Addiction (Lecture Notes)
Addiction: An unhealthy relationship between a
person and a mind altering substance or experience that renders the person
unable to quit
A disease of extreme.
Preoccupation to the point of avoiding reality or sidestep the challenges and
responsibilities of everyday life
Chemical dependencies: alcoholism, drugs, tobacco.
Nonchemical dependencies: Process or activity addictions ie
gambling, working, netsurfing, sex, eating
Characteristics
n The
impulse to ignore the problem and hope that it will go away
n Rationalization
: creating logical explanations to
explain one’s behavior.
n Preoccupation
with the activity and a drivenness to engage in it. In contrast, moderation and integration into
real life mark a behavior as healthy
n Addicts
are secretive about their activity and deceptive when discovered.
n The
tendency to make a single substance, person or process one’s sole source of
meaning, identity and value.—Unhealthy dependence.
n Isolation
and unreality. The narrower one’s focus
and the more removed from the real life and real relationships one’s behavior,
the greater the likelihood that he/she is developing an addictive disorder.-
n especially
true for nonchemical dependencies such as compulsive worrying, caretaking or
control, workaholism, cyberspace addiction etc
Any activity a person make highest priority in his/her
life when s/he does so to his/her own detriment or the detriment of the people closest to them and when they continue to do so in
the face of adverse consequences ie the loss of family, job, freedom or health.
n Neglect
important social, occupational or relational responsibilities
n Behavior
becomes increasingly unmanageable
n Make
futile attempts to regain control
n All
activities are scheduled around the habits
n Unable
to predict how much s/he will take after first dose (powerless to stop)
n Inability
to quit is a by product of changes in the brain
Why Risk addiction?
n Rewarding
n Relaxing
n Stress
Relieving
n Make
one feel good
Effects of Addiction on family
n Effects
on family ie children same in various forms of addiction
n Eg alcoholics vs workaholics
Etiology
l Social
cultural Factors
l Situational
Factors
l Individual
Factors
Social & Cultural
l Social
class – lower socioeconomic class, more likely to become addicted – alcohol,
drug, cigarette – self destructive behavior
l Other
observation – heavy drinkers in lowest and highest income household
l Process
addictions ie anorexia, workaholics in middle and upper classes
l Parenting
modeling
l Peer
Pressure – choice of friends and associates critical
l Culture
– ‘slim is beauty’; alcohol in festivities ie Pesta Keamatan
l Ethnic
Considerations – Amerian Indian and Irish more prone to excessive drinking; our
society - Indian
Situational Factors
l Stress
– Vietnam war – heroin
l Social
Support – lack of it
l Purpose
in life and Positive rewards; having a purpose in life less likely to get
addicted; normal rewards in life.
Delayed gratification.
Individual Factors
l Values
– family values, personal health, self restraint, delayed gratification
l Attitudes
– adolescent’s vulnerability – personality attributes antisocial, extreme
independence, deviance proneness, aggressiveness
l Fears
– fear of failure/rejection – ‘thin is beautiful’
l Self
esteem – low sense of self worth more prone
l Age. Anorexia (15-30). College age more prone to addiction. Older more successful in life –other rewards;
more coping skills. Older age – drug addiction/dependence
Are we addicted?
•
Our unique ‘addictions’ chocolate, ice cream
•
Addictive behavior in different areas ; food,
work, sex, net, exercise’
•
Complex issues involved
Addictive Cycle
•
Mind-body relationship
•
Experimentation à Habits àAddiction à Brain chemistry
•
Example : cigarette, psychosocial and
physiological rewards
•
Adolescent à adulthood -smoking
Nicotine Addiction
•
Biphasic stimulation depression
•
Dopamine effect
•
Fagerstrom
Fagerstrom Tolerance Questionnaire
•
an instrument to gauge the severity of Nicotine
addiction
•
It has a scoring range of 0-11 points
•
Score of 0 minimum Nicotine dependence
•
Score of 11 maximum dependence
•
The mean score is usually within the range of
5-7 points
• for smokers asking for treatment, the mean is usually 6.5.
•
1. How soon after you wake up do you smoke your
first cigarette?
•
Within 30 min = 1 pt. After 30 min = 0 pt.
•
2. Do you find it difficult to refrain from
smoking in places where it is forbidden?
•
Yes = 1 pt.
No
= 0 pt.
•
3. Which cigarette would you hate most to give
up?
•
First in the morning = 1 pt. Any other = 0 pt.
•
4. How many cigarettes per day do you smoke?
•
< 15 = 0 pt.
15 - 25= 1 pt. >
25 = 2 pt.
•
5. Do you smoke more frequently during the first
hours after awakening than during the rest of the day?
•
Yes = 1
pt. No = 0 pt.
•
6. Do you smoke even though you are so ill that
you are in bed most of the day?
•
Yes= 1 pt. No= 0 pt.
•
7. What is the Nicotine level of your usual
brand of cigarette?
•
<1.0 mg = 0 pt. 1.0-1.2 = 1
pt. > 1.2 = 2 pt.
•
8. Do you inhale?
•
Never = 0 pt. Sometimes =1 pt.
Always = 2 pt.
Alcohol use &
Abuse
•
Legal drug
•
Central to celebration, enjoyment, relaxation,
reward
•
Belief protective of coronary heart
Prevention
•
Parent’s role
•
Education system
•
Public health education
Stages of Change
(Prochaska)
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Termination
Pre-contemplation
(Not Ready)
Has no intention to take action within the next 6 months
•
not really ready for a change:
•
simply
not aware of the need
•
Or
denying the need.
•
Or feel overwhelmed by what it would take to
make a change; so one feel change is not a realistic option.
•
May need a rude awakening to jolt the person out
of complacency or fear of change.
Contemplation
(Gettting serious)
Intends to take action within the next 6 months.
•
become conscious of the problem
•
intention to do something about it, but not
right now
•
incubation stage, a transition towards doing
something. Internally become more open to the possibility of change
•
Paying more attention to the consequences of not
making the change will motivate you to start doing something about it.
Preparation
Intends to take action within the next 30 days and has
taken some behavioral steps in this direction.
closer to actually doing something, paying more attention to
the specifics
internal negotiation going on
plan shapes up, taking into consideration goals as well as
the realities of life
•
Understanding that the plan need not be perfect,
and setting a date to actually start acting on it.
Action
Has changed overt behavior for less than 6 months
Actually carrying out plan
Likely assailed by
all kinds of negative thoughts, fears, doubts.
•
The more specific the plan, the easier it is to
follow
•
treat one’s goals as a priority & plan for
some rewards
Maintenance
Has changed overt behavior for more than 6 months.
•
An important part of making lasting changes is
not taking these changes for granted. Keep working at it
•
Prevent relapse
•
Whole lifestyle supports (friends)
•
Being aware that the temptation to relapse
•
not an "all or nothing" proposition:
Relapse is not failure
Termination
•
Overt behavior will never return, and there
is complete confidence that one can cope without tear of relapse.
•
New habits have now become second nature
•
no longer feel tempted to go back to the
behavior, under any circumstances
•
However, the power of habits is such that one
may always be fighting against temptation. It's human nature
.
Dealing with Addiction
Step 1
n Does
he want to stop?
n Does
he need to stop?
n Does
he have to stop?
n Until
one comes to the stage where s/he admits and wants to deal with the problem, it
will be very difficult to change
Step 2
n When
does s/he plan to do it?
n Select
a date in the near future
n Plan,
and prepare for the day
Step 3
n Quit
date
n Get
rid of all things associated with the addiction
n Avoid
association with people involve in the addiction
n Firm
resolution to change way of life even though it is tough
n For
drug, nicotine – juice fast is helpful
n Medication
can help – methadone, Bupriprion, anti depressants
n Hydrotherapy
– bath, shower
Step 4
n Talk
to someone about the habit and its effect
n Reinforce
the knowledge about the harmful effect
n Repeat
the decision of wanting to be Free from the addiction
n Write
down how s/he feels; and the coping options when the urge comes
n Exercise
– brisk walk – bring positive feeling
Step 5
n Make
a plan for drug free life
n Visualize/imagine
what it will be like
n Keep
active
n Stay
alert. Beware of pitfall. Keep close to
mentor/buddies/counselor
Rehabilitation Treatment
n
Basic elements
n
Initial evaluation
n
Abstinence
n
Learning about addiction
n
Group counseling
n
Individual counseling
n Family
program
Advantages of Rehab
n
Abstinence
n
Removal of Denial
n
Removal of Isolation
n “Basic
training”
Inpatient or Outpatient?
n Outpatient
requires
n Willingness
and ability to attend sessions diligently and regularly
n Ability
to abstain for 48 hours at a stretch of time, with little supervision/support
What if the addicted person does not believe s/he has a
problem?
n External
motivation is OK. Most people start recovery because of a push from someone
else
n All
rehab program is voluntary. So, all patients must give his/her consent. This level of acceptance is good enough to
begin the journey to recovery
n For
adolescent, basic training is worthwhile even if the addicted clearly plans to
return. Many needs multiple attempts
before finally successful
What if s/he has been treated before?
n If
previous failure, get an evaluation and advice from a professional familiar
with recovery.
n Evaluation
esp these areas
n Was
there ever a full recovery program in place?
n Is
there a source of enabling that is preventing recovery from working?
n Is
there an internal ‘stuck point’ that stops the recovery process at a certain
spot?
What if the problem has significant psychiatric aspects?
n Professional
evaluation is a must
n There
is a problem in recognition of this aspect as
n Anxiety
is part of the addiction, or result of the addiction or contributor to the
addiction
n When
in doubt, ask for second opinion or professional opinion
Management of Addiction
n Professional
treatment – addiction recovery treatment centre
n Twelve
step program ie Alcoholic Anonymous
Keys to solution
n Honesty
n Open-mindedness
n Willingness
5 Steps to Help
Mild Addiction
n Recognizing
the problem
n Acknowledging
powerlessness
n Seek
God’s help
n Seek
help from others
n Offer
praise and thanksgiving
1 Recognize the Problem
n Addictive
behavior is enjoyable
n Denial
is common
n Helping
another person to recognize addiction needs a lot of wisdom and patience –
listening heart, appropriate words at appropriate time
2 Acknowledging Powerlessness
n Step
one of the 12 Steps of AA “We admitted we were powerless over alcohol-that our
lives had become unmanageable”
n Addiction
is powerful – one is incapable of shutting it off by his/her own strength
n AA
says “ We were the victims of a mental obsession so subtly powerful that no
amount of human willpower could break it
n Helping
the addict to see this point again need lots of wisdom and patience
3 Seek God’s Help
n Powerless,
therefore need help
n Most
important help is God’s help
n “God,
I’m powerless over this obsession (name it). Please remove the desire for it
and give me instead a desire for what’s right”
4 Seek Help from Others
n Encourage
him/her to join support group
n Or/and
see a Counselor
n Professional
treatment
5 Offer Praise & Thanksgiving
n Help
him/her to have Faith
n “Thank
You, God, for Your power that is breaking the hold this addiction has had over
my life”
n “God
I thank You for accepting me right where I am”
n Praise
God even for small progress
The 12 Suggested Steps of Alcoholics Anonymous
n
We admitted we were powerless over
alcohol--that our lives had become unmanageable.
n
Came to believe that a Power greater than
ourselves could restore us to sanity.
n
Made a decision to turn our will and our lives
over to the care of God as we understood Him.
n
Made a searching and fearless moral inventory
of ourselves.
n
Admitted to God, to ourselves and to another
human being the exact nature of our wrongs.
n
Were entirely ready to have God remove all
these defects of character.
n
Humbly asked Him to remove our shortcomings.
n
Made a list of all persons we had harmed, and
became willing to make amends to them all.
n
Made direct amends to such people wherever
possible, except when to do so would injure them or others.
n
Continued to take personal inventory and when
we were wrong promptly admitted it.
n
Sought through prayer and meditation to
improve our conscious contact with God, as we understood Him, praying only for
knowledge of His will for us and the power to carry that out.
n Having
had a spiritual awakening as the result of these steps, we tried to carry this
message to alcoholics, and to practice these principles in all our affairs.
NGO Rehab centres
The Hiding Place, 52 Jln Minden Height 1; Contact person: Mr Gideon Khoo, 04-6588742
Rumah PENGASIH (RP) 3201 Jalan Syers, Off Langgak Tunku,
50480
Bukit Tunku, Kuala Lumpur,
Malaysia
Tel :
+603.6201 3179 / 0287
Fax :
+603.6201 3013
Email :
info@pengasih.net
All enquiries and referral are welcomed.
Please call Ms Veera Noor, at 019-668-9361 or email khidmat@pengasih.net.
THE END
