Substance Abuse - Broken Hearts Ministry


Substance Abuse and Treatment

Greg Bohall, M.S., C.R.C., MAC, CADC-II



Types of Use

Stages of Addiction

Types of Drugs

Routes of Administration



What things do we look for when diagnosing?

Tolerance and withdrawal (Tolerance Tiger)

Taking more of a substance over a longer period than intended

Desire or unsuccessful efforts to cut down/stop use

Time spent to obtain, use, recover from the substance

Social, occupational, recreational activities that have been reduced

Use when you know you shouldn’t (psychological/physiological)

Recurrent use resulting in failure to fulfill role obligations

Recurrent use in physically hazardous situations

Recurrent substance-related legal problems

Continued use despite interpersonal problems

(American Psychiatric Association, 2000)

Types of Use

Experimental use

This is short-term, random use of one or more drugs. Usually done out of curiosity, an encouragement by friends, or just to reach an altered state of mind.

Recreational use

Occurs most often when friends get together occasionally to take the drug out of pleasure or interest.

Circumstantial use

At this point, the drug is used to cope with a problem or achieve a certain mood.

They may take the drug with friends, strangers, acquaintances, or alone. They may binge and they back of when they need less or when problems from using the drug overcome the benefit.

Compulsive use

This is drug addiction. The person’s life is dominated by getting and using the drug. All other life areas are less important. A person may be able to function quite well as long as they have access to their drug but most frequently the use becomes uncontrollable and many life areas suffer.

(Gahlinger, 2001)

Stages of Addiction

Experimental Stage

Taking drugs usually starts with experimental use. It can be simple curiosity, a rite of passage into a social group, or peer pressure.

Social Stage

At this stage, the person still feels normal, but the use of the drug is a big part of social acceptance and the person’s identity.

Instrumental Stage

Person takes the drug for the purpose of pleasure or to cope with anger, shame, guilt, etc. Signs of dependency begin to appear. The user begins to drift away from clean friends and socializes more with people who also use the drug heavily.

There is tolerance to the substance leading to more drug use and extreme mood swings. The person no longer feels normal.

Compulsive Stage

The final stage of addiction. The person is preoccupied with the drug and will do anything to get it, i.e. theft, prostitution, etc. The person will hide drugs even from fellow users. MOST PEOPLE DO NOT RECOGNIZE THEIR


(Gahlinger, 2001)

Types of Drugs

Amphetamines- Stimulant

Injected, smoked, snorted, ingested

Ex: Methamphetamine and amphetamines (adderal)

Cocaine- Stimulant

Ex: Powder, freebase, crack

LSD- Hallucinogen

Ingested or applied

Marijuana- Hallucinogen

Ingested or smoked

Ecstasy (MDMA)- Stimulant

Ingested, snorted, injected

Opiates- Depressant

Ingested, smoked, snorted, injected

Ex: Heroin, morphine, hydrocodone

(Gahlinger, 2001)

Routes of Administration

Smoking (Time to Brain= 7 to 10 seconds):

Enters the lungs and quickly absorbed into the bloodstream through tiny vessels lining the air sacs.

Injecting: The most direct way to take the drug but not as fast as smoking. If injected into vein, it returns to the right side of the heart where it is pumped to the lungs, returned to the left side of the heart, then pumped to the brain.

Injecting to vein- “slamming”(15-20 seconds)

Injecting to muscle- “muscling” (3-5 minutes)

Injecting deep into the skin- “skin popping”(3-5 minutes)

Snorting (3 to 5 minutes)

Sniffing the drug. It is sniffed into the nose and absorbed by blood vessels in mucous membranes of the nasal passages. Although they are close to the brain, they still return to the heart and some of it is pumped back to the brain.


Some drugs can be absorbed directly through the skin or mucous membranes in the eyes (3-5 minutes), mouth (15-30 minutes), vagina(15-30 minutes, or anus (15-30 minutes). Ex: Fentanyl patches, nicotine patches, LSD.

Ingesting (20 to 30 minutes)

A drug that is eaten, drunk, or taken as a pill. It passes to the stomach, moves to the small intestine, then liver (where it is filtered), then the heart where it is pumped to the brain.

(Gahlinger, 2001)


What does “treatment” mean?

Why is it important for you know what this means?

Types of Treatment


First stage of addiction treatment

Safe management of acute physical symptoms of withdrawal associated with stopping drug use

Physicians, nurses


Typically a 28 day program in a hospital setting

Inpatient stays are often shortened and it barely addresses the physical needs of persons.

The basic treatment model has shifted from inpatient to residential treatment.

Residential Treatment

Has become the primary modality for treating substance use

Operated by hospitals or agencies

Removes the client from their maladaptive environment

Optimal timeframe is 3 months

(Stevens & Smith, 2009)

Types of Treatment

Partial Hospitalization and Day Treatment

Similar to residential treatment

High degree of structure and treatment happens during the work day then the client leaves.

Most often with dually diagnosed persons


Graduates of residential or inpatient typically go to outpatient after.

Continued care, 2-3 appointments a week.

Intensive outpatient

Big step to “normal”

(Stevens & Smith, 2009)

Treatment Topics

What is addressed in substance abuse treatment?

Defense mechanisms

Stages of change

Family and social

Medical issues

Addictive lifestyle

Coping skills

Knowledge of addiction

Self help meeting


American Psychiatric Association (2000). Diagnostic and

statistical manual of mental disorders-fourth edition-text

revision. Arlington, VA: American Psychiatric


Gahlinger, P. M. (2001). Illegal Drugs; A complete guide to their

history, chemistry, use and abuse. Sagebrush Press.

Stevens, P. & Smith, R. L. (2009). Substance abuse counseling;

Theory and practice. Upper Saddle River, NJ: Pearson.