Course: Drug, Solvent And Alcohol Abuse Counselling. Assignment one. Describe what `dependency ` and `addiction` mean. Initially the words dependency and addiction have the same meaning, used in the context of drug, solvent and alcohol abuse, the words are understood in general as an individual being either physiological or psychological (or both) dependent on drugs, solvents or alcohol, the individual is not able function and cope with life without the use of substances. Some of the criteria`s for the diagnosis of substance dependency that the Diagnostic and Statistical Manual of Mental Disorders have described in their definition of substance dependence is that the individual is not able to stop using substances even though the consequences of their dependency have become more and more problematic and at the same time the misuse of substances becomes compulsive and repetitive. (DSM-IV, Wikipedia) Addictions is as an illness/ disorder a complex concept; we understand that an individual can be addicted to a specific substance and interpret it as meaning that the individual is dependent on a specific substance, but referring to an individual as having the disease of addiction or having an addictive nature, we then see that there are differences. Both the DSM-IV and the World Health Organization Expert Committee on Addiction-Producing Drugs have defined substance dependency and substance addiction as a disorder while another description of addiction is, A learned emotional obsession, which periodically or ongoing manifests itself in a usefully and compulsive behaviour seeming as a normal drive, with the purpose to attain pleasure or to avoid pain.(Bejerot, Page 246-255). Furthermore in 12 step programs as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), addiction is referred initially to as an illness that is twofold- an obsession of the mind and allergy of the body and later on as a threefold disease adding the term spiritual malady to the concept of the obsession of the mind and allergy of the body. (AAWS, Page 64) The first view was initially proposed by Dr. Silkworth in a famous letter where he addressed alcoholism as an illness; this letter is referred to in the Big Book of Alcoholics Anonymous as The Doctors Opinion (AAWS, Page xxiii) and later the concept of addiction as a threefold disease was developed in the culture of the different 12 step self-help movements like AA and NA. Dependency and addiction can differ in interpretation, therefore it is worth noting that an individual can become dependent on a substance due to trauma or over medication relating to medical surgery but still not fulfil some of the criteria`s required for diagnosis of the disease of addiction according to the theories of AA and NA. Regardless of whether an person is diagnosed with the disease of addiction or not, common in both cases, is that once an individual has become dependent or addicted, he/she has lost control over his/her life and drug, solvent or alcohol dictates the individuals priorities, as long as the substance abuse is continuing both persons will experience loss of control and different kinds of unmanageability in their lives. This will create tolerance to the specific substance they are using and will experience withdrawals symptoms when they stop using.

1

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. What actions make people feel secure and comfortable? Basic routines like eating, washing and resting definitely contribute to a persons sense of security and comfort; furthermore one would say that actions like paying bills and honouring commitments solidify these senses of security and comfort and then again working, studying and finding means to sustain a measure of livelihood generally would create a sense of achievement and make the achiever feel comfortable and secure. Also small habits like eating in a certain way, eating certain food or listening to certain music can make an individual feel comfortable. Habits like travelling at specific times of the year and to certain places are part of a structure that can bring certainty and security to an individuals life. The same could be said about dressing according to a specific group standard and thereby identifying and becoming accepted in this group which creates a sense of belonging. One factor that affects humans in a more spiritual way is the observance of rituals especially if the individual belongs to a religious group. Certain rituals fortify the sense of being part of a community and can create a way to deduct meaning and purpose out of life. (Nakken, Page 40) So, one can say that rites and rituals that make us feel part of a group or a community would have a great part in making us feel a sense of belonging and thereby feel secure and comfortable.

List some actions that make you feel secure, comfortable and satisfied Paying my bills Making a livelihood Obeying society rules Shopping Running Participating in my community Eating good food Watching TV Reading Having sex Sleeping Relaxing Cleaning Studying Praying Meditating.

2

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling.

Are some people more likely to become addicted than others? There are varied theories regarding why people become addicted to substances; some theories say that certain individuals can have a genetic disposition to dependency and addiction and have what is termed an addictive nature; others say that addiction is also influenced by social and environmental influences. Evidence used to back up the heredity and genetic theories have been alcohol studies of families to see how alcohol abuse by parents has influenced the children. (Petersen, McBride, Page 31) Through research of Adult Children of Alcoholics (ACOA) it has become apparent that children of alcoholics are four to six times more prone to becoming alcoholics than children of non-alcoholics (Levin, Culkin, et al. Page 40) Regardless of the amount of contribution from biological, psychological and social sciences to the theories concerning the how`s and why`s of people becoming addicted, it is important to acknowledge that until now there is still no complete picture that can fully explain the phenomenon of addiction and dependency to drug solvent and alcohol (McBride, Petersen page 36). But whether or not it is one or the other that initially starts the cycles of addiction it is safe to say that somehow and maybe for different reasons and different from individual to individual, some are more prone to become addicted than others and common for most individuals who have become addicted is the fact that escapism is an initial drive avoiding some kind of physiological or psychological pain in their life and to cope with feelings of low self-esteem. (Twerski, Page 58)

3

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. How does dependency and addiction grow? In the beginning of dependency and addictive cycles the most obvious are the physiological symptoms. The individual abusing substances creates a physical tolerance of the chemicals; the body initially craves more and more to satisfy the physical threshold developed by the increasing amount of substances. Psychological symptoms like lack of confidence and the inability to deal with life and emotions is proclaimed by some theories to precede initial substance abuse leading to dependency and addiction, (Twerski, Page 52) but still it is important to recognize that a deeper kind of inner and outer unmanageability is developed parallel with the physical tolerance. An initial indication of unmanageability will be seen in the addicts economic situation where drug solvent and alcohol will have financial priority over basic necessities for life like covering of essential bills for example, rent, electricity and food. One of the more all-round and covering ways that the development and progression of addiction is presented is as a process with a starting point progressing towards an end where the main focus is control and sustain of pleasure, security/power and happiness. This process is described as a three stage development where stage one is described as a time where internal changes happen and the individuals personality will be altered; stage two is where the behaviour and way of living starts to change and solidify itself and finally stage three is described as the breakdown stage were all the problems and unmanageabilitys start to become apparent to the addict. (Nakken, Page 19) It is clear when we look at the progression of addiction that more wants more both physical and psychological, emphasising that the more the addicted individual fails to take responsibility for the essential needs like paying bills and honouring basic commitments to self and socially the more outer unmanageability and with increase in outer unmanageability comes more inner unmanageability and finally this increase of internal emotional havoc creates the need for more drugs, solvent or alcohol to cope with the pain the individual is experiencing. It is a vicious cycle that feeds itself and is in the 12 step programs referred to as a progressive illness (NAWSO, Page 14)

4

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. What happens to the body as addiction to alcohol, solvent(s) or drug(s) occurs? Once the addictive cycle is manifested in the daily life of an individual the continuous intake of alcohol, solvent or drugs will start to affect the body in a more severe way and malfunctions of vital organs occur. It is worth noting that there is both long term and short term damages from substance abuse; furthermore it is not only the direct intake of a substance that can damage the body but also the way the substance is consumed especially use of needles can have severe side effects on the individual. (Byrne, Andrew, Page 33-34) The direct damaging side effects from substance dependency and addiction are many and usually they lead to severe health problems or in worst cases to death. One of the very well documented side effects from substance abuse is the consequences of alcohol abuse; it is a known fact that alcohol intake in large quantities has a devastating damaging toxic effect on the majority of all human organs (McBride, Petersen, Page 9). It is not only the heart, kidneys, liver and the nervous system that is damaged by the toxic effect of alcohol but also changes in the blood system takes place and continuous intake of alcohol can cause anaemia and blood clotting problems. Parallel toxic effect is also detected in the brain where continued alcohol abuse can result in serious problems with cognition and memory. (bloodalcohol.info) Side effects produced by the abuse of solvents like glue, lighter fuels and paint can cause direct damages to the brain and organs, damaged brain cells, toxins infecting organs such as kidney and liver. These kinds of toxins can cause liver cancer, indirect damages like suffocation from use of plastic bags to sniff paint or glue and aerosols freezing air channels causing death through suffocation. With stimulants like cocaine and amphetamines, we find the same reoccurring theme of direct and indirect damaging effect on the brain and organs. A difference though occurs with opiates like morphine and heroin,-the direct side effects on the body and brain by the actual drug are minimal, except from vomiting and constipation caused by the direct intake of heroin or morphine the most direct consequence to the body is the chance of death by overdose; it is important though to point out the high risk of getting deadly diseases transmitted by blood when the addict uses dirty needles. (McBride, Petersen, Page 18) Common for substance dependency and addiction is that the continual abuse of alcohol drugs or solvents will always have an effect on the addicted individuals health either as a direct result of using or as an indirect result of using unhealthy paraphernalia, and very commonly both ways will play a major role in the deterioration of the individuals health, sometimes the damage will be reversible when the consumption of substances is brought to an end but very often it is realized that the damage of alcohol drug and solvent abuse can have severe and everlasting consequences.

5

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. Why is self- esteem important? For a long time it has been recognized that self-esteem is a determent factor of emotional and psychological wellbeing in humans; self-esteem has been described as the perception of ones self-worth and how much we deserve well-being and happiness. In one definition of self-esteem, it is proposed that it is made up of two major pillars- the first is self-efficacy which is the ability to cope with challenges, think, make choices and to learn, the other is self-respect which the confidence in the belief that one can achieve success, love, good relationships and that it is OK to achieve all these things, that one is worthy- these characteristics and views on one self will determine how the individual perceives and relates primarily with one self but also as important, how one interacts with others and with life as a whole. (Branden, Page 9) Self-esteem is important for an individual to develop a healthy sense of belonging and also a healthy self-image allowing a person to reason with one self in a realistic way, having a correct perception of one self and ones place in life leading to having a more sound perception of reality and adjust in a realistic and somehow healthy way avoiding external and internal unmanageability. A big part of our own reality is created by our own perception and having a healthy view of our self contributes to a somehow grounded view of reality (Twerski, Page 24, 38, 39)

How does dependency and addiction effect self- esteem? There are theories proposing that having a low self-esteem is more or less a predisposition for the initiation of substance use and later the development of dependency and addiction, but it is important to acknowledge that the kind of low self-esteem evolving from the consequences of dependency and addiction is not the same as the low self-esteem preceding chemical abuse -this preceding low self-esteem is claimed to have evolved through a wrong way of perceiving self and the world. (Twerski, Page 52) So one could argue that the effect of dependency and addiction on self-esteem is like a selffulfilling prophecy strengthening the already negative belief the individual has of themselves. The powerlessness that the addict experiences over the solvent, drug or alcohol re enforces the feelings of inadequacy and failure, the unmanageability that the substance abuse carries with it creates the need for more drugs solvents or alcohol to cope with pain and despair, and this need for more substances again creates more and deeper feeling of failure, inadequacy and low self-esteem keeping the person trapped in a vicious cycle of pain and misery.

6

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. Is dependency and addiction a weakness? From the various theories, it is understood that there doesnt exist a fully and complete theory about the how and why`s of addiction and dependency .It is widely recognized that dependency and addiction is a disease, a very complex disease but none the less a disease and it would be misleading to call it a weakness. An important criterion that is used to diagnose it as a disease is the following, The traditional medical model of a disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual afflicted. (Leshner, Page.45 - 47).So it is difficult to argue that dependency and addiction doesnt cause: Physical and psychological discomfort due to excessive misuse of chemical substances. Emotional and behavioural dysfunction as well as physical dysfunction due to medical side effects. Distress and mental tiredness due to continuous and compulsive behaviors and obsessive thinking.

What kind of help is counselling? One can easily say that counselling is a form of help that guides the client to discover and explore their own issues and thereby acknowledge responsibilities in matters concerning their life and the problems they are encountering. Through different strategies, the counsellor guides the client towards the clients empowerment by allowing the client to participate in their own plan for recovery. The counsellor can, through listening objectively and observing the client, help the client to reach issues, places of pain and emotions that is blocked to the client. So it would be right to think of councelling as a form of help to self-help, where the counsellor acts as a mirror and at the same time as a kind of detective and co explorer helping the client to investigate the clients own story and experiences. As a counselor one tries through factual knowledge and practical techniques to allow the client to reach a more clear and complete understanding of the problems they are dealing with. (Levin, Culkin, et al. Page 3) Counselling points and directs the clients to a place where the clients feel that they themselves are making a decision to work towards change.

7

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling. Explain the quotation from Rob Gilbert in relation to work with people who are dependent and addicted. First we form habits, then they form us. Conquer your bad habits or they will conquer you Rob Gilbert. In the beginning the individual has control over whatever substance he or she chooses to use and in the end the substances control the individual, so it is important to understand that the end result, the personality of a dependent and addicted person asking for help is a personality formed by the substances and their consequences not a personal choice. It is easier said than done to ask a person who is addicted to substances to just control their using or just say no, but at the same time the only one who can choose to change is the addicted person themselves and one could say that if nothing changes then nothing changes. Furthermore the addicted individual would find great comfort and hope in knowing that if bad habits creates bad results like unmanageability and emotional pain then good habits might create just the opposite result. Then again when the addicted individual is enlightened about the dynamics of his or her dilemma, one could go further and say that just because the addicted or dependent person is not responsible for their illness or disease it doesnt mean that they are not responsible for their recovery from addiction and dependency.

8

Student Number: MAR011DW

Course: Drug, Solvent And Alcohol Abuse Counselling.

References: Abraham J. Twerski, Addictive thinking: Understanding self-deception, Hazelden, 2nd edition, 1997 Alcoholics Anonymous World Services, Big Book of Alcoholics Anonymous, AAWS, 4th edition, 2002 Andrew McBride, Trudi Petersen, Working with Substance Misusers: A Guide to Theory and Practice, Routlegde, 1st edition, 2002 Byrne, Andrew, MD, Addict in the Family: How to Cope with the Long Haul, Redfern, NSW, Australia, Tosca Press, 1996 Craig Nakken, The addictive personality: understanding the addictive process and compulsive behavior, Hazelden, 2nd edition, 1988 Jerome David Levin, Joseph Culkin, Richard S. Perrotto, Introduction to chemical dependency counseling, Jason Aroson,1st edition, 2002 Leshner, Alan I, Addiction Is a Brain Disease, and It Matters, Science, Vol. 278. No. 5335, 1997 Nils Bejerot, Theories of Drug abuse, Selected contemporary perspectives, NIDA, 1980 World Service Office, Basic Text, The Twelve Steps and Twelve Traditions of Narcotics Anonymous, World Service Office ,5th edition,1988 http://www.bloodalcohol.info/how-alcohol-affects-your-body.php http://nathanielbranden.com/catalog/pdf/working_with_self.pdf http://wikipedia/wiki/Substance_dependence

9

Student Number: MAR011DW