DSM IV CRITERIA FOR ADDICTION *Pre-occupation between use *Using more than has been anticipated – Loss of Control *Development of Tolerance *Characteristic Withdrawal Syndrome *Use to avoid or control Withdrawal symptoms *Repeated efforts to stop or cut back *Intoxication at inappropriate times or when Withdrawal interferes with daily functioning *Reduction in social, occupational or recreational activities in favour of further use *Use continues despite social, emotional and physical problems related to such use

Occasional escape drinking Frequent escape drinking Early alcoholic phase True alcoholic phase Complete alcohol dependence Last phase Detoxification Rehabilitation After-Care 12-Step Meetings

DISEASE MODEL  Has a cause  Has specific signs and symptoms  Has a natural history and course  Has an outcome  May or may not have a treatment  Recovery may or may not be possible  Relapse is likely if appropriate treatment is not followed

Facts about Alcoholism Alcoholism - chronic, progressive and fatal disease- tolerance, physical dependency, pathological organ changes 7-10% of alcohol consumers are alcoholic. Formal treatment for 15% in developed countries For every alcoholic, four people are directly affected More than 50% fatalities caused by Cirrhosis, alcohol- related psychosis, accidents, homicides and suicides

Facts about Alcoholism Disease disregards sex, age, ethnicity, religion, geographic location, social-economic status 5-10% employees are alcoholic Drunk driving causes 50% traffic fatalities Alcoholics 10 times more likely to die from fires, falls and suicide Treatment is possible Alcoholism is preventable

UNDERSTANDING RELAPSE SYMPTOMS Become over-confident - ignore follow-up measure Appear depressed, not communicate, prefers loneliness Becomes irritable, angry, argumentative, resentful over minor issues Indulges in gambling etc Makes major decisions without adequate thinking Is unable to eat/sleep properly Goes with drinking friends Stops meeting counsellor/going to AA meetings Talks about social drinking

WAYS OF HELPING IF YOUR LOVED ONE IS AN ALCOHOLIC Don’t regard this as a family disgrace Don’t nag, preach or lecture to the alcoholic Guard against a "holier than thou" attitude or martyr-like attitude Don’t use the "if you loved me,” appeal Avoid any threat unless you think it through carefully and definitely intend to carry it out. Don’t hide liquor or dispose of it Don’t let the alcoholic persuade you to drink with him

WAYS OF HELPING. Don’t be jealous of the method of recovery the alcoholic chooses Don’t expect immediate 100% recovery Don’t try to protect the recovering alcoholic from drinking situations Do learn all the facts and put them to work in your life Do attend AA meetings, Al-Anon meetings Remember you are emotionally involved Encourage all beneficial activities of the alcoholic

Causative Theories 1.Genetic Causation (inherited predisposition to contract disease) 2.Social Learning Causation (environment condition reinforces chemical use and addiction). 3.Psychological Causation (chemical reduces stress) 4.Biological Causation (organic predisposition to disease) 5.Spiritual Causation (Spiritual separation/ bankruptcy cause disease)

Identifiable Symptoms 1.Craving for alcohol/other drugs 2.Blackouts 3.Lose of control 4.Loss of memory 5.Changes in tolerance 6.Withdrawal symptoms 7.Compulsion to drink/use

Harmful consequences Physical/Mental health Marital /family health Social Health Job health Financial health Legal health Spiritual health Volitional (Will/Desire)

Alcoholism/Chemical dependency is 1.PRIMARY 2.PROGRESSIVE 3.CHRONIC 4.FATAL 5.PERMANENT 6.TREATABLE

MISUNDERSTOOD 1.Willpower Myth 2.Moral myth 3.Skid row myth 4.Popularity myth 5.Prescription myth 6.Self-infliction

Symptoms and Characteristic of Depression 1.Depressed, sad, blue, or irritable mood 2.Poor appetite or weight loss 3.Trouble sleeping or sleeping too much 4.Loss of energy, fatigue, or listlessness 5.Loss of interest or pleasure in usual activities 6.Decreased sex drive

Symptoms and Characteristic of Depression 7. Feeling of guilt, inadequacy, or worthless. 8. Trouble concentrating, thinking, or making decisions. 9. Suicidal thoughts and behaviours. 10. Psychomotor retardation or restlessness. 11. Frequent crying spells. 12. Feeling of helplessness and hopelessness.

Denial 1.Justifying- (I drank because, I had a tough job). 2.Minimising- (I drank, but always gave the pay cheque to my wife). 3.Blaming- (I drank because wife kept on nagging). 4.Threatening- (If you object to my drinking, I will find another woman). 5.Silence- (See, I am so quiet, I am not doing anybody harm). 6.Diverting- (Why are the children not studying/why is the house not in order) 7.Bribing- (You can go for a film tonight-here is the money)

WHAT IS INTERVENTION? Intervention consists of a crisis or crises that, in an objective, unequivocal and non- judgmental way, confront the alcoholic with the reality of his condition.

Accept the definition of addiction Realize that the effect of the alcohol itself further reduces the strength of even "normal" willpower Realize that the alcoholic has developed a defense system so effective that it results in a serious degree of self- delusion Understand that because of this degree of self-delusion, the alcoholic is absolutely unable to look at his behavior objectively and realistically