Addiction

Nadine Pelling, PhD

Senior Lecturer

University of South Australia

January 2009

Overview• Drug Use• Continuum of Use• Why people use Drugs/Have problems with

Drugs• Treatment by professionals & Action by other

people who care• Resources

Drug Use

• Psychoactive drug– Changes one’s psychological state

• Caffeine, alcohol, cocaine, nicotine etc.

• Most peoples/cultures sanction drug use of some sort

• Most use/abuse legal drugs• Some use can be

• Helpful when prescribed• Used religiously/socially• Small does not necessarily harmful

Continuum of Substance Use Behaviours

• No use• Experimental Use

– Voluntary/little or no impact

• Mild Use– Integrated substance

use/little or no impact on functioning/voluntary

• Moderate Use–Misuse/Abuse/interferes but

consequences not necessarily significant/voluntary

• Heavy Use–Dependence/functional

impairment/involuntary

Why people use drugs is complex …not solved simply

Why people use …

• Historically people thought it was THE DRUG– The Demon Rum

• Temperance movement

• Then people started to talk about the Addictive Personality– But no support for one addictive personality

• Some look at the Drug Culture and Availability– War on Drugs

• Truth almost always a combination– BioPsychoSocial

We see some of this view now with the evil opiate

Reasons Why People Take Drugs

• Drug Reasons– Based in the drug itself

» Speed/amphetamines; i.e., Truck drivers

• Individual Reasons– Psychology (habit, mood HALT, mental illness)– Biology (genetic predisposition)

• Environmental Reasons– Social Pressure/Support (drug culture)

Why Drink or do drugs . . . Why Drink or do drugs to Excess?

• emotional needs– Stress/distraction/reinforcement – Negative affect– Thrill seeking

• oral fixation (good old Freud and breast feeding)• avoid anxiety• learned to drink - reinforced• think benefits of drinking > costs

– avoid self awareness– excuse for failing

If drink to excess … parents likely to

have … take a guess

• social aspects & biological aspects - drink more when – more income– more education– abuse– race (more likely culture and oppression) differences

• Canadian example ….

– gender differences• Telescoping for women

– peer pressure• predisposing genetic factors

– more important for men

• Availability of drug/alcohol very important• Beliefs about risks and prevalence

– If feel low risk and others are doing it … more use

• Abuse/Dependence generally a developmental process– Attitude, experimental use, regular use, heavy

use, abuse/dependence • Does not explain all use

Self Reported Reasons for Using Drugs

• To relieve boredom.• To provide stimulation.• To enhance mood- euphoria, relaxation,

sensory intensification.• To be social with peers.• To relieve anxiety and depression (low

doses).

• Hall, W (1998) ‘Cannabis and psychosis’, Drug and Alcohol Review, 17:433-444

My favourite bit of drug use information ….

• The evening meal ….– What does your dinner table look like?– Do people eat together? At a table? On the sofa?

With the radio or television on? Who sits next to who? Are people talking to each other?

– Research shows that families that have dinner together raise children that are less likely to use drugs

• Can see if children under influence, know where they are, opportunity to talk, maybe appropriate modelling of use

Treatment

• Depends on theoretical orientation

• Depends on level of problem

• Biopsychosocial approach best

• Depends on goal of treatment

Goal of Treatment

• Abstinence

• Moderation– Controlled drinking

• Harm reduction– HIV, Crime

Continuum of Treatment

• None• Brief Intervention• Self Help (12 step groups)• Outpatient• Intensive Outpatient• Supported Living Environment• Residential Rehabilitation• Detoxification

– Home– Centre

Treatment: What Works . . .

• Basic psychological and counselling interventions– Addressing motivation and reinforcing variables– Non-confrontational

• no aggressive interventions please

– Teaching specific skills– Promoting active coping and goal setting– Address socio environmental factors

• Family and peer supports

Treatment?

• If you are not a clinician, physician, social worker, counsellor, or psychologist– You are probably not qualified to provide

treatment– You could, however, engage in and

encourage healthy action • bio psyco social

Biopsychosocial Action – Overview

– Exercise– Structured Daily Activities and a Return to

Normalcy– Education & Homework Activities– Social Involvement

Exercise

• Aerobic – improves aerobic capacity and endurance

• Nonaerobic– improves muscular strength and endurance or

flexibility/coordination/relaxation

Effectiveness

• Exercise has a long tradition in medicine– physicians often recommend exercise for

patients – exercise prescribed in pre-Hippocratic Greek

medicine

• Recent research supports effectiveness of exercise– depressive and anxiety symptoms lessened with

exercise• effects can last up to one year

– Exercise found to • enhance mind function • enhance emotional state• create alertness• enhance creativity• enhance sleep

– Exercise effective for mild to severe depression and anxiety and for people with physical problems

Guidelines for Use

• Enjoyable• Positive role models• Education about fitness• Appropriate level • Gradual start• Social aspects• Focus on Goals• Realistic• Outside the Home• No Overtraining: staleness may result• Behavioural addiction

Compliance?• Will people exercise?

– Compliance may be improved if one exercises with a companion or takes part in an exercise program at a gym

– Support likely needed when starting a program• supervision• check on progress

– at least until activity becomes self-reinforcing

• Are you a positive role model?• Research shows people will exercise

How Much?

– five weeks of 3x weekly sessions of aerobic or nonaerobic of 20-60 minutes duration

– echoed by fitness experts for health benefits– the longer you engage in an exercise program

the greater the emotional benefits

How To Exercise ….

• Lets go for a walk, swim, play tennis, do some deep breathing exercises, stretch etc.

Structured Daily Activities and a Return to Normalcy

• Depressive and anxiety related disorders generally include deficits in daily functioning– household roles, chores, leisure activities,

social involvement, work performance

• Those who show clinical improvement spend more time in chores and less time in passive leisure

• Return to normal activities as quickly as possible– maintain feelings of belonging and usefulness– limit labeling as ill– form of exposure therapy

• limit avoidance

How To Return to Normalcy …

• Lets do the dishes together, make the beds, tidy up together etc.

Education

• Education regarding one’s symptoms suggested as a first step in preparing client for treatment– normalize symptoms– Need contact with professional

• Internet resources not usually very good

How To Education …

• I have heard that a lot of people have difficulty with x, maybe we should look into the impact x could have. Why don’t we go to the doctor/professional or library together to find some information?

Homework Activities

• Homework/Self exploration to help explore circumstances and behaviours that contribute to continuation of symptoms– explain why given, follow up, client

involvement

How To Homework …

• I find that when I am angry I eat more junk food/have trouble sleeping etc. I wonder if how you feel and what is going on in life for you has an impact on your use of x. It might be a good idea for you to keep a diary for a while, to explore what is going on in your life and results

Social Involvement

• Social support buffers individuals from life stress– may be related to amount of external stimulation

in the environment• too little/much focus on internal state

• Social involvement can be used in treatment also– generalize and practice skills learned– reinforcement from others for healthy behaviour

How To Social …

• Encourage healthy connections …. – A regular meeting (Church, 12 Step group,

tennis or art club) versus ‘hanging out’– Note People Places and Things

• Can be difficult to do!

– Company for a meal or a chat

Remember

• People are responsible for themselves BUT we can make an impact

ResourcesResources Local phone bookLocal phone book

Existing community addiction services and self-help groupsExisting community addiction services and self-help groups Psychologists and counsellors can call to make professional Psychologists and counsellors can call to make professional

connectionsconnections Australian national organisationsAustralian national organisations

www.nationaldrugstrategy.gov.auwww.nationaldrugstrategy.gov.au www.adca.org.auwww.adca.org.au www.fds.org.auwww.fds.org.au www.adf.org.auwww.adf.org.au

Other sitesOther sites www.alcoholics-anonymous.orgwww.alcoholics-anonymous.org www.kidsource.comwww.kidsource.com www.atforum.comwww.atforum.com www.health.orgwww.health.org

Books etc.Books etc. Pelling, N. (2003). Biopsychosocial activities as adjuncts in Pelling, N. (2003). Biopsychosocial activities as adjuncts in

the treatment of depression and anxiety. the treatment of depression and anxiety. Psychotherapy in Psychotherapy in Australia,Australia, 99(4), 30-36.(4), 30-36.

Addiction Workbook by Fanning & O’Neill (1996)Addiction Workbook by Fanning & O’Neill (1996) The Heart of Addiction by Dodes (2002)The Heart of Addiction by Dodes (2002) Substance Use Disorders Assessment and Treatment by Substance Use Disorders Assessment and Treatment by

Dodgen & Shea (2000)Dodgen & Shea (2000)