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Understanding Substance Abuse and Addiction
Contributor: Yvette McBride Thomas
Intrapersonal Abuse and Addiction
- Intrapersonal abuse involves the misuse of objects or substances that were produced for one purpose, such as healing (prescriptive medication) or entertainment (video games), but are exploited excessively to the detriment of the person involved.
- The result is that often an addiction (a state of physiological or psychological dependence) occurs with excessive amounts of time and effort being devoted to the object or substance.
- Three C’s of addiction conceptualize its core characteristics: loss of control over addictive behaviors; compulsive use; and continued use regardless of negative consequences.
Substance Abuse and Addiction
- The habitual misuse of intoxicating and addicting substances, such as alcohol, drugs, and tobacco.
- Drugs – any substance other than food that can affect the way a person’s mind and body works, including stimulants, depressants, and hallucinogens.
- Abuse and addiction cause mental, physical, emotional, social, and spiritual damage.
- A major public health issue found across all demographic areas.
The Nature of Substance Abuse and Addiction
- Occurs frequently as a mental health problem in the US.
- One of 10 adults in the US has a significant problem related to alcohol use.
- Alcohol abuse/addiction is believed to be greater among Native Americans.
- A significant percent of patients who are hospitalized abuse alcohol.
- Health care costs are doubled among alcoholic families.
- Drug abuse/addiction among adolescents affects development and well-being more than crime, social pressure, grades, or sex.
- Approximately 3 million teenagers are addicted to or abuse alcohol,
- Half a million are marijuana users, and
- One out of 10 teenagers has tried cocaine.
- Substance abuse/addiction affects more than just the individual.
- Other than the abuser, up to four others are being adversely affected including family members, friends, or associates.
Polysubstance abuse/addiction
- Abuse of two or more substances at the same time is a growing problem.
- Social conditions may evoke other substance abuse/addiction, such as smoking.
- Conditions related to smoking
- Unsatisfactory life rooted in poverty and hopelessness
- Peer pressure
- Poor school performance
- Parental smoking
- Minority ethnic status
- External locus of control
- A behavior pattern with biological, psychological, sociological, and behavioral components .
- A persistent and intense involvement with and stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal.
- Addiction is characterized as a preoccupation with one object that controls behaviors and limits other actions over time.
Reference:
Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.
The Effects of Drugs
- Drugs come from plants either as by-products of them or developed chemically.
- In the US, $150 billion is spent on legal pharmaceutical drugs.
- All pharmaceutical drugs have at least three names.
- chemical name of a drug is the organic chemistry chemical description of the molecule. Most will never know or understand this name of a drug they are taking.
- generic name of a drug is the official name of the drug. It is still a detailed chemical name but much simpler.
- brand name is for a specific formulation and manufacturer.
- The big difference between the generic name and the brand name is that a generic name is public domain while a brand name is trademarked by the company that developed the drug. The developing company gets to name the drug but it must be FDA approved.
- One drug can be a painkiller, a controlled substance, a schedule II substance or just morphine.
- Categories of psychoactive drugs are:
- stimulants
- hallucinogens
- marijuana
- depressants
- opioids
- psychotherapeutics
- nicotine.
- All drugs have defining characteristics.
- The Physician’s Desk Reference has color photographs of most legally manufactured drugs; it also includes information like dose and potency.
- The placebo effect is usually thought of in terms of a sugar or fake pill.
- Many drugs effects are influenced by the users experiences, mood, how tired they are, in addition to other substances in the system, such as food to other drugs.
- Dose-response refers to the correlation between the response and the quantity of drug administered.
- The response may vary due to factors such as tolerance.
- With a dose-response curve we hope to be able to answer a verity of questions; from what is an effective dose or a lethal dose.
- Toxicity, in early animal studies, is measured in how many animals die as a result of taking the drug. After more studies, the therapeutic index is set as LD50 / ED50.
- The margin of safety is the difference between doses necessary for an intended effect and toxic unintended effects.
- Potency refers to the amount of drug necessary to cause an effect, while toxicity is the capacity of a drug to upset or destroy normal body functions.
- The forms and methods of taking drugs greatly effect how the drugs will interact with the users system.
- Oral ingestion is the simplest way the drugs enter the body, but also the most complicated way to enter the bloodstream. Oral ingestion must make it through the acid in the stomach while avoiding neutralization by food and drink. When the drug gets past the stomach it still has to go through the liver, as well as other organs.
- Inhalation is when the drug is smoked or “huffed”. Nicotine, marijuana, crack are most effective when delivered this way. It is also rapidly absorbed due to all the capillaries in the lungs consequently moving quickly into the blood. This is the fastest way to get psychoactive drugs into the system.
- Injection put the drug into the system as well.
- Intravenous injection puts the drugs right in the vein, so the onset of the effect of the drug is fast. You can so put a high concentration of drugs in because it does not have to pass through a membrane.
- Intramuscular injection puts the drug into the muscle and subcutaneous goes just under the skin.
- Topical application is not used as often because many drugs are not absorbed effectively through the skin.
- After drug administration, the body eliminates the drug through metabolism and excretion.
- The drug will either leave the system or be changed so much that it will no longer have an effect on the body.
- Prodrugs have been developed to start working only after they have been altered by the body.
- The body has adaptive processes such as tolerance and dependence to protect against potential harm.
- With drug disposition tolerance the more the drug is used the faster the metabolism or excretion.
- Behavioral tolerance (conditioned tolerance) is when the behavior of the user changes even if the bio-chemical reaction in the body does not. There is strong evidence that tolerance effects are maximized when the drug-taking behavior occurs consistently in the same surroundings or under the same circumstances.
The Actions of Drugs – Slide show
Reference:
Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray
Drugs, Behavior, and Modern Society by Levinthal, C.
Drug Use in Today’s Society
- Drug use is taking an aspirin for a headache, or a single dose of cough syrup for a cough or a hit of acid.
- How the drug is taken has an effect on how the body reacts.
- How much and how often are points that make the difference between normal use and abuse.
- Four principles of psychoactive drugs:
- Drugs are not bad or good; they are not evil, they are a substance. By itself a drug
cannot do anything until it enters a body. Some drugs help the body function when taken correctly but can cause harm when misused or abused. - Every drug has multiple effects. No part of the body works independently from the rest; all systems are connected. When a drug is taken it affects all parts of the body it passes through.
- Both size and the quality of the drug affect the effects of the drug. The better the quality, or the larger the dose the larger the response or the more severe the response.
- The effects of a drug depend on the person. Not only personality, but age, race, weight… all of them influence how the body takes in and responds to the drug.
- History tells us that humans have used, misused and abused some plants or substances for as long as humans have been around.
- Four pharmacological revolutions
- 19th century – vaccines. This is the first time drugs were used to help stop the number one killers at the time: communicable diseases. For the first time there were drugs that were powerful and have selective beneficial effects. This helped people have faith in medicine stopping illness.
- WWII – antibiotics. Not only did they help cure diseases but also helped prevent infection. This got us to the point that we are now; we expect to take something to fix everything.
- 1950’s – anti-psychotic drugs. This was the first time that drugs were used to treat psychotic disorders. This changed the way people saw and treated mental illness. We have new drugs that effect how we think, our emotions, and perceptions.
- Oral contraception – now we have control of our body through chemicals. Some drugs are not meant to treat anything but to control and change the way the body was meant to work.
- Then there were many social changes in the US: The Beatles, civil rights, Vietnam, LSD, etc. Drugs became more common and accepted.
- In 1971 Nixon declared the first “War on drugs”; yet during this time the legal drinking age was lowered and penalties for having marijuana were eased.
- In the 80’s tolerance lessened. The legal drinking age was raised to 21 again and penalties were stiffened on all drugs, including marijuana.
- Perception of the risk – when the perception of the risk is low the use is high and vice versa. This differs from perception of availability.
- Longitudinal studies are one way we have looked for antecedents of drug use.
- Evidence tells us not to do things but we do them anyways; from eating too much, driving too fast,drinking too much, texting while driving, and driving while intoxicated
- Cultural trends influence what drugs are being used.
Drug Use: An Overview – Slide show (recommended)
Drug Use as a Social Problem – Slide Show
Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray
Drugs, Behavior, and Modern Society by Levinthal, C.
8. Professional and Ethical Responsibilities
Professional and ethical responsibilities are the obligations of an addiction counselor to adopt ethical and behavioral standards of conduct and continuing professional development. Our competencies in this area, are:
1. To adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional standards and protect the client.
Knowledge, skills, and attitudes:
- Federal, State, agency, and professional codes of ethics.
- Clients’ rights and responsibilities.
- Professional standards and scope of practice.
- Boundary issues between client and counselor.
- Difference between the role of the professional counselor and that of a peer
- counselor or sponsor.
- Consequences of violating codes of ethics.
- Means for addressing alleged ethical violations.
- Nondiscriminatory practices.
- Mandatory reporting requirements.
- Openness to changing personal behaviors and attitudes that may conflict with ethical guidelines.
- Willingness to participate in self, peer, and supervisory assessment of clinical skills and practice.
- Respect for professional standards.
2. To adhere to Federal and State laws and agency regulations regarding the treatment of substance use disorders.
Knowledge, skills, and attitudes:
- Federal, State, and agency regulations that apply to addiction counseling.
- Confidentiality rules and regulations.
- Clients’ rights and responsibilities.
- Legal ramifications of noncompliance with confidentiality rules and regulations.
- Legal ramifications of violating clients’ rights.
- Grievance processes.
3. To interpret and apply information from current counseling and psychoactive substance use research literature to improve client care and enhance professional growth.
Knowledge, skills, and attitudes:
- Professional literature on substance use disorders.
- Information on current trends in addiction and related fields.
- Professional associations.
- Resources to promote professional growth and competency.
- Read and interpret current professional and research-based literature.
- Apply professional knowledge to client-specific situations.
- Apply research findings to clinical practice.
- Apply new skills in clinically appropriate ways.
- Commitment to life-long learning and professional growth and development.
- Willingness to adjust clinical practice to reflect advances in the field.
4. To recognize the importance of individual differences that influence client behavior, and apply this understanding to clinical practice.
Knowledge, skills, and attitudes:
- Differences found in diverse populations.
- How individual differences affect assessment and response to treatment.
- Personality, culture, lifestyle, and other factors influencing client behavior.
- Culturally sensitive counseling methods.
- Dynamics of family systems in diverse cultures and lifestyles.
- Client advocacy needs specific to diverse cultures and lifestyles.
- Signs, symptoms, and patterns of violence against persons.
- Risk factors that relate to potential harm to self or others.
- Hierarchy of needs and motivation.
- Assess and interpret culturally specific client behaviors and lifestyles.
- Convey respect for cultural and lifestyle diversity in the therapeutic process.
- Adapt therapeutic strategies to client needs.
- Willingness to appreciate the life experiences of individuals.
- Appreciation for diverse populations and lifestyles.
- Recognition of one’s biases toward other cultures and lifestyles.
5. To use a range of supervisory options to process personal feelings and concerns about clients.
Knowledge, skills, and attitudes:
- The role of supervision.
- Models of supervision.
- Potential barriers in the counselor–client relationship.
- Transference and countertransference.
- Resources for exploration of professional concerns.
- Problem-solving methods.
- Conflict resolution.
- The process and effect of client reassignment.
- The process and effect of termination of the counseling relationship.
- Phases of treatment and client responses.
- Willingness to accept feedback.
- Acceptance of responsibility for personal and professional growth.
- Awareness that one’s personal recovery issues have an effect on job performance and interactions with clients.
6. To conduct self-evaluations of professional performance applying ethical, legal, and professional standards to enhance self-awareness and performance.
Knowledge, skills, and attitudes:
- Personal and professional strengths and limitations.
- Legal, ethical, and professional standards affecting addiction counseling.
- Consequences of failure to comply with professional standards.
- Self-evaluation methods.
- Regulatory guidelines and restrictions.
7. To develop and use strategies to maintain one’s physical and mental health.
Knowledge, skills, and attitudes;
- Rationale for periodic self-assessment regarding physical health, mental health, and recovery from substance use disorders.
- Available resources for maintaining physical health, mental health, and recovery from substance use disorders.
- Consequences of failing to maintain physical health, mental health, and recovery from substance use disorders.
- Relationship between physical health and mental health.
- Health promotion strategies.
- Carry out regular self-assessment with regard to physical health, mental health, and recovery from substance use disorders.
- Use prevention measures to guard against burnout.
- Employ stress-reduction strategies.
- Locate and access resources to achieve physical health, mental health, and recovery from substance use disorders.
- Model self-care as an effective treatment tool.
- Recognition that counselors serve as role models.
- Appreciation that maintaining a healthy lifestyle enhances the counselor’s effectiveness.
7. Documentation
Documentation involves the recording of the screening and intake process, assessment, treatment plan, clinical reports, clinical progress notes, discharge summaries, and other client-related data.
The competencies in this area, are:
1. Demonstrate knowledge of accepted principles of client record management.
- Regulations pertaining to client records.
- The essential components of client records, including release forms, assessments, treatment plans, progress notes, and discharge summaries and plans.
- Composing timely, clear, complete, and concise records that comply with regulations.
- Documenting information in an objective manner.
- Writing legibly.
- Using new technologies in the production of client records.
2. Protect client rights to privacy and confidentiality in the preparation and handling of records, especially in relation to the communication of client information with third parties. Our knowledge and skills in this area, are:
- Federal, State, and program confidentiality rules and regulations.
- The application of confidentiality rules and regulations.
- Confidentiality rules and regulations regarding infectious diseases.
- Apply infectious disease regulations as they relate to addictions treatment.
- The legal nature of records.
- Request, prepare, and complete release of information when appropriate.
- Protect and communicate clients’ rights.
- Explain regulations to clients and third parties.
- Provide security for clinical records.
- Willingness to seek and accept supervision regarding confidentiality rules and regulations.
- Respect for clients’ rights to privacy and confidentiality.
- Commitment to professionalism.
- Recognition of the absolute necessity of safeguarding records.
3. Prepare accurate and concise screening, intake, and assessment reports. Essential elements of screening, intake, and assessment reports, include:
- psychoactive substance use and abuse history
- physical health
- psychological information
- social information
- history of criminality
- spiritual information
- recreational information
- nutritional information
- educational or vocational information
- sexual information
- legal information
4. Record treatment and continuing care plans that are consistent with agency standards and comply with applicable administrative rules.
- Current Federal, State, local, and program regulations.
- Regulations regarding informed consent.
5. Record progress of client in relation to treatment goals and objectives.
- Appropriate clinical terminology used to describe client’s response to intervention and progress made toward completing treatment goals and objectives.
- How to review and update records:
- Prepare clear and legible documents.
- Document changes in the treatment plan, client status, client response to and outcome of interventions, level of care provided, and discharge status.
- Use appropriate clinical terminology and standardized abbreviations.
- Note client’s strengths and limitations in achieving treatment goals.
- Record client’s response to and outcome of interventions.
- Record changes in client’s status, behavior, and level of functioning.
- Note limitations of treatment provided to client.
6. Prepare accurate and concise discharge summaries. The components of a discharge summary, include:
- client profile and demographics
- presenting symptoms
- diagnoses
- selected interventions
- critical incidents
- progress toward treatment goals
- outcome
- continuing care plan
- prognosis
- recommendations
6. Client, Family, and Community Education
Addiction counselors play an important role in providing clients, families, significant others, and community groups with information about the risks involved with alcohol, tobacco, and other drugs use, as well as available prevention, treatment and recovery resources.
Our competencies in this area are:
- To provide education both formal and informal about substance abuse prevention and treatment programs, and the recovery process. In order to help people from multicultural backgrounds, we need to keep in mind:
- Cultural differences among diverse communities.
- Cultural differences in substance use behaviors.
- Delivery of educational programs that are culturally relevant.
- Research and theory on prevention of substance abuse problems.
- Learning styles and teaching methods that we can adapt to our clients.
- How to facilitate discussions in a safe and respectful environment.
- How to preparing outlines and handout materials.
- How to make public presentations to deliver the information effectively.
- Cultural issues in planning prevention and treatment programs.
- Age and gender differences in substance use patterns.
- Culture, gender, and age-appropriate prevention, treatment, and recovery resources.
- Awareness of our own cultural biases.
- To describe the risk and protective factors that increase and decrease the likelihood for an individual, community, or group to develop a substance use disorder. Our knowledge in this area includes:
- Risk and protective factors for the onset of substance use disorders.
- How to present the issues from a non-judgmental perspective.
- To describe the warning signs, symptoms, and the course of substance use disorders. We must be familiar with:
- The continuum of use and abuse, including the warning signs and symptoms of a developing substance use disorder.
- The current Diagnostic and Statistical Manual of Mental Disorders (DSM) categories or other diagnostic standards associated with psychoactive substance use.
- To describe how substance use disorders affect families and significant others. We need to educate our client about:
- How psychoactive substance use by one family member affects other family members or significant others.
- The family’s influence on the development and continuation of a substance use disorder.
- The role of the family, couple, or significant others in treatment and recovery.
- To describe the continuum of care and resources available to the family and significant others. Our goals are:
- To present available treatment options, including local health, allied health, and behavioral health resources.
- To motivate both family members and the client to seek out resources and services from the full continuum of care.
- To describe different treatment modalities.
- To identify and make referrals to local health, allied health, and behavioral health resources.
- Although this may sounds easy to do, we need to keep in mind the difficulties families and significant others go through when seeking help. We must work from a strengths-based principle, which emphasizes client autonomy.
- We must be familiar with the models for substance abuse prevention and treatment, and recovery from substance use disorders.
- Awareness of our own biases when presenting the information.
- Delivering educational sessions.
5. Counseling – Part III Family and Significant Others Counseling
This is third component of the 5th practice domain: Counseling. (check out Part I Individual Counseling and Part II Group Counseling)
Addictions affect the person who has them and also her/his family members and significant others. Counseling addicted families should be required, and offered, as part of every treatment service. Unfortunately, some treatment agencies can only afford treating the person with the addiction, and due to lack of resources and funding they cannot get the family and significant others involved.
Regardless for this situation, substance abuse counselors can offer a competent practice when they have the following knowledge:
- Systems theory and dynamics.
- Dynamics associated with substance use, abuse, dependence, and recovery in families and significant others.
- Interaction patterns on substance abuse behaviors.
- Cultural factors associated with family dynamics and substance abuse disorders.
- Signs and patterns of domestic violence.
Although it is difficult to accept sometimes, the truth is that family members contribute in different ways to the substance abuse behavior. It is not about putting the blame on someone, but inevitably each member of a family plays a specific role in a family’s issue; understanding family dynamics helps us understand why addiction is called a family disease.
As I mentioned in a previous post, in family counseling the client is the family as a whole, always considering individual differences. The required experience an addictions counselor must have in this area includes:
- Models of diagnosis for families
- Intervention strategies appropriate for different stages of the problem.
- Intervention strategies for violence within the family.
- Laws and resources regarding violence within the family.
- Methods for engaging family members and significant others in the treatment and recovery processes.
- Confidentiality and regulations regarding family counseling.
Our goals in family counseling are:
- To help families and significant others understand the effect of their interactions on substance use.
- To assist them in identifying and stopping harmful patterns of interaction.
- To help them learn healthy strategies and behaviors that maintain recovery and promote healthy relationships.
- To assist them with referral to appropriate support resources.
LCDC Exam Review 