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| • ADDICTION SERVICES •
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WHAT IS ADDICTION? Addiction is an illness in which there is a pattern of misuse of a drug, problems with social life or work, and/or evidence of tolerance (gradually needing a higher dose to get the same effect) or withdrawal (having certain dangerous physical symptoms if you stop the alcohol or drug suddenly). People with addiction suffer from an irresistible need to use a drug at higher doses and more often, despite knowing the serious physical or emotional results and despite extreme disruption of their lives. Addiction is a chronic, but treatable, brain disorder. The brains of addicted people have been modified by the drug in such a way that absence of the alcohol or drug makes a signal to their brain that is equivalent to the signal of when you are starving. It is as if the individual was in a state of deprivation, where taking the drug is indispensable for survival. It is as powerful as that. The official psychiatric term for addiction is Substance Dependence. Addiction grows more serious over time. Substance use disorders travel along a continuum. This progression can be measured by the amount, frequency and context of a person’s substance use. As their illness deepens, addicted people need more alcohol or other drugs; they may use more often, and use in situations they never imagined when they first began to drink or take drugs. The illness becomes harder to treat and the related health problems, such as organ disease, become worse. This is not something that develops overnight for any individual. Generally there is a series of steps that individuals go through from experimentation and occasional use to the actual loss of control of use. It is this process that defines addiction. ABUSE VS. DEPENDENCE Some people who start as casual drinkers or drug users will stay that way. But others will become substance abusers or dependent, feeling that they need the drink or drug to stay alive. The difference between abuse and dependence is not always clear to the general public, but medical professionals use a set of criteria to distinguish between these two categories of problem use. The essential feature of Abuse is a pattern of substance use that causes someone to experience harmful consequences. Clinicians diagnose substance abuse if, in a 12 month period, a person is in one or more of the following situations related to alcohol or drug use:
Dependence is more severe. Medical professionals will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a 12 month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral problems occur with every substance. The physiological factors are:
The behavioral patterns are:
CAGE Questionnaire
Two or more affirmative answers indicate probable dependence. Any single affirmative answer flags further evaluation. Reprinted with permission from the Journal of the American Medical Association, 252, 1905-1907 (1984). The National Institute on Drug Abuse has declared that addiction is a Brain Disease. THE DISEASE “ADDICTION IS A PRIMARY, CHRONIC, NEUROBIOLOGICAL DISEASE, WITH GENETIC, PSYCHOSOCIAL, AND ENVIRONMENTAL FACTORS INFLUENCING ITS DEVELOPMENT AND MANIFESTATIONS. IT IS CHARACTERIZED BY BEHAVIORS THAT INCLUDE ONE OR MORE OF THE FOLLOWING: IMPAIRED CONTROL OVER DRUG USE, COMPULSIVE USE, CONTINUED USE DESPITE HARM AND CRAVING.” ~ AMERICAN SOCIETY OF ADDICTION MEDICINE (ASAM) It is Primary where it stands alone and is not a symptom of something else. There is a biological basis where there are identifiable signs and symptoms. It is Progressive and as the illness progresses, the person does whatever is necessary to obtain the alcohol or drugs. Criminal behavior may occur and there is total alienation from the non-drug culture. (Early, Middle and Late stages) It is Chronic and like hypertension or diabetes, addiction is a lifelong illness. For hundreds of years, people have considered addiction to be a problem of willpower or of moral failing. It is not a matter of free will. Now we know that addiction is a disorder much like other chronic illnesses that involve behavior and lifestyle. It is Fatal where the person’s physical health declines and continued drug use leads to death. Alcohol causes more organ damage than any other drug. Alcohol affects the liver, pancreas, digestive system, heart, muscles and the brain. And alcohol withdrawal is considered the most dangerous over any other drug. WHAT CAUSES ADDICTION? Experts are not sure why some people are addicts and others aren’t. Many people inherit a predisposition to addiction, but anyone can become addicted, whether or not addiction problems run in the family. There is no evidence that there is such a thing as an “addictive personality,” nor is there evidence that childhood trauma or life stressors CAUSE addiction. However, there is evidence that a high level of stress can bring out or worsen the symptoms of this illness in susceptible people. Stress and addiction produce some of the same changes in the brain systems and so they are intimately connected HOW DOES THE BRAIN BECOME ADDICTED? Typically it happens like this:
HOW IS ADDICTION TREATED? Addiction is a lifelong illness. It cannot be cured, but it can be treated. However stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need. Society imposes stigma – and its damage — on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can’t be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery. Getting treated for an addiction is hard work. It inevitably involves a slew of difficult challenges—logistical, financial and personal. Patients may find it hard to get time off from their jobs. They may have trouble getting transportation. They are likely to be called upon to explore personal or family issues that are painful. Treatment is available in residential, ambulatory and inpatient settings. Treatment always involves total abstinence from the drug that was abused and from all other drugs of addiction. If there is physical dependence, treatment begins with detoxification (that is, gradual withdrawal of the drug or alcohol). Other treatment methods include individual, group and/or family therapy, counseling, education and behavior modification. FROM TREATMENT TO SUSTAINED RECOVERY Professional treatment of alcohol and drug problems can start someone on the road to recovery, but a few weeks of treatment should not be mistaken for long-term recovery. It is about where you live, how you work and play, who is included and excluded from your life and how you cope with the stresses of daily life. Recovery is more than just not drinking or using drugs; it is about putting together a new and meaningful life in which alcohol and drugs no longer have a place.
Some of the most important factors affecting a person’s willingness to stick with therapy include:
CO-OCCURING DISORDERS (DUAL DIAGNOSIS) People with addictions often suffer from other mental health disorders. Some with untreated mental health problems start using alcohol or drugs as a way to self-medicate. Conversely, there are cases where an individual begins to develop the symptoms and signs of a mental illness only after using drugs; suggesting that drug abuse caused or exacerbated the mental disorder. Illnesses that frequently co-occur with addiction include:
FAMILY SYSTEMS—DON’T TALK, DON’T TRUST, DON’T FEEL Experts have long known that addiction can negatively affect all family members and disrupt family relationships. Family members have been living in an addicted world, and they are suffering whether they realize it or not. They have learned survival skills that are inappropriate for normal living. They will need to examine exactly what they are doing wrong and learn how to do it another way. They need to practice the tools of recovery in the family groups and with the addicted individual. The first thing that the family members need is support. They need to feel listened to, known and understood. They need to be encouraged to share the reality of their lives. They need to feel as though they are in a safe, loving place where others care for how they feel and will respond to what they want. These people are not used to being cared for; they are used to caring for someone else. Some of them will resist any attempt by a clinician to help them. They will tell the clinician they are fine. They want the clinician to help their loved one, not them. They have identified that person as the “sick” one. Codependency is what happens to someone who is trying to control someone else. If their loved one is chemically dependent, they have probably tried to help him or her. They have attempted to fix the problem. But family members cannot fix the addict or alcoholic any more than they could fix their loved one if he or she had cancer. Chemical dependency is a disease for which no one is to blame. Research shows that the family member who looks at his or her own life will immeasurably help the addict or alcoholic to achieve a stable recovery. There are a variety of codependent traits. These are maladaptive thoughts and behaviors that have been learned in response to the chemically dependent person. It is important for the family member to take a look at each of these traits because they inhibit them from being able to live a normal life. Family members cannot solve problems accurately when these traits are at work. These traits are a distraction and keep the families from seeing the truth. Minimization: Taking reality and making it smaller than it really is. Pretending the problem is not bad when it is bad. Thinking that drinking a six pack of beer every night is normal. Doesn’t everyone drink like this? Minimizing financial problems in that they don’t seem that bad either. Doesn’t everyone struggle like this? Family members may minimize about verbal and physical abuse in thinking that the person was just mad, out of control or drunk. Family members may minimize that the addicted person just overdid it at the party. When family members minimize they are telling themselves that they have no reason to feel afraid. If the problem were bad, then they would have to be frightened and do something about it. But it is not so bad, so they can relax. Rationalization: Making excuses for the addicted person. The loved one is drinking or drugging because he or she has had a hard life, just had a fight with someone, had a bad childhood, got fired, has financial stressors. Codependents can think of a million reasons why the person is using, but the real reason is that the person is chemically dependent. The person is sick and needs help. Family members do not want to see the truth because it is frightening. They do not want to believe their loved one is ill. They want to believe that this person is just fine or is only having temporary difficulty. A rationalization is a lie. By Minimizing and Rationalizing, family members get more and more cut off from reality. They cannot accurately see what is going on anymore. They are using these defense mechanisms to cut themselves off from the painful truth. Denial: The most characteristic form of defense used in chemical dependency. This is where the mind refuses to experience the full emotional impact of what is happening. The family is falling apart, relationships are strained, communication has deteriorated, there is severe financial trouble and family members will still think they can fix these things. Family members will still believe that all of these problems are something else other than chemical dependency. Family members may even be so fooled to think that the problems are their fault. If they were a better wife, husband, child or parent then the chemically dependent person would not be having problems. Caretaking: Codependent people focus on the other person. Codependent family members are obsessed with taking care of the chemically dependent person to the point where they lose contact with reality. They actually think that everything will be all right if they do the right things. Codependent people think that they can fix things if they just work hard enough. The fact of the matter is that they cannot control someone else’s behavior, no matter how much they try. The more they try, the more frustrating it becomes. Enabling: In treatment, it is important to understand that the only behavior one can control is their own. If family members work to keep the chemically dependent person out of trouble, then they are keeping that person from suffering the natural consequences of his or her behaviors. If family members call the boss and make excuses, then the chemical dependent person does not learn from his or her mistakes. This is called enabling. By Caretaking and Enabling, codependent people constantly get the chemically dependent person out of trouble. They protect the addict or alcoholic from the consequences of his or her actions. They may comfort other abused family members and try to make everything better. Codependent people enable the illness to stay hidden. They help the chemically dependent person to avoid reality. Each person in a family has to accept the responsibility for his or her own behavior. Everyone must make his or her own decisions and live with the consequences. Inability to Know Feelings: People who are codependent do not know how they feel. They are so focused on the chemically dependent’s feelings that they ignore their own. They know how the other person is doing, but they do not know much about themselves. For the most part, codependent people think that they are fine, but what they are really feeling is frustrated, frightened and depressed. They are desperately trying to bring order to disorder and confusion. People who live in a chemically dependent home do not trust how they feel. They feel as though something is wrong with them. They try to block out the reality of the nightmare that they are living. They might even make up what their family is like. In chemically dependent homes, family members learn that feelings are dangerous. They keep the secrets sharing them with no one. Inability to know what they want: Codependent people are so obsessed with the wants and wishes of the chemically dependent person that they lose what they want for themselves. They believe that they have no wants. They are trying so desperately to control the situation that they have no time for their own needs. Lack of Trust: Family members from a chemically dependent home have been living in a situation where they cannot trust anything or anyone. They do not know what is going to happen. Family rules change when the chemically dependent person is intoxicated or hung over. A father who is loving can turn into a monster. A mother who is quiet can turn loud, aggressive or pushy. Alcohol and drugs can change any rule at any time. This is an atmosphere permeated by fear. Family members live in a constant state of tension. When family members come home they do not know what to expect. Things can get out of control in a hurry, and the behaviors can be life threatening. No one in the home can be trusted. No one knows the truth. This increases feelings of isolation and helplessness. People Pleasing: Codependent people are people pleasers. They will do virtually anything to keep someone else happy. They feel personally responsible for the other person’s feelings. People pleasers never are interested in what they themselves want. They are interested in what the other person wants. They want to keep the other person happy. They tell people that they are feeling fine when, in fact, they are coming apart at the seams. They have a smile for everybody. They are nice, nice, nice. They are almost incapable of saying no. If they say no, then they feel guilty. They will allow people to violate their boundaries. They never rock the boat. Feelings of Worthlessness: Codependent persons feel worthless compared to other people. They do not feel as though they deserve good stuff. They have been treated so badly, been taken advantage of so many times, and given of themselves without getting anything back so often that they have given up. They are tired. They feel like they are carrying the world around on their shoulders. They feel like they are small persons of little worth. They feel like they do not matter. They feel lost, vulnerable and alone. Dependent: Codependent people are overly dependent. They feel incapable of making good decisions. They do not trust themselves. They get their self worth from someone else. They may coerce and threaten to leave an addicted spouse, but the thought of leaving fills them with panic. They do not feel as though they can do things on their own. Dependency is fueled by deep-seeded feelings of inadequacy and shame. Codependent persons do not feel capable of doing anything other than holding on. Poor Communication Skills: Codependent people have poor communication skills. They cannot ask for what they want or share how they feel. This leaves them incapable of communicating effectively. Closeness in interpersonal relationships depends on the ability to share the whole truth with someone. Codependents do not want to know the truth. The truth is too painful. If they knew the whole truth, then they would be terrified. Codependents feel lonely because they feel as though no one knows them. They feel as though no one understands them. They try to communicate but feel as though the message never really gets across. One has to be able to tell another person how they feel and ask for what they want. To be a good communicator, one has to be a good listener. HOW TO TREAT FAMILY MEMBERS Family members need to understand that they are powerless over the disease and that their lives have been unmanageable. If they think that they can still control things, then they might try to work the chemically dependent’s treatment program for him or her and that is a setup for relapse. The family members need to admit to the addict or alcoholic that they have problems too. The family members need to identify exactly what the problems are, understand the problems and learn what they are going to do differently in their recovery. IF YOU NEED HELP, PLEASE CALL:
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