Access to Recovery: Substance Abuse and Independent Living

1. Access to Recovery: Substance Abuse and Independent Living October 19 and 21, 2006 Richmond, B.C. Centre for Addiction & Mental Health CAILC Toronto Rehabilitation Institute Canada Drug Strategy

2. Learning Objectives At the end of the workshop, participants will: ·List the most commonly used drugs and their effects ·Discuss the most current trends in drug use   · Understand how these issues affect people with disabilities ·Understand treatment options and how to access the addiction treatment system, · Integrate prevention and health promotion in your work · Develop a plan for working with local communities to improve awareness of and access to recovery for persons with disabilities

3. MORNING Welcome and overview: Jennifer Introduction to Addiction: Keith Key concepts Models of addiction Break Stigma, discrimination & addiction :Jennifer & Keith Patterns of drug use, with emphasis on use within disability communities: Keith & Jennifer Lunch AFTERNOON Stages of change and motivational interviewing: Jennifer & Keith Empowerment and self change: Keith Break Drug effects, with emphasis on drugs most commonly associated with harm: Keith Harm reduction: Keith Q & A’s: Jennifer & Keith Agenda DAY 19:00 – 4:30

4. MORNING Welcome and overview: Jennifer Health promotion & illness prevention : Keith Break Treatment approaches: Keith The addiction treatment system:Jennifer Lunch AFTERNOON Barriersto access: Keith Advocacy& systems change: Keith Break Making it happen: Jennifer & CAILC participants Wrap-up Agenda DAY 29:00 – 4:30

5. WELCOME • Agenda overview • Ground rules: • Participant led • Introductions: • Names • Where from and what role is • What want to get out of the training

6. Society’s most common, serious & neglected problems. • 1 in 4 Canadians will experience addiction or mental illness during their lifetime (1/10 in a year). • 2/3 who need care receive none • affect more people than heart disease – more than cancer, arthritis & diabetes combined. • Costs Canada $32-billion a year, • 14% of the net operating revenue of all Canadian Business (33% of short-term disability claims). • 20% of Ontario children require help (only 4% currently receive help).

7. Why do people use drugs? • Brainstorm a list of reasons people give for using drugs. • What are some of the positive, beneficial or desirable effects that people might experience when using drugs

8. Some reasons people give for using drugs • Fun/enhance pleasurable activities/intensify feelings • Experiment, explore new experiences • Unwind, cope with stress • Escape reality, numb feelings • Deal with emotional pain or discomfort • Respond to social pressure or norms • Make social contact easier • Enhance artistic creativity • Spiritual or meditative pursuits • Self-medicate for anxiety, depression, cognitive dysfunction

9. KEY CONCEPTS • What is “addiction”? • What is “substance abuse”? • What are the causes of addiction? • A brief history of the meaning of addiction and substance abuse

10. What is “addiction”? What is first word that comes to mind if you are asked that question?

11. The meaning of “addiction”: • varies widely within and across societies • is to some degree culturally determined • is an evolving concept within our society

12. Models of addiction • Moral models • Disease models • Social models • Biopsychosocial models

13. Moral models of addiction • The temperance movement • The War on Drugs

14. Disease models of addiction • The 12-Step Movement • Biology of addiction

15. Social models of addiction • The behaviourists • The Independent Living Movement

16. Biopsychosocial models of addiction • Determinants of health & disability • Inclusion of spiritual factors • Better understanding of interaction of physical, psychological, social & spiritual factors

17. Addiction: An Integrated Model BIO PSYCHO SOCIAL SPIRITUAL CULTURAL

18. Current concepts in understanding meaning of “substance abuse” and “addiction” • Physical dependence • Drug tolerance • Withdrawal • Psychological dependence • Harm

19. Physical Dependence • state in which the body has adapted to the presence of the drug at a particular level • when the drug concentration falls, withdrawal results

20. PHYSICAL DEPENDENCETolerance • the need for an increased amount of a given drug to achieve intoxication or desired effect • or the reduction of a drug’s effect with continued use of the same dose over time

21. PHYSICAL DEPENDENCE Withdrawal • Occurs when a drug is abruptly removed, or dose is significantly decreased • Cluster of symptoms often accompanied by directly overt physical signs

22. Withdrawal ...cont’d • Withdrawal generally looks opposite to the intoxication. • Unpleasantness of withdrawal may be so severe that the individual fearing it may use drug again just to avoid or relieve symptoms

23. Psychological Dependence • a state in which stopping or abruptly reducing the dose of a drug produces non-physical symptoms • characterized by emotional and mental preoccupation with the drug’s effects and a persistent craving for the drug

24. Harm • Central concept in understanding both addiction and substance abuse • Types of harm: • Physical • Psychological • Social (e.g., family, friends, job, financial, legal system) • Spiritual

25. Abbreviated List of Criteria for Abuse and Dependence • Preoccupation with substance • Increased use of substance beyond expected • Inability to control use • Withdrawal symptoms • Signs of tolerance • Restricted activities • Impaired functions • Harmful or hazardoususe

26. DSM IV Definitions

27. DSM IV SubstanceDependenceAt least 3 within a 12-month period: • Tolerance • Withdrawal • Unintentional Overuse • Persistent desire or efforts to control drug use • Reduction or abandonment of important social, occupational or recreational activities • Continued drug use despite major drug-related problems

28. Substance Abuse: At lease one criterion must apply within a 12 month period • Recurrent use leads to failure to fulfill major role obligations at work, school, or home • Recurrent use in situations which are physically hazardous • Recurrent substance-related legal problems • Continued use despite persistent physical, social, occupational, or psychological problems

29. Aside from the DSM…“Drug Abuse” is… • a highly complex, value-laden term that does not lend itself to any single definition. • Its meaning differs from one society to another

30. Review of key points… • Our understanding of the meaning of addiction is evolving. The current model of addiction is called the “___________” model. • What are 3 key concepts in our current understanding of addiction & substance abuse? • Of these 3 concepts, which one is common to both substance dependence & substance abuse?

31. Coffee Break

32. Values Clarification Activity • Individually review the list of drug users on the next slide and make note of the first thought, feeling and or image that comes into your mind. • As a group discuss and rank the harms associated with the list on the next slide.

33. Values Clarification Activity • Coffee drinker • Teen smoker • Person on Methadone • Crack addict • Person addicted to oxycontin • Valium user • Pregnant heroin user • Social drinker • Raver • Marijuana smoker

34. STIGMA, DISCRIMINATION & ADDICTION

35. What is stigma ? • A complex idea that involves beliefs, attitudes, feelings and behaviour. • Refers to the negative “mark” attached to people who possess any attribute, trait, or disorder that marks that person as different from “normal” people. • This ‘difference’ is viewed as undesirable and shameful and can result in negative attitudes/responses (prejudice and discrimination) from those around the individual.

36. Stigmatizing language • Addict • Substance “abuse”/abuser • Drunk • Crack-head • Junkie • Others…

37. Legal status of drugs does not reflect harms • Alcohol and tobacco cause more illness and death than all other drugs combined • Consider the ratio of harms to stigma

38. CAMH study on stigma & addiction

39. PATTERNS OF DRUG USE • within the population at large • among persons with disabilities

40. 79% of general population drink, 14% use cannabis. (CAS 2004) • 18% exceeded drinking guidelines. • 14% reported hazardous drinking. • Majority of acute problems are the result of average drinkers who drink too much on single drinking occasions. (Rehm 2003) • Alcohol, tobacco and other drugs cost Canadians over $18 billion annually. (Single, 1996)

41. Over 90% of the alcohol consumed by males aged 15 to 24 years and over 85% consumed by young females exceeded Canadian guidelines. (Stockwell 2005) • Close to 60% of those between 15 and 24 have used cannabis at least once; 38% used cannabis in the past year. (CAS 2004) • Over 80% of Grade 12 students drink and almost half of these students report hazardous drinking. (Adlaf 2005) • Daily cannabis use has increased significantly and 1 in 5 students report driving after using cannabis. (Adlaf 2005) • Although smoking has gone down, 1 in 7 students still smoke. (Adlaf 2005)

42. OSDUS 2005 HIGHLIGHTS…The good news The following drugs declined in use • cigarettes: from 19.2% to 14.4% • alcohol: from 66.2% to 62.0% • LSD: from 2.9% to 1.7% • PCP: from 2.2% to 1.1% • hallucinogens: from 10.0% to 6.7% • methamphet: from 3.3% to 2.2% • heroin: from 1.4% to 0.9% • Ketamine: from 2.2% to 1.3% • barbiturates: from 2.5% to 1.7%

43. OSDUS 2005 HIGHLIGHTS…The good news More students in 2005 reported being drug free (including alcohol and tobacco) during the past year compared to 2003 (35.9% vs. 31.6%)

44. Special Populations • Populations with higher than average levels of substance use: • Homeless Youth & Adults • Lesbian, gay, bisexual and transgendered youth and adults • Aboriginal people • Sex workers • People in detention centers, jails & prisons Substance Use in Toronto: Issues, Impacts & Interventions, February 2005

45. Non-disability factors can be more important predictors of patterns of use than type of disability • Regional differences • Cultural differences

46. Higher incidence of drug use among people with: • Mental illnesses • Learning disabilities • Acquired brain & spinal cord injuries • Painful conditions

47. Primary drugs of concern among people with disabilities • Tobacco • Alcohol • Opioids • Marijuana • Barbiturates & benzodiazipines • Polydrug use

48. Alcohol & tobacco

49. Opioids • Narcotic analgesics • Opiophobia • Issues related to treating chronic pain in people with a histories of drug dependence or abuse

50. Marijuana • Medicinal uses • Risks