Transcript Lecture_1_chapter_1

Seminar in Counseling
Addictions
ECED 6952
Introduction
Dr. Paul F. Hard, LPC-S, NCC
Why Worry about
Recreational Drug Use?
 Substance use disorders are collectively
still the most prevalent mental health
problem facing the United States
Ongoing issues
 Approximately 25% of patients seen by primary
care physicians have an alcohol or drug
problems
 Between 20% and 50% of all hospital
admissions are related to the effects of alcohol
abuse/addiction
 Between 24% and 31% of patients seen in the
emergency room, and possibly as many as
50% of those patients who suffer severe
injuries that require hospitalization, have
alcohol use disorder
Death
 Substance abuse is the number one
cause of preventable death in the
United States, killing more people each
year than any other preventable cause
of death
 Alcohol use disorders are the third
leading cause of premature death in the
United States
Significant contributing factor
to psychiatric problems
 Alcohol or illicit drug abuse is a factor in 50% -
75% of all psychiatric admissions
 Alcohol dependence is the second most
common psychiatric disorder in the United
States
 Between 40% and 60% of those who commit
suicide were intoxicated at the time
 Approximately 10% of those individuals with a
substance use disorder eventually commit
suicide
Related Violence
 Adults with a substance use disorder were 2.7
times as likely to report having engaged in the
physical abuse of a child and 4.2 times as likely
to report child neglect as non-using control
substance.
 50% of perpetrators of violent crimes in the US
were using alcohol at the time of offense.
 Illicit drug use in home increase a woman’s
chances of being murdered by a significant
other by 28-fold even if she was not herself
using drugs.
Who “treats”
 Less than one-fifth of physicians considered
themselves prepared to deal with alcoholdependent patients
 Less than 17% thought they had the skills
necessary to deal with prescription drug
abusers
 Most physicians have a more negative attitude
toward patients with SUD than they did at the
beginning of their graduate training
 Average time devoted to training is 8 hours
Relationships
 Attempts at family or marital therapy is
ineffective unless the addictive disorder
is identified and addressed
The scope of the problem
 Globally, about 200 million people (5% of
the world’s population) have abused illicit
substance at least once.
 The retail cost is estimated at $457 billion
(a figure larger than the gross domestic
product figures of 90% of the world’s
countries).
 Although the population of the USA makes
up under 5% of the world’s population, we
consume 60% of the world’s illicit drugs.
Problems of substance abuse in
the USA
 Alcohol is the most popular
 Estimated 119 million alcohol users
 Alcohol
is recreational chemical ingested
 Between 8 to 16.27 million drinkers are
physically dependent on it
 5.6 million abuse it on a regular basis
Who?
 Majority of individuals with alcohol use
disorder (AUD) in the USA are male in a
ratio of between 2:1 and 3:1
 Legal chemical
narcotics
 Globally around 10 million people
 In the USA, approximately 3 million
 Cost $21 billion annually
 Fully 76% of illicit users are employed
cocaine
 Globally estimated 15 million people
abuse or are addicted
 2.5 million cocaine addicts in the United
States
marijuana
 Most commonly abused illegal drug in
the United States and Canada
 25% of the entire population of the US
(70 million) have used marijuana at
least once
 Of this, approximately 3 million are
addicted
hallucinogenic
 10% of the entire population of the
United States has abused
hallucinogenics at least once
tobacco
 25% of Americans are current smokers
 25% of Americans are former smokers
 50% of Americans never smoked
 24 million smokers in the US are male
 22.3 million smokers are female
Statement of the Problem of
Substance Use Disorders
What do we mean when we
say . . . ?
 We are driven to find ways to alter our
perspective of the reality around us.
5 different patterns of
recreational chemical use
1. Total abstinence;
2. A brief period of experimentation
followed by a return to abstinence;
3. Irregular, or occasional use;
4. Regular use;
5. Pathological or addictive pattern of
use
The continuum
 Level 0: total abstinence
 Level 1: rare/social use
 Level 2: heavy social use/early problem
drug use
 Level 3: heavy problem use/early
addiction
 Level 4: middle to late stage addiction
The continuum of use
Factors that influence
Recreational drug use
 The pharmacological reward potential
 Reward
process
Increase the individual’s sense of pleasure
 Decreases discomfort

 Punishment
potential
Increased the individuals’ sense of discomfort
 Reduced the person’s sense of pleasure

 Immediate
consequences has a stronger
impact on behavior than delayed
consequences
Social learning
 Be taught that substance use is
acceptable;
 Recognize the effects of the chemical
 Interpret them to be desirable
Expectations
 Individual’s expectations as a
component of drug use is a strong
influence on how that person interprets
the effects of that chemical.
Cultural/social influences
 The general cultural environment;
 The specific community in which the
individual lives;
 Subcultures within the specific
community;
 Family/peer influences
 The context within which chemical is
used
Chemical Use Decision Making Process
DSM IV-TR
 Preoccupation with use of the chemical
between periods of use;
 Using more of the chemical than had
been anticipated;
 The development of tolerance to the
chemical in question;
 A characteristic withdrawal syndrome
from the chemical
DSM IV TR (continued)
 Use of the chemical to avoid or control
withdrawal symptoms;
 Repeated efforts to cut back or stop the
drug use;
 Intoxication at inappropriate times (such
as at work) or when withdrawal
interferes with daily functioning;
DSM IV TR (continued)
 A reduction in social, occupational, or
recreational activities in favor of further
substance use;
 Continuing chemical use even though the
individual suffers social, emotional, or
physical problems related to drug use
 Any combination of four or more of these
signs is used to identify the individual who
is said to suffer from the “disease” of
addiction
Terms to know
 Alcoholism
 Psychoactive Substances
 Substance abuse
 Drug of choice
 Addiction/dependence
 Tolerance
 Pharmacodynamic tolerance
 Withdrawal symptoms
Terms to know
 Relapse
 Controlled Substances
 Substance Induced Disorders
 Process Addiction
 Craving
 Tolerance
 Cross Tolerance / Addiction
 12-Step
History & Context:
The View from the Trenches
 Likely we all know someone: a word
about “Outing”.
 The Legal Drugs:
 Tobacco
 Alcohol
 Rx
 Illegal Drugs
 Emergency Rooms
History & Context: Alcohol
 Use of drugs goes back to prehistoric times.
 Has been used medicinally, religiously, and




socially.
Tribal societies used in healing and religious
ceremony.
Alcohol use recorded as early as Paleolithic
times.
Coke-a-Cola
Farmakia - Pharmakia (sorcery/witchcraft)
or Farmakos - Pharmakos (sorcerer)
History & Context: Alcohol
 Animal Kingdom
 http://www.videosift.com/video/Happy-Hour-
at-the-Watering-Hole
History & Context:
 Alcohol
 Cocaine
 Marijuana
 Opioids
 Amphetamines
 Hallucinogens
 Tobacco
 Caffine
Patterns of Use
 National Patterns 2001
 State Patterns
Societal Costs
 National Patterns 2001
 State Patterns
Substance Use & Sexuality
 Alcohol
 Amphetamines & Cocaine
 Marijuana
 IV Opiate Use
 Amyl Nitrate
Substance Related Diseases
 Hepatitis
 HIV/AIDS
Working in the Field – with those people.
Sources
Stevens, P. & Smith R.L. (2005). Substance abuse
counseling: Theory and practice (3rd ed.). Upper Saddle
River, NJ: Pearson.
Doweiko, H.E. (2006). Concepts of chemical dependency (6th
ed.). Belmont, CA: Thomson.
Uys, J. (Director). (1975). Animals are beautiful people.
[Motion picture]. United States: Warner Home Video