THE FUTURE

Will substance use and abuse ever change? In ways, I believe. I think that humans will always use substance and I think the motivating factors for their use will always be similar such as genetics, coping, and positive reinforcements. However, I am sure we will see major changes in they types of drugs use such as the use of tobacco had changed over the past 20 years. Also, I am quite positive we will see changes in the best practices used in treating or approaching substance use and abuse. This, again can be seem when we look at the ‘scare tactic’ method which used to be used to create enough fear in an individual to make them want to quit using.

Addiction is essentially the compulsion to consume a substance or participate in a behavior for some form of reward may it be the physical high, the alleviating of stress, to fit in with peers or whatever it may be. This, unfortunately, I predict will forever be prevalent within society. There are also a wide variety of terms or classifications of addictions including substance use, substance dependence, misuse, harmful involvement, abuse and so on; these may stay relevant or be subjected to change depending upon how the general population continues to view addiction related behavior.  I have used this terminology so far as it was is relevant within the field. The field of addictions is ever changing so I can foresee changes to be made in the future.

It is my hopes that our greater community continues its advancement in the overall view of addictions and what is means to have substance related issues. There have been major strides taken over our history in how we perceive addictions which have come far from the moral theory; progressions have been made to include biology, psychology and sociology in the theory development of addictions. I would like to see a more extensive knowledge of substance abuse in the general population and to move towards harm reduction and away from trying to hide or remove these individuals from society. I believe it will be difficult to move away from the stereotypes we have place on addictions that make certain assumptions  about drug users (i.e. drug users are: dirty, scary, criminals, crazy, violent etc.) but I hope it is possible.

The field of addictions has grown substantially over the years and I can only hope it continues to progress and new research is being conducted and current best practices are being implemented. 

BENZODIAZEPINES COMIC

APPROACHING SUBSTANCE USE

As previously mentioned, there are countless treatment options available within the five tiers of services provided in Canada. Some methods work more effectively for some individuals rather than others; there are differences similar to how the substance issues began. Some treatment focuses on total abstinence while other programs may favor reduction; each option is unique.

Most significantly, I believe that treatment lies solely in the hand of the individual in terms of developing the overall treatment plan. Primarily, I think there needs to be an importance placed on individuals receiving adequate screening and assessment to ensure they are receiving the best possible treatment program (i.e. screening for mental health issues). With proper screening and assessment individuals will be directed to the tier of care which will best suit their needs for recovery. As well, I think it is extremely important that individuals presenting with substance use or abuse problems be welcomed in a supportive and non-judgmental environment. A part of this, I believe, includes being approach with motivational interviewing techniques and the subtle push towards change talk. It is important that clients are able to share and address what they need to

Within an individual seeking treatment for substance or behavior abuse problems it is important to know where they lie within the stages of change. There are six possible stages, which include: pre-contemplation, contemplation, preparation, action, maintenance, and relapse. Where an individual fits within this continuum relates to how far into the change process they are. If they are in the pre-contemplation stage they may not even be thinking about changing their behavior however, if they are in the contemplation stage they may be realizing how their substance use is having negative impacts on their life. In the preparation phase, individuals have decided to change and have made a plan to do so while in the action phase they begin to make the changes outlined. The final two stages involve constant monitoring on the behavioral changes as well as relapse which is a possibility at anytime however, part of the process. Motivational interviewing, techniques, as previously mentioned, are a way in taking an individual in the pre-contemplation to the contemplation stage but using strategies to aid a client in opening up and making personal realizations.

Personally, I believe in harm reduction as being a leading form of increasing wellness among substance users/abusers. Harm reduction methods strive to reduce the overall harm or consequences associated with drug use as they have accepted that substance use and abuse is an unavoidable part of life. The specific goals of harm reduction models are disease prevention, to reduce deaths due to drug use, to provide treatment for substance dependence, to empower communities and reduce stigma as well as to reduce the societal, community and individual impacts. I think this method of approaching substance use and abuse is most effective way of confronting the issue as it takes a realistic approach. Basically, the theory revolves around the idea that substance abuse can never be solved or become extinct; it will always be around so why not make it safer? Examples of these strategies include safe injection sites for intravenous drug users. In these locations, drug users have access to clean needles, health care, and addictions services if needed. This particular resource reduces disease contracted from dirty needles, provides monitoring for potential overdose, and takes drug users off the streets and out of the way of the public. Overall, there is a reduced risk for intravenous drug users who use safe injection sites.

Finally, I think it’s important, when approaching drug use, to withdrawal personal opinion and judgment. There will be no progress made when an intervener is telling a client that what they are doing is wrong or inappropriate or detrimental to their health. It is necessary to ignore our personal biases, writing reflex and the stigma attached to drug use (in both a individual and societal manner) and focus on the individual who is seeking to change their behavior. 

THE INTERVENER

As we have learned in class, only 10% of individuals with substance related problems visit substance related organizations for help. Although substance related organizations are beneficial they are not the only source of help available, similarly, as how a 28 day treatment program is not the only option when intervention in necessary. The intervener within substance abuse can have many roles, which differ substantially.

As we know, in Canada, we have a tier system of resources, which at one end, provides very intensive, specific and individual interventions while the other maintain a more broad, general and group-based interventions.  The role of the intervener is very much decided upon which tier is being targeted. Tier one is marked by health promotion and prevention for the general population; here the role of the intervener can include educating the population in mass such as can be seen with last years new cervical cancer advertisements on television.  The helper, in this stage, may be involved in school system programs (i.e. D.A.R.E.), work with family support groups, or self-care based prevention strategies.

In the second tier of services we see primary care and public health. These may be programs that are targeted at individuals at risk for substance abuse or addictive behaviors such as anger management or mental illness support groups. Here, the intervener may have the role of running seminars or workshops; they may see people consistently for a short while or be interacting with different people all the time. They may be responsible for presenting information, skills, running self-help groups, facilitating discussions or a variety of other tasks. The first two tiers mentioned are centered on the community as their prime user; these are not limited to an individual rather serve the population however they can have profound impacts on individuals.

The third tier of services is where we see outreach, methadone maintenance treatment, home based withdrawal management. In this capacity, the role of the intervener is to help structure an individuals treatment plan while allowing them room to fulfill it with minimal monitoring. The helper may see the client on a daily or weekly basis for short periods of time and offer support or assistance for the individual to complete their developed treatment plan. From here onwards, the helper’s role is more focused on the individual rather than on the greater community.

In the fourth tier of addictions based services in Canada, the interveners role is centred on outpatient counseling and day treatment options. Here, the intervener has a close and consistent relationship with the clients however; the clients do not live within the service. In many cases, the helper may be providing similar care as seen in an inpatient treatment option, which may include full days and a variety of different treatment methods (i.e. group therapy, individual counseling, education sessions, other therapies ex: animal, music etc.)

The final tier of services, the fifth tier, involves more intensive programing, which is usually specialized and provides an impatient or residential personalized treatment plan. Here, the helper is involved in a more one-on-one or focused treatment. The intervener is more apt to be working closely and frequently with individuals with substance use issues while the client lives within an organization/institution. Here, is where a 28 day program may be found; where a client is working towards treatment goals while being supervised 24/7.

No matter what role the intervener may be taking there are some factors which ideally should remain consistent regardless of what capacity the helper is involved; these include building a relationship, this means the approach should be client centered, however, there should be engagement on both parts. Furthermore, it is important for the intervener to withhold judgment or their righting reflex; it is not the helper’s job to tell the client what to do rather to support the clients’ realizations. Also, it is important for the intervener to be organized and prepared; a lack or organization can give the impression of incompetence to the client, which may bring out further feelings of ambivalence. Furthermore, in any situation where individual or group discussion is being used it is important to stay true to motivational interviewing techniques where the helper focuses on open-ended questioning, reflections, affirmations and summaries while evoking change talk with the client.

There are many possibly roles for an intervener within the field of addictions. Help is offered at a variety of differing levels within the continuum which makes choosing a intervener role or choosing a method of help much more open. 

DIMENSIONS OF WELLNESS

There are seven dimensions of wellness which can effect and are effected by substance use/abuse which include the emotional, environmental, intellectual, occupational, physical, social and spiritual dimensions.

Emotional wellness is a very broad dimension; it can involve experiencing, identifying and dealing with one’s own feelings as well as recognizing and understanding the feelings of others. Environmental wellness relates to how we treat our physical environment both inside our homes as well as outside our homes. Intellectual wellbeing relates to how we use our brains, more specifically our reasoning, decision-making and learning skills to guide us through life. Occupation wellness involves feeling a sense of reward as a result of complete your job/task. Physical wellness involved taking care and managing our physical beings; maintaining good health, good fitness, good eating habits, as well as avoiding bad habits are all ways in which we can increase our physical wellbeing. The foundation of social wellness lies within our personal relationships and in the manner in which we keep these relationships. Finally, spiritual wellness is very much up to the individual interpreting it; Spirituality, for some of use, can mean religion, meditation, beliefs and values, the meaning of life or any other definition, which stays true to the individual.

These dimensions of wellness are vital for assessing an individuals overall wellness; together they make up the areas in which wellness needs to be maintained. Substance use and/or abuse can be very detrimental to any or all of these areas; it can be the reason substance abuse begins or can be the affect substance abuse produces. Everyone would ideally be mentally, physically, and emotionally well if at all possible however, it is rarely the case that an individual is all of these (or has no areas to be improved). Substance use can drastically make overall improvements more difficult on individuals as they often are ignoring their current or previous issues.

Substance or behavioral addictions have the ability to interrupt ones education or employment (i.e. showing up under the influence, reduces concentration, missing work/school), cause great financial loss, loss of other assets such as ones house, family, possessions, dignity and so one. The occurrence of substance abuse increases the risk for personal illness or injury; other physical necessities may also be ignored such as hygiene and nutrition when one is harmfully involved in substance use/abuse. Other areas on an individual’s wellness, which could be impacted, include one’s social relationships – substance use/abuse can cause strain, judgment, or complication to existing relationships and may be the end to others.

Substance abuse can also take a large emotional toll on individual involved. Substance use can be a method of stress management or as a coping mechanism for life events or stressors. Using substances or participating in an addictive behavior can cause added stress which can also be seen with the loss of relationships, jobs, possessions, money and so on. A positive life balance is difficult to achieve in the best circumstances – with the added pressure of other dimensions of wellness being affected it is easy to see how substance use can have an effect, emotionally.

It is important to have a working knowledge of these areas of wellness not only for personal benefit but when working within the field of addictions. These dimensions of wellness can be the areas, which may have lead to the initiation of substance use or a problematic behavior or as well, may be affected (or the result) of continued substance use or behaviour. Furthermore, it is essential to have personal positive wellness before attending to someone else's wellness within this field. This is a reason why I have developed a personal wellness plan - to improve my overall wellness in hopes to be more able to improve the wellness of future clients. 

FRAMEWORK

In terms of a general theory or model of the origins and specifics of how addiction develops in individuals, there are none in which I find adequate enough to full identify the ‘why’ as to why people become ‘addicted’ to substances or behaviors. However, I do believe that there are many valid options or points made within the addictions theories existing today.

Initially, there was the moral theory, which basically underlines the moral weakness, which was hidden within those who had substance dependence problems. These people are weak, their addiction is their own fault due to bad personal choices and their behavior is sinful. This is very different from a more resent theory, the Disease model, which implies that substance dependence is a disease or illness. The disease model believes that addiction is not the fault of the individual rather the issue lies with involuntary biological traits. Other theories consist of genetic, or allergy related origins; some include psychological processes such as learning theory, personality theory and humanistic theory while others are based on sociological process such as culture. There are a great many explanations as to why substance dependence or addiction occurs – many more than stated here, however, I have yet to find one that can explain it all.

My personal theory includes small sections of each of the previously mentioned examples as well as the many, which went unmentioned. I believe that there are a variety of differing ways individuals come to be substance dependence or develop a behavioral addiction. I believe it is possible for a person to have developed harmful behavior as a result of a parent or family member having the same behavior (either developed as a result of nature or nurture). I think it is also possible that an individual becomes substance dependent as a result of substance use being positively reinforces just as easily as differences within metabolism (biochemical theory) could influence the harm cause by consistent substance use. It is my belief that the driving cause for substance dependence is different for each individual and furthermore, that it is the individuals interpretation of how they got into the situation which matters rather than what others believe to be the root cause.

The manifestation of substance abuse, misuse, addiction, and dependence is different for everyone who experiences it. The main goal within the field of addictions is to help and treat those who are experiencing harmful involvement with substances and/or behaviors. That being said, it only makes sense to address the root problem when interacting with clients who are experiencing these issues; this is where my theory comes into play. To be successful in treatment I think it is necessary to address the cause for the initial drug use, which more often than not, varies greatly between individuals. One theory cannot begin to account for each individual experience and it makes no sense to me to group them into one framework – rather, the importance lies in what the individual believes to be the underlying cause.

Current theories, in whichever pathway they may be, also lack a lot of components within themselves. Some theories only focus on how the substance dependence begins, while others only specify why it becomes problematic. Each substance or behavioral based issues has it’s own story which I believe to be the most important aspect when explaining the ‘why’ component of addiction.