This lesson looks into current and fundamental knowledge of drug abuse and addiction counselors by exploring the terminology and typology of addiction and substances.
Your brain runs off things called neurotransmitters. They allow individual neurons of your brain to communicate by way of passing neurotransmitters between each one. Since nature has a tendency to reuse things, many chemicals found in the outside world tend to be very similar to the ones found in your body. Over time, people have learned to produce these chemicals in the laboratory.
These substances, produced naturally in nature or in the lab, can cause major issues with how your brain works. In fact, these substances can trick your brain into thinking you need them, or they can trick your brain into not producing neurotransmitters on its own. But we will get more into that in a bit.
There are many levels of using substances. Substance use is defined as the ingestion of a substance. This is how most people use cigarettes and alcohol. It is even possible, although many people may adamantly disagree, to use marijuana without developing dependence. A person who can eat, drink, or smoke it without being dependent on it or needing it is a substance user. Some people may put a classy term on this, like 'social drinker.'
The next level is substance abuse, which is defined as a disorder characterized by the regular ingestion of a substance that is causing distress or difficulty functioning. Here the substance is being ingested regularly and is no longer fully under the control of the user. There is some kind of problem, such as the user not wanting to use as much as they did or they have trouble functioning. The person who smoked too much and can't do his job at the pizza parlor is an abuser.
The most severe level is substance dependence, which is defined as a disorder characterized by the individual needing the substance to function normally. If you've ever watched any TV show or special about drug users, you will hear 'I need it to get by.' This is drug dependence. They are now dependent on the substance in order to function.
One major difference between abuse and dependence is that dependent people have withdrawal, which is an onset of physical and psychological symptoms when substance use is halted. Withdrawal symptoms are a lot like hunger pangs. If you don't eat for a day, you hurt and it's hard to think. This would be considered mild withdrawal. Severe withdrawal, like that from alcohol, can kill you after hours of brutal agony. It's not so fun.
An older term you may run into is polysubstance abuse, which is a disorder in which three or more substances are abused without preference for any one substance. This is where people will take anything to get high; it doesn't matter what. It has been phased out in the fifth edition of the diagnostic manual due to its highly specific nature and ease of diagnosing it as something else.
All of the substance issues have a larger effect. Monetarily, we can say we have spent over $1 trillion dollars on the War on Drugs without any real progress being made. That's a 1 followed by 12 zeros.
In other ways it is more difficult to measure. How many children are impeded by developmental issues due to substance use while their mother was pregnant? How many people in places of power have made poor choices for their city, state, or country while using? It's harder to answer these questions.
What we can talk about more specifically is how different substances affect your mind and body. We can also discuss the ways that specially trained counselors can help those with substance problems.
Psychoactive is a fancy way of saying 'affects the mind.' This includes things like antipsychotic medication as well as rave drugs and everything in between. More specifically, it can be divided into four subgroups based on how it affects the mind.
A stimulant is a substance that arouses or accelerates the body. The most commonly used drug in the world is a stimulant: caffeine. This is the type of drug that makes things run faster and smoother. It usually works by kicking the body's adrenal system into high gear. The downside is that it tends to wear the body out and overheat it. Common examples of stimulants include cocaine, methamphetamine, MDMA (also known as ecstasy), and ADHD medication.
An opiate is a substance derived from the poppy plant, which induces sleep and pain reduction. Your brain produces natural opioids, which help reduce pain. It is what gives you the 'runner's high.' Higher concentrations and more potent forms are often used in hospitals under the name of codeine and morphine. These can be highly addictive because of their pain-reducing qualities, but the catch is your brain only wants so many opioids in the system. So when the opiate is stopped, that means you have no natural opioids in your system, making you feel every bump and scrape magnified to a howling pain. Common types of opiates are morphine, heroin, and oxycodone.
A depressant is defined as a substance which slows down and reduces functional activity. These work by interfering with the normal neurotransmitter functions in the neurons, like a bouncer at a club. These have a varied number of symptoms, including reduced pain, dissociation, and cognitive impairment leading to feelings of being high. Basically, that 'high' is your brain slowing down so much that it gets really stupid. Common types of depressants include antipsychotics, sedatives, and, and alcohol.
A hallucinogen is defined as a substance that changes the user's perceptions and thoughts. This is where all the crazy stuff comes in, like being able to taste color or feeling like you're trapped on a wheel outside of time. These basically cause the brain to trip (pun intended) and spill a bunch of neurotransmitters all over the brain. Common types include lysergic diethylamide acid (LSD or acid), salvia, and psilocybin (aka magic mushrooms).
Training to be a substance abuse counselor also requires you to take a little bit of all of the previous drugs. No! No, it does not. But all jokes aside, past drug use can be a source of tension when it comes to those who makes the best counselors. Really, who is more qualified? A former addict with basic certification or a highly trained academic who hasn't lived the life of addiction?
While those aren't the only two types of counselors out there, it's still a very real debate in the rehab world, and it can even affect who gets hired. My personal opinion is that one doesn't need to have had parts of their life ruined by taking drugs to be an effective counselor. Regardless, all counselors need to complete some level of formal training.
Training involves a basic understanding of the therapeutic process as well as an understanding of the basics of substance abuse. I say basics because there are certificate programs that require as little as 6 college credits to earn. More advanced training can be achieved by entering master's and higher level programs designed to teach the students advanced types of counseling and more information about how the substances affect brain chemistry. However, these types of counselors tend to be more expensive than the certificate level.
Treatment typically takes one of two forms:
- Inpatient treatment, also known as residential, is defined as an extended program lasting for several weeks in which the client lives and attends therapy inside a facility.
- Outpatient treatment, or community treatment, is defined as a structured environment where clients go for therapy and treatment.
Clients who are accepted into inpatient treatment typically need to be monitored for dangerous levels of withdrawal and to keep them from using. For example, someone coming off of a steady use of opiates could have severe heart and brain issues when coming down and will likely crave it so strongly that they will use whatever they can find to stop the pain.
Clients in outpatient treatment are likely to be more stable and able to handle their own housing. These people will come to the treatment center and attend groups. Think Narcotics Anonymous.
Drug counseling involves many aspects. First is differentiating between the different levels of use, which are:
- Substance use, defined as the ingestion of a substance
- Substance abuse, defined as a disorder characterized by the regular ingestion of a substance that is causing distress or difficulty functioning
- Substance dependence, defined as a disorder characterized by the individual needing a substance to function normally
The different types of substances that can be used fall into four main types. A stimulant is a substance that arouses or accelerates the body. An opiate is a substance derived from the poppy plant, which induces sleep and pain reduction. A depressant is defined as a substance which slows down and reduces functional activity. A hallucinogen is defined as a substance that changes the user's perceptions and thoughts.
Lastly, treatment can be inpatient treatment, also known as residential, defined as an extended program lasting for several weeks in which the client lives and attends therapy inside a facility. Or it can be outpatient treatment, or community treatment, defined as a structured environment where clients go for therapy and treatment.
Upon completion of this lesson, you should be able to:
- Differentiate between drug use, abuse or dependence
- Define stimulants, opiates, depressants, and hallucinogens
- Identify the best treatment options: inpatient, residential, outpatient or community