Addiction and Substance Abuse

Transcription

1 1 Addiction and Substance Abuse Thomas Yeung, Sadee Dalley, Austyn Haymond Brigham Young University

2 2 Table of Contents Introduction.. 3 Definition... 3 Classification of Drugs... 4 Causes of Addiction... 5 Progression... 6 Introduction to the Population... 7 Diagnosis. 14 Symptoms Prognosis.. 16 Systems Affected. 17 Specific Needs.. 17 Tests and Medication. 18 TR Implications.. 20 Video Links for Further Understanding. 21 Resources 21 Works Cited. 23

3 3 Introduction Addiction is everywhere. All around us there are people trapped in a cyclical existence of addictive living. Major companies prey on individuals who feel a void and buy substances or experiences that only fuels their addiction. Companies like casinos, pornography distributors and porn stars, tobacco and alcohol companies and illegal substances surround their products with displays of success, prestige, and desire. Addiction is also inside of us. Many entertain addictive trains of thought that are damaging and poisonous. There are 2 main types of addictions: substance abuse and behavioral addictions. Substance abuse includes drugs, painkillers, alcohol, and tobacco, among other things. Behavioral addictions include sex, gambling, pornography, and gaming; even eating and exercising can become addictions. Definition An addiction does not typically develop over night. The process begins when an individual uses a specific substance or a certain behavior to fill a void or to alter their sense of self and their perception of reality. There are two main categories of these motives or needs that these addictive behaviors stem off of according to Steve and Alan Sussman; which are first, a hedonistic motive: ie drug use, sex, and gambling; and second, a nurturant motive: ie work or shopping addiction, exercise, even eating (2011). When we refer to addictions we most frequently refer to those addictions that are caused by the hedonistic motivations; however, all addictions may share in common a function to shift subjective experience of self (Sussman 2011) A definition of addiction given by the American Society of Addiction Medicine states:

4 4 Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations and is reflected in an individual pathologically pursuing reward and/ or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one s behaviors and interpersonal relationships, and a dysfunctional emotional response. According to this definition, addiction occurs when there is a dysfunction in the brain s reward system, which distorts an individual s motivations, desires, appetites and passions and is characterized by an inability to just stop using these substances or doing this behavior. Addictions change the makeup of the brain, and for this reason it is so difficult to break habits once these circuits are created. Genetic factors also contribute and amount to about 50% of the likelihood that an individual will develop an addiction. Classification of drugs. Slows normal brain function, drowsiness; calming effect slurred speech; confusion, poor concentration Speed up motor functioning, elevate mood, increase heart rate, respiration, blood pressure, energy, and alertness Quick, intense feeling of pleasure followed by a sense of calm, decreases pain, causes lethargy; lack of motivation; drowsiness

5 5 Alters perceptions, feelings, and sense of time, may cause auditory, visual, and tactile hallucinations, may cause panic and paranoia Causes of addiction. People engage in addictive behavior for a variety of reasons, but these reasons have been grouped into five different causes of substance related disorders, including behavioral addictions. Circumstances often influence the use and abuse of substances and other addictions. A family or group of friends who is tolerant and even supportive of using such substances can influence the individual through examples and proximity to these substances. On the other hand, individuals who feel alone and abandoned by their social groups, either family or friends, are also prone to engaging in these behaviors to find acceptance or, if anything, as a means to feel good or alter their perception of reality. Substance abuse is often a second diagnosis, often used as a coping mechanism for other emotional and mental disabilities such as depression, anxiety, high levels of stress and those individuals who have poor coping skills. Substances provide positive effects and feelings that act as a reinforcement for addictive behaviors. Dopamine in the brain is a hormone associated with pleasure and is released when using drugs and participating in other potentially addictive behaviors, thus encouraging the user to continue to misuse the substance. An individual who has a history of addiction in his or her family is more likely to develop a substance use problem, even when social factors are

6 6 controlled for. These individuals may inherit greater sensitivity to the positive psychopharmacological effects of substances. As previously stated, dopamine and serotonin affect the reward pathways of the brain, thus causing a psychological change in the individual and perpetuating addiction because of the difficulty of stimulating the brain naturally. Progression from general use to addiction. This process progresses largely depending on the individual and their circumstances, genetics, and influences of their social, spiritual, or emotional well being. Not everyone will be immediately addicted to a substance if they try it once, but there are some people that are prone to such rapid progression. There are six steps or terms to define in this addiction process. is the ingestion of alcohol and/or other drugs (AOD) [or behaviors] without negative consequences. occurs when an individual experiences negative consequences from the use of this drug. is the continued use of a drug despite negative consequences. is reduced sensitivity resulting in the need for increased dosage to achieve the desired drug effect. refers to a state of psychological and/or physical need for a substance, usually characterized by compulsive use, tolerance, and physical dependence manifested by withdrawal sickness. describes

7 7 addiction to AOD as differentiated from non chemical addictions (behavioral addictions). is a pattern of behavior characterized by an overwhelming involvement with using a drug and securing its supply regardless of adverse consequences associated with use of the drug and with a significant tendency to relapse after quitting or withdrawal. Introduction to the Population. Each addiction is distinct and each can affect any individual of any age. That being said, in the United States, a majority of the individuals diagnosed with substance use disorder a re between the ages of 18 and 25.

8 8 The above image expresses the relationship between illicit drug use and age. The evidence suggests that illicit drugs are used primarily between the ages of 18 and 30 years old. The above image documents the trends of illicit drug use over a 10 year time frame. According to Wood, Wyble, and Charters, 22 million americans have tried cocaine at least once. Cocaine is associated with crime and homelessness, and half of all drug related deaths and visits to hospital emergency rooms are cocaine related (2001, p. 95). Drug abuse is also very costly. In 2002, for example, the cost of substance abuse to American society was an estimated $181 billion. Of this, an overwhelming $107 billion was associated with drug-related crime (Caron Treatment Centers).

9 9 Marijuana is also trending upward. Here are some international statistics found on Foundation for a drug free world that will help to understand just how common the use of marijuana is. Over 94 million people in the US have admitted using it at least once. According to the 2007 National Survey on Drug Use and Health, 2.1 million people in the US abused marijuana for the first time that year. Among 12- to 17-year-olds, 6.7% were current marijuana users in According to US government estimates, domestic marijuana production has increased tenfold over the last twenty-five years: from 1,000 metric tons (2.2 million pounds) in 1981 to 10,000 metric tons (22 million pounds) in Not surprisingly, 58% of those aged 12 to 17 state that pot is easy to obtain. US marijuana users spent approximately $10.5 billion on the drug in the year In 2005, 242,200 emergency room visits in the United States involved marijuana. According to the US Drug Enforcement Administration, a large percentage of those arrested for crimes test positive for marijuana. Nationwide, 40% of adult males tested positive at the time of their arrest. Of adults 26 or older who used marijuana before age 15, 62% went on to use cocaine at some point in their lives; 9% went on to use heroin at least once; and 54% made some nonmedical use of mind-altering prescription drugs. Next to alcohol, marijuana is the second most frequently found substance in the bodies of drivers involved in fatal automobile accidents. This is the most prevalent form of drug million Americans are thought to be problem drinkers or alcoholics, and some estimates go as high as 28 million (Wood, Wyble, & Charters, 95). Each of these alcoholics affects those around them, thus influencing another 58 million people. Half of those individuals are their

10 10 children, who are greatly affected by the habits of their parents and display emotional and social difficulties. Studies show that almost 90% of individuals try alcohol before they turn 18. If substance abuse begins before the age of 15, this becomes a predictor for later substance abuse. Smoking is the leading cause of preventable death in the United States. Here are a few statistics on the populations that smoke. Each day, more than 3,200 people under 18 smoke their first cigarette, and approximately 2,100 youth and young adults become daily smokers. 9 out of 10 smokers start before the age of 18, and 98% start smoking by age in 5 adults and teenagers smoke. In 2011, an estimated 19% of U.S. adults were cigarette smokers. Approximately 18% of high school students smoke cigarettes. In 2011, nearly 18% of high school boys were current cigar users. From 1964 to 2014, the proportion of adult smokers declined from 42.0% to 18.0%. More facts about health related issues caused by smoking include: More than 16 million people already have at least one disease from smoking. More than 20 million Americans have died because of smoking since 1964, including approximately 2.5 million deaths due to exposure to secondhand smoke. 8.6 million people live with a serious illness caused by smoking. On average, smokers die 13 to 14 years earlier than nonsmokers (Facts About Smoking)

11 11 Utah is one of the top states in abusing prescription medication. Here are some statistics that highlight specifically Utah s problem with prescription drugs. In 2014, 32% of Utah adults aged 18 years and older had been prescribed an opioid pain medication in the last 12 months. From 2000 to 2014, Utah has experienced a 398% increase in deaths associated with the misuse and abuse of prescription drugs, making prescription drug overdose one of the leading cause of injury deaths in Utah. Since 2010, deaths from prescription opioid overdoses have increased 26.7%; calls to the Utah Poison Control Center decreased 45% during the same time period. From 2012 to 2014, Utah ranks 4th highest for drug overdose deaths in the U.S. Over the last decade, prescription pain medications have been responsible for more drug deaths in Utah than all other drugs combined. In 2014, 59% of all prescription pain medication deaths in Utah involved oxycodone, however the risk of death is significantly higher when methadone is involved. In 2015, 2.9% of students in grades 8, 10, and 12 reported that they had used prescription drugs in the past 30 days, not prescribed to them by a doctor.

12 12 In 2015, 10th and 12th grade students were significantly more likely than 8th grade students (3.0%, 3.4%, and 1.5%, respectively) to report using prescription drugs not prescribed to them within the past 30 days. All above information found at useonlyasdirected.org. For individual stories and experiences, watch this short clip: Testimonials from Recovering Addicts. Because of the natural biological reaction in our brains to pleasurable experiences, pornography and other sexual behaviors can be highly addictive and extremely difficult to quit- especially because pornographic images are so hard to forget and because a sexual addiction originates in our minds. There are staggering figures and statistics of just how far reaching pornography is. It would seem that people in general are fixated on sex so much so that 72 Million worldwide internet users visit adult sites per month. Also, about 12% of total websites are pornographic (4.2 Million websites). There are many other statistics relating to sexual addiction. Here are a few: 42.7% Of internet users view pornography. The National Council on Sexual Addiction Compulsivity estimated that 6%-8% of Americans are sex addicts, which is 18 million 24 million people. More than 80% of women who have porn addiction take it offline. Women, far more than men, are likely to act out their behaviors in real life, such as having multiple partners, casual sex, or affairs

13 13 A sexual addiction can have many damaging effects. Among those are sexually transmitted diseases and deterioration of real relationships and self esteem. Matt s story- includes both pornography and substance abuse: created by FightTheNewDrug For more information on sexual addiction, please take time to watch this. It is long, but this is an interview of Dr. Carnes, a specialist in the area of sexual addiction. Gambling is a bigger problem than we acknowledge. A recent research reveals that in America, approximately 2.5 million adults suffer from compulsive gambling, about 3 million are considered problem gamblers, around 15 million adults are under the risk of becoming problem gamblers and 148 million fall under the low risk gambler category (Gambling Addiction Statistics). This same source states that more than 500 million dollars are spent annually on wagers. Further, those who have an alcohol addiction are 23 times more likely to develop a gambling addiction. According to statistics, gambling addictions begin most between the ages of 20 and 30 years old (addictions.com). Addictions.com has a list of very alarming statistics on game usage. According to this website, the average length of time spent playing video games was 20 hours per week. An estimated 72 percent of American households play video games. An estimated nine percent of the 3,034 participants in the study showed signs of video game addiction. Four percent of percent of study participants were categorized as extreme users who played video games 50 hours per week on average. 50 hours!

14 14 Addicts use video games as a way to escape the real world. This much time playing video games, especially violent ones, increases the violent and aggressive nature of the individual in the real world, not only in their virtual reality. Diagnosis The official diagnosis of an individual who is struggling with an addiction to substances is divided into two types, substance use disorder and substance-induced disorder. Substance-induced disorder is then divided into intoxication and withdrawal. Substance use disorder looks at the problems related with ongoing use of the substance (Wood, Wyble, & Charters). It requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they're not a diagnostic test for addiction. These tests may be used for monitoring treatment and recovery. For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment. DSM-5 criteria for substance use disorder include a behavior pattern of drug use that causes significant problems and distress, regardless of what drug is used. In order for the addiction to be clinically significant, only two of the 11 criteria must be met.

15 15 Symptoms. 1. The substance is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 4. Craving, or a strong desire or urge to use the substance. 5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use. 7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance. 8. Recurrent use of the substance in situations in which it is physically hazardous. 9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. 10. Tolerance, as defined by either of the following: 1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

16 16 2. A markedly diminished effect with continued use of the same amount of the substance. 11. Withdrawal, as manifested by either of the following: 1. The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance). 2. The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. Prognosis. To continue the definition from the American Society of Addiction Medicine, Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. If left unchecked, addictions can leave individuals with a permanent mental or physical disability or could be fatal. Substance abuse can also lead to dual diagnoses and has severe impacts on life circumstances. Many drug abusers lose their homes, jobs, and their families deteriorate because of their habits. They rely on drugs to avoid withdrawal. Addictions take away your life and chain you to a miserable cyclical existence Individuals who suffer from substance abuse tend to be more successful in recovery when they are highly motivated to be in treatment, are actively engaged in their own recovery, and receive intensive treatment services. Prognosis for substance abuse recovery is further improved by being able to easily access community-based social supports (Substance Abuse Causes).

17 17 System Affected. Illness, injuries, hyperactivity of the autonomic nervous system, and physical damage to the body.. Anxiety, depression, loss of motivation, anger, agitation, and irritability Strained or un happy relationships with the possibility of a breakdown, work or school Short-term confusion, learning problems, memory loss, delusions are possible Additional problems Poor impulse control, poor judgment, poor sleep Lifestyle issues including financial instability, unemployment, homelessness, traffic accidents, conflict with the law, food insecurity, poor nutritional intake, and poor dental hygiene. Specific Needs - Studies suggest that adding exercise to addiction treatment can strengthen the effects of recovery. Exercise can give a natural high to replace the artificial ones these individuals seek. - Most people who have an addiction problem also have an emotional problem. Depression and anxiety are common dual diagnoses. You may hear the message that you need to get clean before you can work on an emotional problem. That doesn't always work. Getting help for an emotional problem

18 18 can help your addiction recovery. The most important thing to know is that you have resources for help to overcome your addiction. - Addictions damage relationships because often the addict is not honest with his family and friends and has to hide his or her addictive behaviour. Dishonesty and a lack of trust or dishonesty in an effort to protect those you love is not worth it. Facing your addiction and turning to those you love for help is the first step in the recovery process. Recognize the problem and do not hide it anymore. Hiding only increases your desire to indulge in whatever addiction you are struggling with. When someone does turn to you with the truth, do not judge them. This will only tell the person that he was right not to trust you in the first place, or will increase the feelings of hopelessness. Telling someone is taking a step of faith, both faith in the person they told, and a plea for help. If you brush that off, you may be throwing away your relationship and their life for good. - We must help addicts to understand that God will never abandon them, regardless of how far they feel from him. Specific Tests and Medication Successful treatment has several steps: detoxification (the process by which the body rids itself of a drug) behavioral counseling medication (for opioid, tobacco, or alcohol addiction) evaluation and treatment for co-occurring mental health issues such as depression and anxiety

19 19 long-term follow-up to prevent relapse Medication There are some approved medications to help addicts specifically of alcohol, opioid and tobacco addictions. Medication is used for the withdrawal and relapse prevention. Medication is used to dampen the effect of withdrawal during detoxification, and used to help re-establish healthy neuro-pathways and to help prevent relapse. Drugs specific to Opioids are Methadone (Dolophine, Methadose ), buprenorphine (Suboxone, Subutex, Probuphine ), and naltrexone (Vivitrol ). Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments. For tobacco use, there are several available options of nicotine replacement products that are available over the counter. There are only 2 approved methods of prescription drugs. They are bupropion (Zyban ) and varenicline (Chantix ). They prevent withdrawal symptoms and work better when coupled with behavioral treatment. There are three medications that have been approved by the FDA for use with individuals addicted to alcohol. They are: 1. Naltrexone, which reduces relapse to heavy drinking by blocking opioid receptors; 2. Acamprosate (Campral ), which reduces the effects of withdrawal such as insomnia, restlessness and anxiety. 3. Disulfiram

20 20 (Antabuse ) interferes with the breakdown of alcohol. This may be very unpleasant to take, but it may help those who are motivated to quit (H. DrugFacts). Aside from specific medications, there is a vast network of treatment centers, detoxification centers, residential treatment centers, rehabilitation centers, and counseling services that are available for struggling addicts to turn to for support and help quitting. TR Implications Role of the Recreational Therapist: Assist the client in: Identifying barriers to leisure participation Recognizing their strengths Improving ability to choose healthy alternatives Developing feelings of competence, control, and master Improving functional skills and overall health Developing a supportive social network Using the APIE process, establish: An overall treatment goal A long-term goal An intermediate goal A short-term goal

21 21 Videos and Other Websites for Further Understanding TR Addiction Help Resources: Video: Recreational Therapy and Addiction Recovery Video: Success Story Addiction Recovery Video: Mara s Story Before and After Pictures of Addicts Resources Addicts to Athletes Addiction and Psychological Services - Provo Outpatient substance abuse testing, assessment and evaluation, treatment and detoxification. A special focus on both mental disorders and substance abuse. Group therapy also available. USARA (Utah Support Advocates for Recovery Awareness) Utah Recovery Resources

22 22 Peer Support Services The National Center on Addiction and substance abuse provides different presentations and conferences Utah Addiction centers specializes in drug rehab and alcohol addiction 12 Step Treatment Centres.com This 12-step treatment center guide provides a unique section on International Treatment Centers. Addiction Helper Developed by recovering addicts and alcoholics, the Recovery Healthcare team consists of trained counselors, therapists and medical specialists in the field of addiction and mental health. Asia - Addiction Friend Asia offers free and independent advice on addiction treatment services in Asia.

23 23 References American Society of Addiction Medicine. (n.d.). Retrieved October 31, 2016, from Austin, D. R., & Crawford, M. E. (1991). (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. A. (n.d.). Tobacco Facts and Figures. Retrieved November 03, 2016, from Gambling Addiction Statistics. (n.d.). Retrieved November 02, 2016, from cs H. (n.d.). Treatment Approaches for Drug Addiction. Retrieved November 03, 2016, from ug-addiction Marijuana Statistics - Cannabis Use Statistics - Drug-Free World. (n.d.). Retrieved November 03, 2016, from tml Substance Abuse Causes, Symptoms, Treatment - Prognosis of Substance Abuse - emedicinehealth. (n.d.). Retrieved November 02, 2016, from

24 24 Sexual Addiction Symptoms, Abuse Stats, Withdrawal Effects - Addiction Hope. (n.d.). Retrieved November 02, 2016, from Sussman, S., & Sussman, A. N. (2011, October 20). Considering the Definition of Addiction. (10). Retrieved October 31, 2016, from Useonlyasdirected.org Useonlyasdirected Website and Webhosting Information. (n.d.). Retrieved November 03, 2016, from Wood, S., Wyble, J. R., & Charters, J. (2015). (H. R. Porter, Ed.). Enumclaw, WA: Idyll (n.d.). 5 Alarming Gambling Addiction Statistics. Retrieved November 02, 2016, from (n.d.). Video Game Addiction - Signs, Symptoms & Help for Gaming Addictions. Retrieved November 02, 2016, from