Download Consequences of Addiction

HEALTH AND WELLNESS 2/2013
WELLNESS AND ENVIRONMENT
CHAPTER XV
Katedra i Zakład Zdrowia Publicznego
Uniwersytet Medyczny w Lublinie
Chair and Department of Public Health
Medical University of Lublin
KRZYSZTOF WŁOCH, PIOTR KSIĄŻEK,
EWA WARCHOŁ-SŁAWIŃSKA, BARTŁOMIEJ DROP
Some Problems Of Addiction
Wybrane Problemy Uzależnień
People who have addiction have no control over their behavior. Addiction is not
only restricted to using substances, such as drugs or tobacco, but also includes
abstract things like gambling. Addiction refers to substance dependence or behavior.
The paper will focus on drug addiction.
Drug addiction: a drug addict has a compulsive need to use controlled substance
in order to function normally. When such substances are unobtainable, the user
suffers from substance withdrawal.
WITHDRAWAL SYMPTOMS
The patient has physical and emotion symptoms. The physical symptoms include
headache, diarrhea, and insomnia. Some substance withdrawal may trigger violent
behavior, seizures, and hallucination. The emotional symptoms include depression,
loneliness, “frustration, anger, resentment and bitterness”.
DEMOGRAPHICS
There is no data to indicate which particular group is more susceptible to drug
addiction. Drug addiction is across racial and ethnical boundaries. It is also across
sexual and age boundaries. However, there is a strong indication that men are more
prone to be drug addicts than women. Younger people are more likely to become
addicts than the older people.
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CONSEQUENCES OF ADDICTION
Addiction to drugs may also increase the tendency of high risk behaviors
possibly due to the influence of the drug. An addict may do risky things such as
driving fast, involving in unprotected sexual activities.
Addiction to substances may also cause addicts to give up social relationships.
The influence of addictive substances, such as drugs, may cause domestic abuse and
lead to poor relationships with one’s family and loved ones. Drug addicts tend to
conduct their addictive habits in secrecy. This may lead them to prefer solitude over
companionship with others and not care about having relationships with family
members or friends [1].
Addiction can lead to various financial issues due to the cost of the drugs as
addictive substances can be very expensive. In the United States, a smoker who
smokes 20 cigarettes per day will need to spend $330 per month to keep up his or
her addiction. The costs of other substances, such as cocaine and heroin are even
higher.
Addiction to drugs may lead to law breaking behaviors. In order to maintain their
substance addiction using high cost substances, an addict may conduct illegal
activities, for example, stealing, robbery or murdering due to the financial burden
that the substances have put them through. Furthermore, certain addictive drugs are
illegal in certain countries, thus the usage of the drug would be considered illegal
behavior.
PERSONALITY
People with certain personality traits, such as higher levels of curiosity,
aggressiveness and lack of self-esteem, will be more likely to become a drug addict.
The degree of curiosity one possesses may contribute to the individual becoming
an addict. Some people are more curious than others. They will be more likely to
experiment new things, such as drugs. This will increase the chance of them to
experiment with highly addictive drugs and become addicted. Some personal traits
like aggressiveness can lead to addiction. The drug satisfies their ego of being
dominating over others. People who not have confidence in themselves and lack of
self-esteem are more likely to turn to drugs in order to feel happy and secure [2].
PSYCHOLOGICAL FACTOR
Mental illness. People who have psychological problems will have a higher risk
to become the addict. The mental disorders include depression, attention-deficit
disorder, obsessive compulsive disorder, and bipolar disorder. According to the
survey conducted in 2002 by the National Survey on Drug Use and Health, 17.5
million adults were diagnosed with a serious mental disorder in the U.S.A. About 4
million of them have serious problems of addiction and mental disorders.
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Some problems of addiction
Loneliness. Individuals that feel a lack of companionship in their lives may turn
to fill this void in their life. They may also take the drugs in order to escape their
lonely situation.
Stress. In order to cope with the stress in life some people will resolve in using
drugs to alleviate the level of the stress. In a neurological experiment, researchers
found that monkeys who were under tremendous stress by being dominated by
monkeys from the upper social ladder were more likely to self-medicate with
cocaine. The scientist concluded that being in a stressful situation is an important
contributing factor for a person to become the addict.
SOCIOLOGICAL FACTOR
Peer pressure can play a significant role forcing one to start taking drugs. The
youth who tries to gain acceptance in a group, often will take drugs to become
accepted in a social group. This is more common among the adolescent than other
age groups as the young people desperately try to fit in and be accepted in a group.
The type of family environment that one has experience can also influence the
chance of an individual to start taking addictive substances. Young individuals from
the family that takes drugs will be more likely to become a drug addict. Young
people who not have a strong attachment to their family or siblings are at risk of
becoming a drug addict.
SOCIAL ENVIRONMENT
Accessibility of drugs. Accessibility of drugs can certainly contribute to the
problem of drug addiction. The typical example is Punjab, the city of India that is
situated between India and Pakistan. Opium was legally consumed before India and
Pakistan gained independence in 1947. Punjab is a gateway for smuggling opiates
from Pakistan and Afghanistan. With the accessibility, drug usage is prevalent. Even
schoolboys eat black bails of opium with tea before going to school. The majority of
addicts are the young people between the ages of 15 and 35.
Poverty, unemployment. A survey conducted on 600 drug addicts in rural and
urban areas of Punjab found that the majority of the addicts are young people who
are unemployed and poor.
Rural versus urban. Most people assume that urban communities have a more
serious problem with drug addiction because of high population and accessibility of
drugs in the cities. However, in Canada, drug taking is less common in larger cities
than in rural communities. The study published in the Canadian Journal of
Psychiatry indicates the average substance use in Canada is approximately 11%,
while in the rural area the rate of substance use can reach 14.02%. Isolation and
limited programs contribute to the youth becoming drug addicts because of the lack
of entertainments.
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BIOLOGICAL FACTOR
Genetics. Like alcohol abuse, some people with certain genetic components will
be more susceptible to drugs. From much research it is found that people with
certain genetic makeup will run a higher risk in becoming a drug addict. If certain
genetic makeup influences the chance of getting addicted, the identical twins who
have the same genomes will have higher concordance in displaying the same
behavior, while the fraternal twin who do not have the same genomes will have less
chance to display the same behavior. The study conducted in 1934 at the Medical
College of Virginia on female twins found strong evidence to support this idea. The
study showed that “the concordance for cocaine usage was 54% for identical twins
and 42 % for fraternal twins”. Furthermore, the study indicated the “concordance for
cocaine abuse was 47 percent for identical twins and 8 percent for fraternal twins;
and for drug dependence, 35 percent for identical twins and zero for fraternal twins”.
Age when drugs were first consumed. Because of the malleability of the youth’s
brain, the young people are more likely to become addicted. This is supported by the
data showing the higher percentage of addicts from their youthful time.
Gender. The data showed that a higher percentage of people addicted to drugs
are males. “According to Mayo Clinic, USA, males are twice as likely as females to
have problems with drugs addiction” [2].
DELIVERY OF SERVICES IN THE HEALTH SERVICE SYSTEM
PRIMARY CARE
Screening and early intervention. Early detection and intervention increase the
chance of recovery from the addiction. “It is estimated that two thirds of addicts see
primary doctors every six months”. Thus primary doctors have an opportunity to
recognize, diagnose the patients who suffer from drug addiction and intervene at an
appropriate time.
Treatments. In the primary care the goal is to get the addictive substance out the
patient’s system. The regular procedure is to get it done “gradually by giving
reduced dosages (tapering)”. In some cases a substitute drug is given. The primary
care can either be inpatient or outpatient care depending upon what drug the patient
is addicted to.
Psychological therapy. Provide one-on-one therapy section with a psychiatrist or
family sessions with a counselor.
SECONDARY CARE
In the primary care patients are under supervision all the time. In the secondary
care facilities, patients are given more freedom. The goal of the secondary care is to
help the addicts to reintegrate into “normal society in an assisted and safer manner”.
Secondary care focuses on the psychological treatment. In the secondary program
the newly recovering patients learn to deal with life issues such as “death of a loved
one, disappointments, frustrations and boredom” in constructive ways. They learn to
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Some problems of addiction
take part in charity works and rebuild their relationship with their friends and family
[1].
Treatment for substance abuse is critical for many around the world. Often a
formal intervention is necessary to convince the substance abuser to submit to any
form of treatment. Behavioral interventions and medications exist that have helped
many people reduce, or discontinue, their substance abuse. From the applied
behavior analysis literature, behavioral psychology, and from randomized clinical
trials, several evidenced based interventions have emerged:
 Behavioral marital therapy
Behavioral marital therapy, sometimes called behavioral couple, or couples,
therapy, has its origins in behaviorism and is a form of behavior therapy. The
theory is rooted in social learning theory and behavior analysis. As a model, it is
constantly being revised as new research presents.
 Motivational Interviewing
- Express empathy. Empathy involves seeing the world through the client's
eyes, thinking about things as the client thinks about them, feeling things as
the client feels them, sharing in the client's experiences. Expression of
empathy is critical to the MI approach. When clients feel that they are
understood, they are more able to open up to their own experiences and share
those experiences with others. Having clients share their experiences with
you in depth allows you to assess when and where they need support, and
what potential pitfalls may need focus on in the change planning process. In
short, the counselor's accurate understanding of the client's experience
facilitates change.
- Develop discrepancy. This guides therapists to help clients appreciate the
value of change by exploring the discrepancy between how clients want their
lives to be vs. how they currently are (or between their deeply-held values
and their day-to-day behavior). MI counselors work to develop this situation
through helping clients examine the discrepancies between their current
behavior and future goals. When clients perceive that their current behaviors
do not tend to some important future goal, they become more motivated to
make important life changes. Techniques used can include decisional balance
sheets
- Roll with resistance.
- In MI, the counselor does not fight client resistance, but „rolls with it.”
Statements demonstrating resistance are not challenged. Instead the counselor
uses the client's „momentum” to further explore the client's views. Using this
approach, resistance tends to be decreased rather than increased, as clients are
not reinforced for becoming argumentative. MI encourages clients to develop
their own solutions to the problems that they themselves have defined. In
exploring client concerns, counselors may invite clients to examine new
perspectives, but counselors do not impose new ways of thinking on clients.
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-
Rolling with resistance allows therapists to accept client reluctance to change
as natural rather than pathological.
Support self-efficacy. This guides therapists to explicitly embrace client
autonomy (even when clients choose to not change) and help clients move
toward change successfully and with confidence. As clients are held
responsible for choosing and carrying out actions to change in the MI
approach, counselors focus their efforts on helping the clients stay motivated,
and supporting clients' sense of self-efficacy is a great way to do that. One
source of hope for clients using the MI approach is that there is no „right
way” to change, and if a given plan for change does not work, clients are
only limited by their own creativity as to the number of other plans that might
be tried.
 Community reinforcement approach. A comprehensive operant program built on
a functional assessment of a client's drinking behavior and the use of positive
reinforcement and contingency management for non-drinking. When combined
with disulfiram community reinforcement showed remarkable effects. One
component of the program that appears to be particularly strong is the nondrinking club. Applications of community reinforcement to public policy has
become the recent focus of this approach.
 Exposure therapy. A technique in behavior therapy intended to treat anxiety
disorders and involves the exposure to the feared object or context without any
danger in order to overcome their anxiety. Procedurally it is similar to the fear
extinction paradigm in rodent work. Numerous studies have demonstrated its
effectiveness in the treatment of anxiety disorders such as PTSD and specific
phobias [1, 2].
 Contingency management. A type of treatment used in the mental health or
substance abuse fields. Patients' behaviors are rewarded (or, less often,
punished); generally, adherence to or failure to adhere to program rules and
regulations or their treatment plan. As an approach to treatment, contingency
management emerged from the behavior therapy and applied behavior analysis
traditions in mental health. By most evaluations, contingency management
procedures produce one of the largest effect sizes out of all mental health and
educational interventions.
 Pharmacological therapy - A number of medications have been approved for the
treatment of substance abuse. These include replacement therapies such as
buprenorphine and methadone as well as antagonist medications like disulfiram
and naltrexone in either short acting, or the newer long acting form. Several
other medications, often ones originally used in other contexts, have also been
shown to be effective including bupropion Modafinil and more.
According to some nurse practitioners, stopping substance abuse can reduce the
risk of dying early and also reduce some health risks like heart disease, lung disease,
and strokes.
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Some problems of addiction
In children and adolescents, cognitive behavioral therapy (CBT) and family
therapy currently have the most research evidence for the treatment of substance
abuse problems. These treatments can be administered in a variety of different
formats, each of which has varying levels of research support
Social skills are significantly impaired in people suffering from alcoholism due
to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area
of the brain. It has been suggested that social skills training adjunctive to inpatient
treatment of alcohol dependence is probably efficacious, including managing the
social environment.
Rehabilitation using some of these treatment methods can be both institutional
and in programs where the patients live at home and go to follow up-meetings
connected with the therapy program. For substance abusers, the tertiary care in the
form of rehabilitation is extremely important in the plan of letting the patients come
back to normal life without the addiction.
The final step to a complete recovery is through the tertiary care. The goal of the
tertiary care is to turn an addict into a completely healthy person, physically and
emotionally. Tertiary care encourages patients to “maintain their hobbies, interests
which are conducive in bringing happiness to their life instead of using drugs. Get
continuous support from local communities such as churches, charity groups. The
tertiary care institutions help patients plan their education and career goals in order
to help them reintegrate with the normal society. Hence live a happy and meaningful
life without drugs [1, 2].
SPECIAL PROGRAMS
Self-help groups. Self-help-groups allow people with the same problem to meet.
In the process of discussion and sharing their feeling people are encouraged and
motivated. These self-help-groups include “drug addiction anonymous” and “12
Steps”. “12 Steps” is a recovery program that helps patients remain motivated with
spiritual assistance by trusting in God and admitting one’s mistake.
SUBSTANCE ABUSE
Substance abuse, by definition is a “patterned use of substance which can include
drug, tobacco, or alcohol”. One can abuse drugs, alcohol, or tobacco and can be
considered a substance abuser. Substance abuse is no good in any circumstances.
People abuse substances such as alcohol, tobacco, and other drugs for varied and
complicated reasons, but it is clear that our society pays a significant cost. The toll
for this abuse can be seen in our hospitals and emergency departments both through
direct damage to health by substance abuse and its link to physical trauma. Jails and
prisons tally daily the strong connection between crime and drug dependence and
abuse. Although the use of some drugs such as cocaine has declined in recent years,
the use of other drugs such as heroin and “club drugs” has increased.
It is all too common within most populations, especially in a lower economic
class. Some of the people that you may see on the streets would probably be your
typical user, but there are some drugs that are used by your everyday “girl or boy
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next door” types. When it comes to helping individuals that abuse drugs, nurses can
be the front line in aiding their care. Nurse can help these individuals with finding
resources to help them, educate them about stopping the abuse of drugs, and how the
government can help these individuals, as well. Nurses that are not familiar with
individuals with substance abuse problems can be educated by laws, policies, what
their role is in the care of these individuals, and by trying to get what the community
itself provides, or what the state that they live in provides [1, 2].
Club drugs are favored over other recreational drugs, such as marijuana, lysergic
acid diethylamide (LSD), methamphetamine, and opiates, because they are believed
to enhance social interaction. They often are described as “entactogens”, giving a
sense of physical closeness, empathy, and euphoria. MDMA is structurally similar to
amphetamine and mescaline, which is a hallucinogen. However, it is not as
stimulating or addictive as amphetamine, and is considered much less likely to cause
psychosis than LSD and other potent hallucinogens. 2 GHB and Rohypnol are
powerful sedative/hypnotic agents. Ketamine is a dissociative anesthetic that
produces a dreamy tranquility and disinhibition in small doses. Unlike opiates, these
sedatives encourage sociability and seldom cause nausea.
There are many laws that encompass substance abuse addiction. When
individuals become part of any governmental program to help them kick the habit,
there are laws and policies that these individuals have to follow in order to be part of
a drug rehabilitation program. Some addicted individuals are embarrassed of their
problem, and when it comes to entering the program by law they must be tested to
see what substances they come back positive on. Mandatory drug screens can be
court appointed or be appointed by a drug rehab facility. However, mandatory
screens are not only done once, they can be done periodically throughout the course
of treatment, and even after treatment to make sure that, the individual does not use
the substance. These screenings are mostly done by surprise without the individuals
being notified. Law also protects substance abusers that enter into a rehab facility by
this I mean all their information is held confidentially and only those working
specifically with the individual are allowed to know their information [1].
Health education, promotion, and prevention are crucial for people with
addiction. These people are weak and only know one way to solve their problems
and that is by using substances.
Often, a drug user has an underlying behavioral disorder or other mental illness,
one that increases risk for substance abuse. Such disorders must be treated medically
and through counseling along with treatment of the drug abuse.
Substance abuse may start in childhood or adolescence. Abuse prevention efforts
in schools and community settings now focus on school-age groups.
In conclusion, substance abuse is something that is preventable. If we follow the
primary, second and tertiary steps, the society as the whole can lower the substance
abuse cases. Programs seek to increase communication between parents and their
children, to teach resistance skills, and to provide information in order to correct
children’s misperceptions about cigarettes, alcohol, and drugs and the consequences
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of their use. Most importantly, officials seek to develop, through education and the
media, an environment of social disapproval from children’s peers and families [2].
WNIOSKI
1. Edukacja zdrowotna stanowi podstawę postępowania profilaktycznego w
uzależnieniach.
2. Systemy wsparcia społecznego za podstawę III fazy profilaktyki w
uzależnieniach.
CONCLUSIONS
1. Health education constitutes the basis of prophylaxis approach in drug addiction.
2. Social support systems are the background in the tertiary care system in drug
addiction.
LITERATURE
1. Brunn K.: Alcohol consumption – from public health perspective, London 1974.
2. Glendening M., Laing W.: The politices of health care. ABPI, London, 1987.
ABSTRACT
The aim of the paper is the analysis of these data of ecological system which affect drug addiction. Their monitoring allows for functional and organizational reorganization of drug addiction treatment in the primary care system.
STRESZCZENIE
Celem pracy jest analiza tych danych systemu ekologicznego, które wpływają na
nadużywanie narkotyków. Ich monitoring pozwala na organizację i funkcjonowanie
systemu terapii w opiece pierwszorzędowej w ramach poz.
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