If you are reading this part of the website you probably have questions about treatment, not for yourself, but for other people who need help with addiction. You could be a medical professional, social worker, or peer worker.
When it comes to getting people into treatment the other sections of the website cover the most practical details. However, there’s more to treatment than procedures and the nuts and bolts of how things work.
Life is always far more complicated than we would like it to be. So to make things a little less complicated this section is dedicated to resources that help people understand addiction.
So let’s take a look at the root of the matter and define what we are talking about.
Substance dependence (addiction) is a maladaptive pattern of substance use, leading to clinically significant impairment or distress.
In order for addiction to exist several components need to be present.
There are seven possible components, if three or more of them are present at any time in a 12-month period, a person is said to have an addiction. These components are as follows:
Tolerance is defined by two factors. The first is the need for increased amounts of the substance to achieve intoxication or the desired effect. The second is diminished effect with continued use of the same amount of the substance.
Withdrawal is defined by the characteristic withdrawal symptoms for the substance. In other words feeling “sick.” The same or closely related substance is taken to relieve or avoid withdrawal symptoms.
The substance is taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful attempts to cut down or control substance use.
A great deal of time is spent on activities to obtain the substance.
Important social, occupational, or recreational activities are given up or reduced because of substance use.
The substance use is continued even though they know that doing so is continuing to cause harm to them.
When you look at the criteria you can see that many people who have been prescribed opioids for acute pain for example may meet less than three of the components.
If a person is taking their medication as directed and having good results they are not addicted. They are simply taking their medication. It is only when things start to get out of control that they transition into addiction.
Determining if some factors apply can be as simple as asking a few questions or observing changes in the person’s behavior patterns.
Observing withdrawal can be more difficult if you don’t know what you are looking for. The following list describes some of the withdrawal symptoms.
They can be broken down into three separate categories. There are physical symptoms, psychological symptoms, and physical signs.
- Muscle Aches
- Abdominal Cramps
- Hot Flashes
- General discomfort
- Drug craving
- Dilated pupils
- Abdominal tenderness
People often say they feel “sick” and the symptoms resemble the flu.
You may have known people who were on pain medication following an injury and when they stopped taking their medication they suddenly got the flu and couldn’t go to work.
It is likely that it wasn’t the flu at all but withdrawal symptoms from the discontinuation of their opioid-based pain medication. The symptoms are really awful. In some cases people say they feel like they are “dying.”
The most common cause of withdrawal is a lack of opioids in the body as a result of not taking the regular dose of drugs or medication. Other causes could be taking medications or substances that speed up opioid metabolism, taking other opioids that block the effect of the opioids they are currently taking, or taking an opioid antagonist.
Talking About Addiction
We have the criteria to determine if someone is addicted to opioids. The next question is how do they go about making a change in their life to do something about their addiction?
It is best if they start the conversation because they want to. You can encourage this by letting it be known that you are open to talking about addiction. You cannot make someone talk about it and you can’t force someone to want to change.
If you attempt to start the conversation and it is apparent they are not interested that is their choice. Be prepared to postpone the conversation to a later date. You can always try again and by that time circumstances may have changed and they may be more receptive.
It’s important to know that you can’t force someone to get better. We use Cognitive Behavioral Therapy. This is a type of therapy where patients motivate themselves to change.
Most people decide to make a change when two conditions are met. The first is that they decide they want to change their behavior. The second is that they feel strong enough to face the challenge of making the change.
This isn’t to say that you need to leave people completely on their own in order for them to want to change. You might have influence over their decisions. It can be a touchy subject and people are sensitive about addictions.
There is the myth that people need to “hit rock bottom” before they will make a change. This is not true. The more intelligent or self-aware a person is the more likely they will make a change before things become the absolute worst.
People who are more observant or self-aware can see bad things coming their way. They can anticipate that they will lose things that are valuable to them. In this way they can build the motivation to change.
Before having a conversation about addiction you should know that the conversation might not go the way you expect it to. There are risks involved in engaging in the conversation. It may be in your best interest to seek professional advice on how to handle the situation.
Keep the following in mind when talking about addiction:
- Be prepared to let the conversation go. You can always talk to them again at a later date.
- Be direct and straightforward and keep things simple.
- Ask open-ended questions instead of yes or no questions.
- Assumptive questions work better than wide open ones.
- Addiction is a medical condition. Their body is dependent on the opioids and cannot function normally without them.
- If you’ve never been through withdrawal it feels worse than you can imagine. People do literally say feel like they are “dying.”
- Don’t be judgmental. You may have no idea what the root cause of the addictive behavior is.
- Be honest about hopes and concerns and have a positive attitude.
- Try to avoid any subjects that may trigger their drug use.
- No guilt trips. Be supportive. This is not about you. This is about their life.
If a person is receptive to getting into a treatment program keep the following in mind:
Encourage them to be honest with the treatment team. Counseling and positive social factors will be the biggest factors in a successful recovery.
Getting off and staying off drugs is not quick and easy. Remember this is a long-term thing and will not be over with quickly.
There will be setbacks and relapses. This is totally normal. It does not erase any progress that has been made.
Give them space if they need it. Applying too much pressure for change can have the opposite effect. They need to decide to change on their own.
Relapse is normal. It can take place months or years after opioid use has been discontinued. Relapse is not a failure. It is just a temporary setback. Everyone has personal warning signs and triggers for relapse. CBT counseling can help with self-awareness and allow them to avoid situations that may cause a relapse.
The main triggers for drug use are stress, boredom, and hanging around people who do drugs. Each person may also have a variety of other triggers that are unique.
For example loneliness, fear, anger, depression, frustration, fights, arguments, bad memories, funerals, divorce, overdue bills, debts, and job loss are real life problems that can trigger a relapse.
This is part of why recovery is such a long process. It takes a long time to pay off debt, get though a court proceeding, battle for custody of a child, or get over the death of a loved one
This is hard to explain but it is an intense desire to use opioids. The need to satisfy the craving may drive people to do things that they would not normally do. A person experiencing cravings may report psychological and or physical manifestations.
Cravings are a normal part of opioid dependency. Cravings vary in severity and may not always be extreme in nature. Given time cravings will pass.
To help with cravings it is a good idea to occupy the mind with something like conversation with a good friend, video games, a hobby, exercise, or any other legal and non-drug related activity.
Milestones and goals can’t be erased by a relapse. People should be encouraged to continue to meet goals and move forward.
This is probably the most positive thing you can do to help. It is also usually the easiest to do. Things like driving someone to the clinic if they do not have a ride, helping them clean up around the house, providing food and beverage, and helping with chores.
Anything that is practical that helps to relieve some of the stress and pressure of daily life can be a big help. Often people with addictions are dealing with multiple problems that a very difficult to solve and very stressful.
© 2015 Addiction Centre Toronto.