Addiction Setting the Stage

1. Lecture 1 Addiction Setting the Stage

2. Why Study Addiction? 1 3 2 25% patients seen by primary care physicians have alcohol drug problems 20% to 50% of all hospital admissions are addiction related Suicide is 30 times higher among alcoholic dependent persons Alcohol/drug disordered persons were 2.7 times more likely to have engaged in physical abuse of a child (Knutson & Haines, 2003; Greenfiled & Hennessy, 2004; Mosier, 1999)

3. 4 Illicit drug use in the home increases a women’s chance of being murdered by 28%, regardless if she was using or not. Need I continue… (Rivara et al., 1997).

4. 5 UPWARDS of 40,000 Canadians die from addiction-related causes annually (CCSA, 2009). Canada racks up $40 billion in annual costs attributable to alcohol and other drug addictions

5. WHO TREATS THOSE WHO ABUSE CHEMICALS? TYPICAL TREATMENT PROVIDERS HAVE FEWER THAN 2 TO 4 HOURS OF CLASSWORK ON ADDICTIVE DISORDERS. (Coombs, 1997).

6. ESTIMATES OF THE PROBLEM OF NARCOTICS ABUSE AND ADDICTION GLOBALLY, around 10 million people are estimated to abuse or are addicted to heroine. (United Nations, 2004).

7. Canadian Trends In 2011, prevalence of past-year pot use by youth was 21.6%, 3 X times higher than adults Among people who consumed alcohol in the past 12 months, 18.7% exceeded the guideline for chronic effects and 13.1% exceeded the guideline for acute effects These folks are aged 15 to 24 The Canadian Alcohol and Drug Use Monitoring Survey, 2011 (CADUMS) N = 10, 076

8. Risk Guidelines : Do you Buy it? Chronic effect = no more than 10 drinks for a female in a week with no more than two a day; 15 for male no more than three a day Acute = women no more than 3 drinks on a single occasion; men no more than 4 on any single occasion

9. Harms (CADUMS, 2011) 1.8% of Canadians aged 15 years and older reported experiencing at least one harm in the past year due to their illicit drug use

10. Harms Youth 15 to 24 years of age were approximately five times more likely than adults aged 25 years and older to report harm due to drug use, with 5.8% of youth reporting such harm, compared to 1.1% of adults

11. Harm is…. • Harm to physical health, friends/social life, financial position, home life/marriage, work/studies/employment, legal, difficulty learning, housing

12. How about Prescription Drug use/abuse in Canada? http://www2.macleans.ca/2012/11/20/canadas-drug-problems/

13. A Problem Reporting Prevalence is that Research is often Imperfect One study says this one study says that. Studies use different terminology and often refer to different things /constructs! Moreover, who is reporting? Addicts, non-addicts, persons in treatment? Doweiko, 2009.

14. Where we stand today? The war on drugs was not won. The problem still exists. We have to go beyond scare tactics, toward an understanding of who, and what we are studying. Because we have barely scraped the surface of understanding the baffling and cunning creature called Addiction effects us all!!!! Addiction (Doweiko, 2006).

15. What Do We Mean When We Say Substance Abuse and Addiction? Defining AddictionTraditional View • W – withdrawal • E – escalation • T – tolerance

16. Addiction on a Continuum • People frequently confuse chemical use with abuse and addiction. • However, looking at addiction from a holistic perspective, its quite obvious that there is varying degree’s of addictive behaviours.

17. What is Addiction (cont.) • Complete abstinence is at one end of the continuum; physical addiction to a chemical at the opposite end. • Between these two extremes are various patterns of use that differ in intensity, rendering different consequences for the user. • Thus, for some people drug alcohol / abuse can be equated with possession or demon like behaviors (complete loss of control) • While for others, they can social drink, smoke, others are weekend warriors so to speak, and again, for others, they don’t touch substances at all.

18. The Continuum • Demonstrates classic signs of addiction (WET) • Combination of medical, social, familial, legal problems due to use • However, these individuals may still continue to deny their use. Level 4 • Use has clearly become problem • Person may deny addiction • Person may experience medical problems • Experience withdrawal when discontinuing use • Have lost control / preoccupied Level 3 • Use more than the normal person • Begin to experience a variety of problems • At risk for developing addiction • Deny extent of problem Level 2 Level 0 • No loss of control • Low risk for developing addiction • No problems Level 1 • No use • No risk for developing • problem Total abstinence rare/social use heavy social use heavy problem / addiction starts Entrenched addiction

19. RECREATIONAL DRINKER / USER – [LEVEL 1]USED WITHIN A TRADITIONAL CONTEXT, (E.G. WINE WITH SUPPER, A FEW BEERS WITH THE GIRLS OR BOYS AFTER WORK, ODD TOKE WITH FRIENDS) Breaking the Continuum Down and Defining Terms

20. Substance abuse – “level 2-3”occurs when an individual uses a drug without legitimate medical reason to do so. (I.E., drinking alcohol beyond social standards, begins drinking socially, but at of the end night is overtly drunk, happens somewhat regularlyThus, person is making poor choices, but still has control over their drinking, therefore may drink 3-5 drinks, but can stop. Maybe if one cannot stop at 3 to 5… A clear sign of level 3?

21. Addiction / dependence – “level 4”person has no control over their use, person is preoccupied with using and when not using will go to lengths to secure a source to use again. Use has manifested multiple psychosocial problems, legal, family, social, employment, spiritual / religious. Pharmacodynamic tolerance CNS becomes insensitive to drug’s effect

22. STANDARIZED TEST FOR ALCOHOLISM Michigan Alcoholism Screening Test (MAST) Scoring – Score one point if you answered the following: • No; 2) Yes; 3) Yes; 4) No; 5) Yes 6) Yes; 7 through 22: yes 0 – 2 No apparent problem 3 – 5 Early or middle problem 6 or more Problem Drinker

23. WHAT DO FOLKS MAKE OF THE MAST? • CLASS SCORES ANYONE? • GOOD QUESTIONS • BAD • ANY CHANGES TO MAST YOU WOULD MAKE?

24. Standardized Test for Drugs DAST • Many modifications • Reliable • Valid • Scoring 1 for every yes except for items 4,5,7 for which a NO response is given a score of 1

25. DAST Cutoff Scores 5 or less no problem 6 to 11 drug problem present 12 or greater – substance use disorder

26. Let’s Talk about Psychological Dependence Psychological dependence is the individual’s perceived need for the drug/chemical/behavior

27. Summing Up What do we really know about addictive disorders? The latter presented addiction continuum and definitions are based on evidence derived from individuals who have presented for treatment or have offered themselves as research participants.

28. Field is it’s infancy However, we know as researchers, clinicians, and professionals in the field that there are: 1) More individuals who discontinue their use on their own; 2) Have problematically used and quit; 3) Who never present for treatment. Thus a great proportion of knowledge about addiction may not be a true representation of the addicted population.

29. So what is addiction? • Thus, it is important for “you” soon to be counselors or practioners in field at whatever level to determine for yourself what constitutes an addiction. • Your future clients have their own opinion, but what is yours? • What level are they at, are they experiencing withdrawal, does their culture and social norms consider addiction differently from you.