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Continuum of Substance Use
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Objectives
To provide information about substance abuse
To assist students in understanding the symptoms and consequences of substance use and abuse
To motivate students to make informed choices about substance use and abuse
Earn CEUs at AllCEUs.com NBCC #6261, NAADAC #599 Copyright AllCEUs 2006-2020
Overview
Substance use can be thought of on a continuum from social/recreational use to abuse and dependence.
Many factors affect whether substance use is a problem including whether it causes significant impairments in health, social, legal or occupational functioning
No certain amount of substance use necessarily means there is a problem. It is important to consider the situation, the consequences and whether the person was in jeopardy of causing themselves physical harm by using.
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What is Addiction
Three facets to the definition
– A person, substance, or activity
– Regularly used to escape from negative feeling states
– Continues to be used despite experiencing negative consequences.
– Note: Physiological dependence is NOT necessarily a part of addiction
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Definition of addiction cont…
Another way to understand addiction is to apply the four Cs:
– Behavior that is motivated by emotions ranging along the Craving to Compulsion spectrum
– Continued use in spite of adverse Consequences, and
– Loss of Control.
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“Trademark” Addictive Behaviors
Denial
Manipulation
Throwing focus
Blaming
Minimizing
Rationalizing
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The Continuum
Powerpoint Understanding Drug Abuse
Recreational Use
Gateway Drugs
Abuse
Dependence
The “Slide”
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Understanding the “Slide”
Started with occasional drinking for relief/escape/relaxation
Things keep getting worse, so relief drinking becomes more constant
Needing more of the substance to get the same high
Started having blackouts The urge to use became
more urgent
Began feeling guilty
Memory blackouts increase Unable to discuss problems Harder to stop drinking Starting to fail to keep
promises Dramatic and/or aggressive
behavior began as people started to question your behaviors
Efforts to control the use of the substance fail repeatedly
Loss of other interests
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Slide cont…
You begin to avoid family and friends
You begin to have resentments (which you can later look back on as unreasonable)
You start having problems at work and with money
You have lost your will power You begin to neglect your
diet, sleep and general health
You start having a decrease in your ability to tolerate the substance
Your intoxication/use periods become longer (days or weeks instead of a few hours)
Your body begins to deteriorate under the stress of the substance
Your thinking becomes impaired---judgment is bad, memory is lost
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Understanding Addictive Behaviors
Definition of addiction: Diagnosis of a Problem Spent more time that anticipated trying to get the
substance, trying to be around the person or doing the behavior (like gambling or sex)
Used the substance, stayed in the relationship or did the behavior (like gambling or sex) despite knowing the problems it could cause
Spent more money than you anticipated trying to get the substance, do the behavior or stay in the relationship
Failed to fulfill family/work/school obligations as a result of using or recovering from use
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Definition of addiction cont…
Used more of the substance than intended Legal problems as a result of use, doing the behavior or
staying in the relationship Used the substance, did the behavior or stayed in the
relationship for longer than intended Work/home or family problems as a result of the use of the
substance, staying in the relationship or doing the behavior Needed more of the substance or activity for the same high Put yourself in dangerous situations while getting or using
the substance, doing the behavior or staying in the relationship
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Addiction Warning Signs
Read each statement carefully. Identify
which ones are warning signs and why.
I experiment with alcohol or drugs
I drink or use drugs occasionally in social settings
I function well at work and home
I use alcohol or drugs for pleasure
I use drugs/drink regularly at social or sporting events
Using makes me feel like one of the group
My rebellion is normal midlife or college behavior
My tolerance to alcohol or specific drugs has increased
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Warning signs cont…
My functioning at work remains stable
I feel like I need to drink or use drugs
When you use you feel in control
I use drugs or drink on a daily basis
Relationships with my family are becoming strained
I hide my drinking or drug use from my family
Most of my friends do drugs or drink
I devote less time and attention to school work
I drink or use drugs to feel better
I have lost control over my use
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Prevalence of the problem
More than 50% of the population has a substance abuse problem at some point in their lives.
If you factor in non-drug addictions such as gambling, sex and food, the number grows to closer to 75%
Drug Abuse Statistics
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Consequences of Addiction
Individual
– Psychological, Cognitive, Social/Family, Occupational, Financial, Environmental, Physical
Community
– Crime, Commerce, Poverty, Social Modeling
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Readiness for Change
Precontemplation
– “I do not have a problem and nobody can convince me I do!”
Contemplation
– I may use a bit too much sometimes, but I can get it under control”
Preparation
– “Okay, I have a bit of a problem and might consider listening to what you have to say.”
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Cont. . .
Action
– “I have a problem and I cannot fix it by myself. Help me.”
Maintenance
– “ I have a disease. It is in remission. I know what I need to do to keep it that way and I am willing to do it.”
Relapse
– “I recognize some of the signs of my disease coming back in how I think, act and what I want to do. I know I need to take action.”
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Clean vs. Sober
Clean= I have no drugs in my body or am not engaging in the behavior to which I am addicted.
Sober= I am clean and am behaving honestly, consciously and with courage and integrity.
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Other addictive behaviors of concern
Eating Disorders
Gambling
Sexual Addiction
Shopping Addiction Relationships
Generally any person, substance or activity which continues to be used as a primary means of escape despite experiencing negative consequences (legal, relationship, occupational, health, emotional etc.)
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Comprehensive Treatment
Individual
Family
School/Work
Community
Society at large
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Types of Recovery Programs
Treatment Methods Overview Self Help
12-Step (pg. 247)
Recovery SMART Recovery (pg. 249)
Faith Based
Client Centered
Therapeutic Communities (Daytop, Samaritan Village, Phoenix House)
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Duration and Frequency of Recovery Programs
Self-Help– Meets daily or weekly
– Usual involvement: several years
Outpatient– Meets weekly
– Usual involvement 12 weeks
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Recovery Programs cont…
Intensive Outpatient– Meets 3-5 days per week 4 hours per day
– Usual involvement 12-24 weeks
Residential– 24/7 care
– Usual involvement 28 days for addictions programs and 6-12 months for dual diagnosis (addictions and mental health)
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Levels of Prevention
Primary
– Goals are to prevent the problem from occurring in the first place
Secondary
– Goals are to prevent the problem from getting worse
Tertiary
– Goal are to prevent the problem from getting worse and prevent any other complications
Information on Prevention Programs for Those Interested
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Risk and Resiliency Factors
INDIVIDUAL
RISK FACTORS
Certain physical, emotional or personality traits
Inherited genetic vulnerability
Low self esteem
Psychological disturbances
Inappropriate coping responses
Violence/ aggression
Risk taking propensity/impulsivity
Alienation and rebelliousness
Rejection of pro-social values/religion
Lack of peer refusal skills
Early and persistent problem behaviors
Early sexual activity/teen pregnancy
Early anti-social behavior
Peer rejection in elementary grades
Academic Failure
Less involved in recreational, social, activities
Lack of information on positive health behaviors
PROTECTIVE FACTORS
Knowledge regarding risks associated with substance abuse/use
Negative attitudes toward substances and substance use
Bonding to pro-social culture
Positive relationships with adults
Views parents, teachers, doctors, law enforcement officers and other adults as allies
Social competence
Youth involvement in alternative activities
Sense of well-being/self confidence
Has positive future plans
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Peer Risk Factors cont. . .
RISK FACTORS • Reinforcement of negative norms and
expectations within peer group • Thinks alcohol and drug use is "cool" • Inappropriate sexual activity among peers • Ties to deviant peers/gang involvement
PROTECTIVE FACTORS • Involved in substance-free activities • Friends disapprove of alcohol and other
drug use
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Family Risk Factors
RISK FACTORS •Family members with a history of alcohol or other drug abuse •Family members don't spend much time together •Parents have trouble keeping track of teens, who they're with and where they go •Lack of clear rules and consequences regarding alcohol and other drug use •Parents use drugs, involve youth in their use ("Get me a beer, would you?") or tolerate use by youth •Parents have trouble setting consistent expectations and limits •Family conflict/abuse •Loss of employment
PROTECTIVE FACTORS •Close family relationships •Consistency of parenting •Education is valued and encouraged, and parents are actively involved •Copes with stress in a positive way •Clear expectations and limits regarding alcohol and other drug use •Encourages supportive relationships with caring adults beyond the immediate family •Share family responsibilities, including chores and decision making •Family members are nurturing and support each other
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School Risk Factors
RISK FACTORS
Lack of clear expectations, both academic and behavioral
Students lack commitment or sense of belonging at school
High numbers of students who fail academically at school
Parents and community members not actively involved
PROTECTIVE FACTORS
Positive attitudes toward school
School bonding
Regular school attendance
Communicates high academic and behavioral expectations
Encourages goal-setting, academic achievement and positive social development
Tutoring available
Positive instructional climate
Provides leadership and decision making opportunities for students
Fosters active involvement of students, parents and community members
Sponsors substance-free events
School responsive to students' needs
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Community Risk Factors
RISK FACTORS •Alcohol/other drugs readily available •Irresponsible servers and sellers •Laws and ordinances are unclear or inconsistently enforced •Norms are unclear or encourage use •No sense of "connection" to community •Neighborhood disorganization •Rapid changes in neighborhood High unemployment •Residents at or below the poverty level •Lack of strong social institutions •Lack of monitoring youths' activities •Inadequate media portrayals •Misleading advertising •Pro-use messages
PROTECTIVE FACTORS •Opportunities for community involvement •Community religious composition •Laws are consistently enforced •Informal social control •Policies and norms encourage non-use •Community service opportunities Resources (housing, healthcare, childcare, jobs, recreation, etc.) available •Comprehensive risk focused programs available for youth•Programs for parents of children and adolescents •Early childhood and family support programs
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Additional Resources
The Higher Education Center for Alcohol and Other Drug Prevention http://www.edc.org/hec National Clearinghouse for Alcohol and Drug Information http://www.health.org National Council on Alcohol and Drug Dependence http://www.ncadd.org Center for Substance Abuse Prevention (CSAP) http://www.coresoft.comlcsap.html Virtual Clearinghouse on Alcohol, Tobacco, and Other Drugs http://www.ccsa.calatod.htm National Center on Addiction & Substance Abuse http://www.casacolumbia.org Promising Practices - Campus Alcohol Strategies http://www.promprac.gmu.edu Training for Intervention Procedures (TIPS) http://www.gettips.com Harvard School of Public Health College Alcohol Study http://hsph.harvard.edu/cas National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov National Institute on Drug Abuse http://www.nida.nih.gov AI-Anon http://www.al-anon.org Health finder http://www.healthfinder.gov Drugs Awareness Online: Use, Abuse, & Treatment http://www.mhhe.comlhper/health/drugs
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Summary
Substance abuse is defined by impairment in one or more areas of functioning over a 12 month period as a result of substance use
More than 50% of people have an addiction
There are a host of outpatient and more intensive programs and styles