Site icon almostadoctor

Addiction and Drug Abuse

Drugs white powder in a packet

Drugs white powder in a packet. Image by Marco Verch.

Introduction

The abuse of alcohol and drugs from a psychological perspective comes under the heading of externalising disorders. This category essentially encompasses the tendency of an individual to act out their problems. Other externalising disorders include:
This is opposed to the internalising disorders, such as depression and anxiety.

Addiction

Anything that causes the release of dopamine in the brain can become addictive.
 
Stages of Change
There a psychological model known as the stages of change model, which can be a useful tool in understanding alcohol addiction. It can also be applied to any type of addiction. It shows 5 phases of the addiction, which can then also be applied to abstinence. E.g.:
 
By working out what phase the patient might be in, we are then able to target our treatment for them. For example, a patient in Maintenance 1, is very unlikely to stop drinking if you simple say ‘It would be good for your health if you stopping drinking.’, whereas a patient in contemplation 2 would probably respond well to some encouragement and asking them about any plans they have made to alter their behaviour.
However – there are still measures you can take whatever phase the patient is in. You can help ‘push’ the patient along to the next state if you use the right techniques. These techniques are known as motivational interviewing. You should encourage / empower the patient to think for themselves, and not try to guide them through the process! For example, if you wanted to encourage a patient in the maintenance or pre-contemplation phases you could ask questions like:

The idea is to get the patient to think about their life from a different perspective. If you try to push them along the path, you will encounter resistance, and the harder you push, the more resistance you will likely encounter!
Don’t tell the patient they have a problem, just allow them to talk about issues. If they say something that you think is a problem, but to them may not appear a problem, just reflect this back at the patient.

There is also the possibility to leave the cycle, and have a ‘full recovery’ between the maintenance and pre-contemplative stages.

The 12-step approach

This includes the famous Alcoholics anonymous groups, but a similar approach is used in other groups, and for other addictions. In this approach, individuals are encouraged to surrender themselves to a higher power (i.e. God). Patients do not need to be specifically religious, just to have a belief in a higher power. By having the feeling of giving up their choice, many people find it much easier to now give up their addictive substance. Although this approach is not for everyone, it is still very successful.
Generally the 12-steps are recommended to supplement medical and other treatments – e.g. as a follow up treatment after detox. The 12-steps are only really useful for somebody with dependence and not just a heavy drinker.
The original 12 steps are as follows, but they are often slightly adapted to fir different cultural norms:
  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Alcohol

Alcohol use disorders are considered in their own seperate article.

Drugs

Taking a Drug history

This will generally be similar to taking a drinking history, however, you need to ask about each individual substance. You should ask:
 
Clinical features of drug use
Opiates – pinpoint pupils, low BP, venepuncture marks.
Benzodiazepines – disinhibited or gives the impression of intoxicated, but is not drunk
Psychostimulants – rapid speech, large pupils, agitation, restlessness, high BP.
Features of Withdrawal
Opiates – dilated pupils, high BP, sweaty, runny nose (rhinorrhea), cramps
Benzodiazepines – hypersensitivity, hyper-reflexia, depersonalisation
Psychostimulants – agitation, restlessness
Heroin
 

Quick Overview of Types of drugs

Cannabis – THC
Opiates

Cocaine
Amphetamine (speed)
Crystal meth
 
MDMA

LSD
Benzodiazepines
Magic Mushrooms
Ketamine
Dual-diagnosis

Related Articles

Exit mobile version