Substance Use Disorders
The Institute works with many individuals and families who suffer from substance use disorders. Both “substance abuse” and “substance dependence” are classified as substance use disorders (SUDs). They impact negatively not only on the one with an SUD, but also their loved ones, colleagues, and communities.
Robert West defines addiction as “a syndrome in which a reward-seeking behaviour has become out of control.”
At least three of the following over a 12-month period meets the criteria for a substance dependence:
- Tolerance (a need for increasing amounts of the substance over time to get the same effect);
- Withdrawal (uncomfortable symptoms when trying to quit or cutting down the problem substance);
- Using larger amounts over a longer period of time than was intended;
- Persistent desire to reduce or control use;
- Much time spent in obtaining, using, or recovering from the substance;
- Important social, occupational, recreational activities are given up or reduced due to drug use;
- Continued use despite persistent, recurring physical or psychological problems caused or exacerbated by the substance.
Substance dependence develops through repeated and prolonged use of psychoactive substances which alter mood and perception of reality. Intense cravings to use and uncomfortable, sometimes life-threatening, withdrawal symptoms keep an individual trapped in a harmful cycle. Psychoactive substances that cause dependency include alcohol, prescription drugs, cocaine, heroin, marijuana, etc.
Treatment
Substance dependence is a chronic, progressive, relapsing disease. But effective treatment can result in stable recovery. In Theory of Addiction, Robert West uses a three-level framework to explain the repeated failure to refrain from substance use despite prior resolutions to do so: 1) neuroadaptation, 2) desire for drugs, and 3) failures of resolve.
An effective treatment plan must address all three of these levels. There is growing recognition that we need to treat an SUD as a chronic illness that requires regular monitoring (to minimize losses) instead of acute treatments after a relapse.
Beginning Recovery
Many who begin recovery are able to detoxify at home with minimal discomfort, but some need the supportive environment of a community residential detox centre. There are several non-medical detox centres in Toronto, which one can access through the Central Intake line (1-866-366-9513).
For health and safety reasons, the withdrawal from some substances requires medical help. Before an individual makes any changes to their substance use, they must speak to their family doctor. This is important if there has been a history of:
- Alcohol withdrawal–related seizures or DTs (Delirium Tremens: hallucinations, auditory or visual, severe tremor, agitation, and confusion);
- Long-term use of benzodiazepines (Valium, clonazepam, Ativan);
- A combination of alcohol and barbiturate use;
- Long-term use of high doses of opiates (Oxycontin, Percocets, codeine).
The Next Step
Ideally, one would go directly into a substance abuse treatment program after withdrawal, to minimize the chances of a relapse and to learn the skills to sustain a life of recovery. Treatment programs have an intake assessment and a waiting period between time of application and actual admission date. The Drug and Alcohol Registry of Treatment (DART: www.dart.on.ca or 1-800-565-8603) lists all the OHIP-covered treatment centres in Ontario. It is preferable to complete the application process and obtain an admission intake date before accessing withdrawal management to ensure a seamless transition into treatment.
Monitoring and Aftercare
Ongoing monitoring is vital. It ensures accountability to fellow recovering individuals who can assist one in keeping goals, maintaining a substance-free life, and working at improving quality of life. It can include a 12-step program and/or individual or group therapy.
Concurrent Disorders
A “Concurrent Disorder” is a mental illness (e.g., Depression, Anxiety, Schizophrenia, Bipolar Disorder, etc.) that has been independently diagnosed and is not substance induced. Using psychoactive substances for a while affects one’s mental health; thus it makes diagnosis difficult and can impair effective treatment. An integrated approach of mental health and substance abuse care is indicated when mental health symptoms interfere with recovery.
Integrated Care at IFL
Individuals, couples, and families who seek psychotherapy often admit substance use is implicated, that using substances leads to a host of problems. Addressing substance use effectively builds a foundation from which to launch the work of deeper personal growth. IFL marriage and family therapists work collaboratively with each other and with the community of practitioners to provide integrated care to their clients.
by Adrianne Sequeira, CPMHN (C)
Addictions Specialist
Print this article in Adobe Acrobat pdf format
For Further Reading
Another Chance: Hope and Health for the Alcoholic Family by Sharon Wegscheider Cruse
Betty: A Glad Awakening by Betty Ford with Chris Chase
My Recovery: A Personal Plan for Healing by Charles L. Whitfield, M.D.
In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Mate, M.D.
“What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.”
Alice Miller, from Breaking Down the Wall of Silence.
“…addiction inevitably involves both opioid and dopamine circuitry. the dopamine system is most active during the initiation and establishment of drug intake and other addictive behaviours. It is key to the reinforcing patterns of all drugs of abuse — alcohol, stimulants, Opioid, nicotine and cannabis. Desire, wanting and craving are all incentive feelings, so it is easy to see why dopamine is central to nondrug-related addictions, too. On the other hand, opioids — innate or external — are more responsible for the pleasure-reward aspects of addiction….Opioid circuits and dopamine pathways are important components of what has been called the limbic system, or the emotional brain.”
Gabor Mate, M.D., from In the Realm of Hungry Ghosts: Close Encounters with Addiction |
OUR ASSOCIATES
Diane Marshall, M.Ed., RMFT
Director
AAMFT Approved Supervisor
Individual,
Couple, and Family Therapy
Gender Issues and Life Transitions
Philip A. Classen, Ph.D., C.Psych., RMFT
AAMFT Approved Supervisor
Individual,
Couple, and Family Therapy
Adolescent and Child Psychology
Orville Green, M.Div., RMFT
Individual, Couple, and Family Therapy
Employment
Issues and Marriage Preparation
Immigration and Family Reintegration
Nancy Molitz, M.A., RMFT
Individual, Couple, and Family Therapy
Performance
Edge
Trauma — EMDR (Level 2)
Adrianne Sequeira, RN, CPMHN(C), BHA
Individual, Couple and Family therapy
Addictions and Concurrent Disorders
Ann Stocker, B.A., M.Div. (Cand)
Supervised Intern
Individual, Couple, and
Family Therapy
Lindsay Watson, M.A., RMFT
AAMFT Approved Supervisor
Individual, Couple,
and Family Therapy
Trauma — EMDR (Level 2)
Danny Yeung, M.D., C.C.F.P.
Cantonese/Mandarin/English
Medical Assessments
Individual,
Couple, and Family Therapy
Trauma — EMDR (Level 2)
OUR CONSULTANTS
Child and Adolescent Counselling
Cheryl Noble, Ph.D., C.Psych.
Registered Psychologist
Comprehensive Family Mediation
Ed Heide, M.S.W., R.S.W., RMFT
Joan Sinclair, M.S.W., R.S.W., Acc.F.M.
Mediation and Legal Services
Virginia Hamara, B.A., LL.B
Korean Community — Individual, Couple, Family Therapy
Suyeon Jin, M.S.W.,
M.Div.
Psychiatric Assessments
John W. McCormick, M.D., D.Psy., F.R.C.P.©)
Registered Sex Therapist, BESTCO
Wendy Trainor, M.S.W., C.S.W.
Spanish Community — Individual and Couple Therapy
Pablo Munoz, M.A.
Administrative
Newsletter Designer
Shireen A. Jeejeebhoy
www.jeejeebhoy.ca
Receptionist
Betsy Barlow
