NECP Module 1: Exploring Our Beliefs about Addiction
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  • 1. Funding for this module was provided by a Science Education Drug AbusePartnership Award (SEDAPA) from the National Institute on Drug Abuse, acomponent of the National Institutes of Health, Department of Health andHuman Services. #1 R25 DA 020472-01A1Fullscreen
  • 2. To educate students about theneuroscience of addiction & its relevance forworking with clients with addictive disordersOverall Goal# 1 R25 DA 020472-01A1
  • 3. Curriculum Learning Objectives• Develop a working definition of addiction• Describe the prevalence & public health impact of addiction• Identify risk factors that increase the vulnerability to addiction• Understand the brain reward pathway & its central role in the neurobiology of addiction• Recognize research-based principles of addiction prevention & treatment# 1 R25 DA 020472-01A1
  • 4. Module1 ExploringOur Beliefsabout Addiction# 1 R25 DA 020472-01A1
  • 5. Module 1 Learning Objectives1. To examine some pre-conceived ideas about what defines addiction as well as attitudes and beliefs about the people who become addicted and their behavior.2. To develop a practical “working” definition of addiction based on the way scientists and researchers define it.3. To learn some of the key developmental risk factors that increase the vulnerability to addiction.4. To understand the prevalence, costs, and public health impact of addiction.# 1 R25 DA 020472-01A1
  • 6. What Do You Believe About Addiction?1. Why do people become addicted?2. Can addiction be prevented? (Why or why not)3. If treatment works, why do so many people go into treatment multiple times?4. People with addictions are ? (List three characteristics of people with an addiction.)# 1 R25 DA 020472-01A1
  • 7. Why Do PeopleUse Alcohol & Drugs# 1 R25 DA 020472-01A1
  • 8. # 1 R25 DA 020472-01A1
  • 9. ClassroomExercisesClassroomExercises# 1 R25 DA 020472-01A1
  • 10. “Addiction is a choice…they could stop if they really tried.”# 1 R25 DA 020472-01A1
  • 11. How isAddiction Defined# 1 R25 DA 020472-01A1
  • 12. How do YOU define Addiction?1. Come up with a brief statement of how you would define addiction.2. Share your definition with the class.# 1 R25 DA 020472-01A1
  • 13. How Clinicians& Researchers Define Addiction# 1 R25 DA 020472-01A1
  • 14. Substance Use Disorders… a maladaptive pattern of use leading to clinically significantimpairment as manifested by …Substance Abuse: One or more of the following in a 12 month period• Recurrent use leading to failure to fulfill obligations at work, school, or home• Use in hazardous situations• Social or interpersonal problems because of use• Recurrent substance related legal problemsSubstance Dependence (Addiction): Three or more of the following in a 12 month period• Need larger amount to get the same effect (tolerance)• Experience withdrawal symptoms or use of substance to avoid withdrawal symptoms• Difficulty controlling use (substance taken in larger amounts or over longer periods than intended)• Unsuccessful in efforts to cut down• Important social, occupational/school, or recreational activities reduced or given up because of use• Increasing amount of time spent obtaining substances, using or recovering from use• Continued use despite negative physical, mental, social, or legal problems related to substance use # 1 R25 DA 020472-01A1
  • 15. Working Definition of AddictionContinued compulsive usedespite negative consequences# 1 R25 DA 020472-01A1
  • 16. How Do PeopleBecome Addicted# 1 R25 DA 020472-01A1
  • 17. Casual, Experimental UseRegular Use (negative consequences are rare)Misuse (some negative consequences)Abuse (frequent negative consequences)Dependence or Addiction(Use Despite Negative Consequence)AddictionThe Downward Spiral of Drug Addiction# 1 R25 DA 020472-01A1
  • 18. # 1 R25 DA 020472-01A1• Genetic predisposition• Poor coping skills• Early, persistent antisocial behavior• Mental health disorders• Early initiation of substance use• Favorable attitudes towards use• Perception of peers using• Substance using peers• Gang involvement• Substance abuse history• Major/frequent family conflict or disruptions• Parental substance use attitudes• Crime, violence, abuse/neglect• Learning problems or disabilities• Lack of commitment• Behavior problems at school• Early academic failure• Low levels of reading ability• Expulsion/suspension• Availability of drugs/alcohol• High crime rate• Norms favorable to substance use• Low neighborhood attachment• Extreme economic deprivationIndividual Risk FactorsFamily Risk FactorsSchool Risk FactorsCommunity Risk Factors
  • 19. # 1 R25 DA 020472-01A1• Activities with non-using peers• Parental monitoring of friends and activities• Resilient temperament• Positive social orientation• Bonding/attachment to positive family members• Healthy family beliefs• Favorable parental attitudes• Clear standards regarding substance use & behavior• Recognition for positive behaviors, successes• Success in school• Parental monitoring of academic performance/school behavior• Involvement in group activities• Positive recognition for good behaviors, successes• Healthy community substance use & behavior norms• Positive community activities/role models• Work• Anti-drug use policies, policies limiting availability of alcoholIndividual Protective FactorsFamily Protective FactorsSchool Protective FactorsCommunity Protective Factors
  • 20. Prevalence,Public Health Impact,& Costs of Addiction# 1 R25 DA 020472-01A1
  • 21. In 2009, an estimated 9.0% of Americans(22 million individuals) aged 12 or older met thecriteria for substance abuse or dependence(SAMHSA, 2009)# 1 R25 DA 020472-01A1
  • 22. Substance Use Across the Lifespan# 1 R25 DA 020472-01A1
  • 23. PercentUsinginthePastMonthAge(SAMHSA, 2010)Past Month Illicit Drug Use among PersonsAged 12 & Older, 20094%9%17%22%21%14%7%3% 1%010203012-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+# 1 R25 DA 020472-01A1
  • 24. Past Month Illicit Drug Use byAge Category, 200910.0%21.2%6.3%051015202512-17 years 18-25 years 26 + years(SAMHSA, 2010)PercentUsinginthePastMonth# 1 R25 DA 020472-01A1
  • 25. Alcohol Use across the LifespanPercentAge(SAMHSA, 2010)3.513.026.349.770.266.458.750.339.11.67.017.034.746.538.825.412.59.80.2 1.44.511.315.410.87.1 3.8 2.202040608012-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+Alcohol-Current use Alcohol-Binge use Alcohol-Heavy useAge# 1 R25 DA 020472-01A1
  • 26. • 50% of individuals will develop substance abuse or dependence at some point during their lifetime• 47% of adolescents experiment with drugs or alcohol before graduating from high school• Most addicted adults began using when they were adolescents• Most “experimenters” do not become addicted, but those who have developmental vulnerabilities are at greater riskResearch shows that approximately...# 1 R25 DA 020472-01A1
  • 27. Public HealthImpact & CostsAssociated withAddiction# 1 R25 DA 020472-01A1
  • 28. Substance Abuse & Addiction Cost about$1 Trillion per YearLostProductivity71%Other20%HealthcareCosts9%For example:•  Criminal justice costs•  Child abuse/neglect•  HomelessnessFor example:•  ED visits•  HIV/AIDS•  FASDsFor example:•  Poor job performance•  Increased employee turnover•  Illness/absenteeism•  Work-related accidents•  Victims of crime•  Incarceration# 1 R25 DA 020472-01A1 (Califano, 2007)
  • 29. Substance AbuseImpact on theChild & FamilyAssistanceSystem(SAMHSA, 2009)Combined data from 2002 to 2007 indicatethat over 8.3 million children under 18 yearsof age (11.9%) lived with at least one parentwho was dependent on or abused substance.# 1 R25 DA 020472-01A1
  • 30. • 11% of child abuse/neglect cases• 75% of out-of-home child welfare placements(http://sparkaction.org/content/impact-substance-abuse-foster-care; http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html, 2010)Substance abuse is shown to be a factor in at least# 1 R25 DA 020472-01A1
  • 31. Average length of timespent in out-of-homecare is longer for childrenof addicted parents(27 months)compared tonon-addicted parents(10 months)(http://sparkaction.org/content/impact-substance-abuse-foster-care; http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html, 2010)# 1 R25 DA 020472-01A1
  • 32. Underage drinking costs society $68 billion per yearfor youth violence, traffic accidents, property crime,academic underachievement, high-risk sex, &FASDs among teen mothers(OJJDP, 2007)# 1 R25 DA 020472-01A1
  • 33. Substance Abuse Impact on theCriminal Justice SystemOf the $38 billion spent on corrections in 1996,more than $30 billion was spent incarceratingindividuals who had alcohol or drug problems,or committed alcohol or drug related crimes.(ONDCP, 2002; http://www.suite101.com/content/the-economics-of-alcoholism-and-drug-abuse-a85770#ixzz11Wv4mwGz)# 1 R25 DA 020472-01A1
  • 34. Costs associated with driving whileintoxicated were estimated at $230 billionin 2001 due to highway collisions(Califano, 2007; Weisman, 2006)# 1 R25 DA 020472-01A1
  • 35. (12,371 agencies; 2009 estimated population 239,839,971)(http://www.fbi.gov/ucr/cius2009/data/table_38.html#overview)# 1 R25 DA 020472-01A1
  • 36. 46.8% of all arrests for drug abuse violationswere persons under the age of 25# 1 R25 DA 020472-01A1
  • 37. Substance Abuse Impact onWorker ProductivityIn 2005, the reported annual cost to employersfor alcohol-related injuries to employees &their dependents was $28.6 billion(Zaloshnja, et al., 2006)# 1 R25 DA 020472-01A1
  • 38. Substance Abuse Impact on theHealth Care SystemMore than 116 million hospital emergencydepartment visits in 2007• Average per visit cost estimated at $1038• Roughly 1.9 million were drug misuse/abuse related, with over half (52%) involving illicit drugs alone or in combination with pharmaceuticals and/or alcohol(http://DAWNinfo.samhsa.gov)# 1 R25 DA 020472-01A1
  • 39. Fetal Alcohol Spectrum Disorderscould cost up to $4 millionin health care and relatedspecialized services over thecourse of the child’s lifetime.# 1 R25 DA 020472-01A1 (Califano, 2007; Weisman, 2006)
  • 40. An estimated 1 million people in the UnitedStates are living with HIV/AIDS(http://www.drugabuse.gov/Infofacts/DrugAbuse.html)• Roughly 1/3 of those cases are linked directly or indirectly to injection drug use• Approximately 4 of 10 AIDS deaths are drug abuse related• About 400,000 people are co-infected with HIV & Hepatitis C# 1 R25 DA 020472-01A1 (Califano, 2007)
  • 41. Co-occurring substance abuse& medical conditions• Lung and Cardiovascular disease• Stroke• Cancer• Mental disorders• Cell damage in the brain or peripheral nervous system(http://www.drugabuse.gov/Infofacts/infofactsindex.html)# 1 R25 DA 020472-01A1
  • 42. Co-Occurring Substance Abuse& Mental Health Disorders• Substance abuse & addiction increases the risk of mental health problems or psychiatric disorders (e.g., conduct disorder, ADHD, depression)• Mental health problems or psychiatric illnesses increase the risk of substance abuse• 60-80% of adolescents who enter drug treatment programs have co-occurring psychiatric disorders# 1 R25 DA 020472-01A1 (http://www.drugabuse.gov/PDF/RRComorbidity.pdf)
  • 43. National College Survey Data# 1 R25 DA 020472-01A1
  • 44. (Core Institute, 2006)National Profile of Substance Useamong College Students (2006)Tobacco 39.5%Marijuana 30.1%Other drugs 27.2%Alcohol 84.1%•  Heavy or frequent drinkers(defined as 5 or more drinks in onesitting, 3 times or more/week)24.0%•  Average number of drinks/week 5.42 drinks# 1 R25 DA 020472-01A1
  • 45. Consequences of Alcohol & Other Drug Use(CORE Institute, 2006)# 1 R25 DA 020472-01A1
  • 46. Does our campus social environmentpromote substance use?# 1 R25 DA 020472-01A1
  • 47. Module 1Take HomePoints# 1 R25 DA 020472-01A1
  • 48. Working definition of addiction:continued compulsive use despitenegative consequences# 1 R25 DA 020472-01A1
  • 49. The majority of high school studentsexperiment with substances withoutdeveloping a substance use disorder.However…# 1 R25 DA 020472-01A1
  • 50. … a major concern is about doing STUPIDthings while under the influence.# 1 R25 DA 020472-01A1
  • 51. … no one knows ALL oftheir thatcan shift experimentationto addiction.RISK FACTORS# 1 R25 DA 020472-01A1
  • 52. Even those with few risk or protectivefactors can become addicted by repeatedlyusing alcohol or drugs.# 1 R25 DA 020472-01A1
  • 53. (Washton, 2001)# 1 R25 DA 020472-01A1Alcohol & drug problems are prevalent &intricately intertwined with other mentalhealth problems & medical conditions.
  • 54. ...impacts us all.# 1 R25 DA 020472-01A1