Impact of Substance Use On Patients and Families

Alice Mackey, LCPC, LADC, CCSSubstance Abuse Program ManagerCommunity Counseling Center

Agenda: Why people use drugs Impact of drug use on the brain Impact of drug use on the family Drug addiction and recovery

Why do people take drugs?

To feel good To feel better

(stress, anxiety, depression)

To do better (athletic or cognitive performance)

Curiosity, peer pressure, thrill seeking

National Institutes of Health, US DHHS

Addiction: Bio/Psycho/Social Risk Factors

Family influences (childhood environment)

Genetics Personality traits Social and environmental factors

(peer influences, emotional issues, high stress or conflict, etc.)

Addiction: A Chronic Brain Disease

Addiction is a chronic, neurobiological disease characterized by behaviors that include one or more of the following: impaired control of drug use compulsive use continued use despite harm

consequences craving

Addiction: A Chronic Brain Disease (cont.)

Addiction affects people of all ages and backgrounds. And unfortunately, it affects the addict’s family and friends, too.

The process: Try a substance Continue to use the substance Deny that a problem exists Lose control – unable to reduce or

abstain

Addiction: A Chronic Brain Disease (cont.)

It is considered a brain disease because drugs change the structure of the brain and how it works.

These brain changes can be long-lasting and lead to harmful behaviors.

National Institutes of Health, US DHHS

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The Reward System

Natural rewardsNatural rewards FoodFood WaterWater SexSex NurturingNurturing

Dopamine = transmitter

Dopamine response to stimuli

200 200350

1250

0

200

400

600

800

1000

1200

1400

1600

Food Sex Alcohol Cocaine Meth

Brain damage from drug use

Dopamine is one of 8 types of Neurotransmitters in the brain.

It is responsible for Pleasure

Without it = depression Smooth muscle movement

Without it = Parkinsonianism Drug use depletes Dopamine… so a

person’s ability to experience natural pleasure may be gone for years?

Brain effects

The large release of dopamine produced by methamphetamine is thought to contribute to the drug's toxic effects on nerve terminals in the brain.

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The Brain After Drug Use

DA = Days Abstinent

Frontal cortex damage The frontal cortex is a brain region that

supports logical thinking, goal setting, planning, and self-control.

Numerous MRI studies have documented that addictive drugs cause volume and tissue composition changes in this region and that these changes are likely associated with abusers’ cognitive and decision making problems.

Closer to normal after 6 mos. abstinence

Pleasure = neuroadaptation

By repeatedly creating a NEW source of pleasure (drugs) the brain adapts

New protein is laid down in the brain that literally changes brain chemistry

The user creates an additional BASIC SURVIVAL item in the limbic system – drug abuse

Results in a need, not a preferenceThis drives every choice the user makes

Continued use is no longer voluntary

Now the reward system has been altered

The need for drugs has a stronger hold on the brain’s reward pathway

the order of natural pre-programmed survival needs has changed

This change is happening at a molecular level

So… basic instincts have changed and drug use move to the top of the reward system

HOWEVER: Even though the brain has changed, Users ARE responsible for their actions.

Addiction redefined

A state in which an organism engages in a compulsive behavior A behavior that is reinforcing (rewarding or pleasurable) There is a loss of control over limiting

the intake

Drugs affect the brain in ways that are long term although at least partly reversible.

These brain changes profoundly influence cognition, emotions and behavior.

Addiction is a chronic illness, and like other chronic disorders, require ongoing (not episodic) treatment and support.

Summary

Impact on the Individual’s life

Even after many hangovers, damaged relationships, legal problems, memory blackouts or even being

pregnant ─

Some People can’t stop using.

Addiction hijacks brain circuitry leading to maladaptive behaviors.

Family response to the individuals behavior

Denial: Rationalize and tolerate things once

unthinkable. Examples of rationalizing escalate

He’s just experimenting. Going through a stage. It’s only marijuana. He gets high only on weekends. At least he’s not using hard drugs. At least it’s not

heroin. At least he’s alive.”

Family members internalization of the problem

Guilt and self-blame Did I spoil him; was I too strict? Did I give him too little attention; too

much? If only we had not divorced; moved; if

only….

Impact on Family System

Users blame the family – the family blames themselves

Parents and siblings feel ashamed, frustrated, afraid, alone, hopeless

The user feels ashamed, afraid, alone and hopeless and isolates from family

Impact on Family System (cont.) CPS has to remove children from

parents, and grandparents or other family often raise those children.

Families are forced to self-protect: locks on bedroom doors, hiding valuables, orders of protection from the user

Familial crime victims often do not report to police, out of shame and a misguided desire to protect the user.

So is it surprising…

That people don’t simply stop using drugs, considering that drug addiction creates so many problems for them and their families?

or a symptom of the disease… Malfunctioning brain circuitry over

rides rational judgment and intent In active addiction the brain

responds automatically to triggers – reducing the freedom of choice

A key feature of addiction is the continued use despite negative consequences and relapse

SUCCESSFUL RECOVERY FROM ADDICTIONS

Occurs over long periods of time Often involves multiple attempts

and treatments Consists of self change and/or

treatment Involves changes in other areas

of psychosocial functioning

Use of Motivational interviewing in primary health care

Motivational interviewing is a way to relate to the patient that is client-centered, goal oriented and focuses on resolving ambivalence about change while keeping resistance low

MI helps patients who are moving along the continuum of change and

MI employs the same interpersonal skills nurses learn in nursing school

Benefits of Motivational interviewing It provides a brief intervention which

can help the patient find their own solutions for change.

With 1 or 2 sessions change can begin

Just a little counseling can lead to significant change

Can yield outcomes that are similar to those of longer treatments

Motivational interviewing

Motivational interviewing techniques help the patient to:

Re-consider their views about their health Realize that their views are irrational Recognize what will motivate them to be

healthier Realize that they can change Feel supported in the attempts to change Move from negative attitudes to change to

a positive attitude to change

Four Early Motivational Strategies

O: Open-ended questions A: Affirm, notice the persons strengths their motivation, their values

R: Reflect S: Summarize

Willing:Importance of Change

Able:Confidence for change

Ready:A Matter of Priorities

Three Critical Components of Motivation

A Client’s View of Motivation …

Confidence

Low High

ImportantLow

Group A: It is not important and I can’t do it.

Group B: I can do it but it is not important.

High

Group C: It is very important and I can’t do it.

Group D: It is very important and I can do it.

http://www.seattle.gov/neighborhoods/education/SELI_MotivationalInterviewing-parentInvolvementApps.pdf

Transition From Use To Recovery

Assessing Readiness for Change…

Relates to the client’s perceived sense of Importance about the valve of the proposed change

Until they see it to be important – they will not be ready to pursue it.

Level ofConcern counselor/ Family

client

Recovery for the individual

SAMHSA defines: Recovery from alcohol and drug problems as a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.

Recovery for the family

Help family members to understandThey didn’t cause itThey can’t control itThey can’t cure it

Offer family members an assessment of their personal, social and mental health needs

Discuss support groups for families

Summary

Addiction is a chronic brain disease Addicts may not have the freedom of

choice But they do have the choice of freedom Motivational Interviewing helps people

work through their resistant change Due to the close relationship with the

patient, Nurses are in the ideal role to comfortable talk wtih patients about lifestyle behaviours, their need for chang and help them to identify their motivator