"Who Needs Intervention? Not Me!” (Drug Addictions)

1. "Who Needs Intervention? Not Me!” (Drug Addictions) By Emerson G. Miller, Th.D., MSW, LCSW (574) 271-8975 emiller6929@sbcglobal.net

2. Substance abuse knows no class boundaries, devastating families of CEOs as well as families of women on welfare. • Changing demographics, however, have altered the American family in recent years.

3. In the United States today: • Half of all children (35.6 million) live in a household where a parent or other adult uses tobacco, drinks heavily or uses illicit drugs. • 37.4 percent of children (27 million) live in a household where a parent or other adult smokes or chews tobacco. • 23.8 percent of children (17 million) live in a household where a parent or other adult is a binge or heavy drinker.

4. Parental alcohol and drug abuse increase the incidence of family violence, divorce, financial problems and exposure to crime.

5. The good news is • that parents have enormous power to be a healthy influence on their children. • that parents who abstain from cigarettes and illegal drugs, have high expectations for their children, monitor their whereabouts, know their friends and provide loving support and open communication are less likely to have children who smoke, drink and use drugs.CASACONFERENCE, Family Matters: Substance Abuse and the American Family (April 2004)

6. Dangerous Times Twenty-six percent of teens rate themselves as feeling high stress. High stress teens are twice as likely as low stress teens to smoke, drink, get drunk and use illegal drugs.The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003)

7. Girlfriend … boyfriend Teens who spend 25 or more hours per week with a boyfriend or girlfriend are two-and one-half times likelier to smoke cigarettes, five times likelier to get drunk and four-and one-half times likelier to smoke marijuana than teens who spend less than 10 hours per week with their girlfriend or boyfriend. Al-Anon Family Groups. (2004)

8. Who needs intervention? • Addiction does not begin and end with the abuser; it sends shock waves through an entire family unit. • The reach of substance abuse also extends to schools, communities, health and welfare agencies, the justice systems and to society at large.

9. Substance Abuse Extends to All Ethnic Groups Different Ethnic Groups Have Diverse Patterns of Abuse … One Size Does Not Fit All

10. Substance Abuse and Ethnicity Substance use rates are highest among Native American and white children and lowest among black and Asian-American children, with Hispanics falling in the middle. Bernice Yeung, Health & Welfare Daily Report (November 8, 2011); Hazelden Foundation, (1998); L.-T. Wu, G. E. Woody, C. Yang, J.-J. Pan, D. G. Blazer. Archives of General Psychiatry, 2011; 68 (11): 1176; Psychology & Psychiatry (Novmber 7, 2011).

11. Substance Abuse and Ethnicity School Based Youth Research: • Minorities use drugs less than whites until they begin to assimilate into white culture, at which point they begin to use Alcohol & Other Drugs at greater rates. National Institute on Alcohol Abuse and Alcoholism No. 55 January 2002 • Monitoring the Future noted this for 16 consecutive years before first reporting it in 1990 (“We wanted to be sure”)

12. Substance Abuse and Ethnicity Similar trends are tracked for higher education, with a very interesting wrinkle: At HBCU’s (Historically Black Colleges & Universities) White students attending HBCU’s have significantly lower (like more than half) binge drinking rates than their counterparts at mainstream (generic) universities where the binge drinking rate among freshmen is 44%. Anton, Substance Abuse In African American College Students (April 8, 2011); Human Services 200 Understanding Addictive Behavior Winter Term 2004 Dual Diagnosis & Disability.

13. Substance Abuse and Ethnicity Other behaviors bear some scrutiny too: Proliferation of gang behavior among white youth At one time 80% of new gang recruits in Oregon were white. Law Enforcement stopped referring to “black style gangs” and started referring to “L.A. style” gangs. “What’s up n*gga”: Greeting between two white kids on 13th Ave. “ We’re ‘74 Hoover Crips” Wanksta’s, (White Gangstas) Wiggers: White… Why do some White kids want to be black gangstas?

14. WHAT IS AN ADDICTION? A medical diagnosis of addiction depends on finding three or more of the following factors (within a 12-month period)

15. WHAT IS AN ADDICTION? • Tolerance – Use is increased (amount or frequency) to obtain a similar effect. • Withdrawal – Removing the substance or stopping the activity leads to physical or mental symptoms, such as tremor, seizure, or depression. • The substance is taken over longer periods and in larger amounts than intended. This automatic ratcheting up of dosage is particularly obvious with drug addiction.

16. WHAT IS AN ADDICTION? • A desire to stop and a lack of success in doing so. Short-term abstinence will be followed by use that quickly returns to pre-abstinence levels and above. Patients describe this as a loss of control. • Time is spent in obtaining, using, or recovering from the effects of the addictive substance. The addiction begins to define the person’s schedule.

17. WHAT IS AN ADDICTION? • Important activities are sacrificed because of the addiction. These can be work related, personal goals, recreational or social. • Use is continued despite the knowledge that it is harmful, either physically, psychologically or socially.

18. WHAT IS AN ADDICTION? • While all addictions will exhibit some of these signs, substances and behaviors differ depending on the addiction. • Most addicts will deny the extent of their problem, but at some point will admit (at least to themselves) that a problem exists.

19. WHAT IS AN ADDICTION? • Unfortunately, the label, “addict” is has become a powerfully negative and ugly stereotype. It is neither a character defect nor a moral weakness. Anyone can become an addict if they are exposed to the proper stimulus in the right context. • Addiction is a disease and treatments vary somewhat depending on the particular compulsion.

20. ADDICTION AFFECTS THE FOLLOWING DOMAINS:_____________________________________ EMOTIONAL PHYSICAL SOCIAL COGNITIVE SPIRITUAL FAMILY

21. Why Do People Take Drugs In The First Place?

22. I FEEL GOOD (sensation seeking)I FEEL BETTER (self medication)

23. Natural Rewards • Food in the form of leafy green vegetables, salads and such. • Married Sex with a sober partner

24. Drugs have to be available No drug exposure, no abuse

25. PERCEIVED RISK Use of drugs increase as people believe that drugs are harmless

26. Use of MJ compared to perceived harmfulness availability Perceived harm use WOD ’75 ’81 ’85 ’91 ’99 NIDA: Monitoring the Future Study (1999)

27. Vulnerability Why do some people become addicted while others do not?

28. Complex genetic factors play a role In animals and people

29. Lewis Rats Dopamine surges in response to a variety of addictive drugs (opiates, THC, nicotine, cocaine) are much more pronounced in Lewis rats Ref: Lepore M Studies on the neurobiological interrelationship between vulnerability to depression and vulnerability to drug abuse in animal models. Behav Pharmacol 1995;6(suppl1):82-84

30. A Major Reason People Take a Drug is They Like What it Does to Their Brains

32. When you make a mistake a lawyer can always find a colleague who knew you were going to screw up

33. Prolonged drug use changes the brain in fundamental and long-lasting ways

34. Normal Cocaine Abuser (10 Days) Cocaine Abuser (100 Days) NIDA slide teaching packet. Photo courtesy of Nora Volkow, Ph.D. Volkow ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey SL. Long-term frontal brain metabolic changes in cocaine abusers. Synapse 11:184-190, 1992; Volkow ND, Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP. Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169-177, 1993

35. Addiction is a Family Illness Who needs intervention? ... The Entire Family Jacob Spilman, LPC, LMFT, CEAP, Spilman & Associates LLC, www.jacobspolman.com (2012)

36. Alcoholism and drug abuse often are referred to as family diseases because the serious negative consequences of addiction and the importance of recovery affect not only the substance abuser but all members of the family.Fauci, A. S. et al. (1999); McEwen, B. S.. 1998; Glaser, R. et al. (1999); Levenstein, S., Ackerman, S., Kiecolt

37. How Does an Addiction Affect the Family • When a family member has a dependency of any kind the whole family develops ways of coping with the problems associated with the dependency: • less communication • the family avoids talking about the issue and keeps the addiction secret • Some family members may take on some of the responsibilities abandoned by the addicted person. www.jacobspilman.com

38. Who Needs InterventionCodependencyor “What, ME SICK!!!”

39. Codependency is… A compulsion to seek a sense of feeling “worthwhile outside of one’s self.” A set of maladaptive, compulsive behaviors learned by family members in order to survive in a family experiencing great emotional pain.

40. 3 routes to codependency • Relationship with AODA (Alcohol & Other Drug Abuse) • Growing up in a dysfunctional family • Being socialized into accepting a codependent role

41. Characteristics of Codependent People Are

42. An exaggerated sense of responsibility for the actions of others. • A tendency to confuse love and to love people they can pity and rescue. • A tendency to do more than their share all of the time. • A tendency to become hurt when people don’t recognize their efforts.

43. An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship to avoid the feeling of abandonment. • An extreme need for approval and recognition. • A sense of guilt when asserting themselves.

44. A compelling need to control others. • Lack of trust in self and/or others. • Fear of being abandoned or alone. • Difficulty identifying feelings. • Rigidity/difficulty adjusting to change.

45. Problems with intimacy/boundaries. • Chronic anger. • Lying/dishonesty. • Poor communication. • Difficulty making decisions.

46. All addictions are like an An umbrella over a core of pain is formed. At that core the child feels unlovable and/or unloved.

47. The umbrella of addictions includes raising the external sense of self-worth through • Destructive relationships • Abuse of work (Workaholism) • Compulsive over-eating • Internet addiction • Compulsive sexual behavior • Perfectionism • Abuse of power • Abuse of religion • Compulsive gambling • Compulsive over-spending (shopaholism) • Alcohol and drug abuse • Procrastination

48. In the later stages of codependency, codependents may • Feel depressed • Become withdrawn and isolated • Experience a complete loss of daily routine • Abuse or neglect their children • Feel hopeless

49. Become seriously emotionally, physically or spiritually ill • Experience an eating disorder • Become addicted to alcohol or drugs • Think about suicide • Become violent

50. Isn’t everyone codependent? Aren’t people mutually interdependent?