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6. SUBSTANCE ABUSE: ALCOHOL AND DRUGS
In this module, we examine the different kinds of drugs, both those accepted
by Western Society and those which are banned. We explain how people
become dependent, and show how you can help people conquer their
addiction, using the "disease concept" as your guideline.
THE EXTENT OF THE PROBLEM
One hundred thousand people in Britain die prematurely because of
smoking. Seven hundred thousand people have a serious alcohol problem.
Two hundred and fifty thousand people are addicted to tranquillisers.
Each of these people has a family that is affected by their behaviour, so the
problem is a large one. There are more deaths and disabilities each year
from substance abuse than from any other cause. About 18 million
Americans have alcohol problems; about five to six million Americans have
drug problems. More than half of all adults has a family history of
alcoholism or problem drinking.
In the USA, more than 9 million children live with a parent dependent on
alcohol and/or illicit drugs. Fetal alcohol syndrome is the leading known
cause of mental retardation (The National Council on Alcoholism and Drug
Dependence). THE COUNSELLOR’S ATTITUDE TOWARDS DRUGS
Our attitude towards drugs is conditioned by our background and culture. A
judge will soundly condemn a drug addict, and may sentence them to prison,
but the judge may be addicted to alcohol. The journalists reporting the trial
may smoke cannabis for recreation. The clerk of the court may be taking
Benzodiazepines tranquillisers. The police officer that arrested the person
may be addicted to tobacco. Society deems some substances acceptable, and
others not. People then happen to be brought up on the right or wrong side
of the divide.
Attitudes towards drugs vary among different cultures. Moslem countries
frown on alcohol. Bolivian farmers chew coca leaves, which produce
cocaine. EU commissioners condemn cannabis production but subsidize
Yet attitudes are constantly changing. Today, many senior police officers are
in favour of de-criminalizing drug use. So you should try not to hold pre-
conceptions about drug abuse. An open mind and a non-judgmental attitude
Moreover, a drug scene which seems squalid to the outsider can seem
exciting to the drug user. Therefore, the counsellor has to understand the
users culture and needs before they can start to help them. EXERCISE 6.1
What is your attitude to drugs? Are you addicted to any legal or illegal
drugs? How do you think your attitude to drugs will effect your position as a
As a counsellor, you may be asked to help a client quit smoking. Smoking
kills one in four smokers, many of whom die a painful death. Out of 1,000
young male smokers, one will be murdered and six will be killed on the
roads; but 250 will die from smoking. It shows what a big killer smoking is.
Tobacco causes a wide range of illnesses, including lung cancer and heart
disease. Babies born to smokers are under-weight and weak.
Withdrawal is not easy because nicotine is highly addictive. The user may
also experience stress because they have lost an emotional support. SMOKING AND THE COUNSELLOR
Research shows that trying to persuade smokers to quit has little effect
unless the smoker is already considering it. Therefore, exhortations bring
The client may light up at certain times when they make coffee, for ex-
ample. You may ask the client to write down the times and places where
they smoke, and encourage the client to avoid those times and places.
Separating smoking from social breaks may help. LEARN WHY THE CLIENT SMOKES
It is important to find out what has motivated the client to smoke. Smokers
often find that tobacco relaxes them and helps them concentrate.
The oral craving - to have something in the mouth - is another urge. Some
smokers start over-eating when they quit, substituting one problem for
another. See if the client can find a non-fattening, non-harmful substitute.
Nicotine patches work for some clients. Placed on the upper thigh like a
plaster, the patch will slowly release a metered dose of nicotine.
A discussion with the GP is also effective, if the client wants to give up.
Other cures like acupuncture, hypnotism, or smokers' classes have high rates
of recidivism (backsliding). In some cases, 80% of clients return to
Often it is effective for the counsellor to ask the client what it would take to
quit smoking. It is a simple approach, but it works. EXERCISE 6.2
Do you have a friend that smokes? If you do, ask them questions about their
habit. Try and ascertain why they smoke, and discover if they’ve tried giving
up in the past. DRINKING
Alcohol makes people relax, for it is a drug just as much as nicotine or
cannabis. However, thousands of people have a problem with drink - they
drink too much, too often.
Excessive drinking costs British firms £800 million ($1 billion) every year
from absenteeism caused by alcohol.
The alcoholic leads a secret life of hiding bottles, going on secret drinking
trips, and stealing money. They can exhibit shaky hands, slurred speech,
anxiety and depression. They are caught drunk-driving by the police.
Alcohol is easy to get; it is on sale everywhere. It also provides a quick
release from stress. This makes it the obvious choice for people in difficulty.
The World Health Organisation reckons that between 1% to 10% of the
world's population is dependent on alcohol, and is disabled by it. If the
client craves alcohol, and if they cannot control what they drink, they are
Alcohol abuse can stem from excessive stress at home or work. If you can
find out what is stressing your client, you can help them resolve that stress,
which may help them recover.
THE DISEASE CONCEPT
Most health care professionals use the "disease concept" or "model" in
providing treatment to individuals with drink or drug problems (The books
listed in Exercise 6.3 give a full explanation of the disease and recovery
The disease concept does not assign blame or make alcohol or addiction a
moral issue. It identifies the problem, which is pathological consumption of
alcohol or drugs; and it gives the solution, which is abstinence and
Addiction is classified as a disease
and is a primary disorder because it has
In addition, it will result in death if left untreated
Alcoholism is a disease
and not a symptom of another disease or emotional
Alcoholism may also result in physical complications or disability
And reproductive disorders, among others.
In the alcohol treatment community it is generally accepted, and taught to
the client, that the drinking causes the problems. The problems do not cause
the drinking. When working with an alcoholic you should assume this point
and discuss it often. EXERCISE 6.3
Go to the library and explore the "disease concept" used in chemical
dependency (alcoholism and addiction) treatment and recovery programs.
Some books to look for include:
- I'll Quit Tomorrow
- How to Help Someone Who Doesn't Want Help: A Step-By-Step Guide
for Families of Chemically Dependent Persons
Both books are
DIAGNOSING ALCOHOL DEPENDENCE
For a medical diagnosis of alcohol dependence, a person must exhibit within
a twelve month period, at least three of the seven following dependency
1. Tolerance - The need to drink more
2. Withdrawal or drinking to avoid or relieve withdrawal symptoms
3. Drinking larger amounts or for a longer period than intended
4. Unsuccessful attempts or a repeated desire to quit or to cut down on
6. Reduced social or recreational activities in favour of alcohol use
7. Continued alcohol use despite psychological or physical problems
Working with individuals who are alcohol dependent can take you to task.
Education is the greatest asset you will need to keep your client honest and
Most individuals come to a counsellor after their treatment program has
ended. They need firm help and support to heal and to keep them from
drinking or using drugs again. Your work in this field is important. Your
services have great value, especially when you help an addict stay clean.
Honesty, open-mindedness and willingness are essential to the
A chemical dependent individual has "triggers" that can set off a bout of
drink or drug abuse. Triggers should be identified and discussed, often.
Another concern is that a chemical dependent person more often than not
will substitute one drug for another, just because of its availability. DRUG TREATMENTS FOR ALCOHOLICS
Helpful solutions in alcoholism treatment are the drugs:
DISULFIRAM/ANTABUSE Antabuse is prescribed in pill form by a doctor. It reacts against alcohol. If the client drinks alcohol, Antabuse makes them ill - with sweating, vomiting and fainting. If the client wants to stop drinking, the drug can help. CLONIDINE Clonidine is an anti-hypertensive agent used in alcohol withdrawal treatment. Clonidine has benefits in reducing rapid heart rate and sweating and is helpful when used with alcohol withdrawal treatment (It is also used to treat migraine headaches, and nicotine addiction).
Another agent is Naltrexone. It comes in pill form and when taken by an
alcoholic it curbs the craving for alcohol. In an article in the New York
Times, it showed that the drug could be used to make it easier for alcoholics
to stop drinking again and to continue their treatment. The study also
showed that the results are even more beneficial when the drug is used in
Twelve Step (the program used in Alcoholics Anonymous) or other recovery
programs; especially in the early stages of sobriety. ALCOHOLICS ANONYMOUS
Another non-medical treatment for alcoholism is Alcoholics Anonymous. In
the AA group, each person affirms that they are an alcoholic ('my name is
Andrew and I am an alcoholic'). The individuals recount their successes and
failures in giving up the bottle. They share their experience, strength and
hope with each other to stay on their path of sobriety.
THE ADVANTAGES OF AA
Meetings are held outside the home. This gives the recovering person a
chance to meet with other recovering people. When they leave home for a meeting, it also gives the spouse and others in the home a breather while the alcoholic is away for the evening.
Meetings add structure and give the recovering person something to hold
on to through the early and disturbing stages of recovery. The structure of Twelve Step groups is sometimes referred to as "pre-determined" and rigid, but it does save lives.
People who have recovered will tell you the same thing: "You keep
going to meetings, no matter where they are held, no matter how you feel about it. You will eventually see that those AA meetings are places where lives are saved and members learn how to stay sober."
Some groups have their share of "broken down people" who attend
meetings. However, if you look behind the closed door, you will find doctors, lawyers, and a wide range of professional people who attend meetings anonymously. All types of people, blue collar and indigent included, gather in these meetings to get and stay sober. No one knows for sure how, but AA works!
THINGS THAT COULD DISCOURAGE A CLIENT FROM AA
It lacks in-home, one–to-one counselling. Not everyone wants to deal
with their issues in a semi-public forum.
Its insistence on a pre-determined structure
It tends to hold meetings in draughty halls
Agnostic clients will not like its Christian overtones
Find out if there is an Alcoholics Anonymous group in your local area. If
there is, you may suggest that your clients attend to see if it will help them
Also, do some research on the internet into the Twelve Step program of
Librium and Valium are two well-known tranquillisers, which are part of a
group of drugs known as Benzodiazepines (or diazepam). Throughout the
1960s, '70s and '80s, they were prescribed widely, because they are effective
in reducing anxiety, aiding sleep and relaxing muscles.
However, they also have disadvantages. They are highly addictive, and can
induce depression and suicide tendencies. They are even thought to cause
brain damage, aggression, rage and road traffic accidents.
It is hard to stop taking diazepam, which is said to be more addictive than
heroin. Reducing the diazepam intake should be done gradually and under a
Xanax was initially prescribed as a substitute for Valium, especially in the
case of Valium dependency. It was believed to be a safe and non-addictive
alternative. Time proved this wrong. It was found to be as addictive as the
other substances used as tranquillisers.
PRESCRIPTION DRUG ABUSE
When drugs are prescribed and taken as directed there is little chance of
addiction. When the drug is not taken as directed, or if it is prescribed to a
person with a desire to experience the drugs' side effects, that is where the
Prescription drug addiction can affect the young, middle-aged, or elderly.
Addicted individuals may come from any occupation, hold entry level or
high level positions, be parents or grandparents, single or married. As a
counsellor you will encounter clients who are not using prescribed drugs as
directed or using them for a condition other than what they were prescribed.
You can try to counsel a person who is misusing prescription drugs.
However, you need to do it under the supervision of a doctor. The process
goes like this:
The patient has to have a commitment to stop using the drug (s)
Advice and direction from the doctor must be followed
Your client may need additional support from outside groups
If it is proven that the individual cannot stop and abstain, then a doctor
DRUG ABUSE AND THE INTERNET
The recent rise in making drugs easily available is compounding the drug
problem. The internet makes drugs easy to get. Even a child can order them.
Most people do not go to the doctor and falsify their medical complaints,
but the internet makes this easy to do. The attraction of doing it
anonymously adds to the problem. Most people do not realise this is illegal. SOLVENT ABUSE
Solvents are cheap and deadly. There are over 30 sniffable substances in the
average home. Each year, 120 young people die in the UK from glue
sniffing, some on their first sniffing session.
Most glue sniffers are aged between 12 and 16, but some are younger. One
in ten secondary school children try sniffing. Most of them try it once or
twice and then leave it alone. However, solvent abuse can be addictive and
can lead to hard drugs. One in a hundred children become regular abusers.
Students in big cities are "pharming" these days. "Pharming" is a new word for grabbing a handful of prescription drugs and ingesting some or all of them. Young people steal grandma's pills and distribute them at school. Children consider it "cool" and the "in thing" to take drugs. As long as your young client has this belief, you will not be able to change their attitude. They may also not be in the mood to listen to some of the dire warnings given out by the authorities. For example, in response to the threat, 'drugs kill'; they can point to drug abusers who are very much alive. Children may say, "You've got to die of something." It’s a tough problem to solve. Youth are defiant and think they are invincible.
Have you completed the following exercise?
Tick the box when you have completed the exercise. When you have done
the exercise, you can move on to the assignment that follows.
You are able to help a client quit smoking
You know how to help clients stop drinking
You know about tranquillisers and solvent abuse
You are aware of the illegal drugs your clients might be using, and you
You are familiar with the "disease model" of alcoholism and addiction
You are able to help clients addicted to gambling
You can help clients who are addicted to food
You have become more aware of alcoholic/addict behaviours
You have considered using the prepared statement of advice
Brenda has a recognised drinking problem and has not drunk for 90 days.
She wants to get her life back together. She was in a treatment program and
had after-care, but that recently ended. Her friends, a couple, want her to
join them in their weekly get together where they smoke marijuana. Her
husband is indifferent about this. She wants you to help her take charge of
Your assignment is to demonstrate, in essay form, that you have grasped the
main ideas of helping another with an alcohol or drug problem. If you wish,
use the ideas that are set forth in this module. One thing that you should
consider is that conventional wisdom and health care professionals
recommend that the client should not make any major life changing
decisions during the first year of abstinence.
When you have completed the assignment, please send it to your tutor for
Passages Through Recovery: An Action Plan for Preventing Relapse
by Terence T. Gorski Sober for Good: New Solutions for Drinking Problems - Advice from Those
Who Have Succeeded
by Anne M. Fletcher It Will Never Happen to Me
by Claudia Black
Well, that’s the end of the extract. If you want to know more, you’ll have to
We look forward to welcoming you on to the course, and helping you
become a counsellor.
MIT Department of Biology: H. Robert Horvitzhttp://web.mit.edu/biology/www/facultyareas/facresearch/horvitz. Home Faculty and Areas of Research H. Robert Horvitz OVERVIEW Medical InstitutePh.D. 1974, Harvard Universitytransduction, cell lineage, cell fate, and morphogenesis, with some emphasis on nervous system development. Study ofthe cellular and molecular
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