Addiction

Why Counseling for Addiction is so Important

Addiction is prevalent in most cities/towns, all states and throughout the United States. Addiction affects everyone whether the addictions is due to drug use, alcoholism or other addictive behavior such as gambling. It causes health and social issues, disrupts family functioning, increases crime rates in the community, heightens medical costs, causes higher unemployment rates, and significantly contributes to the problems in the economy. The problems related to addiction starts with the individual client. Long term alcoholism and drug dependency cause multiple physical problems, emotional symptoms, employment problems (absenteeism, low productivity, injury at employment site, and termination), legal arrests, marital discord, and family dysfunction including child neglect and child abuse. My interest, knowledge, experience and expertise in addiction has grown over several years because of the prevalence of the disease, and the increased psychological and social need to address addiction issues of clients in my community who have been inflicted with it.

Who is to Blame for Drug Use and Who is Responsible to Stop the Progression.

Although counseling and treatment can be effective resulting in longer duration of sobriety, relapse rates are very high. I also have found that initially addicted individuals do not seek counseling or treatment because they do not recognize the early signs or symptoms of their dependence, deny a problem even when it becomes more obvious, and then are reluctant to get professional help due to shame. They feel guilty, blame themselves and are too embarrassed to tell colleagues, friends and family. Thus, the physical dependence worsens with the related problems and consequences of continued chemical use. I found that many of my clients who started regular drinking or drug use never thought they would become addicted. Either they started with social use as a teen or became addicted over time to a controlled, prescribed medication.

It may not be someone’s fault for becoming physically dependent and/or emotionally addicted to illicit drugs or controlled medication, however it is the responsibility of the addicted person to attend a psychiatric and substance abuse evaluation and participate in a recommended structured counseling and/or substance abuse program along with following through with a long term after care program or community support group. Thus, he/she can have productive life and cause no harm to others.

Along with substance abuse counselling and innovative treatment methods, community prevention programs and education in the schools are essential for detection and early intervention so the disease of addiction does not progress to a point where it is harder to treat. Because addiction and physical dependency is a lifelong disease, family and community support for long term aftercare programs and sober support networks such as AA groups and NA groups are necessary to lower the potential of relapse.

What is Addiction and How it can be Detected by Recognition of Symptoms

Addiction is a biological, psychological, social and economic disease. It is biological because of its are physical symptoms. There are certain drugs that are chemically addictive in nature and are called controlled substances. This includes both illicit drugs sold on the streets and medications used for physical pain or mental health conditions. Continued substance use over time results in physical tolerance. This means that it takes more of the substance, amount and frequency, for someone to get the same effect or “high” than it did with lesser use of the substance. This is also related to medication as well. Over time, a certain medication dose may not be as effective and thus the prescribing doctor may order a higher amount and possibly at a greater frequency. For example, one pain pill may have eliminated pain, but it may take two pain pills to manage the pain 7-8 months later. My clients who become addicted to their controlled medications may deny they have an addiction or drug problem claiming that the consumed drug is a prescribed medication. However, drug abuse is identified when a person consumes more in amount and frequency of the medication than their doctor advises and indicated on the prescription bottle.  

As the body becomes accustomed to having higher amounts of a controlled substance at higher frequency, an individual develops physical dependence. This means that a person is addicted. They abruptly discontinue all use of the controlled substance, they will experience uncomfortable withdrawal symptoms that range from nausea, vomiting, shakes, tremors, cramps, severe anxiety, chronic depression, seizures and death. The symptoms of withdrawal vary and depends on the type of substance used. Admission to detox and inpatient treatment for supervised medication management will aid in eliminating or reducing the symptoms of withdrawal. A structured counseling or substance abuse treatment program, along with community support groups is usually recommended after an inpatient treatment program is completed successfully and the addicted person remained sober.

Chronicity of Substance Addiction

There are stages or degrees of chronicity related to substance use disorders and behavioral addiction. The severity of addiction is determined by the frequency and amount of use, its symptoms, problems and consequences resulting from drug use or addictive behavior, and relapses. Not all of my clients have chronic drug use, associated consequences of use, or in need the structure of inpatient treatment. I am more likely to diagnosis my client with a more severe substance abuse disorder if they have a higher use of a substance than not. Also, there are more physical problems and socioeconomic problems when use is higher in frequency and amount than not or there is a long history of drug use. Problems and consequences of substance abuse disorders and addiction are medical conditions, employment problems, legal arrests, financial problems, family discord, isolation or social issues, and psychological/emotional problems. Different illicit substances can cause anxiety, depression, aggression and psychosis that can also lead to crime, violence, abuse in the family suicide and homicide. A substance use disorder may also be determined when my client continues their use despite its associated problems and consequence, and if he/she have had relapses or unsuccessful attempts to reduce or stop their use. My clients with chronic addiction either substitute one addiction, or substance for another or have more than one addiction, or be physically dependent on more than one substance. For example, a gambler may be dependent on both cocaine and alcohol and participate in a codependent relationship.

Types of Addictions

There are two types of addiction: chemical addiction and behavioral addiction. Chemical addiction or physical dependency is from the over use of controlled substances of prescribed medications or illicit drug use. There are mainly 4 different types of illicit drugs: stimulants ( i.e cocaine, speed and ritalin), depressants (i.e. alcohol), hallucinogens ( i.e. acid ,mushrooms and marijuana) and opiates ( oxycontin, heroin , and fentanyl). Behavioral addictions are a result of changes in natural chemical in the body that perpetuate an addictive or habitual behavior such as sex, gambling, and shoplifting. Increase or change in natural chemicals in the body such as endorphins provide a natural high when the behavior is exhibited and, thus, reinforcing the behavior. Like chemical addiction, behavioral addictions are diagnosed by frequency and duration of behaviors, consequences it presents, and continued or relapse of addictive behaviors despite its associated problems. Codependency is when person dysfunctional and emotionally dependent on another person.

Groups of Substance-related Disorders

There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders. Substance-use disorders are a pattern of symptoms resulting from the use of a substance and use is continued despite resulting problems. Substance-induced disorders are a pattern of physical symptoms that are directly related to the intake or cessation of a substance and includes intoxication, withdrawal, and other substance/medication-induced mental disorders (A guide to DSM 5 criteria for substance abuse disorders, 2018).

DSM 5 Criteria for Diagnosing Substance Abuse Disorders

The symptoms of physical dependence and chemical addiction result in the characteristics described in the DSM 5. I diagnosis my clients with substance use disorders when the following 11 criteria are met:

  1. Taking the substance in larger amounts or for longer than you're meant to.
  2. Needing more of the substance to get the effect you want (tolerance).
  3. Cravings and urges to use the substance.
  4. Wanting to, but unable to cut down or stop using the substance.
  5. Spending a lot of time getting, using or recovering from the use of the substance.
  6. Not fulfilling responsibilities at work, home, or school because of substance use.
  7. Lower participation important social, occupational, or recreational activities because of substance use.
  8. Continuing use even when it causes problems in relationships.
  9. Using substances repeatedly despite the potential danger
  10. Continuing to use, despite a physical or psychological problem that is caused or worsened by the substance.
  11. Development of withdrawal symptoms which is reduced upon use.

(A guide to DSM 5 criteria for substance abuse disorders, 2018).

Stages of Chemical Dependency

According to the DSM 5, severity of a substance abuse disorder is determined by the symptoms, number and severity of problems and consequences that has resulted from alcohol use or drug use. Two or three symptoms of the above eleven symptoms meets a diagnosis of a mild substance use disorder; four or five symptoms is a diagnosis of moderate substance use disorder, and six or more symptoms is a diagnosis of a severe substance use disorder. Upon abstinence of the abused substance, there are diagnoses that indicated amount of time in remission. Early remission is diagnosed when there 3 to 12 months of abstinence with no symptoms. Sustained remission is abstinence for 12 or more months without symptoms. Clients who have been abstinent in a supervised environment such as jail or an inpatient program are identified as abstinent “in a controlled environment.” Clients abstinent from illicit substances but are in a medication assisted program such as methadone maintenance or suboxone treatment are identified as being “on maintenance therapy” (A guide to DSM 5 criteria for substance abuse disorders, 2018).

Treatment and Counseling Interventions

Most often, clients seek counseling when their addiction or drug use has caused a severe problem or many consequences and hindered their general functioning. Intensive treatment facilities and/or outpatient counselors can be found in directories, social media or networking/ ”word of mouth”. Upon evaluation with a licensed counselor, the chronicity of the substance use disorder and then level of care is determined. Frequency, amount, and duration of counseling is based on the level of chronicity. Where client with moderate to severe substance use disorder maybe recommended a substance abuse inpatient program, a client diagnosed with moderate to low substance use disorder is recommended an Intensive Outpatient Program or weekly  outpatient counseling. Many times, clients with emotional symptoms will self-medicate with illicit drug use.  A psychiatric evaluation is recommended for medication management if anxiety or depression is present. A medical evaluation is completed to rule out any other medical conditions that may be causing any physical or emotional symptoms. At times, substance using clients may want medication to help them abstain from illicit substances by reducing urges/cravings and/or blocking the high of the illicit substance upon relapse. Naltrexone is usually recommended for abstinence from alcohol, and methadone or suboxone is usually recommended for abstinence of illicit opiate use. Aftercare counseling and continued participation in community sober support group would reduce potential of future relapses.

Reference

A guide to DSM 5 criteria for substance use disorder. Elizabeth Hartney, PhD. Reviewed by Steven Gans, M.D. Updated Feb. 9, 2018. Retrieved form Https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926