Impact of Substance Use On Patients and Families Alice Mackey, LCPC, LADC, CCS Substance Abuse Program Manager Community 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

9 The Reward System Natural rewards Food Food Water Water Sex Sex Nurturing Nurturing

Dopamine = transmitter

Dopamine response to stimuli

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.

14 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 preference This 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 LowHigh Important Low 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.

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 of Concern 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 understand They didn’t cause it They can’t control it They 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