Professional Development Training to deal with Drug Addicts

Drugs, legal and illegal are a serious issue in modern society. They destroy lives, damage the economy and impact on more people than just those who use them.
All sorts of professionals from health workers and youth workers to pharmacists, school teachers and counselors; can and probably will, encounter drug problems in their work; if not sooner, almost definitely later.

Here at ACS, our psychologists and health experts have developed a great short course, tailor made to train any of these professionals (or anyone else), who needs to know how to better deal with and help people who have a drug problem.

What do Drugs Do to a Person

Drugs are chemicals. Like other chemicals which are consumed, they are metabolised. They affect the brain’s communication systems and affect how our nerve cells send, receive and process information. The exact impact on our brain will vary between different drugs as they all work differently. There are two main ways in which they act on our brain:

• They imitate the brain’s natural chemical messengers.
• They overstimulate the reward circuit within the brain
  
  

For example, heroin and cannabis have chemical structures that effectively mimic neurotransmitters that occur in our body.  They trick our receptors and activate nerve cells, but they don’t work in the same way as natural neurotransmitters. This means that the neurons end up sending abnormal messages around the brain, which causes problems for the brain and our bodies.

Other drugs, such as methamphetamine and cocaine can cause the neurons to release too much dopamine or to prevent the normal recycling of dopamine. Dopamine is a natural neurotransmitter found in the brain which sends signals to other nerve cells. Interruptions to its normal use can lead to exaggerated messages passing around the brain. This may cause problems with the communication channel. A way to imagine this is that it can create a difference between perceiving someone whispering compared to shouting into a microphone.  

The Reward System

Many drugs, such as cocaine, cannabis and nicotine, affect the brain’s reward circuit. This is part of the limbic system.  When the reward circuit is activated it normally responds by releasing dopamine and this creates feelings of pleasure. When a person takes the drug, it can stimulate high levels of dopamine release in the brain, which causes a ‘high’ or intense euphoria that can be linked to drug abuse. Whilst the exact mechanisms triggered by different types of substance are slightly different, each substance leads to a pleasurable ‘high’.  

Our brains have developed to make sure we repeat healthy activities by making us feel good for engaging in them. For example, we might feel good after eating.  The reward circuit will react and think that something important has happened that needs to be repeated without us having to think about it. Drugs and other pleasurable activities can do the same.  For example, regularly drinking alcohol, taking drugs, smoking, gambling, using the internet (such as visiting porn sites), shopping and sex lead to pleasurable feelings, which can in turn lead to a strong desire to repeat them more often.

They can make the brain think that because it felt good when taking drugs it should repeat that. The brain doesn’t distinguish because a natural healthy ‘good feeling’ and the negative, fake ‘high’ which drugs produce. Therefore, instead of achieving pleasurable feelings from useful or adaptive everyday behaviours, the person gains the same sensations of pleasure from the drug which is being abused. Therefore, the behaviour becomes reinforced and the person continues to be a user.

Tolerance
When a person repeatedly uses a drug, the brain starts to adjust to the increased levels of dopamine in their system.  The brain begins to reduce the levels of dopamine it produces. Due to the toxicity of some drugs, some neurons may also die. This results in the person feeling reduced pleasure. They may begin to feel depressed, lifeless, and so on. They may not enjoy things that once brought them pleasure. So, the person starts to need the drug more to bring their dopamine levels back to a normal range. And then they need more and more to create the same “high”, or even to maintain a sense of normality. This is known as tolerance.

Withdrawal

In the long term, drugs can lead to dramatic changes in the brain circuitry and neurons, even if a person has stopped taking drugs. These changes can remain for years. A person who has been addicted to a substance may derive very little pleasure from activities and events that other people find extremely pleasurable. This is why it is so difficult for some people to stay off the substance when trying to quit.  There is little enjoyment in their lives.

In extreme cases the recovering addict may develop a condition known as anhedonia. Anhedonia is the loss of pleasure, satisfaction or excitement from all things. If you can imagine everything that gives you pleasure, including those you love, suddenly having no impact or being able to generate any feelings of enjoyment for you, then this is what it is like to experience this.  

Withdrawal is essentially the syndrome associated with a reduction of the amount of a substance in the bloodstream. It is associated with unpleasant physical and psychological symptoms. When someone goes through withdrawal they often experience an intense craving for the substance. If they take the substance at this time, they are able to relieve the symptoms of withdrawal. The physical symptoms may be different for different substances but psychological symptoms of withdrawal include those associated with depression and anxiety.

Dependence

The way that substances impact upon us, in practical terms, will vary. The effects will also vary depending on whether a person is taking drugs or drinking too much, and by what type of drug they are taking.
 
The term 'dependence' has been used to describe the physical and psychological effects of continually taking a substance. Dependence is synonymous with addiction. The DSM-IV (Diagnostic & Statistical Manual of Mental Disorders) & ICD-10 (International Classification of Diseases) state that dependence includes:

• A strong desire to take a particular substance.
• Difficulty controlling use of the substance.
• The development of tolerance for that substance.
• The neglect of other forms of satisfaction - and increased time spent achieving the     same effect.
• Withdrawal symptoms upon cessation of taking the substance.
• Continued use even when it is clearly harmful.
  
  

The most recent incarnation of the DSM, the DSM-5, no longer separates substance abuse and substance dependence. Instead, for each specific substance, including alcohol, there is a category of 'substance use disorder' (e.g. Alcohol Use Disorder) which combines the symptoms of abuse and dependence.

There is also a second group of 'substance induced disorders' and included under these are categories of intoxication and withdrawal, as well as other mental health disorders (such as depressive disorders, bipolar disorders, delirium, etc.) which may be triggered by use of each substance.   

Substance Abuse

Abuse of a drug is regarded as the use of a substance over a period of 12 months or more. The use is associated with distress to the individual but does not include tolerance, withdrawal or dependence.

The World Health Organisation describes 'harmful use' in the ICD-10 as when a person shows a pattern of substance use which is causing damage to their health, which is either physical or mental. Physical effects include things like hepatitis and liver damage. Mental effects include things like depression as a result of heavy consumption of the substance.

See more about this 20 hour short course at http://www.acsbookshop.com/product-addiction-counselling-short-course-6000.aspx