The document discusses addiction from multiple perspectives: - Addiction involves biological, psychological, and social factors that result in long-term brain changes and compulsion to use substances despite harm. It is considered a chronic disease by medical organizations. - Most people seeking treatment for substance use disorders or mental illness also have a concurrent or co-occurring disorder. Treatment aims to stabilize the individual, help them understand their disease and develop relapse prevention skills. - Recovery is a lifelong process of maintaining abstinence through structure, managing co-occurring issues, and reintegrating into family and community life with support. Understanding addiction helps individuals and families.

1. Addiction:
Disease or Choice?
Presented by Michael Coughlin RN
October 18, 2012
Introduced by
Melanie Willows B.Sc. M.D. C.C.F.P. C.A.S.A.M. C.C.S.A.M.
Assistant Professor University Of Ottawa
Clinical Director
Substance Use and Concurrent Disorders Program
Royal Ottawa Mental Health Centre

2. • How we understand addictions here at The Royal and
why understanding (the model) is important
• Addiction Disease of Choice
• Concurrent Disorders
• Treatment or How People Get Sober
• Recovery or How People Stay Sober
• What Does This Mean?
- for the Individual
- for the Family
Discussion Points

3. Disease does not mean not
capable of responsibility
The individual retains responsibility for correcting
his or her behavior, even if he or she has a disease
such as addiction”(Vaillant,1983,1990)

4. Models of Addiction
• Dispositional disease model – somehow the
individual is different (allergic)
• Educational model – lack of knowledge
• Characteralogical model – abnormal personality
• General systems models – social systems models
• Moral model - choice
• Medical model – Primarily genetic predisposition
• Spiritual model – lost their path

5. Final Common Pathway Model
• Holds that addiction to chemicals is an end-
stage or a common end-point
• States that there is no single cause of
addiction

6. Final Common Pathway Model
Addiction starts from biological, psychological
and social factors but results in a permanently
re-wired brain

7. American Society of Addiction Medicine
(ASAM)
Addiction is a primary, chronic disease of brain
reward, motivation, memory and related circuitry.
Dysfunction in these circuits leads to characteristic
biological psychological, social and spiritual
manifestation. This is reflected in an individual
pathologically pursuing reward and/or relief by
substance use and other behaviours.
www.asam.org Adopted by the ASAM Board of Directors4/12/2011.

8. ASAM
Addiction is characterized by inability to consistently
abstain, impairment in behavioural control, craving,
diminished recognition of significant problems with
one’s behaviours and interpersonal relationships,
and a dysfunctional emotional response…
Adopted by the ASAM Board of Directors 4/12/2011.
www.asam.org

9. 9
Transmitters
Synaptic cleft
Receptors
Neurotransmission and Change
Reward processing
Memory
Stress
Choice

10. Addiction-Disease of Choice
• Altered reward, motivation, memory, stress, &
judgment
• “The breathtaking lack of judgment” that is
one of the hallmarks of addiction

11. Co-occurring Disorders - the Norm in
Medicine
• Concurrent Disorders – two mental health
diagnosis
• A substance use disorder
• And one other mental health disorder

12. Concurrent Disorders
• General population 3-4%
• Mental health tx programs 40-60% had co-
occurring substance use disorder
• Substance abuse tx program 50-60% had co-
occurring mental health disorder
• Suicide 30 times as common in alcohol
dependant persons
• 35% of IV drug users commit suicide

13. Concurrent Disorders
Psychiatric Diagnosis Lifetime Prevalence of SUD
Depression 32%
Bipolar Disorder 64%
Anxiety Disorder 36%
ADHD 23%
Eating Disorder 28%
Schizophrenia 50%
Antisocial Personality 84%
cited in Concepts in Chemical Dependency Harold e. Doweiko

14. Precontemplation
Contemplation
Action
Termination
Stages of Change Model
Relapse
Maintenance
Preparation

15. Denial and the Stages of Change
• NA “it was only in desperation did we ask
ourselves, ‘Could it be the drugs?’” (from the NA
basic text)
• “People with addiction often manifest a lower
readiness to change…and display an apparent
lack of appreciation of the magnitude of
cumulative problems and complication
(www.asam.org)

16. Treatment or How the Addicted Get
Sober – the Kickstart
• First helping to stabilize the individual.
• Treatment starts as process of helping the
individual see the truth of their use clearly.
• Then to understand what happened – the
disease.

17. Treatment
• To help the person develop the skills and
understanding that will help them stay
abstinent.
• To help the individual to understand the
importance of relapse prevention.
• And thru the whole process to model Hope

18. Recovery - The Lifelong Journey
• AA Step 12 Having had a spiritual awakening as a
result of these steps we tried to carry this message
to alcoholics, and to practice these principles in all
our affairs.
• www.samhsa.gov (substance abuse & mental health services
administration) recovery from alcohol and drug problems
is a process of change through which an individual
achieves abstinence and improved health wellness
and quality of life

19. Recovery the supports
• Components of recovery - the supports
– maintenance of the structure
– management of mental health issues
– reintegration into the community. Ex. Work family

20. So what does this mean?
• For the individual
• For the family