SOCI221 Session 11 Crisis and Trauma Issues: Alcohol and other drugs; Eating disorders and Referrals Department of Social Science Endeavour College of Natural Health endeavour.edu.au 1
Session Aim The aim of this session is to provide an overview of: some of the complex issues involved in identifying and responding to alcohol, substance abuse and other addictive dependencies eating disorders within clients The therapeutic role and referrals Endeavour College of Natural Health endeavour.edu.au 2
Substance Dependence, Abuse and Addiction Substance abuse and addiction also known as substance use disorders are a major public health and social problem in our society. Addictions are serious and complex psychological, social, cultural and economic problems, and can be life-threatening. They can be very serious crisis and trauma issues. It is important to understand that the diagnosis of substance use disorders, whether it is for alcohol, drug abuse or for other addiction issues are beyond our scope as health practitioners. It is important to understand what these issues are though, especially when a client communicates addictions or substance abuse to us in their social history. Our role is to refer clients appropriately in such cases. Endeavour College of Natural Health endeavour.edu.au 3
Commonly abused substances Common abused substances include: Nicotine Alcohol Over the counter and prescription medications (E.g. Cough cold medicines; prescription medications; opioids; sedatives; stimulants; anabolic steroids) Recreational Drugs (E.g. ice; ecstasy; cocaine; rohypnol; hallucinogens; heroin; inhalants, marijuana) Endeavour College of Natural Health endeavour.edu.au 4
Commonly abused substances Reflection questions for discussion: 1. How widely available are such substances in our society? 2. Why are the distinctions between dependence, abuse and addictions important for us to understand? 3. Why can substance abuse and addictions be understood as crisis and trauma issues? 4. What is our role in identifying or communicating information to clients with substance abuse and addiction issues? Endeavour College of Natural Health endeavour.edu.au 5
Substance- Related and Addictive Disorders ALCOHOL ADDICTION What is alcohol? Alcohol is a depressant drug, which means it slows down the messages travelling between the brain and the body. There are many effects of alcohol on the body Alcohol affects everyone differently, based on: Size, weight and health Whether the person is used to taking it Whether other drugs are taken around the same time The amount drunk The strength of the drink You may experience: Feeling relaxed Trouble concentrating Slower reflexes Increased confidence Feeling happier or sadder, depending on your mood If you consume a lot of alcohol, you might experience: Confusion Blurred vision Clumsiness Memory loss Nausea, vomiting Passing out Coma Death Endeavour College of Natural Health endeavour.edu.au 6
Substance- Related and Addictive Disorders ALCOHOL ADDICTION Alcohol consumption within moderation is NOT substance abuse. Alcohol dependency or alcoholism is the physiological or psychological dependency on alcohol and can lead to a number of physical and psychological problems. Recent research suggests that alcoholism and other addictions to substances can be understood as a disease and that there may be a genetic or developmental factor in addictive disorders. This needs to be understood alongside the issue that at some point the individual made a conscious choice to smoke, drink or use a drug. Endeavour College of Natural Health endeavour.edu.au 7
The complexity of addiction Addiction and addictive risk behaviours are a complex set of behaviours which each person experiences differently and reveals itself in each clients social history differently. Remember that addiction does not discriminate. Just because someone has a great job, family, friends does not mean that they do not have an addiction. There are many different kinds of addictions widely prevalent in our society. These include addictions to sex, to gambling, to shopping, to spending hours on social media and/or internet, addictions to video gaming or any other activity that gives a highadrenaline rush to the pleasure centre of ones brain. Endeavour College of Natural Health endeavour.edu.au 8
Understanding Addiction Addiction can be understood as either physiological or psychological dependence on a substance that is beyond someone s voluntary control. Physiological or physical dependence implies that the body chemistry has been so affected that withdrawal from the substance produces a physical reaction at the cellular level, sometimes with severe complications. Psychological dependence means that the individual craves the substance being abused for the good feeling it provides. It can therefore, be understood as a coping mechanism, but one that carries a very high risk for the individual and society. Endeavour College of Natural Health endeavour.edu.au 9
Understanding Addiction - Reflection Why might it be suggested that: Physiological or physical dependence and psychological dependence on a substance are part of the same coin? Discuss and Reflect Endeavour College of Natural Health endeavour.edu.au 10
Illicit Drug Dependence in Australia Illicit drug use contributed to 1.8% of the total burden of disease and injury in Australia in 2011. This included the impact of injecting drug use and cocaine, opioid, amphetamine and cannabis dependence. It is estimated that illicit drug use costs the Australian economy $8.2 billion annually through crime, productivity losses and health care costs (Collins & Lapsley 2008). Illicit drug use is associated with many risks of harm to the user and to their family and friends. It has both short-term and long-term health effects, which can be severe, including poisoning, heart damage, mental illness, self-harm, suicide and death (NRHA 2015). Reference: Australian Institute of Health and Welfare http://www.aihw.gov.au/workarea/downloadasset.aspx?id=60129556761 Endeavour College of Natural Health endeavour.edu.au 11
The complex pattern of drug dependency Denial Excessive use of drug Disapproval Rationalisation Guilt Selfrecrimination Endeavour College of Natural Health endeavour.edu.au 12
The Importance of the 5 Cs There are five Cs to recall when identifying substance-dependent clients. REMEMBER: 1.I cannot CURE the disease 2.I did not CAUSE the disease 3.I cannot CONTROL the disease or the substance-dependent client 4. And if I try to, I CONTRIBUTE to the problem 5.AND I go CRAZY Tamparo, C. D & Lindh, W.Q. (2016) Therapeutic Communication for Health Care Professionals (4th ed) Mason, OH: Cengage Learning. p. 224 Endeavour College of Natural Health endeavour.edu.au 13
Crisis and Trauma : Eating Disorders What are eating disorders? Eating disorders are not a lifestyle choice or a cry for attention. Eating disorders are serious mental illness that have the highest mortality rate of any psychiatric illness. Many people experiencing an eating disorder suffer from depression and/or anxiety. Suicide rates for anorexia are 32 times higher than the general population. Currently around 4% of the Australian population is experiencing an eating disorder. This is close to one million people. Eating disorders do not discriminate by age, gender, ethnicity or socio-economic status. Eating disorders not only impact on the person experiencing the disorder, but also on their family, friends and community. Endeavour College of Natural Health endeavour.edu.au 14
The Complexity of Eating Disorders Different Types of Eating Disorders may include: 1. Anorexia Nervosa The reasons behind the development of Anorexia will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors. For some people, restricting their food and weight can be a way of controlling areas of life that feel out of their control and their body image can come to define their entire sense of self worth. It can be a way of expressing emotions that may feel too complex or frightening such as pain, stress or anxiety. It can start with compulsive dieting and exercise, especially in young girls. 2. Bulimia Nervosa Bulimia is characterised by repeated episodes of binge eating followed by compensatory behaviours. In addition, people with bulimia place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person s sense of self-esteem and self worth being wholly defined by the way they look. A person with Bulimia can become lost in a dangerous cycle of eating out of control and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviours can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image. Endeavour College of Natural Health endeavour.edu.au 15
The Complexity of Eating Disorders Different Types of Eating Disorders continued: 3. Binge Eating Disorder A person with Binge Eating Disorder will not use compensatory behaviours, such as self-induced vomiting or over-exercising after binge eating. Many people with Binge Eating Disorder are overweight or obese. 4. OSFED (Other Specified Feeding and Eating Disorder): People with OSFED commonly present with extremely disturbed eating habits, and/or a distorted body image and/or overvaluation of shape and weight and/or an intense fear of gaining weight (if underweight). *OSFED is the most common eating disorder diagnosed for adults as well as adolescents, and affects both males and females. 5. Disordered Eating e.g. fasting or chronic restrained eating; skipping meals; binge eating; self induced vomiting; restrictive dieting cutting out whole food groups Endeavour College of Natural Health endeavour.edu.au 16
Dealing With High Risk Clients If your client s in state of acute distress or in crisis dial 000 (in Australia) for emergency services and request an ambulance If your client is not currently with you (that is, they telephoned you to tell you they were experiencing a crisis), try and keep them on the phone while you ask someone else to call an ambulance for them obviously you will need to find out their exact location and relay this to emergency services Endeavour College of Natural Health www.endeavour.edu.au 17
The importance of Referrals It is important to recognise the limits of our scope as practitioners. Dealing with addictions such as alcohol, substance abuse and eating disorders are complex issues that need to be referred to other health care practitioners. Some points of referral include: 1. In a high risk/crisis situations always call Emergency ServicesTel: 000 2. Lifeline: Crisis Support and Suicide Prevention Tel:13 11 14 3. Refer your client to their General Practitioner (GP) 4. Beyond Blue Support Services Tel: 1300 22 4636 5. Alcohol and Drug Foundation Tel: 1300 85 85 84 6. Butterfly Foundation for Eating Disorders Tel: 1800 33 4673 Endeavour College of Natural Health endeavour.edu.au 18
Important Websites Lifeline https://www.lifeline.org.au/ Beyond Blue https://www.beyondblue.org.au/ Alcohol and Drug Foundation http://adf.org.au/ The Butterfly Foundation for Eating Disorders https://thebutterflyfoundation.org.au/ National Eating Disorders Collaboration http://www.nedc.com.au/ Endeavour College of Natural Health endeavour.edu.au 19
Additional Resources Alcoholics Anonymous Help Line 1300 222 222 http://www.aa.org.au/ Narcotics Anonymous Help Line 1300 652 820 http://na.org.au Gambling Help Online 1800 858 858 https://www.gamblinghelponline.org.au/ Gamblers Anonymous http://gaaustralia.org.au/ Family Drug Support Australia http://www.fds.org.au/ Smart Recovery Australia https://smartrecoveryaustralia.com.au/ Reach Out Support Services for Eating Disorders http://au.reachout.com/support-services-for-eating-disorders Endeavour College of Natural Health endeavour.edu.au 20
References Tamparo, C. D & Lindh, W.Q. (2016) Therapeutic Communication for Health Care Professionals (4th ed) Mason, OH: Cengage Learning. James, R.K., & Gilliland, B.E. (2016). Crisis Intervention Strategies (8 th ed.). Salt Lake City, UT: Brooks/Cole Publishing. Australian Institute of Health and Welfare (2017) http://www.aihw.gov.au/workarea/downloadasset.aspx?id=60129556761 Alcohol and Drug Foundation (2017) http://adf.org.au/ The Butterfly Foundation for Eating Disorders (2017) https://thebutterflyfoundation.org.au/ Endeavour College of Natural Health endeavour.edu.au 21