Patterns of substance use Mary Golding Lloyd

Outline Tacit assumptions about drug use Normal use patterns Conclusions

Common assumptions about substance misuse - A “medicines analogy” Dependence or habitual use typifies drug use Dependence should be explained by neuropsychological mechanisms Individual and situational differences are not primary

Normal use patterns Experimental Occasional, intermittent Recreational Regular binge Light habitual Heavy habitual

Experimental Drug taking on a few occasions and no more, with no signs of increase over time Agreed that this can occur for all drugs Most experimenters use other substances Most experimenters do not increase their substance use Experimental alcohol or cannabis use is largely confined to people opposed to their use

Occasional, intermittent Use occasionally, with no regular annual pattern (often confused with experimental use) Use may be purely opportunistic – the drug is available, or the drug may be deliberately sought out Pattern continues for years without change Most occasional users are more regular users of other substances Occasional users experience no problems with use and if they do, they tend to stop

Recreational Use according to a reasonably regular pattern Use is usually sought out deliberately Use may go along with specific social events or occasions Use may involve a specific social network Use is generally moderate relative to norms for the substance involved Recreational use episodes usually involve multiple substances Weekend use is one classic pattern Acute problems are accepted as minor and manageable

Regular binge Bingeing is like recreational use except that: Quantities consumed are large relative to norms The binge may be protracted, lasting more than 12 hours Bingeing sometimes has adverse acute effects on the user The user may be conflicted about bingeing

Light habitual This involves use probably several times a week or more, even daily But of relatively small quantities of the drug Quantities taken may intoxicate, but will not affect behaviour Light habitual users usually use other drugs occasionally, but use this drug most often When they cannot obtain the drug, they miss it, may substitute others, but can go without Light habitual users score low on measures of dependence and may not show tolerance

Heavy habitual Daily use of large quantities of drug, with signs of tolerance Few other signs of dependence Health may or may not be affected (Depending on quantity and substance) Few difficulties quitting or moderating use if required

What is addiction? Addiction is a pathological love relationship with a mood altering chemical, (or activity – i.e. gambling, sex)

BEHAVIOURAL SIGNS OF ADDICTION Excessive need for privacy Secretive or suspicious behavior Chronic dishonesty Unexplained need for money Change in personal grooming Sudden change in wardrobe, hairstyle, or jewelry

BEHAVIOURAL SIGNS OF ADDICTION Forgetfulness and difficulty paying attention Lack of motivation, energy, self-esteem… ‘I don’t care’ attitude Sudden over sensitivity, temper tantrums Moodiness, irritability, or nervousness Silliness or giddiness Paranoia

BEHAVIOURAL SIGNS OF ADDICTION Change in attitude/personality for no identifiable reason. Change in friends, new hangouts Decreased performance at school, work and/or home. Change in activities or hobbies Change in habits at home Loss of interest in family and family activities

ADDICTION - GRIEF REACTION Grief is at the core of the recovery process. Much like the death or ending of a long-term relationship, the addicted individual has a committed, love relationship with their chemical, person, thing, and the discontinuation of this relationship causes a significant and very real experience of loss.

ADDICTION 5 STAGES OF GRIEF Denial & Isolation Anger Bargaining Depression Acceptance

Conclusions Psychopharmacology tends to conceptualise drugs as taken in regular dose and pattern Dependence is an example of this, so is medical use Recreational drugs are used in more complex ways The ‘standard’ questions are How is dependent use acquired and maintained? What harm does the drug cause? Additional questions could be How can use patterns vary so much over time and from person to person? How is harm avoided? More work on ‘unobtrusive’ drug use is required