Getting the Low Down on Substance Abuse


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Addiction: Disease or Choice?

Presented by Michael Coughlin, RN

Published in: Health & Medicine
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Getting the Low Down on Substance Abuse

  1. 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. 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. 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. 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. 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. 6. Final Common Pathway Model Addiction starts from biological, psychological and social factors but results in a permanently re-wired brain
  7. 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. Adopted by the ASAM Board of Directors4/12/2011.
  8. 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.
  9. 9. 9 Transmitters Synaptic cleft Receptors Neurotransmission and Change Reward processing Memory Stress Choice
  10. 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. 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. 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. 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. 14. Precontemplation Contemplation Action Termination Stages of Change Model Relapse Maintenance Preparation
  15. 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 (
  16. 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. 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. 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. • (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. 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. 20. So what does this mean? • For the individual • For the family