Addiction

1. Addiction Nadine Pelling, PhD Senior Lecturer University of South Australia January 2009

2. Overview • Drug Use • Continuum of Use • Why people use Drugs/Have problems with Drugs • Treatment by professionals & Action by other people who care • Resources

3. Drug Use • Psychoactive drug • Changes one’s psychological state • Caffeine, alcohol, cocaine, nicotine etc. • Most peoples/cultures sanction drug use of some sort • Most use/abuse legal drugs • Some use can be • Helpful when prescribed • Used religiously/socially • Small does not necessarily harmful

4. Continuum of Substance Use Behaviours • No use • Experimental Use • Voluntary/little or no impact • Mild Use • Integrated substance use/little or no impact on functioning/voluntary

5. Moderate Use • Misuse/Abuse/interferes but consequences not necessarily significant/voluntary • Heavy Use • Dependence/functional impairment/involuntary

6. Why people use drugs is complex …not solved simply

7. Why people use … • Historically people thought it was THE DRUG • The Demon Rum • Temperance movement • Then people started to talk about the Addictive Personality • But no support for one addictive personality • Some look at the Drug Culture and Availability • War on Drugs • Truth almost always a combination • BioPsychoSocial We see some of this view now with the evil opiate

8. Reasons Why People Take Drugs • Drug Reasons • Based in the drug itself • Speed/amphetamines; i.e., Truck drivers • Individual Reasons • Psychology (habit, mood HALT, mental illness) • Biology (genetic predisposition) • Environmental Reasons • Social Pressure/Support (drug culture)

9. Why Drink or do drugs . . . Why Drink or do drugs to Excess? • emotional needs • Stress/distraction/reinforcement • Negative affect • Thrill seeking • oral fixation (good old Freud and breast feeding) • avoid anxiety • learned to drink - reinforced • think benefits of drinking > costs • avoid self awareness • excuse for failing If drink to excess … parents likely to have … take a guess

10. social aspects & biological aspects - drink more when • more income • more education • abuse • race (more likely culture and oppression) differences • Canadian example …. • gender differences • Telescoping for women • peer pressure • predisposing genetic factors • more important for men

11. Availability of drug/alcohol very important • Beliefs about risks and prevalence • If feel low risk and others are doing it … more use • Abuse/Dependence generally a developmental process • Attitude, experimental use, regular use, heavy use, abuse/dependence • Does not explain all use

12. Self Reported Reasons for Using Drugs • To relieve boredom. • To provide stimulation. • To enhance mood- euphoria, relaxation, sensory intensification. • To be social with peers. • To relieve anxiety and depression (low doses). • Hall, W (1998) ‘Cannabis and psychosis’, Drug and Alcohol Review, 17:433-444

13. My favourite bit of drug use information …. • The evening meal …. • What does your dinner table look like? • Do people eat together? At a table? On the sofa? With the radio or television on? Who sits next to who? Are people talking to each other? • Research shows that families that have dinner together raise children that are less likely to use drugs • Can see if children under influence, know where they are, opportunity to talk, maybe appropriate modelling of use

14. Treatment • Depends on theoretical orientation • Depends on level of problem • Biopsychosocial approach best • Depends on goal of treatment

15. Goal of Treatment • Abstinence • Moderation • Controlled drinking • Harm reduction • HIV, Crime

16. Continuum of Treatment • None • Brief Intervention • Self Help (12 step groups) • Outpatient • Intensive Outpatient • Supported Living Environment • Residential Rehabilitation • Detoxification • Home • Centre

17. Treatment: What Works . . . • Basic psychological and counselling interventions • Addressing motivation and reinforcing variables • Non-confrontational • no aggressive interventions please • Teaching specific skills • Promoting active coping and goal setting • Address socio environmental factors • Family and peer supports

18. Treatment? • If you are not a clinician, physician, social worker, counsellor, or psychologist • You are probably not qualified to provide treatment • You could, however, engage in and encourage healthy action • bio psyco social

19. Biopsychosocial Action – Overview • Exercise • Structured Daily Activities and a Return to Normalcy • Education & Homework Activities • Social Involvement

20. Exercise • Aerobic • improves aerobic capacity and endurance • Nonaerobic • improves muscular strength and endurance or flexibility/coordination/relaxation

21. Effectiveness • Exercise has a long tradition in medicine • physicians often recommend exercise for patients • exercise prescribed in pre-Hippocratic Greek medicine • Recent research supports effectiveness of exercise • depressive and anxiety symptoms lessened with exercise • effects can last up to one year

22. Exercise found to • enhance mind function • enhance emotional state • create alertness • enhance creativity • enhance sleep • Exercise effective for mild to severe depression and anxiety and for people with physical problems

23. Guidelines for Use • Enjoyable • Positive role models • Education about fitness • Appropriate level • Gradual start • Social aspects • Focus on Goals • Realistic • Outside the Home • No Overtraining: staleness may result • Behavioural addiction

24. Compliance? • Will people exercise? • Compliance may be improved if one exercises with a companion or takes part in an exercise program at a gym • Support likely needed when starting a program • supervision • check on progress • at least until activity becomes self-reinforcing • Are you a positive role model? • Research shows people will exercise

25. How Much? • five weeks of 3x weekly sessions of aerobic or nonaerobic of 20-60 minutes duration • echoed by fitness experts for health benefits • the longer you engage in an exercise program the greater the emotional benefits

26. How To Exercise …. • Lets go for a walk, swim, play tennis, do some deep breathing exercises, stretch etc.

27. Structured Daily Activities and a Return to Normalcy • Depressive and anxiety related disorders generally include deficits in daily functioning • household roles, chores, leisure activities, social involvement, work performance • Those who show clinical improvement spend more time in chores and less time in passive leisure

28. Return to normal activities as quickly as possible • maintain feelings of belonging and usefulness • limit labeling as ill • form of exposure therapy • limit avoidance

29. How To Return to Normalcy … • Lets do the dishes together, make the beds, tidy up together etc.

30. Education • Education regarding one’s symptoms suggested as a first step in preparing client for treatment • normalize symptoms • Need contact with professional • Internet resources not usually very good

31. How To Education … • I have heard that a lot of people have difficulty with x, maybe we should look into the impact x could have. Why don’t we go to the doctor/professional or library together to find some information?

32. Homework Activities • Homework/Self exploration to help explore circumstances and behaviours that contribute to continuation of symptoms • explain why given, follow up, client involvement

33. How To Homework … • I find that when I am angry I eat more junk food/have trouble sleeping etc. I wonder if how you feel and what is going on in life for you has an impact on your use of x. It might be a good idea for you to keep a diary for a while, to explore what is going on in your life and results

34. Social Involvement • Social support buffers individuals from life stress • may be related to amount of external stimulation in the environment • too little/much focus on internal state • Social involvement can be used in treatment also • generalize and practice skills learned • reinforcement from others for healthy behaviour

35. How To Social … • Encourage healthy connections …. • A regular meeting (Church, 12 Step group, tennis or art club) versus ‘hanging out’ • Note People Places and Things • Can be difficult to do! • Company for a meal or a chat

36. Remember • People are responsible for themselves BUT we can make an impact

37. Resources • Local phone book • Existing community addiction services and self-help groups • Psychologists and counsellors can call to make professional connections • Australian national organisations • www.nationaldrugstrategy.gov.au • www.adca.org.au • www.fds.org.au • www.adf.org.au • Other sites • www.alcoholics-anonymous.org • www.kidsource.com • www.atforum.com • www.health.org • Books etc. • Pelling, N. (2003). Biopsychosocial activities as adjuncts in the treatment of depression and anxiety. Psychotherapy in Australia,9(4), 30-36. • Addiction Workbook by Fanning & O’Neill (1996) • The Heart of Addiction by Dodes (2002) • Substance Use Disorders Assessment and Treatment by Dodgen & Shea (2000)