction - a practical definition The 3 “C’s” Control - there are repeated attempts to cut back or control use, with episodes or loss of control in between. Compulsion - a person experiences a sense that they must use. Can be due to tolerance, withdrawal or psychological need. Consequences - substance use is continued despite significant negative consequences.

Other Definition Substance abuse is any drug use that breaks healthy connections with family, friends and society.

Risk Factors - Personal Factors Lack of attachment to healthy adults/mainstream culture Genetic / Biological factors / Drug effects Personal characteristics (e.g. high vulnerability to anxiety / depression; impulsiveness; etc.) Health / Mental Illness Sex / Gender Early drug use

Risk Factors - External Factors Family of Origin Abuse from the family and others Culture External Stressors e.g. poverty; job stress; single parenting; unemployment; divorce Exposure to Trauma e.g. natural disaster; civil war; international conflict, rape, etc Availability of Substances Peer Group

Possible functions: It can be useful to understand what processes maintain an addiction after drug use is no longer enjoyable. provides role / identity / friends helps forget the past a way of avoiding responsibilities withdrawal from intimacy stave off physical withdrawal slow suicide or self-punishment acting out self hate

Addiction to Other Experiences Since many of the factors which promote and maintain addiction are psychological, or social, people can develop addictions to other human behaviours. Sex Gambling Exercise Pornography Shopping Internet Television Role-playing games

THE PROCESS OF DEPENDENCY

Non-Users Refers to people who choose to abstain from substance use. Some reasons include: Personal choice for health, personal or social, or family reasons. Membership in particular religious or cultural groups. Negative experiences of long-term substance abuse / addiction. Deciding that using is unpleasant or dangerous.

Experimental Use Refers to the first few times a person tries alcohol or other drugs. Possible contributing factors: 1. Willingness to try the drug. 2. Friends or acquaintances that use. 3. A sense of safety about the drug and the setting. Possible reasons for experimenting include: * Boredom * Need to Belong * Curiosity * Depression * Peer Pressure * Desire for stimulating or exciting alternatives

Experimental Use Key Concept: cont’d Key Concept: In experimentation, people are exploring their relationship with the substance. If they don’t enjoy the effects, they go back to non-use. If they do, they may become social users.

Experimental Use Risks: cont’d Risks: Using too much and / or taking too strong a dose due to inexperience. Beginners do not know how much their body can handle. They often are teenagers, bingeing with the intention of getting drunk / high. If they are using street drugs, they often don’t know the source / the dealer / manufacturer.

Social Use Refers to using a substance in social settings Social Use Refers to using a substance in social settings. It is one factor in the event but is not the main purpose of the gathering. Key Concepts: Using does not take priority over other life activities and experiences. Examples of Social Use: No aspect of a person’s life is affected negatively. To socialize. To celebrate important occasions.

Instrumental Use Using a substance as an instrument to fulfill a purpose, often seeking pleasure or avoiding pain. Pleasure Seeking: Fun, feelings of power and control. Experiencing altered states and perceptions. Reduces inhibitions. Avoiding Pain Psychological: suppress negative feelings such as anger, guilt, shame, grief, boredom, etc. Physical: seek relief from physical discomfort.

Habitual use Drinking / drugging on a regular basis, potentially increasing risk for problems in one or more areas of a person’s life. Key Concepts: Problem use is generally characterized by frequent use of substance. Problems may emerge in areas of: * Relationships * Work / School * Health * Finances * Legal Status Social life and circumstances may narrow to include only other users and social functions involving using. A person is not considered dependant at this point and still has some choice about their usage.

Compulsive Use The person experiences an overwhelming physical and / or psychological need to use. Key Concepts: A person experiences: Physical Dependence, including: a) Tolerance - a need for increasing doses to feel the same high. b) Withdrawal - characteristic of the particular drug; usually the opposite effect of the high.

Compulsive Use Psychological Dependence cont’d Psychological Dependence a) - an all-consuming focus on the drug (getting it, getting high, dealing with coming down, finding more); brain chemistry has changed. b) - person experiences no choice about using and feels no control over the amount consumed.

Binge Use Refers to heavy drinking or drugging on a sporadic basis, with periods of little or no use in between. Key Concepts: Binge use can be as problematic as regular use. Binge drinking is often associated with higher levels of: * hostility and aggression * police altercations * domestic violence * work problems * hospital admissions (in comparison to heavy, steady users) The unpredictable nature of binge use can create a destructive set of stressors for those involved in the user’s life.

THE PROCESS OF RECOVERY

Recovery is a process that involves:

Stages of Recovery Early Recovery: Getting Clean Concrete changes in daily living Adequate sleep, diet, exercise Staying away from those who are using Building support; education

Stages of Recovery Middle Recovery: Stabilization Able to turn energies to family, work, relationships, friendships Support, life skills, relaxation, stress management Less focus on using

Stages of Recovery Late Recovery: Maintenance Insight into early trauma Healing, repairing self-esteem

Aspects of Recovery: Recognition Cessation Education Support Counselling Relapse Prevention Dealing with Underlying Issues

Model of Change

Model of Change

Relapse Definition: Relapse: Return to previous behaviors

Relapse Factors Common Triggers of Relapse Individual Unpleasant feelings Unpleasant physical states Positive emotional states Testing personal control Urges, cravings

Relapse Factors Common Triggers of Relapse (cont.) Interpersonal Enhancing good feelings Social Pressure Conflict with others

Personal Relapse Factors People – former ‘using’ friends (i.e. dealers, partiers, etc.) Places – former ‘using’ settings (i.e. pubs, crack-houses, etc.) Things – former ‘using’ objects / paraphernalia (i.e. pipes, etc.)

Personal Relapse Factors Times – former ‘using’ rituals (i.e. beer after work, etc.) Activities – previously associated with substance use (i.e. pool, darts, etc.) Emotional states – emotions previously associated with substance use (i.e. anger, etc.) Events – events formerly associated with substance use (i.e. concerts, etc.)

Blaming Addiction is often maintained by the process of blaming (people, events, myself, etc) Blaming occurs through the process of projection Healing from this requires both insight and the willingness to take responsibility for one’s life Blaming is looking backwards, responsibility is about looking forwards

What does the person know now that they Processing a Relapse A relapse is not inevitable but it is a common experience in the recovery process. It can be an opportunity to learn: What was the trigger(s)? What was the high risk situations? What will one do differently in the future? How did the person manage to stop drinking / drugging? How was this lapse / relapse different from the last one? In what ways is the person stronger / wiser? What does the person know now that they did not know before?

ADDRESSING SUBSTANCE-USE WITH OTHERS

Relevance Motivational information has the greatest impact. Always tailor discussion to each person. Disease status or risk Family or social situation Age, gender Prior experience in recovery

Risks Highlight the risks of continued substance use and also the risks of change. Ask the person to outline potential consequences and benefits on both sides of issue. Emphasize that loss may occur whenever life changes are made.

Rewards Improved health Ask the patient to identify the benefits of using as well as potential benefits of ending substance use. Improved health Feel better physically Not worry about hurting loved ones Modeling healthy lifestyle choices to children

Roadblocks Assist person to identify barriers to making change. Lack of belief in ability to change Withdrawal symptoms Fear of failure

Repetition Reinforce the motivational messages at every visit. Re-enforce to those not yet ready to make changes that when they are ready to discuss substance use, you are there to help.

You become successful the moment you start moving toward a worthwhile goal. (Unknown)