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Access to Recovery: Substance Abuse and Independent Living

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Title: Access to Recovery: Substance Abuse and Independent Living


1
Access to Recovery Substance Abuse and
Independent Living
  • October 19 and 21, 2006
  • Richmond, B.C.
  • Centre for Addiction Mental Health
  • CAILC
  • Toronto Rehabilitation Institute
  • Canada Drug Strategy

2
Learning Objectives
  • At the end of the workshop, participants will
  •  List the most commonly used drugs and their
    effects
  •  Discuss the most current trends in drug use  
  • Understand how these issues affect people with
    disabilities
  • Understand treatment options and how to access
    the addiction treatment system,
  • Integrate prevention and health promotion in
    your work
  • Develop a plan for working with local
    communities to improve awareness of and access
    to recovery for persons with disabilities

3
Agenda DAY 1 900 430
  • MORNING
  • Welcome and overview Jennifer
  • Introduction to Addiction Keith
  • Key concepts
  • Models of addiction
  • Break
  • Stigma, discrimination addiction Jennifer
    Keith
  • Patterns of drug use, with emphasis on use within
    disability communities Keith Jennifer
  • Lunch
  • AFTERNOON
  • Stages of change and motivational interviewing
    Jennifer Keith
  • Empowerment and self change Keith
  • Break
  • Drug effects, with emphasis on drugs most
    commonly associated with harm Keith
  • Harm reduction Keith
  • Q As Jennifer Keith

4
Agenda DAY 2900 430
  • MORNING
  • Welcome and overview Jennifer
  • Health promotion illness prevention Keith
  • Break
  • Treatment approaches Keith
  • The addiction treatment systemJennifer
  • Lunch
  • AFTERNOON
  • Barriers to access Keith
  • Advocacy systems change Keith
  • Break
  • Making it happen Jennifer CAILC participants
  • Wrap-up

5
WELCOME
  • Agenda overview
  • Ground rules
  • Participant led
  • Introductions
  • Names
  • Where from and what role is
  • What want to get out of the training

6
Societys most common, serious neglected
problems.
  • 1 in 4 Canadians will experience addiction or
    mental illness during their lifetime (1/10 in a
    year).
  • 2/3 who need care receive none
  • affect more people than heart disease more than
    cancer, arthritis diabetes combined.
  • Costs Canada 32-billion a year,
  • 14 of the net operating revenue of all Canadian
    Business (33 of short-term disability claims).
  • 20 of Ontario children require help (only 4
    currently receive help).

7
Why do people use drugs?
  • Brainstorm a list of reasons people give for
    using drugs.
  • What are some of the positive, beneficial or
    desirable effects that people might experience
    when using drugs

8
Some reasons people give for using drugs
  • Fun/enhance pleasurable activities/intensify
    feelings
  • Experiment, explore new experiences
  • Unwind, cope with stress
  • Escape reality, numb feelings
  • Deal with emotional pain or discomfort
  • Respond to social pressure or norms
  • Make social contact easier
  • Enhance artistic creativity
  • Spiritual or meditative pursuits
  • Self-medicate for anxiety, depression, cognitive
    dysfunction

9
KEY CONCEPTS
  • What is addiction?
  • What is substance abuse?
  • What are the causes of addiction?
  • A brief history of the meaning of addiction and
    substance abuse

10
What is addiction?
  • What is first word that comes to mind if you are
    asked that question?

11
The meaning of addiction
  • varies widely within and across societies
  • is to some degree culturally determined
  • is an evolving concept within our society

12
Models of addiction
  • Moral models
  • Disease models
  • Social models
  • Biopsychosocial models

13
Moral models of addiction
  • The temperance movement
  • The War on Drugs

14
Disease models of addiction
  • The 12-Step Movement
  • Biology of addiction

15
Social models of addiction
  • The behaviourists
  • The Independent Living Movement

16
Biopsychosocial models of addiction
  • Determinants of health disability
  • Inclusion of spiritual factors
  • Better understanding of interaction of physical,
    psychological, social spiritual factors

17
Addiction An Integrated Model
CULTURAL
18
Current concepts in understanding meaning of
substance abuse and addiction
  • Physical dependence
  • Drug tolerance
  • Withdrawal
  • Psychological dependence
  • Harm

19
Physical Dependence
  • state in which the body has adapted to the
    presence of the drug at a particular level
  • when the drug concentration falls, withdrawal
    results

20
PHYSICAL DEPENDENCETolerance
  • the need for an increased amount of a given drug
    to achieve intoxication or desired effect
  • or the reduction of a drugs effect with
    continued use of the same dose over time

21
PHYSICAL DEPENDENCE Withdrawal
  • Occurs when a drug is abruptly removed, or dose
    is significantly decreased
  • Cluster of symptoms often accompanied by directly
    overt physical signs

22
Withdrawal ...contd
  • Withdrawal generally looks opposite to the
    intoxication.
  • Unpleasantness of withdrawal may be so severe
    that the individual fearing it may use drug again
    just to avoid or relieve symptoms

23
Psychological Dependence
  • a state in which stopping or abruptly reducing
    the dose of a drug produces non-physical symptoms
  • characterized by emotional and mental
    preoccupation with the drugs effects and a
    persistent craving for the drug

24
Harm
  • Central concept in understanding both addiction
    and substance abuse
  • Types of harm
  • Physical
  • Psychological
  • Social (e.g., family, friends, job, financial,
    legal system)
  • Spiritual

25
Abbreviated List of Criteria for Abuse and
Dependence
  • Preoccupation with substance
  • Increased use of substance beyond expected
  • Inability to control use
  • Withdrawal symptoms
  • Signs of tolerance
  • Restricted activities
  • Impaired functions
  • Harmful or hazardous use

26
DSM IV Definitions
27
DSM IV Substance Dependence
At least 3 within a 12-month period
  • Tolerance
  • Withdrawal
  • Unintentional Overuse
  • Persistent desire or efforts to control drug use
  • Reduction or abandonment of important social,
    occupational or recreational activities
  • Continued drug use despite major drug-related
    problems

28
Substance Abuse At lease one criterion must
apply within a 12 month period
  • Recurrent use leads to failure to fulfill major
    role obligations at work, school, or home
  • Recurrent use in situations which are physically
    hazardous
  • Recurrent substance-related legal problems
  • Continued use despite persistent physical,
    social, occupational, or psychological problems

29
Aside from the DSMDrug Abuse is
  • a highly complex, value-laden term that does not
    lend itself to any single definition.
  • Its meaning differs from one society to another

30
Review of key points
  • Our understanding of the meaning of addiction is
    evolving. The current model of addiction is
    called the ___________ model.
  • What are 3 key concepts in our current
    understanding of addiction substance abuse?
  • Of these 3 concepts, which one is common to both
    substance dependence substance abuse?

31
Coffee Break
32
Values Clarification Activity
  • Individually review the list of drug users on the
    next slide and make note of the first thought,
    feeling and or image that comes into your mind.
  • As a group discuss and rank the harms associated
    with the list on the next slide.

33
Values Clarification Activity
  • Coffee drinker
  • Teen smoker
  • Person on Methadone
  • Crack addict
  • Person addicted to oxycontin
  • Valium user
  • Pregnant heroin user
  • Social drinker
  • Raver
  • Marijuana smoker

34
STIGMA, DISCRIMINATION ADDICTION
35
What is stigma ?
  • A complex idea that involves beliefs, attitudes,
    feelings and behaviour.
  • Refers to the negative mark attached to people
    who possess any attribute, trait, or disorder
    that marks that person as different from normal
    people.
  • This difference is viewed as undesirable and
    shameful and can result in negative
    attitudes/responses (prejudice and
    discrimination) from those around the individual.

36
Stigmatizing language
  • Addict
  • Substance abuse/abuser
  • Drunk
  • Crack-head
  • Junkie
  • Others

37
Legal status of drugs does not reflect harms
  • Alcohol and tobacco cause more illness and death
    than all other drugs combined
  • Consider the ratio of harms to stigma

38
CAMH study on stigma addiction
39
PATTERNS OF DRUG USE
  • within the population at large
  • among persons with disabilities

40
  • 79 of general population drink, 14 use
    cannabis. (CAS 2004)
  • 18 exceeded drinking guidelines.
  • 14 reported hazardous drinking.
  • Majority of acute problems are the result of
    average drinkers who drink too much on single
    drinking occasions. (Rehm 2003)
  • Alcohol, tobacco and other drugs cost Canadians
    over 18 billion annually. (Single, 1996)

41
  • Over 90 of the alcohol consumed by males aged 15
    to 24 years and over 85 consumed by young
    females exceeded Canadian guidelines. (Stockwell
    2005)
  • Close to 60 of those between 15 and 24 have used
    cannabis at least once 38 used cannabis in the
    past year. (CAS 2004)
  • Over 80 of Grade 12 students drink and almost
    half of these students report hazardous drinking.
    (Adlaf 2005)
  • Daily cannabis use has increased significantly
    and 1 in 5 students report driving after using
    cannabis. (Adlaf 2005)
  • Although smoking has gone down, 1 in 7 students
    still smoke. (Adlaf 2005)

42
OSDUS 2005 HIGHLIGHTSThe good news
  • The following drugs declined in use
  • cigarettes from 19.2 to 14.4
  • alcohol from 66.2 to 62.0
  • LSD from 2.9 to 1.7
  • PCP from 2.2 to 1.1
  • hallucinogens from 10.0 to 6.7
  • methamphet from 3.3 to 2.2
  • heroin from 1.4 to 0.9
  • Ketamine from 2.2 to 1.3
  • barbiturates from 2.5 to 1.7

43
OSDUS 2005 HIGHLIGHTSThe good news
  • More students in 2005 reported
  • being drug free (including alcohol
  • and tobacco) during the past year
  • compared to 2003 (35.9 vs. 31.6)

44
Special Populations
  • Populations with higher than average levels of
    substance use
  • Homeless Youth Adults
  • Lesbian, gay, bisexual and transgendered youth
    and adults
  • Aboriginal people
  • Sex workers
  • People in detention centers, jails prisons
    Substance Use in Toronto Issues, Impacts
    Interventions, February 2005

45
Non-disability factors can be more important
predictors of patterns of use than type of
disability
  • Regional differences
  • Cultural differences

46
Higher incidence of drug use among people with
  • Mental illnesses
  • Learning disabilities
  • Acquired brain spinal cord injuries
  • Painful conditions

47
Primary drugs of concern among people with
disabilities
  • Tobacco
  • Alcohol
  • Opioids
  • Marijuana
  • Barbiturates benzodiazipines
  • Polydrug use

48
Alcohol tobacco
49
Opioids
  • Narcotic analgesics
  • Opiophobia
  • Issues related to treating chronic pain in people
    with a histories of drug dependence or abuse

50
Marijuana
  • Medicinal uses
  • Risks

51
Access to Recovery Substance Abuse and
Independent Living
  • LUNCH BREAK

52
AGENDA DAY 1
  • AFTERNOON
  • Stages of change and motivational interviewing
    Jennifer Keith
  • Empowerment and self change Keith
  • Break
  • Drug effects, with emphasis on drugs most
    commonly associated with harm Keith
  • Harm reduction Keith
  • Q As Jennifer Keith

53
Making Changes Group Activity
54
STAGES OF CHANGE
  • Relapsing back to problem use

55
Stages of Change
56
PRE-CONTEMPLATION Characteristics
  • No problem
  • See no reason to change
  • Lack of awareness

57
PRE-CONTEMPLATION Tasks of Change
  • Information Both factual and personal
  • Consider circumstances which indicate a need for
    change
  • Engagement of client, create positive relationship

58
Stages of Change
59
CONTEMPLATIONCharacteristics
  • Ambivalence
  • Fear of change
  • Wishful thinking
  • Interest in the problem

60
CONTEMPLATIONTasks of Change
  • Examine the ambivalence
  • Weigh and consider alternatives
  • Examine pros and cons of particular actions

61
Stages of Change
62
PREPARATIONCharacteristics
  • Readiness to consciously engage in change process
  • Temporal imminence of change

63
PREPARATION Tasks of Change
  • Gather information about options
  • Make initial contact

64
Stages of Change
65
ACTION Characteristic
  • Change in behaviour

66
ACTIONTasks of Change
  • Understanding factors supporting the behaviour
  • Strategies which will support behavioural change
  • Communication with others

67
Stages of Change
68
MAINTENANCECharacteristics
  • Consolidation of changes
  • Need for support
  • Skills development

69
MAINTENANCETasks of Change
  • Establish support system
  • Practice behavioural changes
  • Act on relapse prevention plans

70
Stages of Change
  • Relapsing back to problem use

71
LAPSE/RELAPSE Characteristics
  • Initial return to use
  • Re-establishing previous pattern

72
LAPSE/RELAPSE Tasks of Change
  • Reconnecting with supports
  • Examining and learning from lapse experience
  • Reviewing and modifying relapse prevention
    strategies

73
EMPOWERMENT AND SELF CHANGE
  • Understanding motivation
  • Autonomy
  • Motivational interventions

74
Afternoon Break
75
DRUG EFFECTS
  • How do drugs work?
  • What makes one drug more addictive than another?
  • Which drugs are creating the most harm?

76
How Drugs Work
In order to predict the effect of a drug, we need
to know
  • the type of drug
  • size of dose
  • how drug was taken
  • distribution and absorption
  • metabolization
  • interactions

77
Metabolization
  • blood-brain barrier
  • body doesnt distribute all drugs in the same way
  • some are stored in fat cells and released slowly
  • others bind to plasma protein in the blood and
    move to the brain quickly

78
Liver Action
  • Liver contains enzymes that work to eliminate the
    drug from the body.
  • As the liver breaks down the drug it forms
    metabolites - some may not be psychoactive
    others may be more potent than the original drug.
  • Metabolites eliminated from the body in urine or
    feces

79
Drug Interactions
  • taking different drugs together creates new
    effects that are different than those from a drug
    taken alone
  • known as potentiation, its like multiplying the
    effects of two drugs rather than simply doubling
    the dose
  • some drugs cancel the effects of others. This is
    known as an antagonist effect

80
Types of DrugsClassified by Psychoactive Effect
  • Stimulants
  • Depressants
  • Hallucinogens
  • Antidepressants
  • Antipsychotics

81
Stimulants
  • increase activity by stimulating the central
    nervous system
  • reverse the effects of fatigue and elevate a
    persons mood
  • nicotine and caffeine are the most common drugs

82
Depressants
  • slow down body activity by depressing central
    nervous system
  • induce sleep, coma and even death
  • sleeping pills (barbiturates), tranquilizers
    (benzodiazepines), antispasmodics and alcohol are
    most common depressants
  • opiates such as heroin and morphine can be
    thought of as a special class of depressants, as
    can neuroleptics such as neurontin gabapentin

83
Hallucinogens
  • cause user to see hear or feel things that arent
    there yet without causing serious disturbances to
    CNS
  • LSD (acid), psilocybin (magic mushrooms) and
    mescaline are common examples of drugs
  • inhalants and marijuana have characteristics of
    depressants and hallucinogens

84
Antidepressants
  • MAO inhibiters
  • Tricyclics, such as amitriptyline, Elavil,
    imipramine
  • SSRIs, such as Prozac, Paxil, Celexa, Zoloft
  • SSNRIs
  • Others, such as Wellbutrin, Effexor

85
Antipsychotics
  • Major tranquilizers, such as chlorpromazine,
    Haldol
  • Atypical antipsychotics, such as clozapine,
    olanzepine, resperidone Seroquel

86
Factors related to addictive abuse potential of
drugs
  • Biochemical biological
  • Central Nervous System effects
  • Rout of transmission
  • Rate of absorption/metabolizing
  • Rate of elimination
  • Side effects

87
Factors related to addictive abuse potential of
drugscontd
  • Personal
  • Neurochemistry
  • Developmental history
  • Aspects of personality
  • Experiences in use of this other drugs
  • Values, beliefs expectations
  • Some types of disorders disabilities
  • Age health

88
Factors related to addictive abuse potential of
drugs contd
  • Environmental
  • Availability of drug
  • Immediate social group (e.g., family peers) and
    community with whom the person identifies
  • Societal norms sanctions re use of the drug(s)
    in question

89
HARM REDUCTION
90
Drugs Cause Real Harms!
  • Implicit in the term harm reduction is the belief
    that drugs can cause real harms.
  • These harms are not an inevitable consequence of
    drug use, and can be prevented or ameliorated
    through a range of strategies that include but do
    not invariably require complete cessation from
    all drug use

91
Harm Reduction Key Concepts
  • Harm reduction aims to reduce the adverse health,
    social, and economic consequences of alcohol and
    drug use without requiring abstinence.
  • Goal is to reduce harms to the individual and the
    community.

92
Harm Reduction- Key Concepts
  • Focuses on reducing harms and not necessarily on
    reducing use
  • Accepts that drug use is universal and brings
    with it both risks and benefits
  • Does not judge drug use as good or bad.
  • Morally neutral - does not promote use or
    condemn use
  • Non-Coercive

93
Harm Reduction Key Concepts
  • Acknowledges that quitting drug use may not be
    realistic or desirable.
  • Provides practical strategies
  • Public health
  • Human rights approach
  • No person should be denied access to services
    because of their drug use.

94
Harm Reduction Key Concepts
  • Hierarchy of Goals instead of one all or nothing
    decision.
  • Balances Costs and Benefits
  • Provides accurate information.
  • Attempts to promote facilitate access to care
    for addiction mental health problems.
  • Engage drug users in a continuum of care from
    which they would otherwise be excluded

95
Harm Reduction Abstinence
  • Non-use is a viable choice
  • Can described as overlapping elements within a
    continuum of care.
  • Drug holiday short-term abstinence
  • Abstinence from one drug but not all drugs
  • Long-term abstinence from all drugs.
  • Abstinence as the goal, but harm reduction
    strategies used if one relapses.

96
WRAP UP CLOSING Day 1
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