Transcript What is Addiction?

A Fresh Look at Addictions
Bonnie Teitleman, LICSW
Faculty Staff Assistance Office
October 4, 2016
Agenda
• Addiction definition
• Alcohol
• Risk factors
• Identification
• Current treatments
• Opioids
• Risk factors
• Statistics
• Treatment
• Other drugs
• Marijuana
• Benzodiazapenes
• Older people
• Women
• Adolescents
• Resources
What is Addiction?
• Do people do it to themselves or is it something that happens to
them?
• Physical vs Psychological addiction
• High potential with rapid onset high and loss
• Addictive substances and behaviors
• SUD
Symptoms of Substance Use Disorder
• Using more and longer periods than intended
• Unsuccessful effort to stop or cut down
• Time spent using and recovering from increases
• Impairment
• Tolerance
Addiction Risk
Genetics
Environment
40%
60%
Risk Factors: Alcohol
• Alcohol metabolizing enzymes
• Low response level (can drink a lot without visible effect)
• Impulsivity
• Psychiatric disorders
• Peer pressure
• Low self-esteem
• Culture of drinking
• Family stress
Problem?
• Times you used more than you
intended?
• Tried to stop or cut down?
• Spent time using or being sick
• Cravings?
• Used although interfered with
work or family
• Risky driving, environment or
sex?
• Depressed or anxious
• Blackouts?
• Increased tolerance?
• Withdrawal symptoms?
CAGE Questions
• Have you tried to Cut back on your drinking?
• Have you gotten Angry with someone who’s been on you about your
drinking?
• Have you felt Guilty about your drinking?
• Have you had to have an Eye-opener?
Current Treatments for Addictions
Motivational Interviewing
CBT, DBT
Mutual Support Groups
Medications
Couples or Family Therapy
Harm Reduction
Alternative Therapies
Goals of Treatment
• Patient wishes
• Abstinence
• Controlled use
• Risk reduction
• Prevent disease
• Prevent OD death
• Improved functioning in home
and work
• Improved mental and physical
health
• Reduce crime, jail time
Opioids
• Oxycontin
• Oxycodone
• Hydrocodone
• Heroin
• Morphine
• Codeine
• Percocet
• Vicodin
• Fentanyl
• Buprenorphine
Opioid Statistics
• Unintentional deaths 15:100,000
• 1526 deaths MA 2015
• 88% increase since 2012
• More than MVA and guns
combined 47,055
• 46 deaths daily from
prescription meds
• 75% opioid users switch to
heroin - cheaper
• Communities
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Ware
West Bridgewater
Wareham
Lynn
Salisbury
Revere
Quincy
New Bedford
Everett
Boston Globe October 22, 2015
Opioid Treatment
• Withdrawal management
• Outpt/inpt treatment/EU
• Medication-Assisted Treatment
• Suboxone
• Agonist action
• Reduces HIV and HCV
• Mutual help group
• Therapeutic communities
• Ideal treatment: combination of modalities
Cannabis/Marijuana-Changing Landscape
• Short term Intoxication
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Euphoria
Relaxation
Sleepiness
Munchies
Apathy
Giggles
Time distortion
• Long Term Effects
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Loss of motivation
Lung irritation
Loss of gray matter, IQ
Less dopamine
“Amotivational syndrome”
Adolescent Marijuana Use
• Brain development
• Up to 8 point drop in IQ
• Risky behaviors
• Problems studying, learning new things, poor memory
• Increased risk of depression, ADD, anxiety or other BH d/o
• Gateway drug?
SUD in Women
• Women different experience than men w/SUD
• Increased drug and alcohol prevalence in last 25 yrs, lower
abstinence, higher dependence
• Heightened vulnerability to adverse medical and social consequences
• Telescoping (SUD progresses more quickly)
• More medical, psychiatric and social consequences than men
Older People
• What age would you consider “old” for someone with alcohol or
SUD?
• Invisible epidemic- Baby Boomers
• Physical or psychiatric problems
• Social –driving, finances, family
• “Let them be”
• Suicide
New Thinking
New Thinking
• A majority but not all people progress in their addiction
• Some people can manage controlled drinking or drug use
• Medications can be helpful
• Medications (Suboxone) increases success by 50% in Opioid
Addictions
• Kindness,respect vs judgment,anger
outcome
• Family and friends make a difference
Last Thoughts
• Good news/bad news
• 50% recover
• 50% do not
• Treatment challenging
• No one size fits all, customized treatment
• Prevention
• Early detection > better outcome
• Hope
Resources
• FSAO www.bu.edu/fsao
• Alcoholics Anonymous
• Smart Recovery
• BSAS
• Bureau of Substance Abuse
Services
• www.mass.gov/eohhs/gov/depart
ments//substance -abuse
• SAMHSA
• Substance Abuse and Mental
Health Service Administration
• www.samhsa.gov
• NIDA
• National Institute on Drug Abuse
• www.drugabuse.gov