addiction_infoguide成瘾信息指南

aD D I C T I O N A n I n f o r m a t io n G u id e Marilyn Herie, PhD, RSW Tim Godden, MSW, RSW Joanne Shenfeld, MSW Colleen Kelly, MSW, RSW aD D I C T I O N An I n f o r m a t io n G u id e A Pan American Health Organization / World Health Organization Collaborating Centre a guide for people with addiction and their families Marilyn Herie, PhD, RSW Tim Godden, MSW, RSW Joanne Shenfeld, MSW Colleen Kelly, MSW, RSW Library and Archives Canada Cataloguing in Publication Addiction : an information guide / Marilyn Herie... [et al.]. Issued also in French under title: La toxicomanie. Includes bibliographical references. ISBN 0-88868-483-5 1. Substance abuse. 2. Substance abuse—Treatment. I. Herie, Marilyn, 1963- II. Centre for Addiction and Mental Health RC564.15.A44 2006 362.29 C2006-905125-9 Printed in Canada Copyright © 2007 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. For information on other Centre for Addiction and Mental Health resource materials or to place an order, please contact: Publication Services Centre for Addiction and Mental Health 33 Russell Street Toronto, ON M5S 2S1 Canada Tel: 1 800 661-1111 or 416 595-6059 in Toronto E-mail: publications@camh.net Website: www.camh.net Disponible en français sous le titre La toxicomanie : Guide d’information CREDITS: DEVELOPMENT/WRITING Michelle Maynes, CAMH EDITORIAL Sharon Kirsch; Diana Ballon, Nick Gamble, CAMH COVER PHOTOGRAPH © Peter Mulcair, 2000 PRINT PRODUCTION Christine Harris, CAMH 2994/01-07 PM043 CONTENTS Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 What is addiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 What causes addiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3 Frequently asked questions about addiction . . . . . . . . . . . . . . . . . . . 12 4 Help for people with addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 5 Change, recovery and relapse prevention . . . . . . . . . . . . . . . . . . . . . 26 6 Help for partners and families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 7 Explaining addiction to children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Addiction An Information Guide 1 ACKNOWLEDGMENTS We would like to thank Caroline O’Grady for her contribution to an earlier draft. We would also like to thank the many reviewers of earlier drafts of this guide for helping to shape this final version. Reviewers include: Kristin Baughan, Kirstin Bindseil, Gord Blain, Bruna Brands, Kelly Brown, Gloria Chaim, Charlane Cluett, Don Crocock, Eva Ingber, Dennis James, Don Keast, Yvon Lamarche, Michael Lee, Michael Lester, Alicia Maynard, Bob McTavish, Peter Menzies, Ronald Olmstead, Laureen Pawis, Kate Tschakovsky, Tom Walker and Leonard M. Wood. INTRODUCTION This guide was written for people who are having problems related to alcohol and other drug use, their families, and anyone else wanting to gain a basic understanding of addiction, its treatment and management. The guide does not replace treatment from a physician or addiction treatment professional, but it could be used as a basis for questions and discussion. Addiction can be hard to talk about. For starters, people often don’t agree on what addiction is. The term is used to describe anything from a desire to have or do something that gives pleasure, to a medical issue, to an uncontrollable compulsion. Because of this confusion, health and social service workers tend to avoid the word “addiction.” When they talk about addiction to alcohol and other drugs, as we will in this booklet, they tend to use the less loaded terms “substance use problems” and “substance dependence.” We too will use these terms, but we will also use “addiction” because it is the term most people use when they talk about substance use as a problem. This guide is divided into seven chapters. Chapters 1 and 2 are written for anyone with an interest in the topic of addiction. Chapters 3, 4 and 5 are more clearly directed to people with substance use problems, and chapters 6 and 7 are written for their families. You can read the guide from cover to cover, or you may prefer to skip to particular sections of interest to you. At the end of the guide, we list agencies, websites and books that can give you more information and assistance. We hope this guide helps you to understand what addiction is, what is thought to cause it, how it may affect your life, and what you can do to change it. When is substance use a problem? Two important signs that a person’s substance use is risky, or is already a problem, are harmful consequences and loss of control. H A R M F U L C O N S E Q U E N C E S The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). While each time a person uses a substance may seem to have little impact, the harmful consequences can build up over time. If a person continues to use substances despite the harmful consequences, he or she may have a substance use problem. The harms of substance use can affect every aspect of a person’s life. Some examples are: • injuries while under the influence • feelings of anxiety, irritability or depression • trouble thinking clearly • blackouts • problems with relationships • spending money on substances rather than on food, rent or other essentials • legal problems related to substance use • loss of hope, feelings of emptiness. The harms of substance use can also extend to the person’s family, friends, co-workers and even strangers (e.g., when someone drives while under the influence of alcohol or other drugs). L O S S O F C O N T R O L Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended, or in situations where they didn’t want to use. Some may not see that their substance use is out of control and is causing problems An Information Guide 3 1 People use alcohol and other drugs for many reasons. Some use these substances to help them to relax, to feel more lively, to feel less inhibited or to feel pleasure. Some find the effects of substances make it seem easier to cope with problems. Some use substances for religious reasons or to fit in with the crowd. Others may be curious about the effects of a specific drug. No one plans to become addicted. People may think that they can handle their substance use and that they only use when they want to. But when they want to change the way they use, they may find it’s not that simple. Because substance use is common, it’s important to be able to see when a person’s use puts him or her at risk of developing a problem. Jessie loves going out after work with her friends. Her job is stressful, and having a few drinks with her friends helps her to unwind and relax. Lately, Jessie’s regular “after-work drink” has turned into a whole evening of drinking. She often misses dinner and doesn’t get home until late. A couple of times Jessie hasn’t remembered how she got home the night before, and she’s been late for work. Her manager has commented that she seems tired and distracted, and wonders if anything is wrong. This example shows how substance use problems can develop slowly, and how it can be easy to overlook some early warning signs that a person’s substance use is becoming a problem. Next, we will look at some things that can signal when a person’s sub- stance use might be a problem. 2 Addiction WHAT IS ADDICTION? Psychological dependence occurs when a person feels he or she needs the drug to function or feel comfortable (e.g., needing to drink alcohol to feel relaxed in social situations, or needing to be high to enjoy sex). Some peo- ple come to feel they need a substance just to be able to cope with daily life. Physical dependence occurs when a person’s body has adapted to the presence of a drug. Tolerance has developed, which means that the person needs to use more of the drug to get the same effect. When drug use stops, symptoms of withdrawal occur. People often think that psychological dependence is not as serious as physical dependence. This is not necessarily true. Cocaine, for example, does not cause physical dependence—but it is considered one of the easiest drugs to get hooked on and one of the hardest to give up. In this booklet, we use the term addiction to refer to psychological dependence, with or without physical dependence. Why do people keep using? Substance use can be hard to change. One thing that makes change so difficult is that the immediate effects of substance use tend to be positive. People may feel good, have more confidence and forget about problems. In contrast, the problems from use might not be obvious for some time. People may come to rely on the effects of substances to bring short-term relief from difficult or painful feelings. The effects of substances can make problems seem less important, or make it seem easier to talk and to be with others. People may come to believe that they cannot function or make it through the day without drugs. When people use substances to escape or change the way they feel, using can become a habit, which can be hard to break. An Information Guide 5 in their lives. This is often referred to as being “in denial.” This so-called denial, however, might simply be a lack of awareness or insight into the situation. Whether people realize it or not, lack of control over use is another sign that substance use is a problem. Dan started smoking marijuana three years ago, around the time his dad left for good. At first he only smoked it with friends after school, but gradually he smoked more often. Eventually he smoked every day, beginning first thing in the morning. He felt the drug helped to “mellow” him out, and thought that it was harmless. His marks in school, however, which were never great, were slipping. His mother nagged him about his schoolwork, and his girlfriend complained that he was always stoned. Dan tried to stop using, but he found that without marijuana he was irritable and tense. His cravings to get high were stronger than his will to quit. In this example, Dan is showing some signs of dependence. He’s smoking marijuana regularly, is experiencing negative consequences of using (problems with his schoolwork and his relationship with his girlfriend), and is not able to stop using. He feels torn between wanting to quit and enjoying the effects of the drug and the relief it brings. The next section will talk about some of the ways we can define addiction and dependence. Defining addiction Another word for addiction is “dependence.” There are two kinds of substance dependence: 4 Addiction friend or colleague who has. Although addiction affects men and women of all ages, rates are: • two to three times higher in men than women • highest among people aged 15 to 24 (Statistics Canada, 2003). A 2002 study of the rates of addiction found that 2.6 per cent of Canadians were dependent on alcohol and that fewer than one per cent were dependent on illegal drugs (Statistics Canada, 2003). These numbers, however, do not reflect the full impact of substance use problems in Canada. Substance use problems can occur even with low levels of alcohol or other drug use, and in people who are not dependent. For example, estimates suggest that more than 25 per cent of men and nearly 9 per cent of women who drink alcohol are “high-risk” drinkers. These are people whose drinking can be said to be hazardous and harmful to themselves or others, even though these people may not be substance dependent (Adlaf et al., 2004). The stigma of addiction Stigma is another reason why the rates of substance use problems may be higher than studies suggest. Stigma marks substance use problems as shameful and makes people want to hide their addiction. Stigma also affects the families of people with addiction. It makes them hide the problem or pretend it isn’t there at a time when families need support. What can we do about stigma? One simple way you can help is to choose to talk about “people with substance use problems” rather than about “addicts,” “alcoholics,” “junkies” or “stoners.” Try this approach whether you are talking about another person or about yourself. When you do this, you put the person ahead of the problem. This helps to show that you know there is more to a person than a problem. You are also giving the person with an addiction the support and understanding it takes to recover. An Information Guide 7 Continued substance use, especially heavy use, can cause changes in the body and brain. If people develop physical dependence and then stop using, they may experience distressing symptoms of withdrawal. Changes to the brain may be lasting. These changes may be why people continue to crave substances and slip back into substance use long after they have stopped using. When people who are addicted stop their substance use, they often compare the experience to leaving a relationship that was very important to them. Alex began using heroin more than 10 years ago. Getting money to buy drugs was always a problem. He grew tired of the stress of always needing to score, and of knowing that if he got arrested again, he’d go to jail. Still, deciding to leave heroin and try methadone treatment was hard. Once the treatment became routine, he felt bored and didn’t know what to do with his time. He wished he could go back to using, but was afraid of what would happen if he did. His counsellor helped Alex to think about what he wanted from life. Alex enrolled in school and got a part-time job. Soon after, he started a new relationship with someone he trusted. Some days are still a struggle, but with time, and keeping busy, it gets easier. Alex found it hard to stop using heroin and to continue with his treatment, especially at first. But just as substance use problems don’t start overnight, they don’t get better right away either. By staying in treatment and continuing to get support, Alex began to get his life back on track. How common is addiction? Addiction affects many people. Those who have not experienced a substance use problem first-hand are likely to have a family member, 6 Addiction E N V I R O N M E N T The home, neighbourhood or community where people live, go to school or work can influence whether or not they develop substance use problems, as can the attitudes of their peers, family and culture toward substance use. People who experience prejudice, discrimination or marginalization due to culture, race, gender identity, sexual orientation, ability, age or other factors may use substances to cope with feelings of trauma or social isolation. M E N T A L H E A L T H I S S U E S Research shows that more than half of people with substance use disorders have also had mental health problems, especially anxiety or depression, sometime in their lifetime (Reiger et al., 1990). The relationship between substance use and mental health problems is complex. Some people with mental health problems use substances to help themselves feel better, but end up making the situation worse. When people have mental health problems, even limited substance use (e.g., a drink or two) can worsen the problems. For more information on the relationship between substance use and mental health problems, see the CAMH publication Concurrent Substance Use and Mental Health Disorders (available online at www.camh.net/About_Addiction_Mental_Health/Concurrent_Disorders /Concurrent_Disorders_Information_Guide/index.html. For order infor- mation, see page 51). An Information Guide 9 2 Many possible factors have been considered in trying to explain and understand the causes of addiction. One thing is clear: no single factor can be said to cause addiction. People become addicted because of a combination of factors. G E N E T I C F A C T O R S It appears that some people may inherit a vulnerability to the addictive properties of drugs. Studies have shown, for example, that the risk of substance use disorders is higher for people who have close relatives with substance use disorders (Glantz & Pickens, 1992). However, many people who have a genetic vulnerability to addiction do not become addicted, and others who do not have a family history of addiction do become addicted. H O W D R U G S I N T E R A C T W I T H T H E B R A I N People use alcohol and other drugs because they stimulate the brain in ways that “feel good.” This immediate rewarding experience makes people want to repeat it. All substances with addictive potential stimulate the release of dopamine, a chemical in the brain that is associated with reward and pleasure. Eating, drinking and having sex are all activities that release dopamine. Substance use, however, brings a flood of dopamine, which alters the chemistry of the brain. The brain, in turn, tries to keep things in balance by developing tolerance, which means that more and more of the drug is needed to bring feelings of pleasure. The brain also adapts by decreasing the amount of dopamine available. That’s one reason why people who are addicted report feeling “flat” and depressed without drugs (NIDA, n.d.; Glantz & Pickens, 1992). 8 Addiction WHAT CAUSES ADDICTION? The protective factors for substance use problems in youth include: • having a positive adult role model (e.g., a parent, relative or teacher) • good parental or other caregiver supervision • having a strong attachment to family, school and community • having goals and dreams • being involved in meaningful and well-supervised activities (e.g., sports, music, volunteer work). Risk and protective factors do not guarantee that a person will or will not develop problems, but they do affect the level of risk. Once a person has a problem with substance use, risk and protective factors also influence how readily that person is able to change his or her use. An Information Guide 11 C O P I N G W I T H T H O U G H T S A N D F E E L I N G S People may turn to substances as a way of coping with difficult emotions or situations. They may find it hard, for example, to calm themselves down when they feel angry or upset, and come to rely on substances to help them regulate their emotions. People may also use substances to help relieve stress, boredom or sadness, or to reduce their inhibitions and make it easier to talk to others and speak up about feelings. S P I R I T U A L O R R E L I G I O U S A F F I L I A T I O N Spirituality can mean different things to different people. One aspect that many people experience is a need to feel connected to others and the world around them. People who lack this sense of spiritual connection may feel empty or hopeless. They may use substances to mask these feelings and develop a sub