INTRODUCTION TO ADDICTION

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1 INTRODUCTION TO ADDICTION

2 HBCU CENTER FOR EXCELLENCE Through a Cooperative Agreement with the Substance Abuse and Mental Health Services Administration s (SAMHSA) Center for Substance Abuse Treatment, (CSAT) and Center for Mental Health Services, (CMHS) Morehouse School of Medicine established the Historically Black Colleges and Universities Center for Excellence in Behavioral Health (HBCU-CFE), funded as Grant No. TI

3 HBCU-CFE GOALS Promote student behavioral health to positively impact student retention Expand campus service capacity, including the provision of culturally appropriate behavioral health resources Facilitate best practices dissemination and behavioral health workforce development

4 SOUTHEAST ADDICTION TECHNOLOGY TRANSFER CENTER (SOUTHEAST ATTC) The Southeast Addiction Technology Transfer Center (SATTC) is one of 10 Regional and 4 National Focus resource centers for addiction-related information funded through by the Substance Abuse and Mental Health Services Administration (SAMHSA). Southeast ATTC, located at the National Center for Primary Care at the Morehouse School of Medicine in Atlanta, serves the states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Southeast ATTC fosters alliances to support and implement best practices and provides technology transfer activities to increase the awareness, knowledge and skills of practitioners and pre-service professionals. The SATTC conducts or co-sponsors training programs for community members, addiction counselors, and other behavioral health professionals.

5 ED JOHNSON, MAC, LPC Ed Johnson obtained a Bachelor s Degree from Auburn University and a Master s Degree in Clinical Counseling from the Citadel. In March 2010 Ed assumed the position of South Carolina Program Manager for the Southeast ATTC located at the National Center for Primary Care, Morehouse School of Medicine. In October 2012 became Program Manager for Kentucky, North Carolina and South Carolina. Ed worked as Client Services Coordinator at Lowcountry AIDS Services in Charleston SC and from June 1992 until February 2010 in various positions at Charleston Center (Charleston County Department of Alcohol and Other Drug Abuse Services) also in Charleston. Starting in November 1999 he served as Program Administrator for the Opioid Treatment Program and Infectious Disease Service at Charleston Center. He has provided numerous trainings in the Southeast on Recovery-Oriented Systems of Care, Professional Ethics, HIV / Addiction, Viral Hepatitis, Opioid Dependency / Treatment and issues related to Lesbian, Gay, Bisexual and Transgender (LGBT) Individuals and Addiction He is currently credentialed / licensed as a Master Addiction Counselor (MAC), a Certified Addictions Counselor (CACII), and a Licensed Professional Counselor (LPC).

6 INTRODUCTION TO ADDICTION ED JOHNSON, MAC, LPC KENTUCKY AND THE CAROLINAS PROGRAM MANAGER SOUTHEAST ADDICTION TECHNOLOGY TRANSFER CENTER

7 LEARNING OBJECTIVES Participants will: Understand the concepts of tolerance and withdrawal. Be introduced to current diagnostic criteria for dependence (addiction). Become familiar with the criteria by which addiction is defined as a chronic disease. Be introduced to the concept of substance vs. process addiction.

8 WHY WE DO WHAT WE DO As human beings we do whatever we do for a reason. We do nothing just because. We do whatever we do for one of two reasons and two reasons only: Increase pleasure Decrease pain

9 TERMINOLOGY Alcohol Drugs Alcohol and Other Drugs Alcoholism Drug Addiction Chemical Dependency Substance Abuse Substance Use Disorders

10 THE SUBSTANCE USE SPECTRUM Use Ingestion of alcohol or other drugs without the experience of any negative consequences. Misuse When a person experiences negative consequences from the use of alcohol or other drugs i.e. drinks too much and gets sick. Abuse Continued use of alcohol or other drugs in spite of negative consequences. Dependence / Addiction Compulsive use of alcohol or other drugs regardless of the consequences.

11 WHAT FLIPS THE SWITCH Changes to brain chemistry Genetic Predisposition Environmental factors

12 TERMINOLOGY: DEPENDENCE VERSUS ADDICTION Addiction may occur with or without the presence of physical dependence. Physical dependence results from the body s adaptation to a drug or medication and is defined by the presence of Tolerance and/or Withdrawal

13 TERMINOLOGY: DEPENDENCE VERSUS ADDICTION Dependence: A state in which an organism functions normally in the presence of a drug. It is manifested as a disturbance when the drug is removed (withdrawal). Can be physiological, psychological or both

14 TERMINOLOGY: DEPENDENCE VERSUS ADDICTION Tolerance: the loss of or reduction in the normal response to a drug or other agent, following use or exposure over a prolonged period a higher dose is required to achieve the same effect.

15 TERMINOLOGY: DEPENDENCE VERSUS ADDICTION Withdrawal: a period during which somebody addicted to a drug or other addictive substance stops taking it, causing the person to experience painful or uncomfortable symptoms OR a person takes a similar substance in order to avoid experiencing the effects described above.

16 ADDICTIVE DISORDER DIAGNOSTIC CRITERIA ( MUST HAVE AT LEAST 3 OF 7 WITHIN PAST 12 MONTHS) Tolerance Withdrawal Greater quantity or intensity than intended Unsuccessful attempts at cutting back/stopping Time spent (preparing, engaging, recovering) Loss of other life domains Continued despite significant consequences Note: With disease progression the elements of, Secrecy, Use as an escape and engaging in Illegal activities develop.

17 Is Addiction a DISEASE, MORAL FAILURE OR JUST POOR CHOICES?

18 WHAT IS ADDICTION? Addiction is a primary chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behavior. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one s behaviors and interpersonal relationships and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. American Society of Addiction Medicine, 2011

19 MEDICAL DISEASE Affects specific organs or parts of the body Has identifiable causes Has identifiable signs and symptoms Is either acute or chronic

20 IF ADDICTION IS A DISEASE THEN: What is the affected organ or part of the body? The Brain, and it is expressed in the form of compulsive behavior. Are there identifiable causes? Yes, but the operative term is multiple causes. Is there a predictable, progressive course? Yes Are there recognizable, measureable signs and symptoms? Yes, outlined in the DSM IV TR

21 IF ADDICTION IS A DISEASE THEN: Is it Chronic or Acute Gradual onset with acute episodes accurately describes it, chronic. Is it a potentially fatal? Yes. Is it treatable? Yes, with abstinence and lifestyle / behavioral modification changes Is it curable? At present No.

22 THE BRAIN Drugs enter the blood stream The Blood Brain Barrier Drugs act on certain parts of the brain Memory

23 THE BRAIN: THE PLEASURE PATHWAY

24 THE BRAIN: WHAT HAPPENS WHERE

25 ACUTE VS. CHRONIC An Acute Condition has: Rapid onset Short course May be severe A Chronic Condition has: Gradual onset Lifetime course May have acute episodes

26 TYPES OF CHRONIC DISEASES Hypertension Diabetes Asthma

27 Relapse Rates Are Similar for Addiction and Other Chronic Illnesses Percent of Patients Who Relapse to 50% 50 to 70% 50 to 70% Drug Dependence Type I Diabetes Hypertension Asthma Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.

28 TREATMENT OF CHRONIC DISEASES Since the causes are usually multi-factorial, treatments must usually be multi-modal. Response rates are variable and depend on the patient, the treatment itself, and outside factors.

29 ADDICTIONS OTHER THAN TO SUBSTANCES ICD-10 and DSM IV TR / V do not single out behavioral addictions as an independent spectrum of mental disorders. Behavioral Addictions are also referred to as: Behavioral (non-chemical) Addiction. Non-Substance-Related Addiction Process Addiction They are sometimes classified as Impulse Control Disorders or merely Compulsive Behaviors

30 DEFINITION Compulsion to repeatedly engage in an action until said action causes serious negative consequences to the person s physical, mental, social, and/or financial well-being

31 EXAMPLES Gambling Food Sex / Viewing Pornography Use of computers / Use of the Internet Video Games Exercise Work Spiritual Obsession (as opposed to religious devotion) Cutting Shopping (shop lifting) Cutting

32 DISEASE VERSUS MORAL FAILURE How do we deal with moral failures or crimes? Punishment, consequences, Incarceration. How do we deal with diseases? Medical care, treatment, meeting the patient where they are at, helping them to move toward a healthier life

33 QUESTIONS?

34 National Center for Primary Care at Morehouse School of Medicine 720 Westview Drive SW - Atlanta, Georgia Ed Johnson, MAC, LPC - South Carolina Program Manager Main phone: Project Director: Dawn Tyus, M.Ed. Main phone: (404) Fax: (404)

35 HBUC-Center for Excellence at Morehouse School of Medicine 720 Westview Dr. SW - Atlanta, GA Office: HBCU (4228) or

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