Chemical Dependency Research Paper

What is drug addiction?

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors. 

Why study drug abuse and addiction?

Abuse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost Americans more than $700 billion a year in increased health care costs, crime, and lost productivity.1,2,3 Every year, illicit and prescription drugs and alcohol contribute to the death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year.4,5 (Hereafter, unless otherwise specified, drugs refers to all of these substances.)

How are drug disorders categorized?

NIDA continues to use the term “addiction” to describe compulsive drug seeking despite negative consequences. However, “addiction” is not considered a specific diagnosis in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—a diagnostic manual used by clinicians that contains descriptions and symptoms of all mental disorders classified by the American Psychiatric Association (APA). 

In 2013, APA updated the DSM, replacing the categories of substance abuse and substance dependence with a single category: substance use disorder. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risky use, and pharmacological criteria (i.e., tolerance and withdrawal). 

The new DSM describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance.
  5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  8. Recurrent use of the substance in situations in which it is physically hazardous.
  9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal, as manifested by either of the following:
    1. The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
    2. The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Please Note: Current national surveys of drug use have not yet been modified to reflect the new DSM-5 criteria of substance use disorders and therefore still report substance abuse and dependence separately.

How does NIDA use the terms drug abuse and addiction?

People use substances for a variety of reasons. It becomes drug abuse when people use illegal drugs or use legal drugs inappropriately. This includes the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other than prescribed or using someone else’s prescription. Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction. These behavioral changes are also accompanied by changes in brain functioning, especially in the brain’s natural inhibition and reward centers. NIDA’s use of the term addiction corresponds roughly to the DSM definition of substance use disorder. The DSM does not use the term addiction. 

What is the difference between physical dependence, dependence, and addiction?

Physical dependence is not equivalent to dependence or addiction, and may occur with the regular (daily or almost daily) use of any substance, legal or illegal, even when taken as prescribed. It occurs because the body naturally adapts to regular exposure to a substance (e.g., caffeine or a prescription drug). When that substance is taken away, symptoms can emerge while the body re-adjusts to the loss of the substance. Physical dependence can lead to craving the drug to relieve the withdrawal symptoms. Drug dependence and addiction refer to substance use disorders, which may include physical dependence but must also meet additional criteria. 

How do drugs work in the brain to produce pleasure?

Nearly all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who use drugs and teaches them to repeat the behavior. 

Is drug abuse a voluntary behavior?

The initial decision to take drugs is mostly voluntary. However, when addiction takes over, a person’s ability to exert self-control can become seriously impaired. Brain-imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decisionmaking, learning, memory, and behavior control. Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of an addicted person. 

Can addiction be treated successfully?

Yes. Addiction is a treatable, chronic disease that can be managed successfully. Research shows that combining behavioral therapy with medications, where available, is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, and social problems. 

Does relapse to drug use mean treatment has failed?

No. The chronic nature of addiction means that relapsing to drug use is not only possible but also likely. Relapse rates are similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors. For the addicted patient, lapses back to drug use indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed. 

How many people die from drug use?

The Centers for Disease Control and Prevention (CDC) report that there were more than 40,000 unintentional drug overdose deaths in the United States in 2011, a 118-percent increase since 1999. More than 22,000 people die every year from prescription drug abuse,6 more than heroin and cocaine combined.7

Comparison of Relapse Rates Between Drug Addiction and Other Chronic IllnessesRelapse rates for drug-addicted patients are compared with those suffering from diabetes, hypertension, and asthma. Relapse is common and similar across these illnesses (as is adherence to medication). Thus, drug addiction should be treated like any other chronic illness, with relapse serving as a trigger for renewed intervention. 
Source: McLellan et al., JAMA, 284:1689-1695, 2000.

1. National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society. Washington, DC: United States Department of Justice, 2011.

2. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373(9682):2223-2233, 2009.

3. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

4. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC.

5. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

6. Centers for Disease Control and Prevention. Prescription Drug Overdose in the United States: Fact Sheet. Available at: www.cdc.gov/homeandrecreationalsafety/overdose/ facts.html. Last accessed: September 15, 2014.

7. Centers for Disease Control and Prevention. Prescription Painkiller Overdoses in the US. Available at: www.cdc.gov/vitalsigns/PainkillerOverdoses/index.html. Last accessed: September 15, 2014.

Title IV-E Program offers free training to San Francisco Human Services Agency staff who work with youth in foster care, group home staff, foster family agency staff, and foster parents in San Francisco.  

Most classes can be offered at an agency’s site on weekdays, evenings, or Saturdays with a minimum of 8 guaranteed participants attending the training.  Agencies can select topics that are currently offered or request new workshops.  Our faculty can customize workshops that fit your agency's needs.

For eligibility questions and more information about scheduling classes, please contact fcstrain@ccsf.edu. 

To register for Title IV-E classes:  Email fcstrain@ccsf.edu.  

Addiction and Recovery: Impact on Problem Drug Users and Their Children
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Addiction is a Brain Disease

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In the assessment and treatment of substance-related disorders for LCSWs and MFTs – also appropriate for any staff members who want to learn more about this topic. Topics covered include: drugs and their effects, screening and assessment, warning signs, an overview of substance-related disorders, treatment strategies such as relapse prevention, harm reduction and motivational interviewing, dual diagnosis/co-occurring disorders and more.

Drugs and Their Effects

Study an overview and/or more in-depth coverage of psychoactive drugs, their effects on the body/brain, signs/symptoms of drug use, and the risks and benefits of using each drug.
- An overview of psychoactive/addictive drugs
- Their effects on the body/brain
- Signs/symptoms of drug use
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Dual Diagnosis; Co-Occurring Diagnosis (COD)
Individuals who have co-existing substance-related and psychiatric disorders must overcome a number of significant hurdles on their way to recovery: multiple health and social problems, double the stigma, a poor response to traditional treatments, a lack of joint treatment options, and a chronic cycle of treatment entry and re-entry. Learn which of your clients are at highest risk for COD and how you can use evidence-based practices (such as integrated mental health and substance abuse treatment) in your practice to help them recover.

Effects of Drug Use on Child Development  

Fetal Exposure: Effects of Fetal Exposure to Alcohol & Chemical Substances

Explore the effects of in-utero alcohol and chemical substance on the developing fetus and its effects on childhood development. Discuss early childhood interventions that best address the needs of children who have had pre-natal exposure.

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How to Talk to Families about Drugs

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Many clients come from families with a severe history of substance abuse and are at high risk for child abuse/neglect or development of substance-related disorders themselves as a result. In order to intervene effectively, staff must have knowledge about some of the effects of these issues and effective treatment strategies. Study an overview of substance use, abuse, and dependence; their effects; the physical and behavioral signs of drug abuse; the impact of parental drug abuse on children, including child abuse and neglect. Examine treatment strategies that work and those that don’t and how and where to make a good referral

Impact of Substance Abuse on Adolescents


Intervention Strategies for Substance Users
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Methamphetamine
Many people are concerned about the impact meth has on clients, families, children, and communities. Learn the facts about this powerful drug. This class also covers assessment and evidence-based treatment strategies so participants feel more prepared to assist clients who have meth-related problems.

Motivational Interviewing Overview   

Strengthen your ability to motivate your clients to make and maintain positive changes. Through interactive exercises, role-play, practice, video, and case examples, learn to apply Motivational Interviewing (MI) more flexibly and effectively and to make MI a more natural and integrated part of your clinical communication style. Become familiar with the spirit, principles, and basic techniques of MI.

Motivational Interviewing
Explore how to help your clients to develop motivation to change problem behaviors (e.g. substance abuse/dependence, diet, exercise, and smoking). Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Strengthen your ability to motivate your clients to make and maintain positive changes. You will become familiar with the spirit, principles and basic techniques of MI. Through interactive exercises, role-play, practice, video, and case examples, you will learn to apply MI more flexibly and effectively and to make MI a more natural and integrated part of your clinical practice. MI was recently redesigned to include Miller & Rollnick's new four-process model.

Motivational Interviewing  3-Hour Refresher

Become more confident in your MI counseling! This three-hour training is for people who have had (at minimum) a two-day beginner's course in motivational interviewing and who want to refresh their skills, update their knowledge, and develop better competence in MI. MI is an excellent evidence-based practice for assisting clients to initiate change in a wide range of problem behaviors. Review the spirit and principles of motivational interviewing. Refresh and develop your skills in helping people who are 'stuck' or unsure of the need for change. MI was recently redesigned to include Miller & Rollnick's new four-process model. Practice skills to help better apply MI theory to real life situations.

Pharmacology Life of the Party: Club Drugs and Harm Reduction


Prescription Medication Abuse

Relapse Prevention Counseling
Addiction is a chronic relapsing disorder, thereby making the prevention of relapse one of the critical elements of effective treatment for alcohol and other drug (AOD) abuse. Studies have shown that 54% of all alcohol and other drug abuse patients can be expected to relapse and that 61% of that number will have multiple periods of relapse. Although relapse is a symptom of addiction, it is preventable. Examine the process of relapse, how to recognize its "warning signs" or triggers, and the elements of relapse prevention treatment methodologies.

Relapse: How to Work with Youth Who Relapse
Most relapses occur in the first year of recovery, with two thirds occurring in the first 90 days. Examine how having appropriate individualized intervention and prevention methods reduce the chances of a youth in care relapsing. Learn: what is relapse, signs of addiction, what is denial, progression of the disease, what support is needed, and the behavior of a chemically dependent youth. Explore various treatment models and the 12-step recovery programs that help create a healthy recover process approach and outcome for youth in out-of-home placement.

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Screening, Assessment, Treatment, Intervention Strategies for Substance Abuse

1-4-hour long trainings, adapted from Demystifying Drugs and Alcohol (above).

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Explore an overview of 12-step groups (e.g. Alcoholics Anonymous, Narcotics Anonymous, Crystal Meth Anonymous, and Dual Recovery Anonymous). Study the barriers to and benefits of participating in them. Obtain information about the structure, format, and “tools” of 12-step programs. Learn to identify how following the 12 Steps aids recovery from addiction.

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We all go through stages when changing something about ourselves. Recognizing what stage of change your clients are in regarding their substance use and tailoring your interventions to each stage will help you be both more effective as a therapist/counselor and more satisfied with your job. Imagine a world where you and your clients are working TOGETHER on drug and alcohol issues instead of struggling with each other. Learning about the Stages of Change model can help you get there!
What do you mean by "Stages of Change?"   The "Stages of Change" consist of different stages that help identify where a person is regarding the change of behavior. There are six main stages: pre-contemplation, contemplation, preparation, action, maintenance, and either relapse/recurrence or termination. Each one of these phases or "stages" describes an individual's attitude toward behavior change.   

Street Drugs & Their Effects
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Substance Abuse: An Overview    

Explore: What is a drug? Why do we use them? What do drugs look like? When are people most likely to overdose? Who is at risk? Why can’t they just quit? Examine the symptoms and difference between use, abuse, and dependence on drugs and why it matters; how addiction affects families; stages of change; harm reduction; and types of treatment.

Substance Abuse in a Residential Setting
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Substance Abuse in a School Setting

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Substance Abuse: Prescribed Medications

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Substance Abuse Relapse Prevention
Addiction is a chronic relapsing disorder, thereby making the prevention of relapse one of the critical elements of effective treatment for alcohol and other drug (AOD) abuse. Studies have shown that 54% of all alcohol and other drug abuse patients can be expected to relapse and that 61% of that number will have multiple periods of relapse. Although relapse is a symptom of addiction, it is preventable. Examine the process of relapse, how to recognize its "warning signs" or triggers, and the elements of relapse prevention treatment methodologies.

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