Lecture 1

Addiction

Setting the Stage

Why Study Addiction?

Alcohol/drug disordered persons were 2.7 times more likely to have engaged in physical abuse of a child

25% patients seen by primary

care physici

ans have

alcohol drug

problems

20% to 50% of 20% to 50% of all hospital all hospital

admissions are admissions are addiction relatedaddiction related

Suicide is 30 times Suicide is 30 times higher among higher among

alcoholic alcoholic dependent persons dependent persons

(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).

GLOBALLY, around 10 million people are estimated to abuse or are addicted to heroine.

ESTIMATES OF THE PROBLEM OF NARCOTICS ABUSE AND ADDICTION

(United Nations, 2004).

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

Canadian Trends

The Canadian Alcohol and Drug Use Monitoring Survey, 2011 (CADUMS)N = 10, 076

These folks are aged 15 to

24

In 2011, prevalence of past-year pot use by youth was 21.6%, 3 X times higher than adults

Acute = women no more than 3 drinks on a single occasion; men no more than 4 on any single occasion

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

Harms

• 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

(CADUMS, 2011)

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

Harm is….• Harm to physical health, friends/social life, financial position,

home life/marriage, work/studies/employment, legal, difficulty learning, housing

How about Prescription Drug use/abuse in Canada?

http://www2.macleans.ca/2012/11/20/canadas-drug-problems/

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?

A Problem Reporting Prevalence is that Research is often Imperfect

Doweiko, 2009.

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

Where we stand today?

Addiction effects us all!!!!

(Doweiko, 2006).

Defining Addiction

Traditional View

• W – withdrawal

• E – escalation

• T – tolerance

What Do We Mean When We Say Substance Abuse and Addiction?

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 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.

The Continuum

No loss of control

Low risk for developing addiction

No problems

Use more than the normal personBegin to experience a variety of problemsAt risk for developing addictionDeny extent of problem

Use has clearly become problemPerson may deny addiction Person may experience medical problemsExperience withdrawal when discontinuing useHave lost control / preoccupied

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.

No use

No risk for developingproblemTotal abstinence rare/social use heavy social use heavy problem / addiction starts

Entrenched addiction

Level 0Level 1

Level 2

Level 3

Level 4

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

STANDARIZED TEST FOR ALCOHOLISM

Michigan Alcoholism Screening Test (MAST)

Scoring – Score one point if you answered the following:

1)No; 2) Yes; 3) Yes; 4) No; 5) Yes 6) Yes; 7 through 22: yes

0 – 2 No apparent problem3 – 5 Early or middle problem6 or more Problem Drinker

WHAT DO FOLKS MAKE OF THE MAST?

• CLASS SCORES ANYONE?

– GOOD QUESTIONS

– BAD

• ANY CHANGES TO MAST YOU WOULD MAKE?

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

DAST Cutoff Scores

• 5 or less no problem

• 6 to 11 drug problem present

• 12 or greater – substance use disorder

Let’s Talk about Psychological Dependence

Psychological dependence is the individual’s perceived need for the drug/chemical/behavior

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.

Field is it’s infancy

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.