Class 3 Jan 16 / 14
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
In 2011, prevalence of past-year pot use by youth was 21.6%, 3 X times
higher than adults
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
The Canadian Alcohol and Drug Use Monitoring Survey, 2011 (CADUMS)
N = 10, 076
These folks are
aged 15 to 24
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
Acute = women no more than 3 drinks on a single
occasion; men no more than 4 on any single occasion
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/
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 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
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
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
3–5
6 or more
No apparent problem
Early or middle problem
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 Look at the AUDIT (Alcohol Use Disorders Identification Test
• 0 to 7 low risk for problem (no intervention warranted)
• 8 to 15 medium level risk for dependence (education or awareness building)
• 16 – 19 or (possible dependence / consultation with addictions specialist
maybe warranted)
• 20 or greater (evaluation and intervention needed probable dependence
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.