What is Addiction?

The 3 C’s of addiction

Compulsion and Obsession – Users think about AOD’s in a vicious negative cycle; their
obsessive concern and preoccupation follow and incessant use of the AOD’s in a
continuous pattern and compulsive lifestyle

Control – inability to or lack of – Users cannot stop using AOD’s for at least 3 months
and/or make feeble attempts to cut back in a stop-then-start pattern. They are unable to
refuse readily available drugs.

Consequences – continued use despite negative consequences – Users are caught up in

their addictions. Eventually, the alcoholic/addict suffers family, social and interpersonal,
economic, and spiritual bankruptcy.

DSM IV Definition of substance abuse:

Substance abuse is described by the following diagnostic criteria in the DSM-IV-TR

A. A maladaptive pattern of substance use, leading to clinically significant
impairment or distress, as manifested by one (or more) of the following
occurring within a 12 month period:
1. Recurrent substance use, resulting in a failure to fulfill major role
obligations at work, school, or home.
2. Recurrent substance use in situations in which it is physically
hazardous. (ex. Driving and automobile or operating machinery)
3. Recurrent substance-related legal problems
4. Continued substance use despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of the
substance
B. The symptoms have never met the criteria for substance dependence for this
class of substances

DSM IV Definition of Substance Dependence:

Substance Dependence is described by the following diagnostic criteria in the DSM-IV-

TR:
A. A maladaptive pattern of substance use leading to clinically significant
impairment or distress, as manifested by three (or more) of the following,
occurring at any time in the last 12-month period:
1. Tolerance as defined by either of the following:
a. A need for markedly increased amounts of the substance to
achieve intoxication or desired effect.
b. Markedly diminished effect with continued use of the same
amount of the substance
 2. Withdrawal as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve
or avid withdrawal symptoms
3. The substance is often taking in larger amounts or over a longer period
than was intended
4. There is a persistent desire or unsuccessful efforts to cut down or
control substance use
5. A great deal of time is spent in activities necessary to obtain the
substance (eg. Visiting multiple doctors or driving long distances), use
the substance (eg. Chain-smoking), or recover from its effects
6. Important social, occupational, or recreational activities are given up
or reduced because of substance use.
7. The substance euse is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely
to have been caused or exacerbated by the substance (eg. Current
cocaine use despite recognition of cocaine-induced depression, or
continue drinking despite recognition that an ulcer was made worse by
alcohol consumption).

Alcoholism and Drug Dependence can be described as:

1. Primary – First, alcoholism and drug dependency contain facets that all diseases
have: symptomology, signs, treatment, and potential for recovery. Second,
treating only the symptoms (ie. A scarred liver) will not take the disease away.
Because many facets of alcoholism and drug dependency must be addressed
before recovery ensues, we say these illnesses are primary.
2. Progressive – The symptoms and signs of alcoholism and drug dependency are
progressive, meaning they will get worse if not interrupted by treatment.
3. Chronic – Alcoholism and drug dependency are chronic, meaning their effects
will continue unless abstinence is maintained.
4. Fatal – Finally, alcoholism and drug dependency can be fatal. They do lead
DIRECTLY or INDIRECTLY to death.

Definitions:

Physical Dependence: a person cannot stop taking a certain drug without suffering
withdrawal and has developed a tolerance to the drug

Psychological Dependence: an emotional or mental need for the repetitive use of a drug
or class of drugs; a mental obsession with the drug.

Withdrawal- the physical symptoms from stopping the use of drugs

Tolerance – a person requires increasingly larger doses to achieve the same effect
Cross-Tolerance – when taking a certain drug you develop tolerance to another drug in
the same class

What are some of the stages of drug use, when does drug use become an addiction?

Stages of Alcohol and Drug Use:

Nonuse → Initial Contact → Experimental Situational Circumstantial Use →

→Integrated Use → Excessive Use → Addiction

Intitial Contact – the first time one tries alcohol/drugs

Experimentation – a positive initial contact usually leads to this stage of drug use.
Experimentation may lead to the subsequent stages which end in addiction.

Integrated Use – the user spends more time, thought, and energy in the use of
alcohol/drugs.

Excessive Use – an increase in alcohol/drug use that results in significant problems or

negative consequences.

Addiction – based on the definition of addiction and the disease model, an addict cannot
return to any of the previous stages of alcohol/drug use.

What are some of the assessment tools used for identifying AOD addiction:

12-step A.A. questions

• Have I tried to stop drinking or using my drug of choice for a week or so, but
could not do it?
• Have I wished people would stop talking about my drinking or drug use?
• Have I changed drinks to try not to get drunk or switch drugs to try not to get
high?
• Do I ever need a drink or my drug of choice to get going in the morning?
• Do I envy people who can drink or use drugs without getting into trouble?
• Does my drinking or drug use cause problems at home?
• Does my drinking or drug use cause problems with other people?
• Do I try to get extra drinks or buy more of my drug of choice on credit?
• Have I tried to stop drinking or using drugs but still got drunk or high?
• Have I missed work, cut school, or dodged responsibilities because of my use of
alcohol or drugs?
• Do I have blackouts-times I cannot remember?
• Would my life be better if I quit drinking or got off drugs?
What do you think are some views on drug use and addiction?

The moral model- addiction is the consequence of personal choice. Individuals are
viewed as making decisions to use AOD in a problematic manner and as being capable of
making their own choices.

The spiritual model- holds that a person has lost touch with a high power and as a result
has lost his or her way. Substance abuse is a result of this loss of touch and can only be
stopped by a return to a spiritual source.

The disease model-(probably the most popular model) addiction is viewed as a primary
disease that is in and of itself and is not secondary to some other condition. The disease is
viewed as being progressive, chronic, and incurable. One implication of this notion is
that the only justifiable goal for the addict is abstinence.

The Psychological Model- places focus on poor adjustment at the emotional and/or
cognitive level. Includes contributing factors such as developmental deficits, adaptive
responses to suffering, and experiences of abandonment. Substance abuse is viewed
more like other compulsions such as gambling and overeating.

The Social Model- Based upon recognition of the impact of negative life experiences.
These may include societal attitudes, family relationships, economic factors, work
pressures, etc. Maladaptive patterns of coping are possible causative agents for substance
abuse.

The Biological-Psychological-Social Model (Pride Site I) – views substance abuse in a

broad manner. It includes biological factors, such as genetics or pain management;
psychological factors such as felling of anger, fear and anxiety; and social factors such as
the family, community, cultural, and economics.