Transcript Class 2 HLSC 1000 2011.ppt

Lecture 1
Addiction
Setting the Stage
Why Study Addiction?
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)
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).
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
WHO TREATS THOSE WHO ABUSE CHEMICALS?
TYPICAL TREATMENT PROVIDERS
HAVE FEWER THAN 2 TO 4 HOURS OF
CLASSWORK ON ADDICTIVE
DISORDERS.
(Coombs, 1997).
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).
Canadian Trends
Alcohol is the most commonly used psychoactive drug in Canada
Four of 5 Canadians aged 15 or older consume alcohol
Of these, 5.6% report heavy infrequent use (binge drinkers)
Of these, 7.1% report heavy frequent alcohol use
These folks are
aged 18 to 24
Statistics from (Canadian Addiction Survey, 2003)
Canadian Trends Illicit Drugs
(Canadian Alcohol and Drug Use Monitoring Survey, 2008).
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.
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!!!!
(Doweiko, 2006).
What Do We Mean When We Say Substance Abuse and Addiction?
• W – withdrawal
• E – escalation
Defining Addiction
Traditional View
• T – tolerance
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.
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 (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.
The Continuum
Level 4
Level 3
Level 2
Level 0
No use
No risk
for
developing
problem
Total abstinence
Level 1
No loss of
control
Low risk for
developing
addiction
No problems
rare/social use
Use more than
the normal
person
Begin to
experience a
variety of
problems
At risk for
developing
addiction
Deny extent
of problem
heavy social use
Use has clearly
become problem
Person may
deny addiction
Person may
experience
medical problems
Experience
withdrawal when
discontinuing use
Have lost
control /
preoccupied
heavy problem / addiction starts
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.
Entrenched addiction
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
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 regularly
Thus, 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?
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
Let’s Talk about Psychological Dependence
Psychological dependence is the individual’s perceived need for the drug/chemical/behavior
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.
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.
SHORT GROUP EXERCISE
Your row’s task is to create a definition for addiction and then present it to the class
THREE COMPONENTS
• Defining Addiction: The Experts
Way In…
CRAVING AND COMPULSION
LOSS OF CONTROL
CONSEQUENCES
• DSM SAYS THERE ARE
THREE COMPONENTS
STANDARIZED TEST FOR ALCOHOLISM
Michigan Alcoholism Screening Test (MAST)