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Access to Recovery: Substance Abuse and Independent Living. October 19 and 21, 2006 Richmond, B.C. Centre for Addiction & Mental Health CAILC Toronto Rehabilitation Institute Canada Drug Strategy. Learning Objectives. At the end of the workshop, participants will:

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Access to recovery substance abuse and independent living
Access to Recovery: Substance Abuse and Independent Living

October 19 and 21, 2006

Richmond, B.C.

Centre for Addiction & Mental Health

CAILC

Toronto Rehabilitation Institute

Canada Drug Strategy


Learning objectives
Learning Objectives

At the end of the workshop, participants will:

·List the most commonly used drugs and their effects

·Discuss the most current trends in drug use  

· Understand how these issues affect people with disabilities

·Understand treatment options and how to access the addiction treatment system,

· Integrate prevention and health promotion in your work

· Develop a plan for working with local communities to improve awareness of and access to recovery for persons with disabilities


Agenda day 1 9 00 4 30

MORNING

Welcome and overview: Jennifer

Introduction to Addiction: Keith

Key concepts

Models of addiction

Break

Stigma, discrimination & addiction :Jennifer & Keith

Patterns of drug use, with emphasis on use within disability communities: Keith & Jennifer

Lunch

AFTERNOON

Stages of change and motivational interviewing: Jennifer & Keith

Empowerment and self change: Keith

Break

Drug effects, with emphasis on drugs most commonly associated with harm: Keith

Harm reduction: Keith

Q & A’s: Jennifer & Keith

Agenda DAY 19:00 – 4:30


Agenda day 2 9 00 4 30

MORNING

Welcome and overview: Jennifer

Health promotion & illness prevention : Keith

Break

Treatment approaches: Keith

The addiction treatment system:Jennifer

Lunch

AFTERNOON

Barriersto access: Keith

Advocacy& systems change: Keith

Break

Making it happen: Jennifer & CAILC participants

Wrap-up

Agenda DAY 29:00 – 4:30


Welcome
WELCOME

  • Agenda overview

  • Ground rules:

    • Participant led

  • Introductions:

    • Names

    • Where from and what role is

    • What want to get out of the training


Society s most common serious neglected problems
Society’s most common, serious & neglected problems.

  • 1 in 4 Canadians will experience addiction or mental illness during their lifetime (1/10 in a year).

  • 2/3 who need care receive none

  • affect more people than heart disease – more than cancer, arthritis & diabetes combined.

  • Costs Canada $32-billion a year,

  • 14% of the net operating revenue of all Canadian Business (33% of short-term disability claims).

  • 20% of Ontario children require help (only 4% currently receive help).


Why do people use drugs
Why do people use drugs?

  • Brainstorm a list of reasons people give for using drugs.

  • What are some of the positive, beneficial or desirable effects that people might experience when using drugs


Some reasons people give for using drugs
Some reasons people give for using drugs

  • Fun/enhance pleasurable activities/intensify feelings

  • Experiment, explore new experiences

  • Unwind, cope with stress

  • Escape reality, numb feelings

  • Deal with emotional pain or discomfort

  • Respond to social pressure or norms

  • Make social contact easier

  • Enhance artistic creativity

  • Spiritual or meditative pursuits

  • Self-medicate for anxiety, depression, cognitive dysfunction


Key concepts
KEY CONCEPTS

  • What is “addiction”?

  • What is “substance abuse”?

  • What are the causes of addiction?

  • A brief history of the meaning of addiction and substance abuse


What is addiction
What is “addiction”?

What is first word that comes to mind if you are asked that question?


The meaning of addiction
The meaning of “addiction”:

  • varies widely within and across societies

  • is to some degree culturally determined

  • is an evolving concept within our society


Models of addiction
Models of addiction

  • Moral models

  • Disease models

  • Social models

  • Biopsychosocial models


Moral models of addiction
Moral models of addiction

  • The temperance movement

  • The War on Drugs


Disease models of addiction
Disease models of addiction

  • The 12-Step Movement

  • Biology of addiction


Social models of addiction
Social models of addiction

  • The behaviourists

  • The Independent Living Movement


Biopsychosocial models of addiction
Biopsychosocial models of addiction

  • Determinants of health & disability

  • Inclusion of spiritual factors

  • Better understanding of interaction of physical, psychological, social & spiritual factors


Addiction an integrated model

Addiction: An Integrated Model

BIO

PSYCHO

SOCIAL

SPIRITUAL

CULTURAL


Current concepts in understanding meaning of substance abuse and addiction
Current concepts in understanding meaning of “substance abuse” and “addiction”

  • Physical dependence

    • Drug tolerance

    • Withdrawal

  • Psychological dependence

  • Harm


Physical dependence
Physical Dependence abuse” and “addiction”

  • state in which the body has adapted to the presence of the drug at a particular level

  • when the drug concentration falls, withdrawal results


Physical dependence tolerance
PHYSICAL DEPENDENCE abuse” and “addiction”Tolerance

  • the need for an increased amount of a given drug to achieve intoxication or desired effect

  • or the reduction of a drug’s effect with continued use of the same dose over time


Physical dependence withdrawal
PHYSICAL DEPENDENCE abuse” and “addiction” Withdrawal

  • Occurs when a drug is abruptly removed, or dose is significantly decreased

  • Cluster of symptoms often accompanied by directly overt physical signs


Withdrawal cont d
Withdrawal ... abuse” and “addiction”cont’d

  • Withdrawal generally looks opposite to the intoxication.

  • Unpleasantness of withdrawal may be so severe that the individual fearing it may use drug again just to avoid or relieve symptoms


Psychological dependence
Psychological Dependence abuse” and “addiction”

  • a state in which stopping or abruptly reducing the dose of a drug produces non-physical symptoms

  • characterized by emotional and mental preoccupation with the drug’s effects and a persistent craving for the drug


Harm abuse” and “addiction”

  • Central concept in understanding both addiction and substance abuse

  • Types of harm:

    • Physical

    • Psychological

    • Social (e.g., family, friends, job, financial, legal system)

    • Spiritual


Abbreviated list of criteria for abuse and dependence
Abbreviated List of Criteria for Abuse and Dependence abuse” and “addiction”

  • Preoccupation with substance

  • Increased use of substance beyond expected

  • Inability to control use

  • Withdrawal symptoms

  • Signs of tolerance

  • Restricted activities

  • Impaired functions

  • Harmful or hazardoususe


Dsm iv definitions

DSM IV Definitions abuse” and “addiction”


Dsm iv substance dependence at least 3 within a 12 month period
DSM IV abuse” and “addiction”SubstanceDependenceAt least 3 within a 12-month period:

  • Tolerance

  • Withdrawal

  • Unintentional Overuse

  • Persistent desire or efforts to control drug use

  • Reduction or abandonment of important social, occupational or recreational activities

  • Continued drug use despite major drug-related problems


Substance abuse at lease one criterion must apply within a 12 month period
Substance Abuse abuse” and “addiction”: At lease one criterion must apply within a 12 month period

  • Recurrent use leads to failure to fulfill major role obligations at work, school, or home

  • Recurrent use in situations which are physically hazardous

  • Recurrent substance-related legal problems

  • Continued use despite persistent physical, social, occupational, or psychological problems


Aside from the dsm drug abuse is
Aside from the DSM…“Drug Abuse” is… abuse” and “addiction”

  • a highly complex, value-laden term that does not lend itself to any single definition.

  • Its meaning differs from one society to another


Review of key points
Review of key points… abuse” and “addiction”

  • Our understanding of the meaning of addiction is evolving. The current model of addiction is called the “___________” model.

  • What are 3 key concepts in our current understanding of addiction & substance abuse?

  • Of these 3 concepts, which one is common to both substance dependence & substance abuse?


Coffee break
Coffee Break abuse” and “addiction”


Values clarification activity
Values Clarification Activity abuse” and “addiction”

  • Individually review the list of drug users on the next slide and make note of the first thought, feeling and or image that comes into your mind.

  • As a group discuss and rank the harms associated with the list on the next slide.


Values clarification activity1
Values Clarification Activity abuse” and “addiction”

  • Coffee drinker

  • Teen smoker

  • Person on Methadone

  • Crack addict

  • Person addicted to oxycontin

  • Valium user

  • Pregnant heroin user

  • Social drinker

  • Raver

  • Marijuana smoker


Stigma discrimination addiction
STIGMA, DISCRIMINATION & ADDICTION abuse” and “addiction”


What is stigma
What is stigma ? abuse” and “addiction”

  • A complex idea that involves beliefs, attitudes, feelings and behaviour.

  • Refers to the negative “mark” attached to people who possess any attribute, trait, or disorder that marks that person as different from “normal” people.

  • This ‘difference’ is viewed as undesirable and shameful and can result in negative attitudes/responses (prejudice and discrimination) from those around the individual.


Stigmatizing language
Stigmatizing language abuse” and “addiction”

  • Addict

  • Substance “abuse”/abuser

  • Drunk

  • Crack-head

  • Junkie

  • Others…


Legal status of drugs does not reflect harms
Legal status of drugs does not reflect harms abuse” and “addiction”

  • Alcohol and tobacco cause more illness and death than all other drugs combined

  • Consider the ratio of harms to stigma


Camh study on stigma addiction
CAMH study on stigma & addiction abuse” and “addiction”


Patterns of drug use
PATTERNS OF DRUG USE abuse” and “addiction”

  • within the population at large

  • among persons with disabilities


  • 79% of general population drink, 14% use cannabis. abuse” and “addiction”(CAS 2004)

  • 18% exceeded drinking guidelines.

  • 14% reported hazardous drinking.

  • Majority of acute problems are the result of average drinkers who drink too much on single drinking occasions. (Rehm 2003)

  • Alcohol, tobacco and other drugs cost Canadians over $18 billion annually. (Single, 1996)


  • Over abuse” and “addiction”90% of the alcohol consumed by males aged 15 to 24 years and over 85% consumed by young females exceeded Canadian guidelines. (Stockwell 2005)

  • Close to 60% of those between 15 and 24 have used cannabis at least once; 38% used cannabis in the past year. (CAS 2004)

  • Over 80% of Grade 12 students drink and almost half of these students report hazardous drinking. (Adlaf 2005)

  • Daily cannabis use has increased significantly and 1 in 5 students report driving after using cannabis. (Adlaf 2005)

  • Although smoking has gone down, 1 in 7 students still smoke. (Adlaf 2005)


Osdus 2005 highlights the good news
OSDUS 2005 HIGHLIGHTS… abuse” and “addiction”The good news

The following drugs declined in use

  • cigarettes: from 19.2% to 14.4%

  • alcohol: from 66.2% to 62.0%

  • LSD: from 2.9% to 1.7%

  • PCP: from 2.2% to 1.1%

  • hallucinogens: from 10.0% to 6.7%

  • methamphet: from 3.3% to 2.2%

  • heroin: from 1.4% to 0.9%

  • Ketamine: from 2.2% to 1.3%

  • barbiturates: from 2.5% to 1.7%


Osdus 2005 highlights the good news1
OSDUS 2005 HIGHLIGHTS…The good news abuse” and “addiction”

More students in 2005 reported

being drug free (including alcohol

and tobacco) during the past year

compared to 2003 (35.9% vs. 31.6%)


Special populations
Special Populations abuse” and “addiction”

  • Populations with higher than average levels of substance use:

    • Homeless Youth & Adults

    • Lesbian, gay, bisexual and transgendered youth and adults

    • Aboriginal people

    • Sex workers

    • People in detention centers, jails & prisons Substance Use in Toronto: Issues, Impacts & Interventions, February 2005


Non disability factors can be more important predictors of patterns of use than type of disability
Non-disability factors can be more important predictors of patterns of use than type of disability

  • Regional differences

  • Cultural differences


Higher incidence of drug use among people with
Higher incidence of drug use among people with: patterns of use than type of disability

  • Mental illnesses

  • Learning disabilities

  • Acquired brain & spinal cord injuries

  • Painful conditions


Primary drugs of concern among people with disabilities
Primary drugs of concern among people with disabilities patterns of use than type of disability

  • Tobacco

  • Alcohol

  • Opioids

  • Marijuana

  • Barbiturates & benzodiazipines

  • Polydrug use


Alcohol tobacco
Alcohol & tobacco patterns of use than type of disability


Opioids
Opioids patterns of use than type of disability

  • Narcotic analgesics

  • Opiophobia

  • Issues related to treating chronic pain in people with a histories of drug dependence or abuse


Marijuana
Marijuana patterns of use than type of disability

  • Medicinal uses

  • Risks


Access to recovery substance abuse and independent living1

Access to Recovery: Substance Abuse and Independent Living patterns of use than type of disability

LUNCH BREAK


Agenda day 1
AGENDA patterns of use than type of disabilityDAY 1

AFTERNOON

  • Stages of change and motivational interviewing: Jennifer & Keith

  • Empowerment and self change: Keith

    Break

  • Drug effects, with emphasis on drugs most commonly associated with harm: Keith

  • Harm reduction: Keith

  • Q & A’s: Jennifer & Keith


Making changes group activity

Making Changes: Group Activity patterns of use than type of disability


Pre- patterns of use than type of disability

Contemplation

Lapse/Relapse

Contemplation

Preparation

Maintenance

Action

STAGES OF CHANGE

Relapsing back to problem use


Pre contemplation tasks of change

Pre- patterns of use than type of disability

Contemplation

PRE-CONTEMPLATIONTasks of Change:

  • Information: Both factual and personal

  • Consider circumstances which indicate a need for change

  • Engagement of client, create positive relationship


Contemplation tasks of change
CONTEMPLATION patterns of use than type of disabilityTasks of Change:

  • Examine the ambivalence

  • Weigh and consider alternatives

  • Examine “pros” and “cons” of particular actions


Preparation tasks of change
PREPARATION patterns of use than type of disabilityTasks of Change:

  • Gather information about options

  • Make initial contact


Action tasks of change
ACTION patterns of use than type of disabilityTasks of Change:

  • Understanding factors supporting the behaviour

  • Strategies which will support behavioural change

  • Communication with others


Maintenance tasks of change
MAINTENANCE patterns of use than type of disabilityTasks of Change

  • Establish support system

  • Practice behavioural changes

  • Act on relapse prevention plans


Lapse relapse tasks of change
LAPSE/RELAPSE patterns of use than type of disabilityTasks of Change:

  • Reconnecting with supports

  • Examining and learning from lapse experience

  • Reviewing and modifying relapse prevention strategies


Empowerment and self change
EMPOWERMENT AND SELF CHANGE patterns of use than type of disability

  • Understanding motivation

  • Autonomy

  • Motivational interventions


Afternoon break
Afternoon Break patterns of use than type of disability


Drug effects
DRUG EFFECTS patterns of use than type of disability

  • How do drugs work?

  • What makes one drug more addictive than another?

  • Which drugs are creating the most harm?


How drugs work
How Drugs Work patterns of use than type of disability

In order to predict the effect of a drug, we need to know:

  • the type of drug

  • size of dose

  • how drug was taken

  • distribution and absorption

  • metabolization

  • interactions


Metabolization
Metabolization patterns of use than type of disability

  • blood-brain barrier

  • body doesn’t distribute all drugs in the same way

  • some are stored in fat cells and released slowly

  • others bind to plasma protein in the blood and move to the brain quickly


Liver action
Liver Action patterns of use than type of disability

  • Liver contains enzymes that work to eliminate the drug from the body.

  • As the liver breaks down the drug it forms metabolites - some may not be psychoactive; others may be more potent than the original drug.

  • Metabolites eliminated from the body in urine or feces


Drug interactions
Drug Interactions patterns of use than type of disability

  • taking different drugs together creates new effects that are different than those from a drug taken alone

  • known as potentiation, its like multiplying the effects of two drugs rather than simply doubling the dose

  • some drugs cancel the effects of others. This is known as an antagonist effect


Types of drugs classified by psychoactive effect
Types of Drugs patterns of use than type of disabilityClassified by Psychoactive Effect

  • Stimulants

  • Depressants

  • Hallucinogens

  • Antidepressants

  • Antipsychotics


Stimulants
Stimulants patterns of use than type of disability

  • increase activity by stimulating the central nervous system

  • reverse the effects of fatigue and elevate a person’s mood

  • nicotine and caffeine are the most common drugs


Depressants
Depressants patterns of use than type of disability

  • slow down body activity by depressing central nervous system

  • induce sleep, coma and even death

  • sleeping pills (barbiturates), tranquilizers (benzodiazepines), antispasmodics and alcohol are most common depressants

  • opiates such as heroin and morphine can be thought of as a special class of depressants, as can neuroleptics such as neurontin & gabapentin


Hallucinogens
Hallucinogens patterns of use than type of disability

  • cause user to see hear or feel things that aren’t there yet without causing serious disturbances to CNS

  • LSD (acid), psilocybin (magic mushrooms) and mescaline are common examples of drugs

  • inhalants and marijuana have characteristics of depressants and hallucinogens


Antidepressants
Antidepressants patterns of use than type of disability

  • MAO inhibiters

  • Tricyclics, such as amitriptyline, Elavil, imipramine

  • SSRIs, such as Prozac, Paxil, Celexa, Zoloft

  • SSNRIs

  • Others, such as Wellbutrin, Effexor


Antipsychotics
Antipsychotics patterns of use than type of disability

  • Major tranquilizers, such as chlorpromazine, Haldol

  • “Atypical” antipsychotics, such as clozapine, olanzepine, resperidone & Seroquel


Factors related to addictive abuse potential of drugs
Factors related to addictive & abuse potential of drugs patterns of use than type of disability

Biochemical & biological

  • Central Nervous System effects

  • Rout of transmission

  • Rate of absorption/metabolizing

  • Rate of elimination

  • Side effects


Factors related to addictive abuse potential of drugs cont d
Factors related to addictive & abuse potential of drugs…cont’d

Personal

  • Neurochemistry

  • Developmental history

  • Aspects of personality

  • Experiences in use of this & other drugs

  • Values, beliefs & expectations

  • Some types of disorders & disabilities

  • Age & health


Factors related to addictive abuse potential of drugs cont d1
Factors related to addictive & abuse potential of drugs… cont’d

Environmental

  • Availability of drug

  • Immediate social group (e.g., family & peers) and community with whom the person identifies

  • Societal norms & sanctions re use of the drug(s) in question


Harm reduction
HARM REDUCTION cont’d


Drugs cause real harms
Drugs Cause Real Harms! cont’d

  • Implicit in the term harm reduction is the belief that drugs can cause real harms.

  • These harms are not an inevitable consequence of drug use, and can be prevented or ameliorated through a range of strategies that include but do not invariably require complete cessation from all drug use


Harm reduction key concepts
Harm Reduction: Key Concepts cont’d

  • Harm reduction aims to reduce the adverse health, social, and economic consequences of alcohol and drug use without requiring abstinence.

  • Goal is to reduce harms to the individual and the community.


Harm reduction key concepts1
Harm Reduction- Key Concepts cont’d

  • Focuses on reducing harms and not necessarily on reducing use

  • Accepts that drug use is universal and brings with it both risks and benefits

  • Does not judge drug use as good or bad.

    • Morally neutral - does not promote use or condemn use

    • Non-Coercive


Harm reduction key concepts2
Harm Reduction: Key Concepts cont’d

  • Acknowledges that quitting drug use may not be realistic or desirable.

  • Provides practical strategies

  • Public health

  • Human rights approach

  • No person should be denied access to services because of their drug use.


Harm Reduction: Key Concepts cont’d

  • Hierarchy of Goals instead of one all or nothing decision.

  • Balances Costs and Benefits

  • Provides accurate information.

  • Attempts to promote & facilitate access to care for addiction & mental health problems.

  • Engage drug users in a continuum of care from which they would otherwise be excluded


Harm reduction abstinence
Harm Reduction & Abstinence cont’d

  • Non-use is a viable choice

  • Can described as overlapping elements within a continuum of care.

    • Drug holiday – short-term abstinence

    • Abstinence from one drug but not all drugs

    • Long-term abstinence from all drugs.

    • Abstinence as the goal, but harm reduction strategies used if one relapses.


Wrap up closing day 1
WRAP UP & CLOSING cont’dDay 1


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