ADDICTION 101ADDICTION 101An Introduction to Substance UseAn Introduction to Substance Use

THE PROCESS OF THE PROCESS OF ADDICTION & RECOVERYADDICTION & RECOVERY

Presented by:Presented by:

Tim Dueck, Tim Dueck, MSW, RSWMSW, RSW

What is a Drug?What is a Drug?A drug is any substance other than food which A drug is any substance other than food which changes the way the body or mind functions.changes the way the body or mind functions.

Drugs may or may not have medicinal properties Drugs may or may not have medicinal properties or purposes.or purposes.

Drugs can come from plants or be made in labs.Drugs can come from plants or be made in labs.

Drugs can be legal, illegal, helpful or harmful.Drugs can be legal, illegal, helpful or harmful.

Substance Use Substance Use - Appropriate Use- Appropriate Use

To get better if you are ill (doctor’s To get better if you are ill (doctor’s prescription).prescription).

To reduce pain from illness or injury.To reduce pain from illness or injury. To prevent illness (inoculation).To prevent illness (inoculation). To manage mental illness by To manage mental illness by

balancing brain chemistry.balancing brain chemistry. To help the body do things it can’t do on its To help the body do things it can’t do on its

own (e.g. make insulin).own (e.g. make insulin).

Psychoactive DrugsPsychoactive DrugsDefinition:Definition: Drugs that work on the mind or on behaviour.Drugs that work on the mind or on behaviour.

Psychoactive drugs alter your mood and the way you think Psychoactive drugs alter your mood and the way you think and act.and act.

CaffeineCaffeine MarijuanaMarijuana Nicotine LSDNicotine LSD RitalinRitalin XanaxXanax CocaineCocaine ValiumValium AlcoholAlcohol HeroinHeroin

Why Do People Use Drugs?Why Do People Use Drugs? Forget problemsForget problems Get highGet high Lose or gain weightLose or gain weight Relax, energizeRelax, energize Go to sleep, stay awakeGo to sleep, stay awake Boredom, depressionBoredom, depression Gain confidenceGain confidence Be cool, socialize, friendsBe cool, socialize, friends Experience altered statesExperience altered states

Why Do People Use Drugs?Why Do People Use Drugs?

Symbol of rebellionSymbol of rebellion SexSex SportsSports Religious ritualReligious ritual Have fun, excitementHave fun, excitement Reduce anxietyReduce anxiety ExperimentExperiment Avoid withdrawal if dependantAvoid withdrawal if dependant Reduce pain (i.e. physical, emotional, etc.)Reduce pain (i.e. physical, emotional, etc.)

cont’d

Substance Abuse / MisuseSubstance Abuse / MisuseMisuse or Abuse - any use of a drug that causes Misuse or Abuse - any use of a drug that causes

personal problems such as health, work, relationship, personal problems such as health, work, relationship, legal, financial emotional.legal, financial emotional.

Too much - taking too much at one time or Too much - taking too much at one time or taking smaller doses more often.taking smaller doses more often.

Too long - taking the drug after it is no longer Too long - taking the drug after it is no longer needed; extending the prescription.needed; extending the prescription.

Improper Use - taking the drug for a different Improper Use - taking the drug for a different illness / complaint. Taking another person’s illness / complaint. Taking another person’s prescription.prescription.

Frequent forms of abuse:

Substance Abuse / MisuseSubstance Abuse / Misuse

Improper Combination - Combinations of drugs Improper Combination - Combinations of drugs can produce unwanted, dangerous effects - can produce unwanted, dangerous effects - even death (e.g. alcohol and tranquilizers).even death (e.g. alcohol and tranquilizers).

You do not have to be an addict / alcoholic to have a problem with substances.

Frequent forms of abuse:

cont’d

DSM IV - Definition of Substance DSM IV - Definition of Substance DependenceDependence

Criteria: A person demonstrates 3 or more of the following, Criteria: A person demonstrates 3 or more of the following, occurring at any time in a 12 month period:occurring at any time in a 12 month period:

1 ToleranceTolerance as defined by either, as defined by either, a) a need for markedly increased amounts to achieve intoxication, ora) a need for markedly increased amounts to achieve intoxication, orb) a markedly diminished effect with continued use of the same b) a markedly diminished effect with continued use of the same

amount.amount.2 Withdrawal Withdrawal as manifested by either, as manifested by either,

a) the characteristic withdrawal syndrome for the substance.a) the characteristic withdrawal syndrome for the substance.b) the same (or closely related) substances are taken to relieve or b) the same (or closely related) substances are taken to relieve or avoid symptoms.avoid symptoms.

3 Amount / Duration: Amount / Duration: The substance is taken in larger amounts or over The substance is taken in larger amounts or over a longer period than was intended.a longer period than was intended.

4 Control:Control: There is a persistent desire or unsuccessful efforts to cut There is a persistent desire or unsuccessful efforts to cut down or control substance use.down or control substance use.

5 Time: Time: A great deal of time is spent in activities necessary to obtain A great deal of time is spent in activities necessary to obtain the substance (e.g. visiting doctors); use the substance (chain the substance (e.g. visiting doctors); use the substance (chain smoking); or recover from its effects.smoking); or recover from its effects.

6 Activities / Commitments: Activities / Commitments: Important social, occupational and Important social, occupational and recreational activities are given up due to substance use.recreational activities are given up due to substance use.

7 Negative Consequences: Negative Consequences: The substance use is continued despite The substance use is continued despite persistent or recurrent physical or psychological problems that are persistent or recurrent physical or psychological problems that are likely to have been caused or exacerbated by the substance (e.g. likely to have been caused or exacerbated by the substance (e.g. current cocaine use despite depression that is induced by the current cocaine use despite depression that is induced by the drug).drug).

cont’d

DSM IV - Definition of Substance DSM IV - Definition of Substance DependenceDependence

Addiction - Addiction - aa practical definition practical definition

TThe 3 “C’s”he 3 “C’s” ControlControl - there are repeated attempts to cut back - there are repeated attempts to cut back

or control use, with episodes or loss of control in or control use, with episodes or loss of control in between.between.

Compulsion Compulsion - a person experiences a sense that - a person experiences a sense that they they mustmust use. use. Can be due to tolerance, Can be due to tolerance, withdrawal or psychological need.withdrawal or psychological need.

Consequences Consequences - substance use is continued - substance use is continued despite significant negative consequences.despite significant negative consequences.

Other DefinitionOther Definition

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

Risk Factors Risk Factors -- Personal FactorsPersonal Factors

Lack of attachment to healthy adults/mainstream Lack of attachment to healthy adults/mainstream cultureculture

Genetic / Biological factors / Drug effectsGenetic / Biological factors / Drug effects Personal characteristics (e.g. high vulnerability Personal characteristics (e.g. high vulnerability

to anxiety / depression; impulsiveness; etc.)to anxiety / depression; impulsiveness; etc.) Health / Mental IllnessHealth / Mental Illness Sex / GenderSex / Gender Early drug useEarly drug use

Risk Factors Risk Factors -- External FactorsExternal Factors

Family of Origin Family of Origin Abuse from the family and others Abuse from the family and others CultureCulture External Stressors e.g. poverty; job stress; single External Stressors e.g. poverty; job stress; single

parenting; unemployment; divorceparenting; unemployment; divorce Exposure to Trauma e.g. natural disaster; civil Exposure to Trauma e.g. natural disaster; civil

war; international conflict, rape, etcwar; international conflict, rape, etc Availability of SubstancesAvailability of Substances Peer GroupPeer Group

Possible functions:Possible functions:It can be useful to understand what processes maintain an It can be useful to understand what processes maintain an

addiction after drug use is no longer enjoyable.addiction after drug use is no longer enjoyable.

provides role / identity / friendsprovides role / identity / friends helps forget the pasthelps forget the past a way of avoiding responsibilitiesa way of avoiding responsibilities withdrawal from intimacywithdrawal from intimacy stave off physical withdrawalstave off physical withdrawal slow suicide or self-punishmentslow suicide or self-punishment acting out self hateacting out self hate

Addiction to Other ExperiencesAddiction to Other ExperiencesSince many of the factors which promote and maintain Since many of the factors which promote and maintain

addiction are psychological, or social, people can develop addiction are psychological, or social, people can develop addictions to other human behaviours.addictions to other human behaviours.

SexSex GamblingGambling ExerciseExercise PornographyPornography ShoppingShopping InternetInternet TelevisionTelevision Role-playing gamesRole-playing games

THE PROCESS THE PROCESS

OFOF

DEPENDENCYDEPENDENCY

Non-UsersNon-UsersRefers to people who choose to abstain from substance use.Refers to people who choose to abstain from substance use.

Some reasons include:Some reasons include:

Personal choice for health, personal or Personal choice for health, personal or social, or family reasons.social, or family reasons.

Membership in particular religious or Membership in particular religious or cultural groups.cultural groups.

Negative experiences of long-term Negative experiences of long-term substance abuse / addiction.substance abuse / addiction.

Deciding that using is unpleasant or Deciding that using is unpleasant or dangerous.dangerous.

Experimental UseExperimental UseRefers to the first few times a person tries Refers to the first few times a person tries

alcohol or other drugs. alcohol or other drugs.

Possible contributing factors:Possible contributing factors:1. Willingness to try the drug.1. Willingness to try the drug.2. Friends or acquaintances that use.2. Friends or acquaintances that use.3. A sense of safety about the drug and the setting.3. A sense of safety about the drug and the setting.

Possible reasons for experimenting include:Possible reasons for experimenting include:* Boredom* Boredom * Need to Belong* Need to Belong* Curiosity* Curiosity * Depression* Depression* Peer Pressure* Peer Pressure* Desire for stimulating or exciting alternatives* Desire for stimulating or exciting alternatives

Key Concept:Key Concept:In experimentation, people are exploring In experimentation, people are exploring

their relationship with the substance.their relationship with the substance.

• If they don’t enjoy the effects, they go back If they don’t enjoy the effects, they go back to non-use.to non-use.

• If they do, they may become social users.If they do, they may become social users.

Experimental UseExperimental Usecont’d

Risks:Risks:

Using too much and / or taking too strong a dose Using too much and / or taking too strong a dose due to inexperience.due to inexperience.

Beginners do not know how much their body can Beginners do not know how much their body can handle.handle.

They often are teenagers, bingeing with the They often are teenagers, bingeing with the intention of getting drunk / high.intention of getting drunk / high.

If they are using street drugs, they often don’t If they are using street drugs, they often don’t know the source / the dealer / manufacturer.know the source / the dealer / manufacturer.

cont’d

Experimental UseExperimental Use

Social UseSocial UseRefers to using a substance in social settings. It is one factor Refers to using a substance in social settings. It is one factor

in the event but is in the event but is notnot the main purpose of the gathering. the main purpose of the gathering.

Key Concepts:Key Concepts: Using does not take priority over other Using does not take priority over other

life activities and experiences.life activities and experiences.

Examples of Social Use:Examples of Social Use: No aspect of a person’s life is affected No aspect of a person’s life is affected

negatively.negatively. To socialize.To socialize. To celebrate important occasionsTo celebrate important occasions..

Instrumental UseInstrumental UseUsing a substance as an instrument to fulfill a purpose, Using a substance as an instrument to fulfill a purpose,

often seeking pleasure or avoiding pain.often seeking pleasure or avoiding pain.

Pleasure Seeking:Pleasure Seeking: Fun, feelings of power and control.Fun, feelings of power and control. Experiencing altered states and perceptions. Experiencing altered states and perceptions. Reduces inhibitions.Reduces inhibitions.

Avoiding PainAvoiding Pain Psychological: suppress negative feelings such Psychological: suppress negative feelings such

as anger, guilt, shame, grief, boredom, etc.as anger, guilt, shame, grief, boredom, etc. Physical: seek relief from physical discomfort.Physical: seek relief from physical discomfort.

Habitual useHabitual useDrinking / drugging on a regular basis, potentially increasing Drinking / drugging on a regular basis, potentially increasing

risk for problems in one or more areas of a person’s life.risk for problems in one or more areas of a person’s life.

Key Concepts:Key Concepts: Problem use is generally characterized by frequent use of substance.Problem use is generally characterized by frequent use of substance. Problems may emerge in areas of:Problems may emerge in areas of:

* Relationships* Relationships * Work / School* Work / School * Health* Health * Finances* Finances * Legal Status * Legal Status

Social life and circumstances may narrow to include only other users and Social life and circumstances may narrow to include only other users and social functions involving using.social functions involving using.

A person is not considered dependant at this point and still has some choice A person is not considered dependant at this point and still has some choice about their usage.about their usage.

Compulsive UseCompulsive UseThe person experiences an overwhelming physical and / or The person experiences an overwhelming physical and / or

psychological need to use.psychological need to use.

Key Concepts:Key Concepts: A person experiences: A person experiences:

Physical Dependence, Physical Dependence, including:including:

a) a) ToleranceTolerance - a need for increasing doses - a need for increasing doses to feel the same high.to feel the same high.

b) b) WithdrawalWithdrawal - characteristic of the - characteristic of the particular drug; usually the opposite effect particular drug; usually the opposite effect of the high.of the high.

Compulsive UseCompulsive Use

Psychological DependencePsychological Dependence

a) - an all-consuming focus on the drug a) - an all-consuming focus on the drug (getting it, getting high, dealing with (getting it, getting high, dealing with coming down, finding more); brain coming down, finding more); brain chemistry has changed. chemistry has changed.

b) - person experiences no choice about b) - person experiences no choice about using and feels no control over the amount using and feels no control over the amount consumed.consumed.

cont’d

Binge UseBinge UseRefers to heavy drinking or drugging on a sporadic basis, with Refers to heavy drinking or drugging on a sporadic basis, with

periods of little or no use in between.periods of little or no use in between.

Key Concepts:Key Concepts: Binge use can be as problematic as regular use.Binge use can be as problematic as regular use. Binge drinking is often associated with higher levels of:Binge drinking is often associated with higher levels of:

* hostility and aggression* hostility and aggression * police altercations* police altercations * domestic violence* domestic violence * work problems* work problems * hospital admissions (* hospital admissions ( in comparison to heavy, steady users)in comparison to heavy, steady users)

The unpredictable nature of binge use can create a The unpredictable nature of binge use can create a destructive set of stressors for those involved in the destructive set of stressors for those involved in the

user’s life.user’s life.

THE PROCESS THE PROCESS

OFOF

RECOVERYRECOVERY

Recovery Recovery is a process that involvesis a process that involves::

Stages of RecoveryStages of RecoveryEarly Recovery: Getting CleanEarly Recovery: Getting Clean• Concrete changes in daily livingConcrete changes in daily living• Adequate sleep, diet, exerciseAdequate sleep, diet, exercise• Staying away from those who are usingStaying away from those who are using• Building support; educationBuilding support; education

Stages of RecoveryStages of Recovery

Middle Recovery: StabilizationMiddle Recovery: Stabilization• Able to turn energies to family, work, relationships, Able to turn energies to family, work, relationships,

friendshipsfriendships• Support, life skills, relaxation, stress managementSupport, life skills, relaxation, stress management• Less focus on usingLess focus on using

Stages of RecoveryStages of RecoveryLate Recovery: MaintenanceLate Recovery: Maintenance• Insight into early traumaInsight into early trauma• Healing, repairing self-esteemHealing, repairing self-esteem

Aspects of Recovery:Aspects of Recovery:

• RecognitionRecognition• CessationCessation• EducationEducation• SupportSupport• CounsellingCounselling• Relapse PreventionRelapse Prevention• Dealing with Underlying IssuesDealing with Underlying Issues

Model of ChangeModel of Change

Model of ChangeModel of Change

RelapseRelapse

Definition:Definition:

• Relapse: Return to previous behaviorsRelapse: Return to previous behaviors

Relapse FactorsRelapse Factors

Common Triggers of RelapseCommon Triggers of RelapseIndividualIndividual• Unpleasant feelingsUnpleasant feelings• Unpleasant physical statesUnpleasant physical states• Positive emotional statesPositive emotional states• Testing personal controlTesting personal control• Urges, cravingsUrges, cravings

Relapse FactorsRelapse Factors

Common Triggers of Relapse Common Triggers of Relapse (cont.)(cont.)

InterpersonalInterpersonal• Enhancing good feelingsEnhancing good feelings• Social PressureSocial Pressure• Conflict with othersConflict with others

Personal Relapse FactorsPersonal Relapse Factors

• PeoplePeople – former ‘using’ friends (i.e. – former ‘using’ friends (i.e. dealers, partiers, etc.)dealers, partiers, etc.)

• PlacesPlaces – former ‘using’ settings (i.e. pubs, – former ‘using’ settings (i.e. pubs, crack-houses, etc.)crack-houses, etc.)

• ThingsThings – former ‘using’ objects / – former ‘using’ objects / paraphernalia (i.e. pipes, etc.)paraphernalia (i.e. pipes, etc.)

Personal Relapse FactorsPersonal Relapse Factors• TimesTimes – former ‘using’ rituals (i.e. beer after – former ‘using’ rituals (i.e. beer after

work, etc.)work, etc.)• ActivitiesActivities – previously associated with – previously associated with

substance use (i.e. pool, darts, etc.)substance use (i.e. pool, darts, etc.)• Emotional statesEmotional states – emotions previously – emotions previously

associated with substance use (i.e. anger, associated with substance use (i.e. anger, etc.) etc.)

• EventsEvents – events formerly associated with – events formerly associated with substance use (i.e. concerts, etc.)substance use (i.e. concerts, etc.)

BlamingBlaming• Addiction is often maintained by the process Addiction is often maintained by the process

of blaming (people, events, myself, etc)of blaming (people, events, myself, etc)• Blaming occurs through the process of Blaming occurs through the process of

projectionprojection• Healing from this requires both insight and Healing from this requires both insight and

the willingness to take responsibility for the willingness to take responsibility for one’s lifeone’s life

• Blaming is looking backwards, responsibility Blaming is looking backwards, responsibility is about looking forwardsis about looking forwards

Processing a RelapseProcessing a RelapseA relapse is not inevitable but it is a common experience in A relapse is not inevitable but it is a common experience in the recovery process. It can be an opportunity to learn:the recovery process. It can be an opportunity to learn:

• What was the trigger(s)?What was the trigger(s)?• What was the high risk situations?What was the high risk situations?• What will one do differently in the future?What will one do differently in the future?• How did the person manage to stop drinking / How did the person manage to stop drinking / drugging?drugging?• How was this lapse / relapse different from the last How was this lapse / relapse different from the last one? one? In what ways is the person stronger / wiser?In what ways is the person stronger / wiser?

What does the person know now that they

did not know before?

ADDRESSING ADDRESSING

SUBSTANCE-USESUBSTANCE-USE

WITH OTHERSWITH OTHERS

RelevanceRelevance• Motivational information Motivational information

has the greatest impact.has the greatest impact.

• Always tailor discussion to Always tailor discussion to each personeach person..

• Disease status or riskDisease status or risk

• Family or social situationFamily or social situation• Age, genderAge, gender

• Prior experience in Prior experience in recoveryrecovery

RisksRisks• Highlight the risks of continued substance use Highlight the risks of continued substance use and and

also the risks of changealso the risks of change..

• Ask the person to outline Ask the person to outline

potential consequences potential consequences

and benefits on both sides and benefits on both sides

of issue. of issue.

• Emphasize that loss may Emphasize that loss may

occur whenever life changes occur whenever life changes

are made.are made.

RewardsRewards

• Ask the patient to identify the Ask the patient to identify the benefits of usingbenefits of using as well as well as as potential benefits of ending substance usepotential benefits of ending substance use. .

• Improved health Improved health • Feel better physicallyFeel better physically• Not worry about Not worry about hurting loved oneshurting loved ones• Modeling healthy lifestyle Modeling healthy lifestyle choices to children choices to children

RoadblocksRoadblocks

• Assist person to identify barriers to making Assist person to identify barriers to making change.change.

• Lack of belief in ability to change Lack of belief in ability to change

• Withdrawal symptoms Withdrawal symptoms

• Fear of failureFear of failure

RepetitionRepetition

• Reinforce the motivational messages at every visit.Reinforce the motivational messages at every visit.

• Re-enforce to those not yet ready to make changes that Re-enforce to those not yet ready to make changes that when they are ready to discuss substance use, you are when they are ready to discuss substance use, you are there to help.there to help.

You become successful the You become successful the moment you start moving moment you start moving

toward a worthwhile goal. toward a worthwhile goal. ((Unknown)Unknown)