Addictions 101:
Diagnosis & Treatment for
Mental Health Professionals
Jessica Holton, MSW, LCSW, LCAS
1
Holton, 2012
Learning Objectives:
Participants will be able to describe
the difference between substance
abuse and substance dependence
according to the DSM IV-TR.
Participants will be able to list four
predisposing factors of addiction:
Biological, Social, Cultural, and
Spiritual.
Participants will be able to apply
knowledge about the correlations
between
addiction
and
the
brain.
2
Holton, 2012
Learning Objectives:
Participants will be able to
identify the five Stages of Grief,
the Five Stages of Healing, and
the five Stages of Change.
Participants will be able to
teach and incorporate adaptive
coping skills, such as
Mindfulness, as components of
Recovery.
3
Holton, 2012
Evidence-Based Practice
Steps for using Evidence-Based Practice:
1.
Conduct a Biopsychosocial assessment
2.
Making the diagnosis and selecting appropriate practice
guidelines
3.
Using practice guidelines to identify problems
4.
Develop goals or planned target of change
5.
Using practice guidelines to develop the intervention plan
6.
Using practice guidelines to establish outcome measures
7.
Evaluation
4
Holton, 2012
Is ADDICTION a choice?
 Many professionals use the term,
“Drug of Choice?”
 Is addiction an actual choice?
 Is addiction a series of behaviors that
eventually turns into a habit?
 Is it due to a chemical imbalance in
the brain?
 Is it attributed to hereditary and
genetics?
5
Holton, 2012
Before determining a diagnosis,
the Clinician must FIRST rule out:
Medical Conditions
AND
Substance-Related Disorders
6
Holton, 2012
Substance-Related Disorders
 Substance Dependence
 Physiological Dependence (Tolerance and/or withdrawal)
 Without Physiological Dependence (compulsive use)
 Substance Abuse
 Do not meet criteria for Dependence (no tolerance or
withdrawal and not using compulsively)
 Substance Intoxication
 Substance Withdrawal
** Must rule out substance-related disorders since
7
they can mimic most mental health disorders.
Holton, 2012
Quick Quiz (C.A.G.E.)
1. Have you ever felt you should cut down on your
drinking?
2. Have people annoyed you by criticizing your
drinking?
3. Have you ever felt bad or guilty about your
drinking?
4. Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover (eye-opener)?
8
Holton, 2012
ADDICTION
Ones first experience with drug
use can be divided into Thirds:
1) Think it
is okay, but
doesn’t need
it.
9
Holton, 2012
Georgi, J. M., 2004
2) Terrified
by it! Will
never use
it again.
3) Absolutely
Loves It!! It
is euphoric.
It is their
‘medicine.’
What factors lead to
an addiction?
Biological
Psychological
Social (Cultural)
Spiritual
10
Holton, 2012
Biological
Vulnerability
*Some people have higher levels.
Some people are more resistant.
11
Holton, 2012
Georgi, J. M., 2004
Psychological
Liability
*SHAME
Type “A” Personalities with Anger,
Frustration, & Negative Thinking.
12
Holton, 2012
Georgi, J. M., 2004
Social
Context
*CULTURE
Society, up-bringing,
childhood…
Person In Environment
13
Holton, 2012
Georgi, J. M., 2004
Spiritual
Bankruptcy
*No hope or belief
False sense of control.
14
Holton, 2012
Georgi, J. M., 2004
Biological + Psychological + Social + Spiritual
Vulnerability
Liability
Context
Bankruptcy
EQUALS
ADDICTION
15
Holton, 2012
Georgi, J. M., 2004
Society teaches us that if
something hurts, take a pill for it.
“Fix it.”
 We live in a shamed based society.
 If one has cancer, treatment
takes place and everyone is proud.
 If one has an addiction, or mental
illness, society places stigmas.
16
Holton, 2012
Georgi, J. M., 2004
CHRONIC DISEASES:
HYPERTENSION - 30% followed
recommendations from doctors; 5060% relapsed within 12 months
DIABETES - Less than 30% follow
recommendations, thus leading to 3050% needed re-treatment
ASTHMA - Less than 30% take
medication as prescribed, thus 6080% have frequent doctor/hospital
visits.
17
Holton, 2012
Shamp, J., 2005
ADDICTION IS A CHRONIC DISEASE,
LIKE HYPERTENSION, DIABETES &
ASTHMA, HOWEVER IT HAS STIGMAS
AND NEGATIVE PERCEPTIONS:
People with addictions are sinners.
Addiction leads to crimes and other
negative activities.
Addiction burdens and/or destroys
relationships, careers, finances, etc.
People with an addiction do not want
help
or
treatment.
18
Holton, 2012
Shamp, J., 2005
Shame has been defined as,
“pain in the soul that can not
be tolerated,” thus one tends
to find their own ‘medicine.’
=
Addiction
Unhealthy Coping Skills
19
Holton, 2012
Georgi, J. M., 2004
The brain weighs
approximately 3
pounds, however
it uses about 33%
of the bodies
energy.
20
Holton, 2012
Georgi, J. M., 2004
The Brain
21
Holton, 2012
The mid-brain is responsible for
emotions.
 Hypothalamus - “Master Gland” or
“Thermostat” – Regulates hormones
 Hippocampus – Functions after 2 yr.
old; Short and Long Term Memory.
 Amygdala - Functions at birth. ‘Fight or
Flight’; Automatic (Auto-pilot); Makes a
decision in a split second; Stores past
experiences; Reacts (depending on the
past experience(s), it may over react).
22
Holton, 2012
Georgi, J. M., 2004
The Brain
23
Holton, 2012
The Brain
24
Holton, 2012
The Brain
25
Holton, 2012
 Information enters through the hind-brain. It
travels through the mid-brain, then finally
reaches the forebrain.
 The hind-brain is responsible for basic body
functions.
 The forebrain is responsible for decision
making.
 The brain is, essentially, placed on “hold” at the
age the chemical use (addiction) began!
Dependence/Addiction Vs Habitual
Use
26
Mid-Brain
Holton, 2012
Georgi, J. M., 2004
Forebrain
The Brain
27
Holton, 2012
The Brain
28
Holton, 2012
29
Holton, 2012
30
Holton, 2012
The Brain After Drugs…….
Normal
2 weeks after stopping cocaine use
31
Holton, 2012
4 months after stopping cocaine use
So is ADDICTION an actual
choice?
Perhaps use language such as:
 “Drug(s) that you are dependent on?”
 “Drug(s) that you abuse?”
 “Drug(s) that you have used?”
Using different terms does not
take away personal responsibility.
32
Holton, 2012
Georgi, J. M., 2004
Types of Coping
 Action-based coping
 Action-based coping involves actually dealing with a problem that is
causing stress. Examples can include getting a second job in the
face of financial difficulties, or studying to prepare for exams.
Examples of action-based coping include planning, suppression of
competing activities, confrontation, self-control, and restraint.
 Emotion-based coping
 Emotion-based coping skills reduce the symptoms of stress without
addressing the source of the stress. Sleeping or discussing the
stress with a friend are all emotion-based coping strategies. Other
examples include denial, rationalization, repression, wishful
thinking, distraction, relaxation, and humor. There are both positive
and negative coping methods.
33
Holton, 2012
Unhealthy Coping Skills
 Harmful coping methods
Some coping methods are more like habits than
skills, and can be harmful. Overused, they may
actually worsen one's condition. Alcohol, cocaine,
and other drugs may provide temporary escape from
one's problems, but, with excess use, ultimately
result in greater problems. Other less extreme cases
involve skin biting, nail biting, and hair pulling.
34
Holton, 2012
Addiction Timeline
Recovery
First use
Social
Experimental
Addiction
Daily
Treatment
Continued Use
35
Holton, 2012
PERSON-IN-ENVIORNMENT (PIE)
APPROACH
 It is essential to get the whole picture, first
hand, and consider various perceptions.
 Individuals grow and change, thus
understand that they are often at a different
level (either better or worse) as their
experiences change.
 If co-occurring diagnosis are present, realize
that the conditions need to be addressed at
the same time!
36
Holton, 2012
UNDERLYING ISSUES & ADDICTION
 Are their links between the addiction and
mood symptoms? Which occurred first?
 Is there patterns of unhealthy behaviors,
such as anger outbursts, turbulent
relationships (codependency),
minimizing issues (denial), control issues
(external locus of control), low selfesteem, low self-worth, etc?
37
It is necessary to understand
feelings and emotions.
Holton, 2012
 What triggers unhealthy coping skills?
 How to cope with the triggers and
cravings in a healthy way?
 Methods to re-train the middle brain.
It takes tools, time and practice to retrain that “survival center” of the
brain.
 Establish and practice positive,
supportive and safe interactions to
encourage replacing the dysfunctional
behaviors to functional behaviors.
 Living compared to Surviving
 Being a Witness rather than a Victim!
38
Holton, 2012
Georgi, J. M., 2004
Grieving Process:
1) Shock/Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
Marrone, 1997
39
Holton, 2012
Revised Healing Process:
1)
2)
3)
4)
5)
40
Denial
Bargaining
Anger (Projection)
Depression (Blah, Guilt)
Acceptance (Sobriety)
Holton, 2012
“Stages of Change” –
It’s A Process
Precontemplation (Denial):
Not thinking of quitting
Feel that things are fine
Do not see a problem
Contemplation(Bargaining):
Maintenance (Acceptance): Thinking of quitting
Have not used in a long time
Accept self and sobriety
Help others who still use
Thinking of how others have been affected
Try small changes
Action(Anger & Depression):
Have quit using
Avoiding triggers
Ask others for help
Holton, 2012
Velasquez, Maurer, Crouch, & DiClemente.,2001
Preparation (Bargaining &
Anger):
Have a plan to quite
May have “cut down” on use
Can see the positives of being clean
41
Mindfulness - Shells
 Dealing with stress, cravings, flashbacks of traumas, mood
fluctuations, pain, triggers, anger, etc. is difficult.
 Practice healthy coping skills:
1) Recognize what is going on
(Observe)
2) Figure out how you are feeling
(Describe)
3) Do something about the feelings
(Participate)
Most people only complete the initial step. Many do not
actively participate in recognizing emotions and changing
their thinking and behaviors.
42
Holton, 2012
Georgi, J. M., 2004 (as cited in Linehan, 1993)
HEALTHY COPING SKILLS
(REACTIONS)
 RECOGNIZING SITUATIONS / EVENTS
 UNDERSTANDING EMOTIONS
 ADDRESS AND DEAL WITH ISSUES AS
THEY COME (DO NOT ‘STUFF’ ISSUES)
 INTERNAL LOCUS OF CONTROL
 CONTROL OF THOUGHTS AND BEHAVIORS
 HEALTHY SELF-ESTEEM
 SENSE OF SELF-WORTH
 SELF-AWARENESS
43
 HOPEFULNESS AND FAITHFULNESS
Holton, 2012
THOUGHTS,
COMMENTS
OR
QUESTIONS?
44
Holton, 2012
For more information, contact:
Jessica Holton
MSW, LCSW, LCAS
Jessica Holton, PLLC
http://www.jessicaholton.com
3491 Evans Street
Suite A
Greenville, NC 27834
252-987-3039
jessica_holton_lcsw@jessicaholton.com
45
Holton, 2012
References
Georgi, J. M. (2004). Treatment issues for dual diagnosis: Post traumatic
stress disorder and substance abuse. Presentation sponsored by Eastern
AHEC. Greenville, NC.
Shamp, J. (2005). Fighting the stigma linked to addiction. Retrieved April
18, 2005, from http://herald-sun.com/durham/4-598156.html
Sidbury, L. & Owens, C. (2005). Critical incident stress and emergency
response. Presentation sponsored by Pitt Community College.
Greenville, NC.
Valasquez, M.M., Gaylyn, G.M., Crouch, C. & DiClemente, C.C. (2001).
Group treatment for substance abuse: A stages-of-change therapy
manual. New York: The Guilford Press.
46
Holton, 2012