Unit 2: : ADDICTION COUNSELLING

ADDICTION DEFINITION
•Substance activity or person used to escape from negative feeling stages despite negative consequences.
•Addiction can be chemical or behavioral.
•They help people escape distress by providing a rush of pleasure chemicals.
•Even though nothing about the persons situations has changed, the activity or substance causes a feeling of
euphoria making them forget about their distress.

Addiction is a biopsychosocial disorder that emerges from the use of alcohol and drugs.
•An individual with an addiction is dependent on a given substance. The cessation of the consumption of such a
substance evokes Addiction is not limited to drugs and alcohol. People can be addicted to many things , such as food
gambling, shopping or most anything that gets in the way of a healthy lifestyle . When things can go out of hand and
people behave compulsively, regardless of the consequences.

MODERN DEFINITION OF ADDICTION

• The American society of addiction medicine defines addiction as a “ treatable , chronic medical disease involving
complex interactions among brain circuits, genetics, the environment and the individuals life experiences .
•A behavioural pattern of drug abuse, characterized by
a) Overwhelming involvement with the use of a drug ( compulsive use)
b) The securing of its supply ( compulsive drug seeking)
c) A high tendency to relapse after withdrawal .

WHY PERSON GO FOR DRUGS

•Drive behind –
1. Relief from tension and anxiety.
2. To get kicks and pleasure
3. Show of identity and hostility to society
4. As a notion of a part of ‘ Hi- FiModern’ society.
5. A misconception that drugs increase creativity.

CHARACTERISTICS OF ADDICTION
•Harm to personal as well as society also.
•Intense craving present
•Tolerance develop
•Life threatening withdrawal effects.
•Health problems do not stop their addiction
• Dealing with issues
• Secrecy and denial
•Relationship issues

SIGNS OF ADDICTION

•Preoccupation with getting, using and recovering from use

•Failed attempt to end or reduce use.
•Needing more(tolerance) and craving
•Declining health
•Declining performance
•Increased risk of job loss, loss of friends

FACTORS INVOLVED IN LEARNING ADDICTIVE BEHAVIOR

• Family history
• Family life
• Peers and school life
• The age at which a person first consume drugs
• the nature of the substance
• Stress

DIAGNOSTIC CRITERIA FOR ADDICTION

•The DSM-V contains a substance use disorder (SUD) diagnosis. The diagnosis is used to assess whether an
individual presents a disorder, as well as how severely.
•The 11 diagnostic criteria fall under the categories of impaired control, physical dependence, social problems and
risky use

BEHAVIOURAL ADDICTIONS
• DSM-5 also recognizes two type of behavioural addiction
• Gambling addiction
• Internet and gaming disorder
While shopping addiction and exercise addiction are often noted as behavioural addiction, DSM-5 does not officially
recognizes these as distinct disorders

ADDICTIONS VS. SUBSTANCE USE DISORDERS

The term addiction is used to describe compulsive drug-seeking behaviors that continue in spite of negative
outcomes
• Substance abuse is a pattern of drug or alcohol use that leads to negative consequences. It often brings about
problems in work or school, impacts relationships with friends or family members, and introduces dangerous
or potentially life-threatening situations.
•Dependence, however, is a physical and mental reliance on drugs or alcohol. People who struggle with substance
dependence are unable to stop using despite the negative consequences, and experience cravings
and withdrawal symptoms when they do.

SUBSTANCE DEPENDENCE ( IMPORTANT TERMS )

•A person is said to be dependent on a substance when he or she has repeatedly self-administered it, resulting in
tolerance, withdrawal, and compulsive behavior (American Psychiatric Association, 2000).
•Substance dependence can include physical dependence, when the body has adjusted to the substance and
incorporates the use of that substance into the normal functioning of the body’s tissues.

•Physical dependence often involves tolerance, the process by which the body increasingly adapts to the use
of a substance, requiring larger and larger doses of it to obtain the same effects, and eventually reaching a
plateau.
•Craving is a strong desire to engage in a behavior or consume a substance. It results from physical
dependence and from a conditioning process:
•As the substance is paired with environmental cues, the presence of those cues triggers an intense desire for the
substance
•Addiction occurs when a person has become physically or psychologically dependent on a substance following
repeated use over time.
•Withdrawal refers to the unpleasant symptoms, both physical and psychological, that people experience when they
stop using a substance on which they have become dependent. Although the symptoms vary, they include anxiety,
irritability, intense cravings for the substance, nausea, headaches, tremors, and hallucinations.
STAGES OF ADDICTION•
The first stages of addiction –
first use or experimentation
•Continued use of substance
•Dependence
•Addiction

EXPERIMENTATION
Experimentation is defined as the voluntary use of drugs without experiencing any negative social or legal
consequences. For many, experimentation can occur without any desire to continue using the drug. For others, it can
start to become a problem when it moves into the next stage of addiction.

CONTINUE USE OF SUBSTANCE (REGULAR USE)

The problem with regular use is that the risk for substance abuse greatly increases during this stage. It also increases
riskybehaviors such as driving under the influence, unexplained violence, and symptoms of depression and anxiety.
DEPENDENCE/ RISKY USE ( ABUSE)
• usually defined as continued use of drugs in spite of severe social and legal consequences.
• warning signs of addiction will begin to appear: craving, preoccupation with the drug, and symptoms of
depression, irritability and fatigue if the drug is not used.
• Characteristics of dependence include:
✔ Failure to fulfill major responsibilities ex: work, family, schools and other roles.
✔ Physically hazardous EX: driving or operating heavy mechinary when intoxicated.
✔ Repeated legal , familial and relationship problems surrounding the substance.

ADDICTION
Physical dependence on a drug is often intertwined with addiction. Characteristics of drug addiction include
withdrawal symptoms and compulsive use of the drug despite severe negative consequences to his or her
relationships, physical and mental health, personal finances, job security and criminal record.

SIDE EFFECTS OF ADDICTION

• Loss of appetite
• Headache
• Anxiety
• Elevated blood pressure
• Chest pain
• Irregular heartbeat
• Difficulty in urinating
• changes in body Temperature

GOAL SETTING IN ADDICTION

•A key to component for recovery from substance use disorder is by setting S.M.A.R.T goals (Specific, Measurable,
Attainable, Realistic & Time Bound).
•Goals help you prioritize, achieve your aspirations, augment your motivation for growth and enhance confidence
and self-worth. Goals are important for staying on track and help to reaffirm recovery process

GOAL SETTING
•Goal setting can be defined as a way be which the individual determines what they want to achieve and then devise
a plan for achieving this. Once people have decided on their objective they can begin working towards it. They will
be able to judge their own progress by assessing if they are any nearer their goal.

SET GOALS THE SMART WAY

• When creating goals, use the acronym SMART:
• Specific: Rather than setting vague goals (ex: “stay strong in recovery”), be specific.
• Measurable
• Attainable: To set attainable goals, you need to know yourself. Instead, set small goals
that you can then increase incrementally. Also, don’t set a goal that depends on another
person’s participation.
• Realistic
• Timely: Putting a time limit on your goal will keep you focused and motivated to push
forward. At the end of the timeframe, you can reevaluate and set another goal.

WHAT TYPES OF GOALS SHOULD YOU SET IN ADDICTION RECOVERY?

1 Commit to Quiet Time Each Day
2 Maintain Your Health Each Day
3 Attend Recovery Meetings Regularly
4 Commit to Fostering Relationships
5 Commit to Taking a Step Toward Achieving Something of Value to You

STAGES OF CHANGE MODEL FOR OVERCOMING ADDICTION

• The “stages of change” or “transtheoretical” model is a way of describing the process by which people overcome
addiction. • There are four main stages in this model: precontemplation, contemplation, preparation, and action.
Maintenance and relapse are also sometimes included as additional stages. • These stages can be represented as a
cycle, and in theory, people should go through these stages in sequence. In reality, people can jump about between
stages, go backward and forward, and even be in more than one stage at a time.

NATURAL RECOVERY Solo (natural) recovery involves the use of one’s own intrapersonal and interpersonal
resources (family, kinship and social network) to resolve Addiction problems without benefit of professional
treatment or involvement in a recovery mutual aid community, called as natural recovery.

WAYS OF NATURAL RECOVERY

1. Humility :Some people independently solve their addiction problem (natural recovery). Others ask for help. In
both cases, it is a humbling experience to face the reality of addiction. This humility extends to treatment
professionals as well.
2. Motivation :
3. Sustained Effort :Sustained effort is needed to persevere through the initial periods of discomfort. •Restore
Meaning and purpose to life : To succeed in recovery, something else must fill that void. At the onset, build your
recovery around things that give your life meaning and purpose. This might mean spending more time with your
kids. It might mean enjoying the benefits of healthy recreation such as hiking or going to the gym.
12 STEPS RECOVERY MODEL

• First developed in the 1930s, the 12 Step model originated with and through Alcoholics Anonymous.
• The role of 12 Step model in the drug treatment process continues to be a vital source of support, direction and
community for people recovering from addiction
. • The 12 Step model helps in strengthening relationships between local treatment facilities.
•The step includes:
❑Confronting the addiction problem ( step 1, 4,5,7)
❑A Change in Attitude ( step 9,10,11)
❑Changing Belief Systems ( step 2, 3 )
❑Behavior change ( step 6, 8 & 12)
•Confronting the Addiction Problem: Confronting the addiction problem becomes the first step in recovery with
Step 1 being an admission of powerlessness over addition. This requires a level of honesty that can only come about
through heartfelt change. Likewise, Steps 4, 5 and 7, all of which speak to a person’s motivation to get well call for
honesty, courage and integrity in the face of addiction.
•A Change in Attitude :. This type of behavior reflects an attitude towards self and others that can only work to
derail a person’s recovery efforts. Step 9 of the 12 Steps deals with asking for forgiveness from those wronged,
whereas Step 10 emphasizes making peace with of one’s mistakes which enables a person to move forward in the
recovery process. Step 11 encourages those in recovering to embrace a life purpose, which also helps in shaping a
healthy attitude towards drug-free living
. •Belief Systems : Faulty belief systems act as a driving force behind the addiction mindset. Steps 2 and 3 in the 12
Step model stress the importance of hope and faith based on the guiding principles of a Higher Power. In effect,
these steps promote perseverance and a belief that recovery is possible.
•Behavior Change: . Step 6 stresses the importance of being willing to let go of old behaviors, while Step 8 calls for
discipline in following through on making the changes necessary to stay well. Step 12 brings the recovery path full
circle calling for actions that demonstrate gratitude by serving and helping others in need.
•Considerations: According to the National Institute on Drug Abuse, a good majority of drug treatment programs
encourage those in recovery to participate in support group settings as a means for gaining insight, social support
and continued guidance throughout the recovery process

THE MINNESOTA MODEL OF ADDICTION

• The Minnesota Model of addiction treatment is commonly called the “abstinence model.” It is an outgrowth of the
original 12-step program developed by Alcoholics Anonymous and was founded by two people who worked in a
state mental hospital in the 1950s. this model is used for the treatment for alcohol and other drug dependence.
• A major element of the Minnesota Model is group work. The majority of treatment takes place in group settings,
with group therapy, support groups, classes, and meditation groups being important focal points

Characteristics of this model :

•Abstinence based treatment
• Professional, multidisciplinary treatment team
• 12 step programme philosophy
•Education about addiction as a primary, chronic treatable bio-psychosocial disease
. •Therapy counselling for families
•Aftercare planning involving ongoing AA.

INDIVIDUAL COMPONENTS OF MINNESOTA MODEL AND THEIR BENEFITS INCLUDE THE

FOLLOWING
• Detoxification
• Psychological Evaluation
• Group meetings
• Education lectures
• Referral to appropriate services
The Minnesota Model also emphasizes longer care periods, with inpatient treatment lasting at least 4 weeks and
incorporating daily requirements. .the Minnesota model aims to make people’s recovery process more involved and
thorough, and therefore more effective, than other treatment programs that focus mainly on detoxification.

MINNESOTA MODEL TREATMENT CHALLENGES

•Minnesota Model Treatment is
❑Expensive
❑Time consuming
❑And often takes more than one course of treatment to help addicts get to the point of having sustainable recovery

WHAT DO WE MEAN BY “COMMUNITY-BASED” TREATMENT?

• Located in the community
• Community empowerment: Mobilization of community resources and participation
• Bio-psycho-social approach
• Primarily outpatient setting
• Continuum of care • Integrated in community health and social services

COMMUNITY BASED TREATMENT SERVICES ARE DESIGNED TO:

• Help patients develop the skills to manage their drug and alcohol dependence and related problems in the
community
• Stop or reduce the use of drugs and alcohol
• Respond to a wide range of individual needs and ensure the best possible outcomes
• Actively involve local organizations, community members and target populations in the establishment of an
integrated network of community-based services in a manner that is empowering
• Reduce the need and demand for residential treatment and custodial services for people with drug and alcohol
problems

PRINCIPLES OF COMMUNITY BASED TREATMENT

• Availability and Accessibility of Dependence Treatment
• Screening, Assessment, Diagnosis and Treatment-Planning
• Evidence-Informed Dependence Treatment
• Dependence Treatment, Human Rights, and Patient Dignity
• Targeting Special Subgroups
• Dependence Treatment and the Criminal Justice System
• Community Involvement, Participation, and Patient Orientation
• Clinical Governance of Dependence Treatment Services
• Treatment Systems: Policy Development, Strategic Planning and Coordination of Services

COMMUNITY BASED INTERVENTION

• Functioning of the community based camp method for helping substance dependents consists of five stages
: 1. Preventive education in locality, combined with motivation of potential clientele to seek help
2. Preparation of clients for detoxification, family counselling and organising community for conducting a camp
3. Detoxification
4. Development of a further treatment/rehabilitation plan by clients with the assistance of family members and
community leaders,
5. Follow-up

.There are three major components to the model:

• Community organizations including NGOs help identify drug users, conduct basic screening of drug problems and
refer to primary health services when required. Community organisations focus on preventive education and health
promotion and on the delivery of basic support, reintegration and rehabilitation services
• Screening, counseling, primary health and referral services are provided in health centers. Patients are referred to
hospitals or clinics as required for specialized treatment of drug dependence, infectious diseases, or mental disorders
• Social welfare agencies and NGOs offer education, counselling, vocational and skills training, income generation
opportunities, micro-credits, and other psychological and social support
•Involving the community members will have certain definite advantages:
❑ Both the common man and the professionals will come together to share their experiences.
❑ Community leaders will become more acquainted with the problem of addiction.
❑Belongingness in the community will increase.
❑Community members will be able to support the recovering addicts’ actively in their recovery.
❑It will rebuild the social contacts and social life of the recovering addict.