Drugs of Abuse: Addiction Theory


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Reviews addiction theory, the Jellenik curve, reasons for use and risk and protective factors related to substance abuse. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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Drugs of Abuse: Addiction Theory

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