JOURNEY JOURNEY TO OBLIVIONTO OBLIVION

““Drugs are a waste of time. They Drugs are a waste of time. They destroy your memory and your self-destroy your memory and your self-

respect and everything that goes along respect and everything that goes along with your self-esteem” Kurt Cobainwith your self-esteem” Kurt Cobain

Drinking patternsDrinking patterns

ToleranceTolerance

The heavy drinker has had more The heavy drinker has had more practice practice in compensatingin compensating for levels of alcohol. for levels of alcohol.

This is motivated by resistance to This is motivated by resistance to concerns by others, fears of addiction.concerns by others, fears of addiction.

Vomiting reflexVomiting reflex can be triggered at 0.12 if can be triggered at 0.12 if alcohol levels rise quickly. With slow, alcohol levels rise quickly. With slow, steady drinking, the vomiting reflex can be steady drinking, the vomiting reflex can be depressed- to a lethal dosage level.depressed- to a lethal dosage level.

Effects of Drinking on studentsEffects of Drinking on students

BlackoutsBlackouts

Drinker appears to be functioning Drinker appears to be functioning normally, but later, when sober, normally, but later, when sober, remembers nothing of the time.remembers nothing of the time.

Blackouts are a sign of serious Blackouts are a sign of serious progression of alcoholism.progression of alcoholism.

Brain function is seriously impaired.Brain function is seriously impaired.

Progression of Progression of dependencedependence

E.M.Jellinek described 2 types of E.M.Jellinek described 2 types of alcoholics:alcoholics:

Alcohol addicts- Alcohol addicts- lose controllose control Habitual symptomatic excessive Habitual symptomatic excessive

drinkers-drinkers- remain functional remain functional

4 phases of addiction 4 phases of addiction (Jellinek)(Jellinek)

Prealcoholic symptomatic phasePrealcoholic symptomatic phase Major tension reduction due to drinkingMajor tension reduction due to drinking

Prodromal stageProdromal stage Blackouts Blackouts

Crucial phaseCrucial phase Loss of control drinking/ compulsionLoss of control drinking/ compulsion Concocting alibis for drinking, shifting responsibility Concocting alibis for drinking, shifting responsibility

for drinking to others with irrational blamingfor drinking to others with irrational blaming Family support diminishesFamily support diminishes Series of hospitalizations for accidents, illnessSeries of hospitalizations for accidents, illness

Final, chronic stage- bingesFinal, chronic stage- binges All function is deteriorating/ tolerance reducedAll function is deteriorating/ tolerance reduced 60% at this point long for some spiritual relief60% at this point long for some spiritual relief

Jellinek’s disease model of Jellinek’s disease model of alcoholismalcoholism

Disease model of alcoholismDisease model of alcoholism

Once a person’s life is unmanageable due Once a person’s life is unmanageable due to compulsive drinking, one is an alcoholic.to compulsive drinking, one is an alcoholic.

Concept expanded to include most drug Concept expanded to include most drug addictions.addictions.

Also includes compulsive behaviorsAlso includes compulsive behaviors

Five levels of riskFive levels of risk

The closer behavior is to the center, the The closer behavior is to the center, the higher the risk involved, the greater the higher the risk involved, the greater the harm to society.harm to society.

RiskRisk is loss of adaptive social function is loss of adaptive social function ReligionReligion is seen as cutting through all 5 is seen as cutting through all 5

levels. It can be a force for healing, or a levels. It can be a force for healing, or a negative force (cults)negative force (cults)

The ultimate risk is The ultimate risk is suicide.suicide.

Five levels of riskFive levels of risk

DenialDenial

Nobody says they want to be an addict when Nobody says they want to be an addict when they grow up, but 20% do.they grow up, but 20% do.

DenialDenial is what supports this paradox. is what supports this paradox. It may be better to describe it as defensivenessIt may be better to describe it as defensiveness Defensiveness suggests concern, dissatisfaction with Defensiveness suggests concern, dissatisfaction with

status quo, desire for something differentstatus quo, desire for something different

Denial allows people to reject clear evidence of Denial allows people to reject clear evidence of their behavior being self-destructive and out of their behavior being self-destructive and out of control.control.

Family members often enable the habit by Family members often enable the habit by collaborating in denial.collaborating in denial.

Deciding to quitDeciding to quit

Conventional wisdom says the Conventional wisdom says the drinker uses drinker uses denialdenial to prevent facing to prevent facing effects of habit.effects of habit.

The drinker must The drinker must hit bottomhit bottom to finally to finally reach out for help, get treatment.reach out for help, get treatment.

Family can jump-start this process with a Family can jump-start this process with a planned planned interventionintervention, which hopefully will , which hopefully will break the denial and motivate user to seek break the denial and motivate user to seek treatment.treatment.

Why are adolescents so at risk for Why are adolescents so at risk for addiction?addiction?

Electronic media exposureElectronic media exposure Teen openness to risk, thrill-seekingTeen openness to risk, thrill-seeking Development of brain structures is unevenDevelopment of brain structures is uneven

Frontal cortex lags behind limbic system/ amygdala, Frontal cortex lags behind limbic system/ amygdala, allowing for more impulsive behaviorallowing for more impulsive behavior

The amygdala can hijack the thoughtful cortexThe amygdala can hijack the thoughtful cortex Cues to drug use have more powerCues to drug use have more power Ancient “GO” system that seeks rewards for Ancient “GO” system that seeks rewards for

survival/ mating behaviors is more powerful than survival/ mating behaviors is more powerful than the “STOP” system that slows impulses toward the “STOP” system that slows impulses toward dangerous behaviorsdangerous behaviors

With negative environmental triggers, addiction With negative environmental triggers, addiction is likelyis likely

Substance preferencesSubstance preferences

Behavioral addictionsBehavioral addictions Any stress-reducing activity can be subject to addiction:Any stress-reducing activity can be subject to addiction: EatingEating SexSex GamblingGambling Activity- work, exercise, sportsActivity- work, exercise, sports Pursuit of powerPursuit of power MediaMedia Isolation- sleep, fantasyIsolation- sleep, fantasy Risk takingRisk taking Religious extremism- cultsReligious extremism- cults Crime and violenceCrime and violence Socializing- relationshipsSocializing- relationships Institutionalization- prison, mental hospitals, sanctuariesInstitutionalization- prison, mental hospitals, sanctuaries

The most reliable sign of continuing The most reliable sign of continuing addiction is the person’s inability to addiction is the person’s inability to

integrate goals & behaviorsintegrate goals & behaviors

Addictive behaviors come in Addictive behaviors come in various formsvarious forms

Arousal dependenceArousal dependence (gambling, thrill seeking) is (gambling, thrill seeking) is compared to amphetamine usecompared to amphetamine use

Satiation effectsSatiation effects (overeating, media use) compares to (overeating, media use) compares to opiate useopiate use

Fantasy dependenceFantasy dependence (daydreaming, sex) compares to (daydreaming, sex) compares to effects of psychedelicseffects of psychedelics

All behaviors require increasing exposure to maintain All behaviors require increasing exposure to maintain desired effects, with greater discomfort upon withdrawal. desired effects, with greater discomfort upon withdrawal.

Urge to reuse is affected by:Urge to reuse is affected by: Expectation of positive (albeit short term) effects of Expectation of positive (albeit short term) effects of

useuse Initial rush of pleasure produced by activityInitial rush of pleasure produced by activity Social pressures to use by a groupSocial pressures to use by a group

Recovery procedures are unique Recovery procedures are unique for each personfor each person

Opiate dependence results in abstinence syndrome- GI Opiate dependence results in abstinence syndrome- GI tract problems, aches, anxiety, insomnia, cravingtract problems, aches, anxiety, insomnia, craving

Barbiturate dependence can produce seizures, requiring Barbiturate dependence can produce seizures, requiring hospitalizationhospitalization

Amphetamine dependence causes depression/ lethargyAmphetamine dependence causes depression/ lethargy Cocaine toxicity can create seizures, heart failure, Cocaine toxicity can create seizures, heart failure,

delusions, hallucinations, violencedelusions, hallucinations, violence Dual addictions produce a complex of symptomsDual addictions produce a complex of symptoms Behavioral addictions requires ending the activity Behavioral addictions requires ending the activity

completely (except for eating) & finding alternative completely (except for eating) & finding alternative behaviors to satisfybehaviors to satisfy

As many as 84% also have a mental disorder that must As many as 84% also have a mental disorder that must be treatedbe treated

Treatment Treatment goalsgoals

Find a non-harmful substitute activityFind a non-harmful substitute activity Remind client that even one encounter Remind client that even one encounter

with substance can lead to relapsewith substance can lead to relapse Support recovery through forming new Support recovery through forming new

relationships that don’t include substancerelationships that don’t include substance Repair social/ medical damageRepair social/ medical damage Promote spiritual development/ ethic of Promote spiritual development/ ethic of

volunteerism, servicevolunteerism, service Restore self-esteemRestore self-esteem

Treatment stagesTreatment stages

DetoxificationDetoxification Active treatmentActive treatment Aftercare Aftercare

(relapse prevention)(relapse prevention)

Treatment effectivenessTreatment effectiveness

Four substances account for 90% of Four substances account for 90% of admissions:admissions: Alcohol – 47%Alcohol – 47% Opiates - 15%Opiates - 15% Cocaine - 15%Cocaine - 15% Marijuana – 13%Marijuana – 13%

Vital components of a successful Vital components of a successful treatment:treatment:

program completion, aftercare program completion, aftercare involvement, family therapy.involvement, family therapy.

Characters in the addictive homeCharacters in the addictive home

EnablerEnabler- bails the addict out of his crises.- bails the addict out of his crises. VictimVictim-takes on extra responsibilities in the -takes on extra responsibilities in the

mistaken belief that this means love or mistaken belief that this means love or obligation.obligation.

ProvokerProvoker- wife/girlfriend who compensates for & - wife/girlfriend who compensates for & tries to control everything that goes wrong at tries to control everything that goes wrong at home. S/he shifts roles as the addict needs home. S/he shifts roles as the addict needs different thingsdifferent things

AddictAddict-switches needs- to be forgiven, taken -switches needs- to be forgiven, taken care of, reprimanded.care of, reprimanded.

Family responsibilitiesFamily responsibilities

For recovery to begin, all the other For recovery to begin, all the other characters must change their behavior- it characters must change their behavior- it puts enough pressure on the alcoholic to puts enough pressure on the alcoholic to make him/her consider recovery. make him/her consider recovery.

PainPain is often the only motivation for some is often the only motivation for some people.people.

Why would family resist Alanon?Why would family resist Alanon? What is gratifying about enabling an What is gratifying about enabling an

addict?addict?

Payoffs for family membersPayoffs for family members

ControlControl AppreciationAppreciation Salve to the egoSalve to the ego Sense of superioritySense of superiority Sense of being indispensableSense of being indispensable The high of chaosThe high of chaos

Process of recoveryProcess of recovery

All members need information, All members need information, education.education. Reality checkReality check requires confrontation of requires confrontation of

misbegotten beliefs- what is love, whose misbegotten beliefs- what is love, whose responsibility is it to change?responsibility is it to change?

ModelingModeling is a powerful impetus to is a powerful impetus to change.change.

Group workGroup work is powerful is powerful in breaking up entrenched in breaking up entrenched habits/ beliefs. habits/ beliefs.

RecoveryRecovery

When an addict can When an addict can integrate stated integrate stated goalsgoals into his real life activities, then into his real life activities, then recovery is becoming a reality.recovery is becoming a reality.

When there are consistent lapses in When there are consistent lapses in responsibility and accountability, there is responsibility and accountability, there is no real commitment to change.no real commitment to change.

Values shift during recoveryValues shift during recovery

Values shift during recoveryValues shift during recovery

First stage- behaviors are congruent with First stage- behaviors are congruent with moral valuesmoral values

As addiction progresses, behavior shifts As addiction progresses, behavior shifts out of stated value system, since they out of stated value system, since they can’t live their values.can’t live their values.

During recovery, people shift values to During recovery, people shift values to emphasize those that support recovery emphasize those that support recovery and drop those that support addiction.and drop those that support addiction.

Values shiftValues shift

Addiction Addiction short-circuits rational short-circuits rational decision-makingdecision-making in favor of instant in favor of instant gratification.gratification.

Repeated use is encouraged by Repeated use is encouraged by neurological processes, cravings, neurological processes, cravings, discomfort of withdrawaldiscomfort of withdrawal..

Psychological dynamicsPsychological dynamics support support addiction.addiction.

Psychological dynamics that Psychological dynamics that support addictive behaviorssupport addictive behaviors

Expectation of positive effects of drugExpectation of positive effects of drug Initial rush of pleasureInitial rush of pleasure Peer pressure to belong to a group, Peer pressure to belong to a group,

familiarity of behaviorsfamiliarity of behaviors Dynamics that erode self-esteemDynamics that erode self-esteem

Identity conflictIdentity conflict Self-blame (feelings of personal weakness)Self-blame (feelings of personal weakness) Expectations of failure in the futureExpectations of failure in the future

The struggle of addictionThe struggle of addiction

Users will tell you they struggle with their Users will tell you they struggle with their addiction every day.addiction every day.

They will stay abstinent until pressure builds up, They will stay abstinent until pressure builds up, cravings overwhelm their resolve.cravings overwhelm their resolve. Stressors that leave the addict feeling trapped will Stressors that leave the addict feeling trapped will

engender use, as it is something s/he can doengender use, as it is something s/he can do

They use again, feel weak and helpless.They use again, feel weak and helpless. They begin the excuse process and self-blame.They begin the excuse process and self-blame. Self-concept is shredded.Self-concept is shredded.

The challenge of sobrietyThe challenge of sobriety

Sobriety is dependent on:Sobriety is dependent on: How committed the addict is to recoveryHow committed the addict is to recovery How long s/he has been abstinentHow long s/he has been abstinent How important the behavior is to the addict.How important the behavior is to the addict.

Addiction is resistant to changeAddiction is resistant to change

75% of all who try to kick a habit fail within 75% of all who try to kick a habit fail within 6 months. (Criminality- 70+%)6 months. (Criminality- 70+%)

Detoxification processDetoxification process entails discomfort entails discomfort OpiatesOpiates BarbituratesBarbiturates Cocaine/ amphetaminesCocaine/ amphetamines

Rate of detoxificationRate of detoxification

Alcohol withdrawalAlcohol withdrawal

Abstinence syndromeAbstinence syndrome is more severe & is more severe & potentially lethal in withdrawal from alcohol potentially lethal in withdrawal from alcohol than from narcotic drugsthan from narcotic drugs

Delirium tremensDelirium tremens is the term for serious is the term for serious withdrawal symptoms- hallucinations, withdrawal symptoms- hallucinations, delusions, delirium, tremorsdelusions, delirium, tremors

Brain damageBrain damage Wernicke-Korsakoff syndromeWernicke-Korsakoff syndrome

Progression of withdrawalProgression of withdrawal

Tremors, rapid heartbeat, hypertension, Tremors, rapid heartbeat, hypertension, sweating, loss of appetite, insomniasweating, loss of appetite, insomnia

Hallucinations, auditory, visual, tactileHallucinations, auditory, visual, tactile Delusions, disorientation, delirium, Delusions, disorientation, delirium,

amnesiaamnesia Seizures Seizures Others: anxiety, nausea, vomiting, feelings Others: anxiety, nausea, vomiting, feelings

of unrealityof unreality

Detoxification needs to be in an Detoxification needs to be in an inpatient settinginpatient setting

Central nervous system is rebounding from Central nervous system is rebounding from constant inhibition, so it is hyperexcitable.constant inhibition, so it is hyperexcitable.

This produces delusions of bugs crawling on This produces delusions of bugs crawling on their skin, snakes, persecutiontheir skin, snakes, persecution

Benzodiazepines, like Valium can relieve Benzodiazepines, like Valium can relieve symptomssymptoms

Protracted withdrawal syndromeProtracted withdrawal syndrome includes high includes high blood pressure, irregular breathing, anxiety, blood pressure, irregular breathing, anxiety, panic attacks, insomnia, depression, cravings.panic attacks, insomnia, depression, cravings.

Physiological effectsPhysiological effects

Peripheral circulationPeripheral circulation is increased as is increased as peripheral blood vessels are dilated.peripheral blood vessels are dilated.

Increases Increases heat lossheat loss from the body, while from the body, while producing feelings of warmth.producing feelings of warmth.

Puts the person at risk if outdoors in severe Puts the person at risk if outdoors in severe weather.weather.

Fluid balanceFluid balance is affected as vasopressin is affected as vasopressin triggers greater urination.triggers greater urination.

Hormonal effectsHormonal effects as catecholamines and as catecholamines and corticosteroids are released.corticosteroids are released.

Chronic disease statesChronic disease states

Chronic ingestion eventually affects every Chronic ingestion eventually affects every organ system in the body. organ system in the body.

Acetaldehyde irritates tissues directlyAcetaldehyde irritates tissues directly Due to empty calories of alcohol, heavy Due to empty calories of alcohol, heavy

drinkers are often malnourished.drinkers are often malnourished.

Brain damageBrain damage

Loss of brain tissue due to toxicity of Loss of brain tissue due to toxicity of alcoholalcohol

Alcoholic dementiaAlcoholic dementia is a general decline is a general decline in intellect due to toxicity of alcohol.in intellect due to toxicity of alcohol.

Can be problems swallowing, impaired Can be problems swallowing, impaired problem solving, judgment, difficulty problem solving, judgment, difficulty manipulating objectsmanipulating objects

Wernicke-Korsakoff syndromeWernicke-Korsakoff syndrome

Wernicke-Korsakoff syndromeWernicke-Korsakoff syndrome

Wernicke’s diseaseWernicke’s disease is due to deficiency is due to deficiency of thiamine- vitamin B1. May be improved of thiamine- vitamin B1. May be improved with supplements. Symptoms: confusion, with supplements. Symptoms: confusion, impaired coordination while walking impaired coordination while walking (ataxia), abnormal eye movements.(ataxia), abnormal eye movements.

Korsakoff’s psychosisKorsakoff’s psychosis results in inability results in inability to remember recent events, learn new to remember recent events, learn new things. Irreversible, although some things. Irreversible, although some improvement in behaviors if drinking stops.improvement in behaviors if drinking stops.

Symptoms of Wernicke's encephalopathy:Symptoms of Wernicke's encephalopathy:• ConfusionConfusion• Loss of muscle coordination (ataxia) (ataxia)

• Leg tremorLeg tremor• Vision changes Vision changes

• Abnormal eye movements (back and forth movements called (back and forth movements called nystagmus)nystagmus)

• Double vision• Eyelid drooping

Symptoms of Korsakoff syndrome:Symptoms of Korsakoff syndrome:• Inability to form new memoriesInability to form new memories• Loss of memory, can be severeLoss of memory, can be severe• Making up stories (confabulation)Making up stories (confabulation)• Seeing or hearing things that aren't really there (Seeing or hearing things that aren't really there (hallucinations

Liver disordersLiver disorders

Liver as affected as it puts priority on Liver as affected as it puts priority on clearing alcohol from system. As a result clearing alcohol from system. As a result other fats, proteins build up & are stored other fats, proteins build up & are stored as droplets in liver cells- as droplets in liver cells- Fatty liverFatty liver..

Eventually they can rupture the cell Eventually they can rupture the cell membranes and kill liver cells.membranes and kill liver cells.

Alcoholic hepatitis-Alcoholic hepatitis- inflammation/ inflammation/ impairment of liver function as cells die.impairment of liver function as cells die.

CirrhosisCirrhosis is deadly. is deadly.

Cirrhosis of the liverCirrhosis of the liver

Caused by heavy drinking over years. (10 Caused by heavy drinking over years. (10 years, a pint of whiskey a day)years, a pint of whiskey a day)

77thth leading cause of death in US leading cause of death in US Liver cells are replaced by fibrous tissues Liver cells are replaced by fibrous tissues

which decreases blood flow, accumulates which decreases blood flow, accumulates fluid in body, fluid in body, jaundicejaundice develops as bile is develops as bile is no longer being flushed from the body.no longer being flushed from the body.

Liver transplantsLiver transplants work if the person will work if the person will stay abstinent.stay abstinent.

Healthy vs. cirrhotic liverHealthy vs. cirrhotic liver

Tasks of recoveryTasks of recovery Identify triggers to useIdentify triggers to use Practice alternative behaviors when facing Practice alternative behaviors when facing

cravingscravings MeditationMeditation PrayerPrayer ExerciseExercise GroupGroup MassageMassage ArtArt Service to othersService to others

Produce a new environment with new people Produce a new environment with new people that do not relate to abuse.that do not relate to abuse.

Demands of recoveryDemands of recovery

Finding Finding alternative behaviorsalternative behaviors to meet the to meet the internal needs met by drugs.internal needs met by drugs.

Becoming Becoming alert to triggersalert to triggers (HALT) (HALT) Becoming Becoming proactiveproactive in managing in managing

emotional needs, not just reactiveemotional needs, not just reactive Coping skillsCoping skills must be practiced must be practiced

Vaillant’s essentials for recoveryVaillant’s essentials for recovery

Find a substitute, a positive dependencyFind a substitute, a positive dependency Reinforce the idea that even one Reinforce the idea that even one

experience with the substance will lead to experience with the substance will lead to relapse.relapse.

Heal the physical damage createdHeal the physical damage created Heal the relational damage done to othersHeal the relational damage done to others Rebuild self esteem with positive Rebuild self esteem with positive

behaviors, goals, giving backbehaviors, goals, giving back

Self help groupsSelf help groups

Develop an environment where the addict Develop an environment where the addict does not have to produce a facade of does not have to produce a facade of pride or detachment.pride or detachment.

It is not shaming to admit failure, struggle, It is not shaming to admit failure, struggle, regrets over one’s behavior.regrets over one’s behavior.

The greater the commitment to sobriety, The greater the commitment to sobriety, the more confrontation of denial s/he can the more confrontation of denial s/he can handle.handle.

Accountability is part of the process.Accountability is part of the process.

Individual counselingIndividual counseling

Useful to confront childhood issues that Useful to confront childhood issues that set addiction up.set addiction up.

Only possible once the addict is clean.Only possible once the addict is clean. Useful in recognizing current threats to self Useful in recognizing current threats to self

esteem, vulnerabilities in relationships.esteem, vulnerabilities in relationships. Requires support, or it can trigger relapse.Requires support, or it can trigger relapse.

Justice systemJustice system

Often people only begin recovery when Often people only begin recovery when mandated by court as an alternative to mandated by court as an alternative to incarceration.incarceration.

There can be powerful external motives to There can be powerful external motives to recover if one’s livelihood is threatened by recover if one’s livelihood is threatened by addiction (Robert Downey, Jr.)addiction (Robert Downey, Jr.)

Mental preparationMental preparation

People at risk are taught the principles of People at risk are taught the principles of addictive process, psychology, biochemistry addictive process, psychology, biochemistry of addiction, consequencesof addiction, consequences

Students are challenged to develop life values/ Students are challenged to develop life values/ goalsgoals

Teachers communicate positive expectations Teachers communicate positive expectations for student’s successfor student’s success

Teachers develop relationships with students to Teachers develop relationships with students to become a support system, mentorbecome a support system, mentor

Skill developmentSkill development

Coping skills are practiced to deal with stress Coping skills are practiced to deal with stress Strategies are developed to build self worth Strategies are developed to build self worth Techniques are practiced to resist peer Techniques are practiced to resist peer

pressurepressureModels show positive responses to stressModels show positive responses to stressAssertiveness trainingAssertiveness trainingBreathing & relaxation techniques are learned Breathing & relaxation techniques are learned

to slow reactivity and give them control under to slow reactivity and give them control under pressurepressure

Guided fantasy gives self confidenceGuided fantasy gives self confidence

RehearsalRehearsal

Role playing Role playing of alternative responses to of alternative responses to temptation.temptation.

PracticePractice is offered to respond quickly and is offered to respond quickly and authentically to real situations that arise.authentically to real situations that arise.

Therapists need to be confident in their Therapists need to be confident in their own recovery to stand up to the anger and own recovery to stand up to the anger and denial of the addict under pressure.denial of the addict under pressure.

Therapist models recovery skills.Therapist models recovery skills.

3 C’s of stress management3 C’s of stress management

CommitmentCommitment- to self, family, sobriety- to self, family, sobriety Control-Control- belief in one’s ability to control belief in one’s ability to control

life outcomes by exerting self-controllife outcomes by exerting self-control ChallengeChallenge- see life as a challenge, - see life as a challenge,

adventure, not an obstacle to escapeadventure, not an obstacle to escape