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Lecture 1. Addiction Setting the Stage. Why Study Addiction?. 1. 3. 2. 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.

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slide2

Why Study Addiction?

1

3

2

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)

slide3

4

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

5

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

estimates of the problem of narcotics abuse and addiction
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).

slide7
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

These folks are aged 15 to 24

The Canadian Alcohol and Drug Use Monitoring Survey, 2011 (CADUMS)

N = 10, 076

acute women no more than 3 drinks on a single occasion men no more than 4 on any single occasion
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
Harms

(CADUMS, 2011)

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

harms1
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 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
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
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.

slide14

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!!!!

Addiction

(Doweiko, 2006).

addiction on a continuum
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
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
The Continuum
  • 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.

Level 4

  • Use has clearly become problem
  • Person may deny addiction
  • Person may experience medical problems
  • Experience withdrawal when discontinuing use
  • Have lost control / preoccupied

Level 3

  • Use more than the normal person
  • Begin to experience a variety of problems
  • At risk for developing addiction
  • Deny extent of problem

Level 2

Level 0

  • No loss of control
  • Low risk for developing addiction
  • No problems

Level 1

  • No use
  • No risk for developing
  • problem

Total abstinence rare/social use heavy social use heavy problem / addiction starts Entrenched addiction

slide19

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

slide20

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 regularlyThus, 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?

slide21

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
STANDARIZED TEST FOR ALCOHOLISM

Michigan Alcoholism Screening Test (MAST)

Scoring – Score one point if you answered the following:

  • No; 2) Yes; 3) Yes; 4) No; 5) Yes 6) Yes; 7 through 22: yes

0 – 2 No apparent problem

3 – 5 Early or middle problem

6 or more Problem Drinker

what do folks make of the mast
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
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
DAST Cutoff Scores

5 or less no problem

6 to 11 drug problem present

12 or greater – substance use disorder

let s talk about psychological dependence
Let’s Talk about Psychological Dependence

Psychological dependence is the individual’s perceived need for the drug/chemical/behavior

what do we really know about addictive disorders
Summing UpWhat do we really know about addictive disorders?

The latter presented addiction continuum and definitions are based on evidence derived from individuals who have presented for treatment or have offered themselves as research participants.

slide28
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
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.