Hot Off the Grill

Index

USA Wellness Café
Coping and Healing
Interview with an Expert on Addictions

Written by Staff Writers of USA Wellness Café ™

USA Wellness Café Interview Questions for Bernie McCann, Ph.D.

Just how prevalent are alcohol and drug use, abuse and addiction?

Bernie McCAnn, Ph.D., CEAPAccording to the most recent data (2010) on the use of alcohol and illegal or illicit drugs by the US population aged 12 or older , available from the annual National Survey on Drug Use and Health, 52% of the population reports being current (past month) drinkers. Additionally:

  • 23% of the population engaged in binge drinking (5 or more drinks on at least 1 day in the 30 days)
  • 7% of the population reported heavy drinking (binge drinking on at least 5 days in the past 30 days)
  • 9% of the population were current (past month) illegal or illicit users
  • Of these, marijuana was the most commonly used drug, with 7% of the population as current users
  • The 2nd largest group, 6% of the population, were current non-medical prescription drug abusers
  • The highest rates of illegal or illicit drug use were seen among 18 -25 year olds

In the past year, 22 million persons (9% of the population) were classified with substance abuse or dependence in the past year.

Of these, 15 million had abuse or dependence on alcohol, 4.5 million had abuse or dependence on illicit drugs, and 3 million with abuse or dependence on both alcohol and drugs.

Of these, only 4 million (1.6% of the population) received assistance or treatment for a problem related to abuse of or dependence on alcohol or drugs – 2.3 million received help via a self-help group, and 1.8 million from a hospital, inpatient or outpatient treatment center or correctional institution.

Perhaps it’s helpful to use the following image to understand that a person's consumption pattern, that is, the frequency and amount of use of alcohol and other drugs used is an important marker for evaluating whether they may have or are at risk of developing a substance use disorder.

Coping Triangle

What are some of the signs that alcohol and drug use have become problematic or of addiction?

The symptoms of preoccupation and loss of control are common in those with substance use disorders. Preoccupation refers to spending inordinate amounts of time concerned with matters pertaining to substance use. The symptom of preoccupation is marked by an individual's tendency to spend a considerable amount of time thinking about, consuming, and recovering from the effects of the substance(s). Loss of control is a symptom usually typified by loss of control over one's behavior while using alcohol or other drugs. Loss of control over substance use is typified by the consumption of more of the substance(s) than originally intended.

While alcohol and drug dependence may be the result of a lot of alcohol or drug use, it is not the same as using alcohol or drugs a lot. Most people who experiment with drugs or even use them regularly for a while do not develop dependence. For psychologically healthy individuals, some experimentation with drugs does not typically have adverse future consequences. For others who already have some emotional or psychological difficulty, alcohol and drug use can easily become part of a broad pattern of self-destructive behavior. Substance use certainly begins as a voluntary behavior, but after a point, the brain changes and continued use (even in the face of negative consequences) becomes involuntary.

Individuals cannot move back and forth between abuse and dependency at will - once dependency develops, an individual's brain has been changed in a fundamental biological way that differs from a non-dependent brain. Long-term use results in substantial changes to brain function that may persist long after an individual discontinues use. Another way to explain the difference in these states is that abuse is a problem to be solved, whereas dependence qualifies as a disease to be treated.

We often hear about the denial associated with alcohol and drug abuse or dependency? Why does this make it harder for people to seek help?

The concept of denial in substance abuse and dependency is the frequent lack of awareness and acknowledgement about the true extent of an individual’s substance use. This lack of insight creates a barrier to a full and realistic understanding of the condition’s consequences - now and in the future. For many struggling with harmful levels of substance abuse, they are not fully aware of how much of their daily life or behavior is associated with seeking, acquiring and using alcohol or other drugs.

People with substance use disorders are often ambivalent about changing their harmful behavior regarding alcohol or drug use. They may be choosing to continue such behavior for to various reasons, such as being attracted to a particular lifestyle, wanting to be included in a peer group, coping with life’s stresses, or they may philosophically disagree with marijuana laws, etc.

When the destructive effect of these behaviors becomes obvious, they are then faced with the reality of giving up most of the people, places and things they have come to enjoy and with which they may strongly identify. Without a clear picture of the future, these individuals may be reluctant to proceed with any change. Thus, a considerable effort is often required by the individual with a substance use disorder -- or their family members, friends or helping professionals -- to become willing to make a commitment to change.

What’s a first step in obtaining help, if someone is experiencing difficulty with alcohol or other drugs?

If an individual can move past denial or lack of knowledge of the harmful effects of their substance use and acknowledge that they have some type of drinking or drug problem, they’ve already begun the first step in obtaining help or treatment. Substance abuse and addiction treatment professionals recognize this initial acknowledgement in honestly facing alcohol or drug abuse disorders takes tremendous strength and courage. Actually reaching out for assistance is the second step.

What kind of genetic factors indicate one may be susceptible to substance abuse? Are some individuals inclined to biologically predispose to difficulty with alcohol and other drugs?

Substance use disorders can be related to many factors, including genetics, how one was raised, one’s social environment, and emotional health. Some racial groups, such as American Indians and Native Alaskans, are more at risk than others of developing alcohol addiction, for example. People who have a family history of substance abuse or dependence or who associate closely with heavy drinkers/drug users are more likely to develop such disorders. Finally, those who suffer from a mental health issues such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol and other drugs may be used to alleviate symptoms of these conditions.

Traditional thinking is that the difference between those who use alcohol or drugs without harmful consequences is physiological. That is alcoholics and addicts are somehow different biologically, that they are allergic to alcohol or other drugs, they have a “genetic predisposition” to abuse, or that they have “addictive personalities”.

The scientific evidence for each of these perspectives is in dispute. Rather, the most recent thinking is that getting high or altering consciousness is a universal biological drive arising out of the human brain’s innate structure. In other words, we are all “hard wired” to get “high”. Viewing intoxication as a biological inevitability gives us a better understanding of how alcohol and drug use differs from drug abuse and alcoholism. Such use is not necessarily immoral or pathological but a natural drive. Everyone has a need to alter their consciousness and they many will do so even at their own peril… from sky diving to drunk driving to smoking crack cocaine.

What are some of the rationalizations an individual suffering from a substance use disorder use to fully deny a problem with alcohol or drug use? Is it difficult for most people to admit their drinking or recreational drug use is out of control?

Since drinking is so common in many cultures and the effects vary so widely from person to person, it’s not always easy to figure out where the line is between social drinking and problem drinking. The bottom line is how alcohol or other substances affect you. If an individual’s drinking or drug use is causing negative consequences in the important aspects of their life, such as work, family, finances, legal status, then many professionals would say that identifies a “drinking or drug use problem.”

For some, the desire to drink, use illegal drugs or misuse prescription drugs is so strong that the mind finds many ways to rationalize this continued harmful behavior, even when the negative consequences are obvious. By keeping one from looking honestly at such behavior and its negative effects, denial also exacerbates substance abuse-related problems at work, home, with finances, and relationships.

Regrettably, the negative effect of stigma about substance use disorders often discourages people from utilizing whatever community resources or health insurance treatment benefits they may have. Some employees fear that if they access their benefits their employers will know about it, even though there are laws in place to protect the confidentiality of medical records (which includes treatment for substance abuse). Others fear their work reputation or standing may suffer, or that they will encounter discrimination and unfair treatment.

How can an employee (or their family members) utilize an Employee Assistance Program to gain help for difficulties with alcohol or drug use?

Once an individual becomes aware of a problem with their own or another’s alcohol or drug use, one excellent source of help is an Employee Assistance Program (EAP). These confidential programs are usually provided free to workers and provide confidential information, counseling and coaching to employees (and their family members) regarding a variety of personal and workplace concerns, including those related to alcohol and drug use.

When a worker or family member contacts the EAP (often by a toll free 800 number) they are typically assigned a counselor and scheduled for an initial appointment. The counselor and the client assess the underlying concern and determine goals, desired outcomes, and timeframes for achieving them. In some cases, an EAP will determine that the individual is best referred to Alcoholics Anonymous, some other self-help group or perhaps to a substance abuse treatment provider. EAPs are bound by legal rules of confidentiality to avoid sharing any information not authorized by the client. Thus, EAPs can serve as a valuable, knowledgeable, supportive and confidential resource for those experiencing difficulties with substance use disorders.

Is it necessary to go to a residential facility to seek treatment for alcohol or drug abuse?

No, today there are a wide variety of resources and modalities available to individuals experiencing difficulties with alcohol or drug use to seek help. Whether you choose to go to substance abuse rehabilitation center, a self-help program, get individual therapy, use a faith-based recovery program or some combination of each – ongoing support is an essential ingredient.

Simply telling someone with a substance use disorder to stop using alcohol or drugs, is a lot like telling a homeless person to get a house, such individuals need a plan of action to achieve the goal of reducing their harmful use. Recovering from alcohol or drug abuse and addiction is more successful when individuals access resources for guidance, encouragement, comfort, or medical attention when appropriate. Without such support, it’s easy to fall back into old patterns when things get tough, and unfortunately, many individuals do relapse before they achieve recovery.

Successful recovery from substance abuse or dependence depends on continuing participation in treatment/recovery programs while learning healthier coping strategies, and making better decisions when dealing with life’s challenges. In order to achieve recovery for the long term, an individual may need to address underlying issues and situations that have contributed to harmful alcohol or drug use in the first place. These may include depression, an inability to manage stress, unresolved trauma, other mental health or just ordinary life issues. Such issues may seem more prominent when individuals are no longer using alcohol or drugs to cope. But individuals in recovery will be in a healthier position to successfully address them.

Can someone in a stressful job keep working while undergoing treatment for substance use disorders?

A stressful job, in itself, is not a barrier to undergoing treatment. The variety of treatment approaches and programs available today should allow an individual, once motivated, to find an approach that is successful for them. Some modifications in work or family schedules may need to made, but many individuals in these same circumstances have accommodated both their careers and their recovery.

How can a person change his social or personal life to support the desire to quit using drugs, stop harmful drinking or stop smoking?

By becoming involved in a self-help group, seeking counseling and/or treatment for substance abuse, individuals with these disorders will learn about the condition, what its potential for greater harm to their mental and physical health is, how they can participate in their own treatment, and how to successfully ensure their recovery from these conditions. No one should anticipate that these may not be difficult, but no more so than many other health conditions that people routinely are diagnosed with, treated for and go on to live their lives. These are the promises of recovery – that help is available, that treatment works, and that a happy healthy life is possible for those who have suffered with these conditions.

Does recovery from alcohol and drug disorders sometimes take a few attempts before an individual can be considered successful “in recovery”?

One of the biggest obstacles for recovering alcoholics and addicts in the first few weeks of sobriety is the constant obsession they have for alcohol or drugs, called craving. It has been widely recognized as one of the major factors in preventing individuals from staying away from these substances in early recovery.

One critical ingredient to increase treatment success and reduce relapse is attendance in continuing care and/or some type of follow up support. In the past, conventional approaches have viewed relapse after treatment as a failure. Similar to other chronic conditions - such as hypertension, asthma, diabetes, etc., substance use disorders can be treated successfully. Also similar with other chronic diseases, it is not uncommon for a person to relapse—in this case, to begin abusing substances again. Relapse, however, does not mean failure but rather, it indicates that treatment should be reinstated, adjusted, or that perhaps an alternate treatment is needed.

Additionally, a number of new medications are now available can be used to treat the cravings commonly associated with the first phase of abstinence. Naltrexone, Vivitrol, and Campral are drugs used to curb cravings felt by many alcoholics in the first stages of recovery. Methadone and Buprenorphine have similar uses for opiate (heroin) cravings in recovery, while Provigil and Topamax are two medications used for reducing stimulant cravings. For many, using medications to reduce cravings, avoid relapse, or decrease the frequency and negative effects of drug or alcohol use can offer hope and reduce the emotional and physical discomfort of recovery from substance abuse and addiction.

What’s the best way to approach a friend or loved one about seeking help?

For family and friends of those with a substance use disorder, addressing the obvious issue is one of the most difficult aspects of helping an individual seek treatment. Often, over time, a family/friend’s involvement has only managed to enable the individual to continue harmful use. Family members and friends frequently do not know how (or want) to bring up the issue of seeking help or treatment, and frequently ignore the issue for fear of pushing their loved one/friend away or making the situation worse.

These are legitimate concerns, and while families should understand that approaching their loved one should be a gentle and supportive process, they also need to understand that most individuals seek help for substance abuse because of positive family involvement and intervention.

What about confidentiality at work? Is it necessary to share detailed information about obtaining treatment with a supervisor or employer?

Sadly, many American workers hesitate to seek treatment for substance abuse and other mental health issues. Substance use disorders, depression, and other mental health conditions are very treatable, however often people hesitate to or will never get the treatment they need strictly out of fear.

However, the Americans with Disabilities Act does provide that employers have a duty to provide reasonable accommodations to individuals with disabilities, including those currently under treatment for or in recovery from substance use disorders. Specifically, if a recovering drug addict is not currently illegally using drugs, then he or she may be entitled to reasonable accommodation. This would generally involve a modified work schedule so the employee could attend Narcotics Anonymous meetings or a leave of absence so the employee could seek treatment.

Does today’s stressful world and job demands contribute to substance abuse? Can employers do anything to support workers in highly intense work environments? For example, would onsite wellness centers and quiet meditation areas--available in some hospital work settings--help employees stay away from unhealthy behaviors such as drinking too much?

Unfortunately, these issues have become exacerbated in today’s economy because many individuals are afraid of losing their job. Showing weakness or not being at the top of their game is not particularly revered in our contemporary American work culture, and the economic climate has probably made that attitude worse.

Encouraging healthy activities and reducing stress in the workplace are proven strategies for supporting workers, and taking step to encourage and facilitate a healthy work/life balance is also important. Employers and work groups that strive to create an environment in which that people have avenues to take care of themselves, are likely to be less stressful and more productive. Make healthier lifestyle choices, including seeking help or treatment is more likely to happen among people who work in a culture that gives them a license to be human.

Online resources for help with concerns about substance use

National Directory of Alcoholism & Drug Abuse Resources - The National Substance Abuse Index provides an easy-to-use directory for resources related to alcoholism and drug addiction. Access the most up-to-date information and help with drug problems such as meth, cocaine, heroin, marijuana, club drugs, alcohol use & abuse – includes information on prevention, rehabilitation, and addiction recovery. Or call toll free: 877-340-0184

SAMHSA’s Substance Abuse Treatment Locator - This searchable directory of drug and alcohol treatment programs shows over 11,000 treatment locations, including residential treatment, outpatient treatment, and hospital inpatient programs for drug addiction and alcoholism facilities around the US that treat alcoholism, alcohol abuse and drug abuse problems. Listings include programs for marijuana, cocaine, and heroin addiction, as well as drug and alcohol treatment for adolescents, and adults. Or call toll free: 800–662–HELP (4357)

Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

DrugFacts: Treatment Approaches for Drug Addiction – This online fact sheet by the National Institute of Drug Abuse provides current science-based research findings on effective treatment approaches for drug abuse and addiction.

SMART Recovery - Self Help for Substance Abuse & Addiction - SMART Recovery is a self-empowering addiction recovery support group. Participants learn tools for addiction recovery based on the latest scientific research and participate in a world-wide community which includes free, self-empowering, science-based mutual help groups. Or call toll free: 866-951-5357

Substance Abuse Resources – DMOZ the Open Directory Project is the largest, most comprehensive human-edited directory of the Web. It is constructed and maintained by a vast, global community of volunteer editors.

RX Safety Matters - Purdue Pharma is working with healthcare professionals, law enforcement and local communities across the country to help curb diversion and abuse of medications, while making sure they remain available for appropriate medical use. The Company is committed to being part of the solution to prescription drug abuse and has developed an array of programs focused on education, prevention and deterrence.

iSource: The National Survey on Drug Use and Health provides national and state-level data on the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States and is sponsored by the Substance Abuse and Mental Health Services Administration, an agency the U.S. Department of Health and Human Services.