Addiction 101
| Site: | CAMH Public Courses |
| Course: | Addiction 101 | CAMH |
| Book: | Addiction 101 |
| Printed by: | Guest user |
| Date: | Saturday, 23 November 2024, 7:56 AM |
Table of contents
- Key messages
- Addiction: Definitions and key concepts
- How common is addiction?
- Impacts of addiction
- Risk factors and causes of addiction
- Co-occurring disorders
- Impact of prejudice and discrimination
- Harm reduction
- Access to care
- Treatment
- Stages of change
- Supporting recovery
- How to help
- Where to get help
- Quiz
- Summary
- Congratulations!
Key messages
Addiction 101 © , CAMH.
Addiction: Definitions and key concepts
Many people are affected, directly or indirectly, by addiction, which may also be called substance use disorder if a person is addicted to alcohol or other drugs.
The indicators of addiction can be summarized using the memory aid ABCDE (ASAM, 2011):
For people working in the addiction field, having definitions of substance-related and addictive disorders can make it easier to diagnose a problem and suggest a treatment program. The Diagnostic and Statistical Manual of Mental Disorders (5th edition; APA, 2013), also called the DSM-5, categorizes substance use and gambling disorders and provides criteria for diagnosing these problems.
An element of addiction is the way a person responds to certain situations and stressors, and not necessarily the amount or frequency of the substance use or addictive behaviour. People with an addiction problem are pre-occupied with obtaining rewards (i.e., alcohol or other substances, gambling). They continue pursuing these rewards, even though there are negative consequences. These behaviours can be compulsive or impulsive and may signal a loss of control.
Note: There are differences in how clinicians diagnose their patients. They may be influenced by the culture and region in which they practice, or by the client’s race, class or gender. Additionally, what is identified as a disorder is always changing in response to new research or social awareness. For example, although substance use disorder and gambling disorder are the only recognized addiction diagnoses in the DSM-5, Internet gaming disorder is currently being considered for future editions of the DSM (APA, 2013).
Addiction 101 © , CAMH.
Substance use
The DSM-5 (APA, 2013) describes ten kinds of substances that can be the focus of substance use disorders, including alcohol, cannabis, opioids, stimulants and tobacco. The DSM-5 (APA, 2013) outlines 11 criteria for substance use disorder, which are divided into four categories of substance use-related behaviours (Portico, 2017):
- loss of control
- social impairment
- risky use
- substance-related signs (tolerance and withdrawal)
Substance use disorder is measured on a spectrum from mild to severe. The severity of the disorder is determined by the number of diagnostic criteria that a person meets (Portico, 2017).
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Video
2015 OSDUHS Survey Findings (2:32)
This video discusses some of the findings of the Ontario Student Drug Use and Health Survey (OSDUHS), one of the longest running school surveys in the world. It is internationally recognized for its contributions to understanding and addressing substance use, mental health, physical health and risk behaviours among adolescents.
Dr. Robert Mann: The Ontario Student Drug Use and Health Survey, or OSDUHS as we call it, is an omnibus survey that collects information on mental health, substance use and health behaviours from students in Grades 7 to 12 in the province of Ontario.
One of the focuses of this report is technology, and by technology we mean things like screen time, cyberbullying, social media use, video gaming. We are seeing high levels of engagement with social media in the student population. Eighty-six per cent report visiting these sites daily. More concerning is we see 16 per cent of students reporting five hours or more per day on social media sites. One of the things we've been tracking is problem video gaming, that's increased significantly over the years from around seven per cent to 13 per cent now in 2015. And that's about 120,000 students, which is a substantial number. And by problem, we mean that these students are having trouble controlling the amount of time that they spend playing these games and meeting their other responsibilities because the games are interfering with that.
Lisa Pont: We know that boys are four times more likely to have a problem with video game playing. Technology overuse in general is a little bit harder to say. Girls tend to use different things than boys. With girls, we know that maybe they might be more likely to have a problem with social media. But we know that things are complex because even within social media, sometimes there are games.
Dr. Robert Mann: One of the measures that we track is texting and driving. And we see that overall, among student drivers in Grades 10 to 12, about a third of them report texting and driving. And by the time the students are in Grade 12, over 44 per cent of them report texting and driving.
Lisa Pont: It's a behavioural response that when something vibrates or dings or lights up we're going to look at it. We're going to want to look at it. When you're a younger person, especially if you are a younger person with tech overuse, it might be more difficult to delay that impulse.
Dr. Robert Mann: Nearly two-thirds of the students are what we call “screen time sedentary,” which means they spend three hours or more per day in front of a screen outside of school hours. And we see that these numbers have increased significantly over the past few years.
Lisa Pont: The results that I'm seeing among young people with technology overuse is increased rates of anxiety and depression, family conflict, school performance issues and often an inverted sleep schedule, so they are up all night with their technology and sleeping during the day or maybe missing some class or not being able to pay attention in class.
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Key concepts in substance use
Tolerance
When a person needs higher doses of a substance to produce the same effects they experienced during earlier use, they have developed tolerance. People often develop tolerance while they are physically dependent on a substance (Portico, 2017).
Withdrawal
When a person reduces or stops their substance use after a period of using regularly, they experience withdrawal symptoms. This results in unpleasant sensations and feelings.
A person’s withdrawal symptoms are opposite to the main effect of the substance used. For example:
Physical dependence
Physical dependence is a bodily state that may develop with regular drug use. It includes withdrawal symptoms and increased tolerance (Portico, 2017).
When at least three of the following occur in the same 12-month period, it is considered physical dependence (WHO, n.d.):
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Video
Ask Dr. Goldbloom: Alcohol Dependence (4:02)
Dr. Goldbloom and his special guest, Dr. Bernard Le Foll, discuss alcohol dependence, a substance use disorder where a person is physically or psychologically dependent on alcohol.
Dr. David Goldbloom: Hi, I'm Dr. David Goldbloom, senior medical advisor at the Centre for Addiction and Mental Health, and I'm with you today to talk about alcohol dependence, a substance use disorder where a person is physically or psychologically dependent on drinking alcohol.
Most people who drink alcohol think of themselves as moderate or social drinkers, but drinking has risks, and for some people it can lead to problems. If you're dependent on alcohol, you can have real trouble stopping, even if you want to, even if the social or financial or other consequences of drinking start to outweigh the benefits for you. At CAMH's Alcohol Research and Treatment Clinic, led by Dr. Bernard Le Foll, the emphasis is on reducing alcohol dependence.
Dr. Bernard Le Foll: Alcohol dependence is the most prevalent and one of the most severe forms of addiction in Canada, so it is important to recognize the warning signs.
Dr. David Goldbloom: The common signs and symptoms of alcohol dependence can include the following: not being able to control your drinking or not being able to quit, needing more and more alcohol to get the same effect, spending more and more of your time either drinking or hungover and finally, experiencing withdrawal acutely when you stop drinking, and that can mean sweats or shakes or simply craving alcohol.
Dr. Bernard Le Foll: Alcohol dependence is associated with multiple health risks. Alcohol affects the proper functioning of the brain, so this results in difficulty thinking, communicating with others or operating motor vehicles safely. Alcohol dependence also results in psychiatric problems, notably high rate of depression, severe anxiety, and the rate of suicide attempts in people with alcohol dependence is six times higher as compared to general population.
Dr. David Goldbloom: Many people will need help to stop drinking. Fortunately, there are options available for people struggling with alcohol dependence. These include individual and group therapies, self-help and support groups, family supports and even residential treatment. Drug therapies, using drugs like naltrexone or acamprosate, are also a viable option for alcohol dependence.
Dr. Bernard Le Foll: Drug therapy is now considered a viable option that is well tolerated, presents not much side-effects and allows increased success rates.
Dr. David Goldbloom: If you're having trouble dealing with your drinking, don't be shy. Talk to a friend or to a professional, like your family doctor, about getting some help. If you'd like some more information about alcohol treatment, you can call CAMH at the number that's on the screen right now (416 535-8501 – press 2) or you can call Ontario's drug and alcohol helpline (1 800 565-8603). They're open 24/7.
And did you know that CAMH has developed an app that allows you to monitor your drinking? You can download the Saying When app at the iTunes Store.
I'm Dr. David Goldbloom. Thanks for watching.
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How common is addiction?
Over the course of the 2015, 13 per cent of people in Canada used at least one of six illegal substances, an increase from 11 per cent in 2013. The increases were mainly in the use of cannabis, hallucinogens and ecstasy (Health Canada, 2017).1
Approximately 21.6 per cent of people in Canada meet the criteria for substance use disorder during their lifetime (Pearson et al., 2013).
Males (15 per cent) are more likely to use illegal substances than females (10 per cent) (Health Canada, 2017).
Youth between 15 and 19 (21 per cent) and young adults between 20 and 24 (31 per cent) are more likely to use illegal substances than adults age 25 years or older (10 per cent) (Health Canada, 2017).
18.1 per cent of people in Canada met the criteria for alcohol abuse or dependence, making it the most commonly misused substance (Pearson et al., 2013).
More Canadians have symptoms of problematic cannabis use (6.8 per cent) than any other illegal drug (4 per cent) (Pearson et al., 2013).2
In Canada, 2.4 percent of the general population has a gambling problem (Williams et al., 2012).
22 per cent of Canadians over age 15 have taken psychoactive prescription drugs, specifically opioid pain relievers, stimulants (such as medication prescribed for attention-deficit/hyperactivity disorder) and tranquillizers/sedatives. Of that population, 3 per cent abused the drug (Health Canada, 2017).
1. This study was completed before the legalization of cannabis in 2018; as such, cannabis is defined as an illegal substance.
2. This study was completed before the legalization of cannabis in 2018.
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Impacts of addiction
Addiction can affect all parts of a person's life, including their physical health, brain function, emotional well-being, finances, work life and social relationships, including with family. Each family member is uniquely affected by a person’s substance use or gambling problem. It may be helpful to think of the family as a mobile: when one part of a hanging mobile moves, it affects all parts of the mobile in different ways. Each part adjusts to maintain a balance in the system (Lander et al., 2013).
Families and friends are significantly impacted by loved ones’ substance use problems in various ways.
Some effects on the family may include:
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A note about culture
A person’s cultural background may affect the way they view their own and other people’s behaviour, whether they seek help for mental and emotional states and from whom they seek help.
Mental health professionals must be trained in cultural competence. These skills help professionals consider a person’s unique cultural experiences when trying to understand their mental state. People in supporting roles also need to be aware of their culturally based values. This awareness can help them avoid treating people with a bias.
For example, many Canadian newcomers from Ethiopia, Somalia, Uganda and Kenya use khat. It is a part of their cultures; it would not be unusual to find a whole family sitting down and chewing khat. In many places, people see this as similar to sharing a cup of coffee or tea. While using khat may be socially accepted and its use may be widespread by people in these cultures, frequent and heavy use is sometimes perceived to have negative consequences for people, their families and the community. For this reason, the use of khat is seen as unacceptable in Canada. As such, it has been made a controlled substance under Canada’s Controlled Drugs and Substances Act (1996). It is important to consider these cultural differences when deciding whether someone may have a substance use problem (Sykes et al., 2010).
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Risk factors and causes of addiction
Addiction problems result from a complex interaction of genetic (e.g., biological/physical) and environmental risk factors (e.g., family behaviours, social norms, a history of trauma). Family,
twin and adoption studies 
show that people who grow up in a family where there is a substance use problem are at significantly higher risk of developing a substance use problem. This indicates that environmental factors play a role, rather than genetics. Other studies show that approximately 50 per cent of alcohol and other drug problems are due to genetic factors (Buscemi & Turchi, 2011). Addiction is complex; many people with substance use problems also have trauma histories. Dr. Gabor Maté believes that pain is the root cause of addiction.
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Video
What is Addiction? Dr. Gabor Maté (3:24)
Dr. Gabor Maté talks about pain being the root cause of addiction and how to deal with pain in other ways.
All the substances of abuse, whether they're opiates or cocaine or anything else, they're actually painkillers. Some of them, specifically, are painkillers. But physical pain and emotional pain, the suffering is experienced in the same part of the brain. So when people suffer emotional rejection, the same part of the brain will light up as if you stuck them with a knife. Eckhart Tolle says very nicely that addictions begin with pain and end with pain, so that all the addictions are attempts to soothe the pain. When I work with addictions, the first question is always not why the addiction, but why the pain. And what you find is emotional loss or a trauma. In the case of the severe addicts, as in the downtown Eastside here, there were every single one of them traumatized. There's no women walking the streets here who have not been sexually abused, not even by accident. But you know whether it's a sex addiction, or Internet, or relationship, or shopping or work addiction, these are all attempts to get away from distress. Keith Richards, the Rolling Stones guitarist, who used to have a severe heroin habit as you know, he said that all the contortions we go through just not to be ourselves for a few hours. Why would somebody not want to be themselves? Because they're in too much distress, in too much pain. So I don’t care what they tell you about genetics or choices or any of that nonsense. It’s always about pain. The Tibetan Book of Living and Dying, it's got a wonderful line in it: “Whatever you do, don't try and escape from your pain, but be with it,” because the attempt to escape from pain is what creates more pain. And that's the reality with addiction. But the question is, how can people be with their pain? Only if they sense some compassion from somebody. As another teacher says, only when compassion is present will people allow themselves to see the truth. Addicted people need a compassionate present, which will permit them to experience their pain without having to run away from it. And all the attempts to run away, it's like another teacher says, the surest way to go to hell is to try run away from hell. So you gotta be with that pain, you just have to be with it, but you have to have some support. And we live in a society that, one way or the other, it is always about instant relief, quick satisfaction, distraction. In other words, we live in a culture that is based on, both economically and psychologically, on not supporting people to be with themselves. So it's always the quick getaway. It's very difficult to deal with addictions in this society but, yeah, it is a matter of, at some point, finding a way of being with your pain so that you can actually get to know what it's really all about.
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Co-occurring disorders
When someone has both a substance use problem and a mental health problem, it is called a co-occurring, or concurrent, disorder. Sometimes substance use can cause a mental health problem. Or, a mental health problem may lead people to use substances to relieve their symptoms. The relationship between substance use and mental health problems is more complicated than simple cause and effect. There are four types of interactions (O’Grady & Skinner, 2007):
Having either a substance use or a mental health problem greatly increases the possibility of having the other problem. Specifically, more than 15 per cent of people with substance use problems have co-occurring mental illnesses, while at least 20 per cent of people with a mental illness have a co-occurring substance use problem (CAMH, n.d.). These problems can look very similar, which makes it difficult for family members and professionals to know whether their loved one or client is experiencing a substance use problem or a mental health problem—or both.
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Impact of prejudice and discrimination
Fear and misunderstanding often lead to prejudice against people with substance use problems. Prejudice includes unfounded and biased opinions, and discrimination is the physical act that is based on these beliefs. This can be referred to as “stigma.” When people experience prejudice and discrimination, they may feel even more hopeless and ashamed. The stigma attached to mental health and substance use problems is a serious barrier, not only to diagnosis and treatment but to acceptance in the community.
Prejudice and discrimination can:
Stigma can have many layers. People may face prejudice and discrimination because of their substance use, as well as their race, culture, religion, sexual orientation, economic status or age. Multi-layered stigma can create huge barriers for people who want to seek treatment or support for their substance use problem.
Some people have said the prejudice they experience is worse than their original substance use problem. Anticipating or experiencing prejudice stops many people with substance use problems from seeking help or continuing treatment.
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Stats
Stigma is a major barrier to recovery. A survey carried out by the Canadian Centre on Substance Use and Addiction (CCSA, 2017) found that:
during active addiction, 48.7 per cent of participants experienced stigma or discrimination
82.5 per cent of participants experienced barriers to starting their recovery journeys.
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Video
Stigma and Discrimination in the Language of Addiction, Dr. Kenneth Tupper (1:32)
Dr. Kenneth Tupper discusses how language can be stigmatizing for people with addiction problems.
My name is Kenneth Tupper. I'm the director of implementation of partnerships with the BC Centre on Substance Use. I'm also an adjunct professor in the School of Population and Public Health at the University of British Columbia.
A language for humans is kind of like water for fish, in that we swim in it. It's part of our everyday reality. But seldom do we, sort of, have an opportunity to, sort of, step outside it and see the influence that it has. So language shapes our thinking. There are, kind of, eddies and swirls that move around us, and sort of push us in certain directions in the way we frame ideas and think about things. That is, they unconsciously can sometimes perpetuate issues, like stigma and discrimination where maybe they're not intended, but still, kind of, have that effect on other people, particularly from systems of power and influence, such as medical or health care professions.
For a long time, we stigmatized people who use drugs with this, sort of, disparaging terms like junkie or addict, but now we understand that these are all people. And to think about them as people first is really important, not just in how we think, but also in how we talk. So to talk about people who use drugs, rather than say junkie or addict or even drug user, is a shift away to a more person-centric frame.
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Harm reduction
It's important to consider harm reduction as part of a broad approach to health and well-being. The goal of harm reduction approaches is to reduce harms for the person using substances, as well as to the community. These measures aim to save lives and reduce suffering without requiring that a person stop a behaviour or activity that may have risks, such as using substances or engaging in sex work. A harm reduction approach emphasizes a person's right to self-determination, allowing them to choose their own definition of recovery and wellness. Abstinence, in which a person stops using a substance completely, is one point on the harm reduction spectrum. People have different opinions about whether this practice is necessary to avoid the harms from substance use.
Harm reduction helps care providers adopt a less judgmental attitude when working with clients who continue to use substances. It also helps reduce the stigma associated with these behaviours (Portico, 2018). Remember that people who use drugs are not defined by their substance use. They are people who are worthy of dignity and autonomy.
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Access to care
Various barriers can make it difficult to gain access to addiction services (CCSA, 2017), including:
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Treatment
Most addiction problems can be treated so that people can maintain day-to-day functioning. Treatment comes in many forms, including individual and group therapy, counselling, psychosocial intervention and medication, such as opioid agonist therapies for opioid addiction (Institute of Health Economics, 2014).
Community supports, such as outreach services, housing-related advocacy and mutual support groups are also available. In Ontario, treatment and supports for substance use and gambling problems are provided across many settings, including by family physicians, psychiatrists, hospitals, outpatient programs and clinics, community agencies and private practitioners (Public Health Agency of Canada, 2015). Many people also use self-help approaches, such as Alcoholics or Narcotics Anonymous.
Since different factors lead to addiction, no single type of treatment will work for everyone. Meeting with a trained counsellor for an addiction assessment is a good start. The assessment helps to identify a person's problems and strengths, and to figure out what treatment approach and level of support best suits each person.
Assessing a client's readiness to change is the best way to improve the chances that change will happen. Interventions that align with the client's stage of change can increase motivation and promote positive change (Portico, 2017).
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Stages of change
The stages of change model (Prochaska et al., 1992) explains how deliberate change can happen.
The model describes five stages that people go through when changing their behaviour: precontemplation (not ready), contemplation (getting ready), preparation (ready), action and maintenance. The model assumes that everyone goes through a similar process when changing a behaviour (Prochaska & Prochaska, 2009). An unofficial sixth stage is called "relapse." At this stage, a person returns to old behaviours. For example, someone might have a beer after a period of abstinence or smoke a cigarette after quitting. Relapse is common. It is best to be realistic about the likelihood of relapsing, and to see it as a normal part of the process, rather than as a failure.
Please click on the information button 
to learn more about each stage.
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Supporting recovery
People can, and do, recover from addiction, especially when the right treatments, services and supports are available. These services can include early identification and intervention, peer support, mutual aid, outreach and engagement, harm reduction, specialized treatment, relapse prevention and continuing care (CCSA, n.d.-b).
Recovery from addiction is best achieved through a combination of mutual support, professional care and self-management (ASAM, 2011).
Informal or self-administered treatments are also very important. Being aware of negative emotions, repeating positive messages, noticing body reactions, countering stress with a healthy diet, relaxing, making art, exercising, listening to music, sleeping, spending time outside and practicing mindfulness are ways that people can manage their mental health and prevent relapse. The most helpful methods are different for everybody. Over time, each person will learn what works best for them.
It’s important to remember that regardless of what stage someone is in, it is possible to be supportive without feeling responsible for fixing the problem. Johann Hari (2017) points out that connection with other people may be one of the key factors for change. Receiving support from someone who cares may be a major factor in someone’s recovery journey.
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Stats
In a survey carried out by CCSA (2017), participants said that the most important reasons for starting their recovery journey were:
People take different paths while on their recovery journeys. In this study, many participants used a combination of professional treatment services, informal supports and mutual support groups.
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Video
Fighting the Stigma of Opioid Addiction with Stories of Recovery (4:37)
People working on the front lines at the Hazelden Betty Ford Foundation offer their insight on the opioid crisis, addiction and recovery.
Woman: Opiates. My drug of choice was opiates.
Man: Barbiturates, Quaaludes, downers and then heroin finally.
Man: I actually lost my mother to an opioid overdose. This was two years ago. She was 59 years old, the most important person in my life.
Man: I don't have a personal story, per se. And I think the humanistic spirit of addiction is what really drew me to it.
Woman: I began self-medicating with prescriptions that were left over in my own medicine cabinet. When those were gone, I began to do, and divert, medications from my place of employment as a nurse.
Woman: I was coming off an amphetamine binge and what would happen is that I would become very tired. So I lied down on the couch with my little boy. While I was asleep, I started coughing, and when I coughed, it woke me up a bit. The house was filled with smoke and the house was on fire. And in my mind I said, “Thank God it's finally over”. Then, my son coughed and I heard in my mind or in my—wherever it came from—the voice said, “You can do what you want with your life. You have no right to take his.”
Man: The first time I used chemicals, it felt like the universe slipped into place.
Man: At its best, addiction was a comfort, it was a friend actually. Addiction, at its worst, was a monkey on my back.
Man: Such a bad feeling, physically and psychologically. And the only way really to effectively stop it at the time was to use again and again.
Man: It's totally illogical. I did not want to get high. I didn't want to use. I didn't want to drink. It was ruining my life.
Man: My parents, when they'd see me high, or that I had used, they'd think I was okay. They’d get worried about me when they’d see me in withdrawal, because that's when I’d look bad.
Man: We make a lot of mistakes about the opioid crisis, partly because of the stigma. Whenever it comes to addiction, especially to opioids, we talk about drugs and we don't talk about people.
Man: People are afraid to ask for help. Families don't want to talk about it.
Man: Like standing here now talking about it, I'm a bit uncomfortable, because I am not sure how people react to it.
Man: I was in my undergraduate program in college, and I needed to go to treatment, and I told someone about it who was in a position of power. They looked it as a—I think—a character issue. I would love for my kids to know that if they're struggling with mental health or addiction, it's not that there's something wrong with their character, it's that they may have this illness.
Man: It's been around forever. And there have been communities devastated by addiction, even opioid or heroin addiction, long before it became national news. When white kids in the suburbs started to die off, is when the country started to pay attention. And there's a shame in that.
Man: Part of my mission in life, and my mission at work, is to expose the public to the other side of the story: the recovery side of the story.
Man: I owe people out there who don't know about recovery, and don't know that recovery is possible, I owe it to them to let them know that it is.
Man: If I could talk to my mother today, and I guess I do in my quiet moments, I'd really want her to know that my recovery is because of her.
Man: I have two beautiful children: I have a four and a two-year-old. I have a wife. I have a job that I love, and I'm happy.
Man: I’m married now. I have two kids. I'm in Center City, Minnesota, and I have to stop and remind myself of that sometimes. I'm from Cairo, and if you would have told me, you know, 15 years ago, “You’ll be standing in a basement of Richmond Walker in Center City, Minnesota, talking to people from PBS,” you know, I’d be like, “Okay.” (Laughter)
Man: My name is Jeremiah Gardner.
Woman: My name is Cecilia Jayme.
Man: My name is Ahmed Eid.
Woman: My name is Carrie Kappel.
Man: My name is Dan Frigo.
Man: My name is Jordan Hansen.
Man: My name is Dr. Joseph Lee, and this is my “brief but spectacular” take.
Woman: “Brief but spectacular” take.
Man:: This is my “brief but spectacular” take on addiction and recovery.
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How to help
You may be concerned about yourself, or about a friend or family member. Encouraging someone to get support, helping them connect with a service or resource and/or becoming an advocate are all ways to help. While there are barriers, it's important to know what services and supports are available. Remember that people must consent to treatment, and that their treatment will be most effective when they participate willingly.
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Where to get help
CAMH.ca is an excellent resource for finding out about services, including crisis services.
Supports and education for families and friends
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Post-course questionnaire
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