Sunday, 11 September 2016 02:48

What is Addiction?

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by Gregory Rennie, BSW, RSW, RP, CCAC | Hasu eCounselling 

'Addiction' is a common and accepted word to describe a serious brain disorder associated with alcoholics and addicts.  According the most recent Diagnostic Statistical Manual of Mental Disorders (DSM 5), which in the medical field is the go to resource, now puts addiction within the spectrum of substance use disorder.  The manual combines previous categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe. Confusing? It certainly is. Its a confusing illness even for the experts and we still don't know everything about this destructive illness.  In this article I will refer to the severe end of the substance use disorder spectrum as addiction. So what do we know so far about this serious and chronic illness?

Recent scientific research and brain imaging has shown us that addiction is disorder of the reward, motivation and memory wiring in the brain and related circuitry.  It is a biological, psychological, social and for some, a spiritual illness. Simply put, an alcoholic or addict develops a very strong 'Go' system in the brain and lacks an interconnected healthy 'Stop' system.  They have bad brakes.  After years of abusing alcohol and drugs, the wiring in the brain becomes altered and changes occur in brain chemistry and can influence how they see themselves, others and the world around them.  This perception is often distorted and because of this deny there is a problem.

Key characteristics of the disorder are loss of control; pre-occupation or thinking about, seeking, using and withdrawing from use and most importantly use despite the risk of repeating past negative consequences.  These characteristics are complicated by denial.  If the person cannot abstain from using their drug of choice (alcohol is a drug), there will be noticeable changes in behaviour at home and at work.  They will be preoccupied and crave the effect the drug provides and will seek it out.  Importantly, they will not recognize negative consequences of use and the impact on family and co-workers.  

The person may repeat destructive behaviour even if it has a risk of further damage to themselves or others. The stark reality is, if they don't seek professional treatment and change their lifestyle, it can result in disability, injury or premature death.  

Relapse

“Between 25-35% of people who complete addiction treatment will be readmitted to treatment within one year, and 50% will be readmitted within five years. Recovery is not fully stabilized until four to five years of sustained recovery.”                                    

William White, ‘From Treatment to Sustained Recovery’, 2007 

Like other illnesses, there is relapse and remission.  After a period of abstinence, they can relapse and use again. This feature is unfortunately, a likely occurrence within the first year.

Relapse rates are much the same for other chronic illnesses such as cardiovascular disease and hypertension which also have physiological and behavioural components. Treatment involves changing one's behaviour and lifestyle.  For those who are addicted to substances or have a behavioural addiction like problem gambling, lapses to old patterns and behaviours indicate that treatment needs to be reinstated or adjusted.  We remind our clients and their families that there is hope.  In my experience as an addiction specialist, many clients experience remission and in recovery, find renewed purpose and meaning in their lives.  The first step is to reach out and ask for help. 

Relapse can be triggered by exposure to rewarding substances and behaviours; exposure to cues in their environment; and by exposure to emotional stress which trigger activity in key circuits in the brain.  For example, an addict who returns to the people, places and things which trained the brain to associate with alcohol or drug use, could trigger craving and return to use.  Going to a favourite bar in early recovery just to play a game of pool and have a soft drink could unknowingly trigger a craving to use alcohol.  This process is not a conscious process, but a biological one. 

The hope is that with a return to professional counselling, these cues and associations can be addressed and future relapses prevented.

Preventing Relapse

“Combining professional treatment and attending recovery support meetings improve your chances of recovery better than either activity alone."                                                                                                                                                        

William White, ‘From Treatment to Sustained Recovery’, 2007 

According to relapse prevention experts, there's a need to learn about relapse and how to manage it. Education helps an individual to understand that: 

1. Relapse is normal and part of  the recovery from addiction.  There is no need to be ashamed, embarrassed or feel that you have failed.  There is a lot to learn from short relapses and that information can be very useful in the future. 

2. No one suddenly starts using alcohol or drugs; it is a process of exposure to cues and associations which set them up to use again.  Recovery takes time. With counselling, the warning signs of relapse can be identified, recognized and action taken. 

3. Once these cues and associations are identified, they can learn to manage the warning signs when sober. 

4. There is hope.  Through relapse prevention counselling, individuals can be taught how to recognize and manage the warning signs, so the risk of returning to use is reduced or eliminated. 

Recovery

"Recovery from addiction is best achieved through a combination of self-management, mutual support and professional care provided by trained and certified professionals."                                                                                                                             

American Society of Addiction Medicine (ASAM) 

“To achieve long-term recovery, treatment must address specific, individual patient needs and must take the whole person into account.  For it is not enough simply to get a person off drugs; rather, the many changes that have occurred - physical, social, psychological - must also be addressed to help people stay off drugs, for good.”                                                                                                                                                                                                                                                                   

William White, ‘From Treatment to Sustained Recovery’, 2007 

Recovery is a process which depends on the commitment and attitude of the person and on an effective treatment plan.  For the most part, it is a change in lifestyle which in time improves self-confidence, hope and an optimistic view of the future. 

The goals in counselling which support recovery are to help the person manage co-occurring mental health issues such as depression and anxiety; reducing or eliminating the exposure to alcohol and drugs; and helping them to improve work, life and relationships.   Research has shown that improving the 'good times' in recovery can be beneficial.  Exploring healthy self-reward by involvement in activities that are enjoyable and fun such as hobbies, sports or volunteer work can stimulate healthy and positive chemistry in the brain without using the 'sledgehammer' of alcohol and drugs. 

Online Addiction Counselling

"Integrated properly, e-Mental health is proving to be just as effective as face-to-face services and the technology is improving every day. Not only will this result in more people getting help, but it will also improve the quality of care we deliver, reduce costs and overcome challenges that are present in our healthcare system. All of this will result in the improved mental health for Canadians."                                                                                                                                                                                   

Mental Health Commission of Canada, 2014

Hasu eCounselling, a Canadian online counselling platform specializing in helping people with a substance use disorder. Individual and group counselling is available as well as counselling for family members.  Hasu provides online video, talk and text counselling for people struggling with substance use disorder and problem gambling as well as co-occurring issues such as depression and anxiety.  In the Toronto area, psychiatric consultations are available usually within two weeks. Direct billing with major insurance companies is also available.

Hasu was founded and designed by therapists in an effort to address long wait times for health care in Canada and provide support after clients have completed treatment programs for addiction and mental health issues. 

Hasu eCounselling providers are experienced healthcare professionals registered with their provincial regulatory body.  These therapists are registered with the Ontario College of Social Workers and Social Service Workers (OCSWSSW); the College of Registered Psychotherapists of Ontario (CRPO); or the Canadian Addiction Counsellors Certification Federation (CACCF). 

For more information or to book an online counselling session go to  www.hasuecounselling.ca.

About the author:

Gregory Rennie is the CEO at Hasu eCounselling and has been an addiction therapist since 2005. He has also worked at agencies in Southern Ontario as an outreach worker and concurrent disorders specialist. He is a registered social worker and a registered psychotherapist.  Gregory is a board member at the Canadian Addiction Counsellors Certification Federation (CACCF). 

Last modified on Sunday, 12 February 2017 20:34