Substance Use

In the first week of the substance use education group we discuss what substances are and some of the different recognizable behaviour patterns that can occur when people use substances.

The first word to come to mind for many of us when we hear about problematic substance use is likely ‘addiction’. Yet the idea of addiction has come to take on certain connotations or stigma that can become a barrier to getting help with substance use problems. For example, one of the myths around addiction is that people need to ‘hit rock bottom’ or experience painful losses before they can change. In actuality, people can change their patterns of substance use whether or not they’ve had an experience that might look or feel like ‘rock bottom’. Substance use behaviour can be difficult to change whether or not we see ourselves as having what might be called ‘addiction,’ but with effort and support change can happen.

Because of the many myths associated with the word addiction, the American Psychiatric Association (APA) has chosen to use the term ‘substance use disorder’ for its official diagnoses around substances, rather than using the word ‘addiction’.

Video and Additional Resources

Here is a short video:

Substance Use Disorder Psych Hub Education (2020. 3:46)

For further reading, you may be interested in our blog posts on stigma and the myths around substance use. The website Verywellmind.com also has an article that describes the criteria for a diagnoses of substance use disorders.

When we use the word ‘substances’, we are talking about those that specifically affect our mental processes, including our thoughts, emotions, and our levels of alertness or energy. This is a pretty large category that includes drugs grown in nature, those manufactured commercially or by pharmaceutical companies, as well as those manufactured illegally. Some specific examples are alcohol, tobacco, cocaine, and fentanyl.

Although we tend to think of our mental processes as originating in our brains, the systems that inform our mental processes run throughout our whole bodies. For example, our nervous system, respiratory system, and hormonal systems all carry chemicals and information throughout our bodies. These systems are both affected by our mental processes (ex. our thoughts and emotions) and influence them. It’s a two-way street for communication! Introducing substances to our bodies affects multiple parts of these natural systems throughout our entire bodies.

During Week 2 of the Substance Use Education Group, members learn about characteristics of different substances and how they affect human bodies. For a close-up look at how substances can affect the body’s stress system, view our blog post on substances and stress.

One thing to remember is that human bodies are extremely complex, and everyone is slightly different. Just imagine, if two people were to only eat fast food for a month, one person might become quite sick while the other person might not show symptoms of being sick at all. This doesn’t mean that eating fast food for a month would be healthy anyone, it just means that people experience negative consequences in different ways and at different rates. How fast food will affect us will depend on multiple factors such as our genetic make-up, our previous eating habits, and other things that are happening in our lives that affect our body’s systems. It is the same for how quickly and in what ways we are affected by substances.

Videos

Here are some videos for further information about how individual substances affect our brains and bodies:

Alcohol: How does alcohol make you drunk?  Judy Grisel (2020)

Caffeine:  How does caffeine keep us awake? Hanan Qasim (2017)

This week group participants are invited to consider the effects of substances on their relationships from a broad view and to learn about some of the shared experiences of adult family members of people with a substance use problem.

There are many ways that substance use can affect our relationships. For example, alcohol lowers our social inhibitions and so many people drink alcohol to help alleviate social fears which, at times, can strengthen relationships. At other times, lowering of our social inhibitions might cause us to tolerate behaviour we would not otherwise agree with and keep us connected with people who are not serving our best interests. Because there are so many different ways our relationships can be affected by substance use, it is important to take a broad picture of our values, goals, and the different roles we take on in our lives when considering the impacts of substance use.

For those of us who love someone who uses substances, it can be difficult to find a balance between supporting that loved one in helpful ways and putting limits on any destructive or abusive behaviours that result from the substance use. Finding this balance can be an emotional journey with very painful periods. It is difficult to see our loved ones struggling, and we may find ourselves concerned for their safety, wellbeing, and their future.

The substance use of a family member can also impact children and youth. Young people are particularly vulnerable to long term negative consequences generated by an adult’s substance use problem because the relationship patterns we grow up around become the primary models for our beliefs and sense of security about relationships later in life. Once we’ve grown-up, we’re not always aware of how these patterns have affected us and changing them can take substantial personal effort.

Whenever we are concerned about a loved one’s substance use it is easy to become trapped into thinking that if we are not forcefully pushing them to make changes, we are somehow condoning what they are doing. However, accepting the fact that we cannot make someone change does not mean we have to approve of their problematic behaviour. When we set boundaries around our concerns, we can turn our attention to what we do have control over: our own behaviour. Instead of focusing on the other person, we can stay focused our own safety, health, and wellbeing. We can also consider how our current behaviours maybe holding family systems in place and whether these broader patterns need changing.

Loved ones of people who use substances may be interested in our blog posts on Family Resources and the Impacts of Stigma on Self and Family. There is also a section on reflections for family members in our Stages of Change post.

Videos

The following videos address starting a conversation with a family member about their substance use.

Substance Use and Relationships: Supporting Your Loved One in Recovery Psych Hub Education (2020. 5:07)

Intervention: How to Talk to a Family Member with an Addiction Part 1 (2018, 2:13)

Intervention: How to Talk to a Family Member with an Addiction Part 2 (2018, 2:29)

Relapse prevention planning involves thinking about, planning for, and addressing obstacles that might come in the way of maintaining sobriety. In week 4 group members learn about identifying triggers and what emotions, thoughts, and behaviours commonly lead to those triggers occurring (see our blog post on triggers to learn more). Once group members have considered this information, they can use it to plan how to cope with challenges to sobriety earlier in the relapse process, rather than relying solely on coping with urges in the moments that they are occurring.

The relapse prevention framework originated when substance use researchers noted certain emotional and behavioural patterns commonly occurred in people’s lives months before an actual return to use. For example, the most common experience preceding a relapse is increased levels of stress. Other patterns include increasingly thinking about the substance(s), focusing on other people’s behaviour instead of our own, and depression. We can intervene with some of these relapse processes by caring for ourselves, managing stress in our lives (covered in week 6 of this group), participating in support groups, and getting help for other mental health symptoms.

We at Deltassist would also like to mention that the term ‘relapse’ can be problematic as it is heavily associated with the idea of a complete loss of control. It can also carry the stigma of a sense of failure. Thinking only in terms of non-use and loss-of-control can increase feelings of shame or defeat when we experience a setback. Instead of this all or nothing thinking, it can be helpful to view change as existing on a spectrum. Experiencing an unplanned return to use does not necessarily mean a completely loss of control. We can learn from the experience of an unplanned return to use and maintain our efforts to reduce or abstain from problematic substance use patterns with newly gained knowledge about ourselves and our triggers. Some people may also plan a return to use after a period of abstinence to experiment with whether they can use differently now. They may still have some control in this experimentation process.

We have chosen to continue to use the term ‘relapse’ in our discussion here because most current publications and webpages still use the term. For example, if you want to find out more about preventing an unplanned return to use, you would find the most information by searching ‘relapse prevention’. However, as you read and think about the return to use process, we encourage you to keep in mind that behavioural change exists on a spectrum. Some alternate words to describe return to use that have less associated stigmata include ‘lapse,’ ‘re-cycling,’ or ‘return to use’.

Video and Worksheet

Here are some links to related material:

Relapse Prevention: Early warning signs and important coping skills (2014: 5:52) by Dr. Steven Melemis

The website therapistaid.com provides worksheets for making simple relapse prevention plans.

In the fifth week of the Substance Use Education Group, members are introduced to the Stages of Change (also known as the Transtheoretical Model of Change). Created by substance use researchers James Prochaska and Carlo DiClemente in the 1970s, this model has been applied to how people make all sorts of changes in their behaviours, particularly around healthy living. According to the model there are five main stages of change:

1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance

Read a more extensive break-down of the Stages of Change in our blog.

The Stages of Change can be a useful tool for considering our commitment to making a change and what kind of life events would move us to a different stage. For example, if someone who enjoys drinking coffee and has no plans to stop (precontemplation stage) is informed by their doctor that they need to reduce or eliminate caffeine intake, this could move the person from the precontemplation stage to the contemplation stage, or even the action stage.

For those supporting loved ones who may have a substance use problem, the stages of change can also be a useful tool for considering how ready for change a loved one may be, and then, how to best support them in the stage they are in.  Since we cannot make people more ready for change than what they are, it is best to work with people at their level of readiness for change.

Video

Here is a video about the stages of change made by the Self-Management and Recovery Training organization (known by the acronym SMART).

Stages of Change

The final week of the Substance Use Education Group is about stress reduction and management. Some stress is normal and good in our lives. Our bodies have a stress system that kicks into gear to help us accomplish challenging tasks. It is the same system that prepares us to go into fight, flight, or freeze when we sense danger.  However, these systems are meant to get us through short periods of intense difficulty. They are not meant to be working all the time. Long periods of stress without relaxation causes uncomfortable muscle tension, stomach and digestion issues, and can lead to significant health problems like heart attacks and heart disease.

Stress is also the leading cause of unplanned returns to substance use. Many substances provide an immediate release of stress or some of the symptoms of stress. When we reach a certain level of stress, our minds may begin to recall memories of the immediate relief a substance provided. However, the release of stress is short-lived, and substances have long-term negative effects on our bodies’ ability to cope with stress. Relying on the short-term relief of substances can actually cause long-term stress. You can read more about the relationship between stress and substances on our blog.

In the substance use group on stress we go a little deeper and discuss various stressors around substance use and abstinence. We also look at tools for recognizing when we are stressed and making long term stress management plans.

Videos

There are quite a few informative videos about stress on the internet, here are a few of them:

Coping with Stress (2018, 2:03)

How stress affects your brain (2015, 4:15)

How stress affects your body (2015, 4:42)

Managing Stress (2010, 2:23)