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Title: SUBSTANCE%20USE%20DISORDERS%20-%20INTERVENTION%20and%20MONITORING:%20%20Framework%20and%20Techniques

Addiction is Addiction LIC 6 Lifestyle
Intervention Conference 2016 October 17
Presented by Dr. Raju Hajela www.healthupwardlymob E-mail or Phone 403-536-2480 Fax
Addiction IsCheck all that apply
  • Bad behaviour or a vice
  • Self-medication
  • Just wanting to get high
  • Wrong choices
  • Just excessive substance use
  • Something that can be fixed or cured
  • Controllable
  • About enjoying ones vice
  • Bad choices
  • Wilful ignorance of reality
  • Being selfish
  • Caused by something else (i.e., trauma)
  • Substance Abuse
  • Loss of morals
  • A psychiatric disorder

Addiction and Mental Health
  • Cause or effect?
  • Addiction/substance use occurs because of
    underlying psychiatric problems, OR
  • Addiction/substance use results in psychiatric

  • Use of substances - stimulants, depressants,
    opioids, hallucinogens and inhalants - continuous
    or intermittent, may cause -
  • Thought disorders
  • Mood disorders
  • Perceptual disorders
  • Neurological damage
  • End-organ damage

  • Opposite of the drug effect
  • Depressant withdrawal most dangerous
    seizures, Delerium Tremens -gt increased mortality
  • Stimulants craving
  • Opioids most uncomfortable but can be managed
    cold-turkey even in pregnancy recurrent
    relapse is the problem if no treatment or
    engagement in recovery
  • Hallucinogens subtle
  • Non-specific nausea, vomiting, sleep
    disturbance, temp intolerance, irritability, mood
    swings, acting out

Addiction Mental Health
  • Addiction underlies many psychiatric conditions
    (e.g., Anxiety, Mood disorders, Psychosis,
    Conduct disorder, Personality Disorders like
    Borderline or Antisocial, ADHD)
  • Treating the psychiatric disorder does not make
    substance related problems or Addiction go away
  • Many treatments focus on behaviour only. Changing
    behaviour alone does not provide full treatment!

Stress, Anxiety Depression
  • Symptoms of intoxication and withdrawal manifest
    as stress, anxiety, and/or depression
  • Fear of the future ? anxiety
  • Shame from the past ? depression
  • Anger about the present ? stress
  • Feelings of hopelessness,
    worthlessness are part of Addictionwill all be
    and will be exacerbated in the absence of
    absence of healthy recovery, especiaally
    especially with no substance use or escape/or

Substance Use Continuum
  • Low-risk use
  • Hazardous use
  • Harmful use
  • Abuse
  • continued use despite negative consequences
  • Dependence
  • pre-occupation, compulsion, obsession (craving)
  • loss of control

The Pickle Line
  • A cucumber can become a pickle, but a pickle
    cannot go back to being a cucumber...

Abuse Hazardous - Harmful
Dependence (Addiction)
Dependence Characteristics
  • Withdrawal
  • Tolerance
  • Use of larger amounts or over a longer period
    than intended
  • Persistent desire for the substance (or process)
    or unsuccessful attempts to cut down
  • A great deal of time is spent in securing access
    to substance/process
  • Social or other activities are given up or
    reduced due to use
  • Use despite recurrent or persistent problems
    (family, social, work)

Addiction is Addiction
  • Addiction is not limited to alcohol and illicit
    drugs. It can include
  • Gambling
  • Food/Eating disorders
  • Sex, love, relationships
  • Internet/video games
  • Shopping
  • Exercise/sports
  • Work
  • Caffeine
  • Nicotine
  • Prescription medication

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  • When compulsive and obsessive thought revolves
    around a desire, craving and ritualized behavior
    often evolves
  • The drive to appease craving leads to
    powerlessness and unmanageability. Sign that
    Addiction and substance dependence are present
  • May continue for months into abstinence. Can be
    physiological and/or psychological
  • Drug/Problem behaviour Survival

  • Cravings are relieved when a person anticipates
    using or has acquired their substance of choice
  • This anticipation releases dopamine, chemical hit
    from the drug is a bonus
  • Relief from cravings is not directly tied to
    ingestion of substance or engagement in

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The Brain
  • The brain operates differently with Addiction
    (hippocampus, VTA, nucleus accumbens, amygdala,
    and frontal cortex are impacted)
  • Neurotransmitters are involved, particularly
    dopamine and glutamate

  • Neurotransmitters are natural chemicals that
    transmit signals from a neuron to a target cell
    across a synapse. They carry information
  • There are many types of neurotransmitters.
    Important ones in Addiction are Dopamine and
    Glutamate, but opioid peptides, GABA,
    norepinephrine, and serotonin are also impacted

Brain Circuitry Affected by Addiction
  • Genes- 40-60 of vulnerability comes from
  • Reward (VTA nucleus accumbens) normally
    enough ? with addiction is more
  • Motivation (Amygdala) feelings appraisal
  • Memory (Hippocampus) previous experience,
  • Tolerance, Withdrawal ? more or need to feel
  • Cognitive (thinking) problems brain receiving
    inaccurate info from other areas, not able to
    make choices

Addictive Thinking by Abraham Twerski
  • Addictive Thinking ? irrational, distorted
  • Everyone on the planet has Addictive Thinking in
    some form or another
  • Difference with Addiction is
  • It escalates and becomes unmanageable
  • Consequences are more severe (i.e., relapse)
  • Feels overwhelming
  • Leads to persistent obsession that takes you away
    from reality

Characteristics of Addictive Thinking
  • Irrational
  • Contradictory
  • Rationalization
  • Minimization
  • Denial
  • All-or-nothing
  • Catastrophizing
  • Skewed time
  • Hypersensitivity
  • Illusion of control
  • Guilt

Hearing Addictive Thinking
  • If you are hearing addictive thinking in someone
    else you may feel
  • Confused/puzzled
  • Irritated/annoyed/angry
  • Physically upset (e.g., sick in the stomach)
  • These feelings may precede your awareness of what
    you are hearing
  • You are hearing the disease in action

Addiction is Addiction
  • Brain cannot distinguish between substances or
    processes like eating, gambling, sex,
    relationships all impact dopamine and other
    neurotransmitters in the brain
  • Therefore abstinence from all illicit drugs,
    alcohol, and certain prescriptions (i.e., ones
    that impact reward circuitry) are important to
    form a foundation of recovery
  • Can look at abstinence from bottom line
    behaviours that increase vulnerability

  • Most rewarding (addictive) drugs produce
    analgesia (opioids and cannabinoids)
  • Natural rewards, notably highly palatable foods
    such as chocolate, milk or sucrose, can produce a
    naloxone-reversible analgesic effect
  • Consumption or anticipation of reward can inhibit
    responses to pain
  • Howard L. Fields, 2004 (Proceedings of the 11th
    World Congress on Pain)

Common Reward Circuitry
  • High levels of dopamine receptors seem to protect
    against Addiction, while low levels increase
    vulnerability including obesity and drug abuse
    levels are affected by genetics and experience
    (exposure) (Volkow, 2006)
  • Relapse associated with re-exposure to
    substance/behaviour, environment or increased

  • Receptors quantity?
  • Function?
  • Withdrawal symptoms?
  • Anxiety? Depression? Psychosis?
  • Social isolation?
  • Criminal behaviour?
  • Disruptions in Life Meaning, Values, Purpose?

Addiction IsCheck all that apply
  • A primary, chronic disease
  • About brain dysfunction
  • About pathologically seeking reward
  • About memory distortion
  • About seeking relief
  • About neglecting self
  • About motivation problems
  • About distortions in thinking, feeling, and
  • About impaired behavioural control
  • About cravings
  • Lifelong

Definition of Addiction
ABCDE of Addiction
  • Inability to consistently abstain
  • Impairment in behavioural control
  • Cravings
  • Diminished recognition of problems with ones
    behaviours and interpersonal relationships
  • Dysfunctional emotional response
  • From the American Society of Addiction Medicine
    definition of Addiction

ABCDE of Addiction
  • A, B, C are especially engaged when people are
    active in their disease
  • The D and E are the lifelong parts of the disease
  • With abstinence and recovery action, their
    presence, power, and impact declines but the
    disease is still there

ASAM 2011 ICD-11
  • Strong desire or compulsion (A)
  • Difficulties in controlling behaviour(B)
  • Progressive neglect, increased time (B)
  • Persistence despite harm (A)
  • Tolerance Withdrawal
  • Inability to consistently Abstain
  • Impairment in Behavioral control
  • Cravings
  • Diminished recognition of significant problems
  • Dysfunctional Emotional response

Role of Genetics
  • Even if a family history of Addiction is not
    known or apparent, there was likely a relative at
    some point in the family lineage who struggled
    with the disease
  • There is no untainted gene pool in the world when
    it comes to Addiction
  • Not important to figure out how or who or why,
    focus on recovery

Brain and Behaviour
  • Behaviours are NOT the disease nor do they cause
    the disease, they are SYMPTOMS of the disease
  • Behaviours can aggravate the disease or help lead
    to recovery!
  • Many healthcare providers and families believe
    that if behaviours are changed, the disease is
    fixed or cured
  • It is impossible to fix or cure the brain
    completely. Behavioural remission helps
    emotional, social, and spiritual growth if action
    is taken
  • Reading recommendation The Selfish Brain by
    Robert DuPont

Impact of Problem Behaviours
  • Problem behaviours, such as eating, sexual
    activity, shopping, gambling, being in a
    relationship, playing video games, and working
    can all have the same impact on the brain as
  • Brain will release dopamine in the same way as
    with substance, telling the brain I want more

  • Behaviour
  • Feelings
  • Thinking
  • Motivation
  • Concentration
  • Memory
  • Reward
  • Brain

  • Behaviour
  • Feelings
  • Thinking
  • Motivation
  • Concentration
  • Memory
  • Reward
  • Brain

  • As Addiction is rooted in the brain and there is
    a genetic predisposition, the disease exists from
  • Often parents will notice oddities or differences
    in children who later develop active Addiction
    behavioural issues, conduct problems, obsession,
    rumination, emotional instability
  • How it manifests depends on environment, exposure
    to substance, trauma, stress, life events

Addiction Beyond Substance
  • Myth Substances cause Addiction
  • Fact Substance use is the behavioural
    manifestation of Addiction and can aggravate the
    disease that already existed, plus have
    additional effects on the body and mind due to

Choice? Or Disease?
  • Myth Addiction and substance use are a choice
  • Fact Neither are a choice. The brain is
    vulnerable to Addiction from birth. Even using
    drugs or alcohol for the first time is not
    necessarily a choice as brain is seeking
    escape, reward, relief
  • Recommendation Watch Pleasure Unwoven by Kevin
    McCauley on YouTube

A Key Message
  • Addiction is a Primary, Chronic Brain Disease,
    NOT a behavioural disorder. A biological
    predisposition to the disease is passed on
    genetically. Other factors (environment, exposure
    to substance, trauma, etc.) impact how the
    disease manifests
  • The disease of addiction is part of you, not all
    of you

Mental Health
  • Some individuals will have Addiction and another
    mental health issue
  • However, without stabilization of Addiction you
    will not know if other issues persist!
  • Addiction must be treated
    first with holistic recovery

Another Key Message
  • Addiction is NOT the result of other mental
    health conditions but a disease in and of itself.
    Treating Addiction will help alleviate mental
    health symptoms including depression, anxiety,
    antisocial tendencies, difficulties in
    relationships, psychosis, lack of interest, lack
    of motivation, and many others!
  • Treating mental health issues only will NOT
    facilitate recovery for Addiction

Another Key Message
  • Addiction is Addiction!
  • Brain does not distinguish between substance or
  • Addiction without the s
  • Cunning and Bafflingdisease
  • Addicted to something versus Addiction
  • Cross, Multiple, Co are misleading terms
  • Whack a Mole
  • Reading recommendation ASAM Definition of
    Addiction from

A Nice Simple OldModelMcLellan, 2004
Substance Abusing Patient
Treatment substance or behavior specific Harm
Reduction or Abstinence
Non- Substance Abusing Patient yet persistent
cognitive, affective and behavioral problems!
Addiction is not the same as intoxication
  • When anyone experiences mild intoxication through
    the use of alcohol or other drugs, or when one
    engages non-pathologically in potentially
    addictive behaviors such as gambling or eating,
    one may experience a high, felt as a positive
    emotional state associated with increased
    dopamine and opioid peptide activity in reward
    circuits. After such an experience, there is a
    neurochemical rebound, in which the reward
    function does not simply revert to baseline, but
    often drops below the original levels. This is
    usually not consciously perceptible by the
    individual and is not necessarily associated with
    functional impairments. 

A Continuing Care Model
ASSESSMENT Motivational Interviewing,
Tailoring Treatment
Withdrawal management, Detox
Rehab Outpatient, Residential, TC etc.
Continuing Care Recovering Patient -
Community Addiction is Addiction - Thinking,
Feeling, Behaviors Concurrent Disorders
Bio-Psyhco-Social- Spiritual Medications,
Therapy, Mutual Support, Monitoring
Addiction Concepts
  • Harm Reduction
  • Treat harm reduction as a means to an end, not an
    end in itself
  • Viewed as what more needs to be done or what
    needs to be done differently rather than be the
    end treatment goal
  • Moderate use/consumption is not possible if
    someone has Addiction

Harm Reduction
  • A treatment and prevention approach that
    encompasses individual and public health needs,
    aiming to decrease the health and socio-economic
    costs and consequences of addiction-related
    problems, especially medical complications and
    transmission of infectious diseases, without
    necessarily requiring abstinence.
  • Abstinence-based treatment approaches are
    themselves a part of comprehensive Harm Reduction
    strategies. A range of recovery activities may be
    included in every Harm Reduction strategy.

Definition of Abstinence
  • More than not using substance
  • ASAM definition intentional and consistent
    restraint from the pathological pursuit of reward
    and/or relief that involves the use of substances
    and other behaviors
  • The pursuit of abstinence is important, which can
    exist even in the context of substance use/relapse

Addiction Concepts
  • Abstinence Alone Is Not Enough
  • Abstinence is a central component of long- term
  • Need to incorporate focus on whole being
  • There is no such thing as a bad feeling
  • Life into Recovery compared to recovery into life
  • Recovery Supports
  • It works if you work it

Addiction Concepts
  • Relapse What to Look For
  • An increase in addictive thinking (precedes all
    relapse behaviour)
  • Continuum of Relapse
  • Spiritual-Emotional-Cognitive-Social-Behavioural

  • Persistent risk and/or recurrence of relapse,
    after periods of abstinence, is another
    fundamental feature of addiction.  This can be
    triggered by exposure to rewarding substances and
    behaviors, by exposure to environmental cues to
    use, and by exposure to emotional stressors that
    trigger heightened activity in brain stress
  • (Eliot Gardner)

  • Relapse triggered by exposure to addictive/
    rewarding drugs, including alcohol, involves the
    nucleus accumbens and the VTA-MFB-Nuc Acc neural
    axis (the brain's mesolimbic dopaminergic "incenti
    ve salience circuitry).  Reward-triggered
    relapse also is mediated by glutamatergic
    circuits projecting to the nucleus accumbens from
    the frontal cortex.
  • (George Koob)

Disease progression
  • Over time, repeated experiences with substance
    use or addictive behaviors are not associated
    with ever increasing reward circuit activity and
    are not as subjectively rewarding. Once a person
    experiences withdrawal from drug use or
    comparable behaviors, there is an anxious,
    agitated, dysphoric and labile emotional
    experience, related to suboptimal reward and the
    recruitment of brain and hormonal stress systems,
    which is associated with withdrawal from
    virtually all pharmacological classes of
    addictive drugs. 

Disease progression
  • While tolerance develops to the high, tolerance
    does not develop to the emotional low
    associated with the cycle of intoxication and
    withdrawal. Thus, in addiction, persons
    repeatedly attempt to create a high--but what
    they mostly experience is a deeper and deeper
    low.  While anyone may want to get high,
    those with addiction feel a need to use the
    addictive substance or engage in the addictive
    behavior in order to try to resolve their
    dysphoric emotional state or their physiological
    symptoms of withdrawal.

Disease progression
  • Persons with addiction compulsively use even
    though it may not make them feel good, in some
    cases long after the pursuit of rewards is not
    actually pleasurable. Although people from any
    culture may choose to get high from one or
    another activity, it is important to appreciate
    that addiction is not solely a function of
    choice.  Simply put, addiction is not a desired

Medication Assisted Recovery (MAR)
  • A transitional term to help the general public,
    recipients of health care services, and
    professional health care service providers
    understand that pharmacotherapy can be helpful in
    supporting recovery. The manifestations of
    addiction-related problems are addressed in their
    biological, psychological, social and spiritual
    dimensions during addiction treatment, in
    treatment approaches that are abstinence-based,
    and in treatment approaches that are
    harm-reduction-based. MAR is one component of the
    treatment and recovery process.Medication
    Assisted Treatment (MAT), another variation on
    the concept of MAR, may involve pharmacotherapy
    alone. It is essential that addiction treatment
    and recovery approaches address the various
    aspects of biological, psychological, social and
    spiritual dimensions for optimum health and
    wellness. It is hoped that as the public and
    professionals recognize that recovery and
    treatment need to be holistic, appropriate
    pharmacotherapy would be well accepted as part of
    treatment and recovery, such that the terms MAR
    and MAT would be deemed unnecessary.

Maintenance Treatments
  • Pharmacotherapy on a consistent schedule for
    persons with addiction, usually with an agonist
    or partial agonist, which mitigates against the
    pathological pursuit of reward and/or relief and
    allows for remission of overt addiction-related
  • Maintenance Treatments of addiction are
    associated with the development of a
    pharmacological steady-state such that addictive
    substances are no longer sought for reward and/or
  • Maintenance Treatments of addiction are also
    designed to mitigate against the risk of
    overdose. Depending on the circumstances of a
    given case, a care plan including Maintenance
    Treatments can be time-limited or can remain in
    place life-long. Integration of pharmacotherapy
    via Maintenance Treatments with psychosocial
    treatments generally are associated with the best
    clinical results. Maintenance Treatments can be
    part of an individuals treatment plan in
    abstinence-based recovery activities or can be a
    part of harm reduction strategies.

  • Dr. Feelgood - opioids are good for pain relief,
    so prescribe short-acting opioids (patient
  • If you have pain, you cant be addicted
  • What would you like? I want you to like me!
  • Dr. Fingerwagger opioids are dangerous and must
    be used very sparingly, if at all
  • If you take opioids, you will be addicted!
  • Motivation through shame and fear
  • Dr. Compass check all directions when
    prescribing opioids or any other psychoactive or
    psychotropic meds
  • Opioids are useful meds that require great care
    in prescribing and ongoing monitoring is
  • Dr. Reality Check patient-centred care

Readiness to Change
  • Resistant Get off my back-gather
    information, develop rapport
  • Ambivalent I am not sure I can provide
    information, preparation
  • Action I really want to, who can help
    alone we cant, together we can
  • Maintenance My new lifestyle is more natural
    watch out for stressors and/or complacency

Motivational Interviewing
  • Miller Rollnick, 2009 collaborative,
    person-centred, guiding to elicit and strengthen
    motivation for change, improve outcomes SAMHSA
  • Motivation is dynamic, awareness leads to action
    leads to awareness, repetition leads to
    conditioning insight is not enough amotivation
    barriers are bio-psycho-social-spiritual!

Motivational Interviewing
  • Task is to create discrepancy between where the
    patient is at and where she wants to be
    Realistic planning?
  • Support self-efficacy, express empathy, roll with
  • Open ended questions, affirmations, reflections,
  • Desire, Ability, Reason, Need
  • Commitment, Activation, Taking Steps

Decisional Balance
  • Positives of changing, negatives of not-changing
  • Positives of not-changing, negatives of changing
    (withdrawal, pain, PAWS)

  • Reflect What I am hearing is? What exactly are
    you saying? Can you tell me more? Feelings?
  • Interpret This is what it means to me What
    does it mean to you?
  • Reframe Are there other ways to look at this?
  • Humanize Many people in this situation think
    this feel this do this

Hajela Irons, 1998
  • A process of sustained action that addresses the
    biological, psychological, social and spiritual
    disturbances inherent in addiction. Recovery aims
    to improve the quality of life by seeking balance
    and healing in all aspects of health and
    wellness, while addressing an individuals
    consistent pursuit of abstinence, impairment in
    behavioral control, dealing with cravings,
    recognizing problems in ones behaviors and
    interpersonal relationships, and dealing more
    effectively with emotional responses.An
    individuals recovery actions lead to reversal of
    negative, self-defeating internal processes and
    behaviors, allowing healing of relationships with
    self and others. The concepts of acceptance and
    surrender are also useful in this process. Since
    some prescribed and non-prescribed medications
    can interfere with recovery, it would be prudent
    to consult with an Addiction Specialist Physician
    in selected cases.

Like Minded Docs
Addiction Concepts
  • Holistic Recovery
  • Therefore, recovery must be holistic
    (bio-psycho-social-spiritual) in the context of
  • Abstinence from all substances is essential, even
    if it was not your substance of choice as
    consumption puts you at risk
  • Recovery for problem behaviours is more
    complicated, must look at bottom line behaviours

Physical Prognosis Brain
  • Proper nutrition for neurotransmitter production
    and function
  • Exercise promotes healthy circulation and release
    of feel good chemicals (endorphins and
  • Development of new synaptic pathways with
    reinforcement of healthy thinking, dealing with
    feelings, and behaviours

Physical Prognosis Body
  • Improved heart function and circulation to all
    organs to carry oxygen that is necessary for
    repair and function
  • Organ healing (e.g., liver function restored over
    time although some cells may become
  • Improved lung function healthy breathing
    (connection to relaxation and meditation)

  • Addiction cannot be cured or fixed but it can
    be managed or dealt with treatment and support!
  • Is progressive (think of a downwards escalator
    that people are climbing up)
  • Holistic recovery can provide a quality of life
    and healthy lifestyle people never thought

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Holistic Recovery
  • Biological
  • Regular exercise/physical activity (20-30
    minutes/day, 3-4x/week)
  • Walking, yoga, cardio, weights, organized sports,
    Tai Chi, etc.
  • Healthy, balanced diet
  • Lots of water, fruit, vegetables, lean protein
  • May or may not include supplements such as Omega,
  • Medication management (if needed)

Holistic Recovery
  • Psychological
  • Focus on identifying and processing emotions
  • Journalling, talking
  • Individual and group counselling
  • Exploration of trauma, mental health and coping
  • Relaxation, meditation, breathing

Holistic Recovery
  • Social
  • 12 Step meetings
  • Developing recovery peer supports
  • Addressing relationship issues
  • Work, school, volunteering
  • Engagement with others to minimize isolation and
  • FUN!
  • From isolation to connectedness

Holistic Recovery
  • Spiritual
  • Re-establishing connection with spirituality
    through individual reflection, prayer,
    ceremonies, group gatherings, etc.
  • Reconnecting with universe, idea that you are
    supported and not alone

Characteristics of Addiction
  • Key feelings with Addiction are Shame, anger,
    and fear
  • Isolation
  • Lack of connection with self, others, and the
  • Holistic recovery provides a platform of healthy
    coping with these challenges

  • A state of wellness where there is an abatement
    of signs and symptoms that characterize active
    addiction. Many individuals in a state remission
    state remain actively engaged in the process of
    recovery. Reduction in signs or symptoms
    constitutes improvement in a disease state, but
    remission involves a return to a level of
    functioning that is free of active symptoms
    and/or is marked by stability in the chronic
    signs and symptoms that characterize active

  • A process in which an individual who has
    established abstinence or sobriety experiences
    recurrence of signs and symptoms of active
    addiction, often including resumption of the
    pathological pursuit of reward and/or relief
    through the use of substances and other
    behaviors. When in relapse, there is often
    disengagement from recovery activities.Relapse
    can be triggered by exposure to rewarding
    substances and behaviors, by exposure to
    environmental cues to use, and by exposure to
    emotional stressors that trigger heightened
    activity in brain stress circuits. The event of
    using or acting out is the latter part of the
    process, which can be prevented by early

  • A state of sustained abstinence with a clear
    commitment to and active seeking of balance in
    the biological, psychological, social and
    spiritual aspects of an individuals health and
    wellness that were previously compromised by
    active addiction.
  • Abstinence Recovery Sobriety!

Johari Window
Johari Window
  • Disease of Addiction thrives in the blind and
    secret panes
  • As families/supports are so focused on the
    addict, life may be in the blind, secret, or
    unknown pane
  • Recovery goal for everyone is to shed light on
    challenges and move to the open pane

  • Move from looking at behavioural change to
    lifestyle change with holistic recovery
  • Life may look completely different than in active
    Addiction, which can fuel fear and apprehension
  • Important that the whole family system look at
    healthy change, not just the person with
    identified Addiction

  • The transition to this new lifestyle can be
    difficult, comes with lots of challenges and
  • Important that each family member focus on their
    own personal journey try not to blame, shame,
    judge, or critique others

Supporting Loved Ones
  • Establish an alcohol-free home
  • Learn about the disease of Addiction
  • Avoid policing/monitoring your loved one
  • Dont encourage your loved one to just try
    harder or control their disease, as this will
    fuel feelings of shame
  • Support their recovery actions
  • Set boundaries
  • Engage in your own process of recovery and

  • Addictive Thinking by Abraham Twerski
  • The Selfish Brain by Robert DuPont
  • Melody Beattie books on Codependence such as The
    Codependents Guide to the 12 Steps, Codependent
    No More, and The Language of Letting Go
  • Al-Anon and Nar-Anon
  • National Institute on Drug Abuse (NIDA)
  • Hazelden for books, CDs, DVDs on Addiction
  • Desire, when sex meets addiction by Susan Cheever
  • Facing Life by Nancy Brown
  • Deceived Facing Sexual Betrayal, Lies, and
    Secrets by Claudia Black
  • Facing Codependence and Facing Love Addiction by
    Pia Mellody

  • Key Messages
  • Addiction is a brain disease
  • It is not the persons fault they have this
  • Addiction is not about bad choices or wanting to
    hurt loved ones
  • Addiction impacts the whole family unit and
    everyone plays a role in recovery

Addiction in the Family
  • Often the dynamic in families shifts to a focus
    on the identified person with Addiction
  • Time, energy, money, and other resources go into
    helping care for this individual
  • Meanwhile, the care of other family members is
    not prioritized
  • Healthy recovery for the struggling addict
    involves everyone taking steps to be healthy

Addiction in the Family
  • With genetic predisposition, everyone in the
    biological family unit may be at risk of
    developing the disease, or other behavioural,
    emotional, or thinking patterns may be present
    that are counterproductive
  • If you are the partner or non-biological relative
    of someone struggling with Addiction, it is
    important for you to look honestly at your
    genetic risk as well as current health

Addiction in the Family
  • The Family Laws of Addiction
  • Dont Talk
  • Dont Trust
  • Dont Feel
  • (It Will Never Happen to Me by Claudia Black)
  • The Family Laws of Recovery
  • Talk
  • Trust
  • Feel

Karpman Triangle
  • Another way to look at family roles
  • People may act as one, two, or all three of these
    roles depending on the time and circumstance

Karpman Triangle
  • Perpetrator Blames and pressures the person who
    is struggling
  • Drawback Perpetuates shame
  • Rescuer Wants to fix, caretake, keep the peace
  • Drawback Enabling of behaviour
  • Victim Feeling hopeless, worthless, punished,
    and in an unfair position over which they have no
    power. Vulnerable to persecution and often
    looking for rescuing
  • Drawback Lack of personal accountability

  • Personal boundaries are guidelines, rules or
    limits that a person creates to identify for him-
    or herself what are reasonable, safe and
    permissible ways for other people to behave
    around him or her and how he or she will respond
    when someone steps outside those limits

  • Important to remember that boundaries are
    internal we cannot force someone to respect our
    boundary! This is our responsibility to ourselves
  • Difference between boundaries and expectations
  • Expectations when we expect somebody else to act
  • Boundaries when we act differently as a result
    of an internal line we have set

Boundaries Are
  • Yours
  • Internal
  • What you will/will not accept for yourself
  • Do not need to be respected by others
  • Are set by you, for you

  • Become more clearly defined as you gain clarity
    on who you are
  • What gives me meaning?
  • What do I value?
  • What is healthy for me?
  • These questions help define boundaries in the
    context of spirituality

Boundaries Communication
  • You have the right to vocalize your needs to
    others, but dont expect them to change as a
  • It is also important to have a plan of action in
    case the verbalization of your boundary is not
  • Please do not raise your voice with me. If you
    do, I will step away from this conversation

  • The capacity to recognize and identify emotions
    that are being expressed by others
  • Understanding does not have to equal acceptance
  • You do not have to feel these emotions yourself,
    which can lead to sympathy

Paradigm shift
Addicted to needs to change to Addiction
involving Alcohol is but a symptom of our
disease AA Big Book RAiAR Remember Addiction
is Addiction Responsible Recovery 9 steps
1,2,3 willing to consider 4,5,6 can and
will (action) and 7,8,9 responsibility
Outcomes to be determined by the grace of our
Higher Power ?
Addiction Treatment
There is no such thing as treatment
failure Only failure of providing the
appropriate treatment Treatment has to be
comprehensive, ongoing, in the chronic disease
framework, with holistic biological,
psychological, social and spiritual recovery!
Addiction is Addictionwww.addictionisaddictionboo
Addiction is Addiction Understanding the
disease in oneself and others for a better
quality of life Raju Hajela Sue Newton Paige
Abbott Friesen Press, 2015
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