Understanding Addiction:Understanding Addiction:Yours, Mine and OursYours, Mine and Ours

H.E. Logue, M.D.H.E. Logue, M.D.

Bias DisclaimerBias Disclaimer

There is no pharmaceutical support There is no pharmaceutical support for this program.for this program.

I am active in the research field and I am active in the research field and involved in clinical trials for most of involved in clinical trials for most of the major pharmaceutical the major pharmaceutical companies.companies.

Goals and ObjectivesGoals and Objectives

Understand the meaning of addictionUnderstand the meaning of addiction

Understand the spectrum of Understand the spectrum of addictionaddiction

Understand the power of addictionUnderstand the power of addiction

Understand treatment/recoveryUnderstand treatment/recovery

Discussion SegmentsDiscussion Segments

Define addictionDefine addiction Differentiate addiction versus dependenceDifferentiate addiction versus dependence Expand scope of addictionExpand scope of addiction Explain denialExplain denial Conceptualize the addictive processConceptualize the addictive process Give a perspective of the cost of addictionGive a perspective of the cost of addiction Explain the relationship between addiction Explain the relationship between addiction

and co-morbid illnessesand co-morbid illnesses Overview of treatment optionsOverview of treatment options Discuss enablingDiscuss enabling Emphasize permanence Emphasize permanence

AddictionAddiction World Book DictionaryWorld Book Dictionary (1993) (1993)

““The condition of being a slave to a habit.”The condition of being a slave to a habit.” I would add “or a substance.”I would add “or a substance.”

American Psychological Association American Psychological Association DictionaryDictionary (2007) (2007) Addiction: “A state of psychological or physical Addiction: “A state of psychological or physical

dependence on a substance.”dependence on a substance.” I disagree with this definition.I disagree with this definition.

Comprehensive Textbook of Psychiatry/VI Comprehensive Textbook of Psychiatry/VI by by Harold I. Kaplan, M.D. and Benjamin J. Sadock, Harold I. Kaplan, M.D. and Benjamin J. Sadock, M.D.M.D. Substance Abuse Syndrome: “A syndrome manifested Substance Abuse Syndrome: “A syndrome manifested

by a behavioral pattern in which the use of a given by a behavioral pattern in which the use of a given psychoactive drug, or class of drugs, is given a much psychoactive drug, or class of drugs, is given a much higher priority than other behaviors that once had a higher priority than other behaviors that once had a higher value…at the extreme is a compulsive drug-using higher value…at the extreme is a compulsive drug-using behavior.”behavior.”

Medical Definition of Medical Definition of AddictionAddiction

Criteria of American Psychiatric Association (DSM-IV) and Criteria of American Psychiatric Association (DSM-IV) and World Health Organization:World Health Organization:

ToleranceTolerance. . Has your use of drugs or alcohol increased over time? Has your use of drugs or alcohol increased over time?

WithdrawalWithdrawal. . When you stop using, have you ever experienced physical or emotional When you stop using, have you ever experienced physical or emotional

withdrawal? withdrawal? Difficulty controlling your useDifficulty controlling your use. .

Do you sometimes use more or for a longer time than you would like? Do you sometimes use more or for a longer time than you would like? Negative consequencesNegative consequences. .

Have you continued to use even though there have been negative Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family? consequences to your mood, self-esteem, health, job, or family?

Putting off or neglecting activities.Putting off or neglecting activities. Have you ever put off or reduced social, recreational, work, or household Have you ever put off or reduced social, recreational, work, or household

activities because of your use? activities because of your use? Spending significant time or emotional energy.Spending significant time or emotional energy.

Have you spent a significant amount of time obtaining, using, concealing, Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? planning, or recovering from your use?

Desire to cut downDesire to cut down. . Have you sometimes thought about cutting down or controlling your use? Have you sometimes thought about cutting down or controlling your use?

Have you ever made unsuccessful attempts to cut down or control your Have you ever made unsuccessful attempts to cut down or control your use? use?

Answering “yes” to three or more of these questions Answering “yes” to three or more of these questions meets the medical definition of addiction.meets the medical definition of addiction.

Who is an Addict?Who is an Addict?

An addict is a person fitting a An addict is a person fitting a behavioral pattern consistent with behavioral pattern consistent with the definitions we have just readthe definitions we have just read

Addiction vs. DependenceAddiction vs. Dependence

Addiction – being dependent on some Addiction – being dependent on some substance or thing that so overpowers one substance or thing that so overpowers one so as to neutralize judgment controls to the so as to neutralize judgment controls to the point that one will behave in a manner point that one will behave in a manner obviously detrimental to themselves or obviously detrimental to themselves or othersothers

Dependence – a person who uses a Dependence – a person who uses a substance or behavior to alleviate some substance or behavior to alleviate some physical or psychological need while physical or psychological need while maintaining adequate judgment to protect maintaining adequate judgment to protect themselves and othersthemselves and others

Addiction vs. DependenceAddiction vs. DependenceThings in CommonThings in Common

Twin assassinsTwin assassins

Dependency developmentDependency development

Tolerance developmentTolerance development

Withdrawal without the substanceWithdrawal without the substance

Cravings for the substanceCravings for the substance

Addiction vs. DependenceAddiction vs. DependenceThings Not in CommonThings Not in Common

Slave to the substance or behaviorSlave to the substance or behavior Powerlessness over the addictive substancePowerlessness over the addictive substance Judgment warped by the desire and need for Judgment warped by the desire and need for

the substancethe substance Thought process commandeered Thought process commandeered Mind protects the substance, denies Mind protects the substance, denies

responsibility of drugresponsibility of drug Denies responsibility for self Denies responsibility for self Blames othersBlames others Makes illogical choicesMakes illogical choices Willing to harm self or others to satisfy Willing to harm self or others to satisfy

cravingcraving

Types of AddictionTypes of Addiction

Drugs Drugs

AlcoholAlcohol Smoking Smoking Gambling Gambling FoodFood InternetInternet Video Video

GamesGames

SexSex PornographyPornography WorkWork RunningRunning Racing Racing ShoppingShopping ““Shoes”Shoes”

The Big ThreeThe Big Three

1.1. SMOKING SMOKING

2.2. ALCOHOLALCOHOL

3.3. OPIATESOPIATES

DenialDenial American Psychological Association American Psychological Association

DictionaryDictionary (2007) (2007) Denial is an unconscious process that functions to Denial is an unconscious process that functions to

resolve emotional conflict or reduce anxiety.resolve emotional conflict or reduce anxiety. One of the mental mechanisms that we use One of the mental mechanisms that we use

Dorland’s Illustrated Medical Dictionary: Dorland’s Illustrated Medical Dictionary: 2525thth Edition Edition Denial: A defense mechanism in which the existence of Denial: A defense mechanism in which the existence of

intolerable actions, ideas, wishes, impulses and affects intolerable actions, ideas, wishes, impulses and affects are unconsciously denied.are unconsciously denied.

New Webster Encyclopedic Dictionary of the New Webster Encyclopedic Dictionary of the English Language English Language (Library of Congress Catalog (Library of Congress Catalog Card Number 73-1877)Card Number 73-1877) Denial: the act of denying; refusal; rejection; Denial: the act of denying; refusal; rejection;

disownmentdisownment

Conceptualize Addictive Conceptualize Addictive ProcessProcess

You or your children hear You or your children hear something fun and friendly something fun and friendly to you: You’re twelve or to you: You’re twelve or fourteen and a peer offers fourteen and a peer offers you a free beer or cigarette you a free beer or cigarette or jointor joint

It seems harmless, cute, It seems harmless, cute, something to enjoy…something to enjoy…

Illustration by Carla Francesca Castagno.Illustration © 2011 Outskirts Press, Inc. All Rights Reserved. Used with permission.

Fellowship and Fellowship and camaraderiecamaraderie

Mind-altering effectMind-altering effect Effect is felt – either Effect is felt – either

calmed or stimulatedcalmed or stimulated A change from status A change from status

quoquo Use becomes more Use becomes more

frequentfrequent Finally, you realize that Finally, you realize that

you actually want the you actually want the substance; you crave itsubstance; you crave it

A closer look reveals…A closer look reveals…

Illustration by Carla Francesca Castagno.Illustration © 2011 Outskirts Press, Inc. All Rights Reserved

Illustration by Carla Francesca Castagno.Illustration © 2011 Outskirts Press, Inc. All Rights Reserved

Monster’s true nature Monster’s true nature evidentevident

You’ve been hookedYou’ve been hooked You use denialYou use denial You blame othersYou blame others You resist treatmentYou resist treatment It costs you in dollarsIt costs you in dollars It costs you in healthIt costs you in health It costs you in It costs you in

relationshipsrelationships It costs you in jobsIt costs you in jobs You will hit bottomYou will hit bottom You die or you wake up You die or you wake up

to recoveryto recovery

Illustration by Carla Francesca Castagno.Illustration © 2011 Outskirts Press, Inc. All Rights Reserved

Cost of Drug and Alcohol Cost of Drug and Alcohol Addiction in AlabamaAddiction in Alabama

Courts, prisons, juvenile justiceCourts, prisons, juvenile justice $436 million$436 millionElementary, secondary Elementary, secondary educationeducation

$304 million$304 million

Health systemHealth system $300 million$300 millionRegulationRegulation $216 million$216 millionChild welfare, family assistanceChild welfare, family assistance $86 million$86 millionPublic safetyPublic safety $12 million$12 millionPrevention, treatment, researchPrevention, treatment, research $8 million$8 millionState workforceState workforce $4 million$4 million

TOTALTOTAL $1.4 billion$1.4 billion

Cost of AddictionCost of Addiction

Cost per capita - $350 Cost per capita - $350 Cost for family - initial $1000 Cost for family - initial $1000 Many are too young to workMany are too young to work Many are retiredMany are retired Many are disabledMany are disabled Some can’t find workSome can’t find work Some are lazySome are lazy

Projected household cost - $2000-$2500 Projected household cost - $2000-$2500 annually of taxpayersannually of taxpayers

Co-morbid IllnessesCo-morbid Illnesses

Borderline Personality DisorderBorderline Personality Disorder Bipolar DisorderBipolar Disorder SchizophreniaSchizophrenia Schizoaffective DisorderSchizoaffective Disorder General Anxiety DisorderGeneral Anxiety Disorder

Big Problem with Co-morbid Big Problem with Co-morbid IllnessesIllnesses

The addictive behavior is disruptive and The addictive behavior is disruptive and counter-productive treatment of any and counter-productive treatment of any and all illnesses or conditionsall illnesses or conditions

The substance alters the body’s The substance alters the body’s physiology and its ability to respond physiology and its ability to respond appropriately to illnesses and to appropriately to illnesses and to treatmenttreatment

Often, substance exacerbates Often, substance exacerbates underlying mental conditions, especially underlying mental conditions, especially depression and bipolar disorderdepression and bipolar disorder

Treatment OptionsTreatment Options

Alcoholics Anonymous, Narcotics Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous, etc.Anonymous, Gamblers Anonymous, etc.

Twelve-step programsTwelve-step programs Wilderness programs (6-12 months)Wilderness programs (6-12 months) Outpatient programsOutpatient programs In-patient dual diagnosis unitIn-patient dual diagnosis unit In-patient residential facilitiesIn-patient residential facilities In-patient psychiatry unitsIn-patient psychiatry units CommitmentCommitment InterventionIntervention

Pharmacological TreatmentsPharmacological Treatments

AntabuseAntabuse

MethadoneMethadone

ChantixChantix

SuboxoneSuboxone

CampralCampral

AnagramAnagram

AAdmit addictiondmit addiction DDeclare freedom from addictioneclare freedom from addiction DDeclare commitment to healthy body, soul, work, eclare commitment to healthy body, soul, work,

and relationshipsand relationships IImagine a healthy lifestyle without addictive magine a healthy lifestyle without addictive

substancessubstances CCommit to continual self-education about addictionommit to continual self-education about addiction TTeach others all you can about addictioneach others all you can about addiction IInvolve a buddynvolve a buddy OOwn up to personal responsibilities and shortcomingswn up to personal responsibilities and shortcomings NNever let your guard down ever let your guard down

Expanded AnagramExpanded Anagram

AAdmit addictiondmit addiction This applies to any and all addictions and that’s the beauty of This applies to any and all addictions and that’s the beauty of

this anagram.this anagram.

DDeclare freedom from addictioneclare freedom from addiction As with all freedom, it must be constantly defended and won As with all freedom, it must be constantly defended and won

over and over again. The declaration should be your personal over and over again. The declaration should be your personal war on addictionwar on addiction, but everyone together can also make it a , but everyone together can also make it a global effort.global effort.

DDeclare commitment to healthy body, soul, work, eclare commitment to healthy body, soul, work, and relationshipsand relationships You must have a healthy body to function well day to day and You must have a healthy body to function well day to day and

to fight any battles or wars. When your soul or spirit is happy, to fight any battles or wars. When your soul or spirit is happy, it is easier to win personal battles. When you dedicate yourself it is easier to win personal battles. When you dedicate yourself to fostering a healthy work environment, you’re making a to fostering a healthy work environment, you’re making a major effort in an extremely important segment of your life. major effort in an extremely important segment of your life. Relationship health is a place to derive continual happiness Relationship health is a place to derive continual happiness and unequaled support. Give it everything you have. and unequaled support. Give it everything you have.

Expanded AnagramExpanded Anagram

IImagine a healthy lifestyle without addictive magine a healthy lifestyle without addictive substancessubstances It should be easy to envision yourself being carefree and It should be easy to envision yourself being carefree and

untethered from the addictive substance. Often people untethered from the addictive substance. Often people continue to look backwards and rather than feeling the continue to look backwards and rather than feeling the joys of the future opportunities, mistakenly reach back for joys of the future opportunities, mistakenly reach back for the temporary “fixes” of the past. the temporary “fixes” of the past.

CCommit to continued self-education about ommit to continued self-education about

addiction addiction The more you learn, the better prepared you will be to win The more you learn, the better prepared you will be to win

your battles with addiction. The more you learn, the more your battles with addiction. The more you learn, the more you can help others. As with anything worthwhile, a you can help others. As with anything worthwhile, a lifetime of learning will not exhaust the things that are lifetime of learning will not exhaust the things that are available to learn.available to learn.

TTeach others all you can about addiction each others all you can about addiction As you repeat what you know for others, you are As you repeat what you know for others, you are

reinforcing the knowledge to yourself, but you are also reinforcing the knowledge to yourself, but you are also imparting it to others who need it. imparting it to others who need it.

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IInvolve a buddynvolve a buddy This is important. It is someone for whom you give of This is important. It is someone for whom you give of

yourself, but it is also someone from whom you receive in yourself, but it is also someone from whom you receive in times of personal crisis or needs. Choose someone times of personal crisis or needs. Choose someone compatible.compatible.

OOwn up to personal responsibilities and wn up to personal responsibilities and shortcomings shortcomings Until one is able to recognize and admit their own Until one is able to recognize and admit their own

shortcomings, they’re not being honest with themselves. shortcomings, they’re not being honest with themselves. Until one accepts the responsibilities that should be their Until one accepts the responsibilities that should be their own, they’re not being equitable or fair. own, they’re not being equitable or fair.

NNever let your guard down ever let your guard down

You must always have an ironclad defense, for there are You must always have an ironclad defense, for there are inevitable urges and impulses that will assail you by all inevitable urges and impulses that will assail you by all means possible. Avoid persons, places, and situations that means possible. Avoid persons, places, and situations that are opportunistic for addictive substance and behavior.are opportunistic for addictive substance and behavior.

TreatmentTreatment

Work recovery daily!Work recovery daily!

Society of EnablersSociety of Enablers

PushersPushers Family Family SpouseSpouse FriendsFriends EmployerEmployer DoctorsDoctors TherapistsTherapists MinistersMinisters

Infinity CircleInfinity Circle

Analogy to AllergyAnalogy to Allergy

Smoked for 19 years (1953-1972)

Quit three times  Dreams 2009 - Still addicted Recovering 37 years

Author’s VignetteAuthor’s Vignette

War on Addiction

Within ourselves

Within our families

Within society

Who are we?Who are we?

Addict (victim)Addict (victim)

Soldier (conqueror) Soldier (conqueror)

SummarySummary

We’re powerless to prevent a habit or the use We’re powerless to prevent a habit or the use of substances despite known dire of substances despite known dire consequencesconsequences

Unless we are heavily indoctrinated not to Unless we are heavily indoctrinated not to begin addictive behavior, we can easily be begin addictive behavior, we can easily be seduced to try itseduced to try it

We can become hooked instantly or insidiouslyWe can become hooked instantly or insidiously Various treatment optionsVarious treatment options There is no cure – only day to day recovery There is no cure – only day to day recovery Addiction is permanent!Addiction is permanent!