Addiction types facts treatment

2. Sidra
Akhtar Ch
Chairperson
(SA Foundation Drug & Psychological
Rehabilitation Centre)
Clinical Psychologist , Speech Pathologist
Media Analyst , Lecturer (Foundation
University, APCOMS)
Contact No: 0514842083
03325024691

3. Addiction, Suicide and
Violence
HOW HABIT BECOME ADDICTION: PUNGENT TASTE OF DEATH

4. Myths & Misconceptions
A person addicted to drugs /
alcohol is
◦Bad, crazy, simply stupid
◦Lacking willpower
◦Hopeless
◦Must be punished as a means
to force them to change.

5. What is Addiction ?
Addiction is a complex condition, a brain disease that is
manifested by compulsive substance use despite harmful
consequence.
An addiction is a chronic dysfunction of the brain system
that involves reward, motivation, and memory.

6. What is an Addictive Drug?
A chemical substance, which effects the physical, social,
psychological, spiritual and economic well being of an
individual and brings changes in his/her behavior.

7. Addiction, suicide and violence nexus

8. Why people commit suicide ?
They're depressed
They're psychotic.
They're impulsive
They're crying out for help
They have a philosophical
desire to die.
They've made a mistake

9. Violence is
behavior
which is
intended to
hurt , injure ,
or kill people.

10. Violence: an alternate perspective.

11. Addiction in Pakistani society
6.7 million adults in Pakistan used drugs in the last 12
months.
4.25 million individuals are drug dependent.

12. Cross-cultural prevalence of
addiction
World Health Organization (2007)
76.3 million - alcohol use disorders
15.3 million - drug abuse disorders
People in 136 countries inject drugs
60 disease and injuries causally related to
alcohol consumptions = 1.8 million deaths
annually
Heroin production tripled since 1985
13.5 million people take opiates/9.2
heroin

13. SIDRAAKHTARCH 13

14. Addiction v/s Habit
Habit – repeated behavior in which
the repetition may be unconscious
Compulsion – if the habit occurs by
compulsion and considerable
discomfort is experienced if the
behavior is not performed, then the
repetition or habit is considered an
addiction

15. Physical warning Sings
Bloodshot eyes, pupils larger or smaller
than usual
Sleep , Appetite Problem
Deterioration of physical appearance,
personal grooming habits
Unusual smells on breath, body, or clothing
Tremors, slurred speech, or impaired
coordination

16. Behavioral signs
Drop in attendance and performance at work or
school
Unexplained need for money or financial problems.
Engaging in secretive or suspicious behaviors
Sudden change in friends, favorite hangouts, and
hobbies
Frequently getting into trouble (fights, accidents,
illegal activities)

17. Psychological warning signs
Unexplained change in personality or
attitude
Sudden mood swings, irritability, or
angry outbursts
Periods of unusual hyperactivity,
agitation, or giddiness
Lack of motivation; appears lethargic
or “spaced out

18. Factors contributing to addiction

19. Types of addiction

20. Cycle of Psychological Addiction
Figure 11.1

21. Risk Factors for Addiction
Figure 11.2.1

22. Risk Factors for Addiction
Figure 11.2.2

23. Risk Factors for Addiction
Figure 11.2.3

24. Addiction i.e. Substance abuse
according to DSM-IV
An addiction must meet at least 3 of the following criteria. This
is based on the criteria of the American Psychiatric Association
(DSM-IV) and World Health Organization (ICD-10).[1]
Tolerance. Do you use more alcohol or drugs over time?
Withdrawal. Have you experienced physical or emotional
withdrawal when you have stopped using? Have you
experienced anxiety, irritability, shakes, sweats, nausea, or
vomiting? Emotional withdrawal is just as significant as physical
withdrawal.

25. Addiction i.e. Substance abuse
according to DSM-IV
Limited control. Do you sometimes drink or use drugs more
than you would like? Do you sometimes drink to get drunk?
Does one drink lead to more drinks sometimes? Do you ever
regret how much you used the day before?
Negative consequences. Have you continued to use even
though there have been negative consequences to your
mood, self-esteem, health, job, or family?

26. Addiction i.e. Substance abuse
according to DSM-IV
Neglected or postponed activities. Have you ever put off or
reduced social, recreational, work, or household activities
because of your use?
Significant time or energy spent. Have you spent a
significant amount of time obtaining, using, concealing,
planning, or recovering from your use?
Desire to cut down. Have you sometimes thought about
cutting down or controlling your use? Have you ever made
unsuccessful attempts to cut down or control your use?

27. The Addiction Cycle & the 4 C’s
Craving (dopamine; brain is hard wired
to crave rewards)
Compulsion (low seratonin levels)
Loss of Control (damage to the
prefrontal cortex; right & wrong)
Continued Use Despite Consequences –
further damage to prefrontal
cortex (interferes with judgement).

28. Causes of Addiction
Family history. About 50-60 percent of addiction is
due to genetic factors
Poor coping skills for dealing with stress.
Negative thinking, such as an all-or-nothing
approach to life.
Underlying anxiety or depression.

29. Family History
Genetics explains 50 percent of whether an individual will
develop an addiction.
50-60 percent of addiction is due to genetic factors

30. Poor Coping Skills for Stress
1. First, the more stressed you are,
the more you will want to escape
or relax, and that is why people
turn to drugs or alcohol.
2. Second, when you are stressed,
you tend to do what is familiar and
wrong instead of what is new and
right, therefore you are more likely
to fall back to your old ways.

31. Negative Thinking
All the different types of
negative thinking make you
feel stressed, uncomfortable,
irritable, and discontent.
you want to escape, relax,
or reward yourself, which
can lead to drug or alcohol
use.

32. Underlying Anxiety or Depression
Approximately 15 to 30
percent of people with
addiction also suffer from
underlying depression.
People who have a dual
diagnosis often use drugs
and alcohol to escape the
feelings of anxiety and
depression.

33. Consequences of addiction ?

34. What Science Says about
Addiction?

36. Neuro-chemical physiology of
addiction

37. A Complex Illness
• Reward Pathways
• Emotional Centers
• Memory Centers
• Perceptions & Judgments

38. Brain Chemicals
a. Dopamine – a feel good chemical.
b. Seratonin – the happy, anti-worry,
flexibility chemical.
c. GaBA – an inhibitory neurotransmitter
that helps calm or relax the brain
d. Endorphins – the brains own natural
pleasure and pain killing chemical
e. Glutamate – locks the pleasureable
experience into memory

39. Why youth start taking drugs?
 Curiosity
 Lack of awereness
 Availability
 Peer pressure
 Poor community support
 Lack of youth counseling
 Early life dilemmas
 Depression

40. Youth’s Choice
Youth under the age of 25
constitutes 63% of total
population of Pakistan.

41. Youth as Partners
 Use of Social Media
 Facebook
 Twitter
 Whatsapp
 YouTube
 Documentaries
 Stage Dramas
 Seminars

42. Planning & Management of
Rehabilitation Support System

43. Prevention Programs
 Primary Prevention:
( To aware the youth)
 Secondary Prevention:
(To aware the drug addicts)
 Tertiary Prevention:
(Treatment of drug addicts)

44. Treatment
Phases
Pre -Treatment:
Initial counseling of client & family,
registration
Treatment:
Detox (symptomatic treatment)
Primary rehab (assessment,
motivational counseling)
Secondary rehab (lectures, groups,
psychological Intervention & counseling)
Post Treatment:
Follow-up sessions

45. Treatment Core
Components and
Comprehensive
Services

46. Medical
Mental
Health
Vocational
Educational
Legal
AIDS /
HIV Risks
Financial
Housing &
Transportation
Child
Care
Family
Continuing
Care
Case
Management
Urine
Monitoring
Self-Help
(AA/NA)
Pharmaco-
therapy
Group/Individual
Counseling
Abstinence
Based
Intake
Assessment
Treatment
Plans
Core
Treatment

47. Indeterminate
Evidence of
Effectiveness
Nonbehavioral marital therapy
Electrical aversion therapy
Placebo therapy
Lithium therapy
Functional analysis
Relapse prevention
Self-monitoring
Selective serotonin reuptake
inhibitor (SSRI) antidepressant
therapy

48. Strong
Evidence of
Effectiveness
Behavioral marital therapy (includes
improving problem solving,
communication skills, and increases in
positive reinforcement)
Motivational enhancement therapies
Behavior contracting
Brief interventions, e.g., FRAMES
Community reinforcement approach
(CRA)
Social skills training
Stress management

49. Strong
Evidence of
Effectiveness
Patient-centered therapy
Behavioral self control training
Cognitive therapy
Covert sensitization (a form of aversion
therapy)
Covert sensitization Oral and implant
disulfiram (placebo effect has not been
ruled out)
Self-help manual
Screening, Brief Intervention, Referral,
and Treatment

50. Classic Models of Addiction
Model Emphasized Causes Example Interventions
Moral Personal responsibility; self-
control
Moral suasion; social/legal sanctions
Spiritual Spiritual defect Prayer; 12-step faith-based treatment
(e.g. AA)
Temperance Drugs Control of supply; calls for abstinence
Educational Ignorance Education
Conditioning Classical/operant
conditioning
Counterconditioning; extinction

51. Classic Models of Addiction
Model Emphasized Causes Example Interventions
Biological Heredity; brain physiology;
self-medication
Risk identification; calls for abstinence;
medical treatment
Psycho-dynamic Personality; defense
mechanisms
Psychoanalysis
Family Dynamics Family dysfunction Family therapy
Social Learning Modeling; expectancies Positive role models; rational
restructuring of expectancies
Sociocultural Environmental; cultural;
economic
Social policy; social services

52. Choosing a Treatment
The National Institute on Alcohol Abuse and Alcoholism
(NIAAA)
Three strategies for addiction treatment were studied:
◦Cognitive-behavioral therapy
◦Motivational psychology
◦12-step programs
Conclusion was that focus for treatment selection should
be on choosing a program that was complete

53. Therapeutic techniques

55. Motivational Enhancement
Therapy
A systematic intervention to evoke change in Abusers.
 Based on the principles of motivational psychology.
 Designed to produce rapid, internally motivated change.
 Does not attempt to guide and train the client, step by
step, through recovery.
 Employs motivational strategies to mobilize the client’s
own change resources.
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

56. Motivation Enhancement Therapy
(MET) (Miller, 2005)
There are four key assumptions of MET (Miller, 2005).
◦ 1. Ambivalence about substance use (and change) is normal and
constitutes an important motivational obstacle in recovery.
◦ 2. Ambivalence can be resolved by working with your client’s intrinsic
motivations and values.
◦ 3. The alliance between you and your client is a collaborative
partnership to which you each bring important expertise.
◦ 4. And empathetic, supportive, yet direct, counseling style provides
conditions under which change can occur.

57. Opening Strategies
1. Ask Open Questions
2. Listen Reflectively
3. Affirm – Compliments or statements of appreciation
4. Summarization –used to link together and reinforce material
5. Eliciting Self- Motivating Statements
◦ Recognizing disadvantages of the status quo (problem recognition)
◦ Recognizing advantages of change
◦ Expressing optimism about change
◦ Expressing intention to change

58. Motivation Enhancement Therapy
Five Basic Principles of MET
◦Express Empathy
◦Develop Discrepancy
◦Avoid Argumentation
◦Roll with Resistance
◦ Arguing
◦ Interrupting
◦ Denying
◦ Ignoring
◦Support Self-efficacy

59. 1. Express Empathy
Communications that imply a superior/inferior relationship
are avoided.
The therapist’s role is a blend of supportive companion and
knowledgeable consultant.
The client’s freedom of choice and self-direction is respected.
Persuasion is gentle, subtle, always with the assumption that
change is up to the client.
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

60. 2. Avoid Argumentation
If handled poorly, raising of discrepancies can create
defensiveness.
The MET style explicitly avoids direct argumentation, which
tends to evoke resistance.
No attempt is made to have the client accept or “admit” a
diagnostic label.
“The client, not the therapist voices the arguments for
change.”
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

61. 3. Roll with Resistance
MET strategies do not meet resistance head on, but
rather “roll with” the momentum, with a goal of shifting
client perceptions in the process.
New ways of thinking about the problem are invited, but
not imposed.
Solutions are usually evoked from the client rather than
provided by the therapist.
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

62. 4. Support Self-Efficacy:
Self -efficacy - the belief that one can perform a particular
behavior or accomplish a particular task..
 The person must believe he or she can change.
 Optimism can also be found in the menu of different
approaches available.
A therapist’s own optimism may also powerfully influence
client motivation and outcome.
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

63. 5. Develop Discrepancy
Motivation for change occurs when people perceive a discrepancy
between where they are and where they want to be.
M.E.T. seeks to enhance and focus the client’s attention on such
discrepancies.
Miller, Chap. 5, Handbook of Alcoholism Treatment Approaches, 1995

64. Relapse Prevention Program

65. Relapse Prevention Program
Isolated or complete return to
addictive behavior
Relapse is not a failure to
change or a lack of desire to stay
well
Relapse is a process, it's not an
event.

66. 10 Most
Common
Triggers of
Substance
Abuse
Relapse
1) Withdrawal symptoms (anxiety, nausea, physical
weakness)
2) Post-acute withdrawal symptoms (anxiety, irritability,
mood swings, poor sleep)
3) Poor self-care (stress management, eating, sleeping)
4) People (old using friends)
5) Places (where you used or where you used to buy
drugs)
6) Things (that were part of your using, or that remind
you of using)
7) Uncomfortable emotions (H.A.L.T.: hungry, angry,
lonely, tired)
8) Relationships and sex
9) Isolation
10) Pride and overconfidence

67. The Stages
of Relapse
Emotional RelapseIn emotional relapse,
you're not thinking about using.
The signs of emotional relapse are:
Anxiety, Intolerance, Anger,
Defensiveness, Mood swings,
Isolation,Not asking for help
Not going to meetings,Poor eating
habitsPoor sleep habits
The signs of emotional relapse are
also the symptoms of post-acute
withdrawal.
Emotional
Relapse

68. How to deal with Emotional relapse?
Early Relapse Prevention
Practice self-care. The most important thing you can do to prevent relapse at this stage is
take better care of yourself. Think about why you use..

69. The Stages
of Relapse
In mental relapse there's a war going on
in your mind. The signs of mental relapse
are:
Thinking about people, places, and things
Glamorizing your past use
Lying
Hanging out with old using friends
Fantasizing about using
Thinking about relapsing
Planning your relapse around other
people's schedules
Mental Relapse

70. Techniques for Dealing with Mental
Urges
Play the tape through.
Tell someone that you're having
urges to use.
Distract yourself..
Wait for 30 minutes.
Do your recovery one day at a
time.
Make relaxation part of your
recovery.

71. The Stages
of Relapse
Physical Relapse
It's hard to stop the
process of relapse at
that point

72. Systematic recovery: a perpetual
flow

73. Case Management

74. Thank you!