Let’s Start At The Beginning… What is a Drug?
The World Health Organisation classify a drug as anything we ingest into our bodies that changes our physiological processes.
If we look at our culture, we really are a drug using society. How often have you heard the refrain “Don’t talk to me until I’ve had my morning coffee” or “I really need a sugar hit” or “there’s nothing like an ice cold beer after a hard days work.” So many of our rituals involve the use of a substance, so how do we determine when our use of drugs moves from purely social to problematic? And why is it that the person who is using problematically often seems like they are the last person to work it out?
What are the Different Drugs:
Classification: Stimulant, Depressant, Hallucinogen
Drugs are classified into three groupings based on how they affect the central nervous system. The central nervous system is the name given to the brain and spinal cord and all of the nerves that send messages to and from the body, to organize all of the activity within the body.
There are three different ways drugs can affect the central nervous system:
Stimulants
These drugs increase the activity in the central nervous system. They include drugs like amphetamines or speed, cocaine and ice. Coffee and Cigarettes are also examples of stimulants.
Depressants
These drugs all slow down the activity in the central nervous system. They include alcohol, benzodiazepines like valium and xanax, heroin, GHB and inhalants (usually paint which is used for chroming).
Hallucinogens
These drugs tend to effect how we perceive the world around us. Their effects are often unpredictable and vary from person to person. They include drugs like magic mushrooms and LSD.
There are two drugs that actually fit into more than one category. Ecstasy: This is both a stimulant and in higher concentrations also acts as a hallucinogen. And Cannabis: which is both a depressant and, when consumed in higher concentrations also is a hallucinogen.
Effects:
Whilst all of these drugs have similar overall affects, how a person experiences them will depend upon several factors.
1) How the person feels at the time they are taking the drug.
2) The environment the person is in when they take the drug.
3) The quality of the drug they are taking.
For example, if a person is feeling happy and relaxed and they decide to have a few beers with friends, the experience is more likely to be a positive one. Than if that same person was out at a busy club, was feeling really angry about a fight they had just had with a friend and had decided to try amphetamines for the first time. In this second situation, as you can imagine the experience has a greater chance of being a negative one.
Cycle of Change
Based on Prochaska and Diclemente’s model (developed in 1982)
In pre-contemplation the person does not believe that a problem exists. They are content with their use and no convincing reason to change their use has been presented.
In contemplation the person is ambivalent – in that they are in two minds about what they want to do. Sometimes they feel the need to change their use and at other times they do not. A person can go back and forth between this wanting to change and not wanting to change daily. This is also the time when a person acknowledges they want to make a change but are not yet ready to. They may say things like; “I will stop tomorrow… or next week.”
In decision the person has decided it is time to change. They begin to prepare and plan for this change.
In action the person is putting into action the plans and preparation they have been making to change. This is usually a very motivated and exciting time. Reinforcement, Motivation and Support is key during this stage as when things become difficult (ie life circumstances) or the cravings are very strong, a person may feel their resolve weakening. This is when drug and alcohol counselling is important.
In maintenance the change has been integrated into the person's life. Some support may still be needed through this stage. In maintenance lasting change is learned, practised and becomes possible. When we are able to maintain what we have achieved we exit the cycle entirely.
In Relapse Prevention the person begins planning and strategizing, in preparation for difficult times and cravings. They implement the strategies and review their effectiveness, amending or adapting the strategies with each new learning.
The aim of this strategizing is to prevent a Lapse (a temporary return to ‘old’ unhelpful thoughts, feelings or behaviours) and Relapse (which is a full return to the old behaviour).
Lapse and Relapse are essential to the Cycle Of Change and do not equate to failure. Ultimately changing our behavior is difficult and it is not uncommon for people to “slip up” or lapse. Consider your last new years resolve, or commitment to fitness. At the start you may have felt highly energized and motivated about this new possibility you were creating for yourself. But then with time, that motivation can wane. “Its too cold to go to the gym” or “I’ve had a hard day, one night off wont hurt.” Each of these lapses provides us an opportunity to reconnect with why we want to change our behavior, re affirm our commitment and motivation, and develop new strategies to ensure we maintain this commitment.
This does not mean a lapse or relapse is desirable but remember it is not uncommon to make several trips through the cycle before long lasting change is maintained.
When You’ve decided to stop using.
Whenever someone has developed a physical tolerance to a drug, they will experience withdrawal symptoms if they stop using “cold turkey.” The physical withdrawal symptoms are most intense in the first 24-72 hours, but can be felt for as long as 4 weeks, depending on the drug and the level of dependence. Emotional withdrawal symptoms, including irritability and emotional instability can will also continue for several weeks and can make the physical withdrawal symptoms feel much stronger.
Different drugs will have different withdrawal symptoms; please note that a withdrawal from alcohol or benzodiazepines must be done in conjunction with medical support. This is because both alcohol and benzodiazepines are central nervous system depressants, (which means they slow the activity in the brain) and the sudden increase in brain activity can lead to seizures, and may place the individual at risk of developing an acquired brain injury.
Generally though, the experience of withdrawals are as follows:
The first 24-72 hours
-anxiety
-perspiration
-flu like symptoms
-tremors
-aches and pains
-sleep disturbances
-nausea
-moodiness
-cravings
-tiredness and fatigue
-irritability
The first 7 days
-the physical withdrawal symptoms should have markedly improved
-eating and sleeping disturbances can still be felt
-mood fluctuations should be starting to subside
2 weeks
-appetite returns
-sleep patterns improve
-moodiness and irritability should be improving
It’s important to remember that the experience of withdrawal symptoms will be worsened by stress, and whilst the physical withdrawals should be easing after 2 weeks, the cravings usually continue for a while longer.
Supporting someone who is experiencing cravings
Cravings are a normal part of any addiction and every one gets them. They are not simply a lack of motivation or lack of will power. Cravings usually last several minutes, but have been known to last for hours.
When you notice you are craving, pay attention to what triggered the craving. Sometimes it can be environmental or situational (ie conflict, peer groups, visiting a place you used to use regularly, even a particular smell can be enough) or it can be emotional (a particular mood state or feeling, often sadness or anger, frustration or feeling overwhelmed).
Notice the types of thoughts you are having; do they reinforce the craving? (ie “go on you deserve it”, “its been a rough day” or perhaps “you’ve been so good this week, one wont hurt”)
Notice the sensations in your body. Where do you feel the craving. Is it a feeling in the stomach? Or an intense feeling in your head?
Pay attention to these thoughts and sensations, almost as if you were watching clouds passing along a blue sky. And know that these thoughts and sensations will too pass by.
Take this opportunity to discover the things that help you relax, and distract you from the cravings. Sometimes simply focusing your attention on your breath, lengthening your in breath and lengthening your out breath, to the count of 4 helps re focus your mind and allows your body to relax. A count of 4 works easily, breathing in for 4 counts and then breathing out for 4 counts. Othertimes the cravings are so distressing you need to move, go for a walk, a run, practise yoga, anything that encourages your body to move. It is much more difficult for our mind to focus on cravings if it has to co ordinate movement! For some people, reading a book or watching a movie help. For others, surrounding themselves with people who don’t use can help, or talking to someone who is supportive and can listen to the battle that they feel is going on inside them.
Consider what activities help you? And know that whilst one thing may work really well at one time, you may need to do something else another time. How we feel in any moment is going to change, so the things we need to do will need to change with it.
SEVERITY OF DEPENDENCE SCALE (SDS)
The following questionnaire is a quick measure to give you an idea of your or another persons level of dependence on their drug use. For each of the five questions, indicate the most appropriate response.
0=Never/ Almost Never 1=Sometimes 2=Often 3=Always/Nearly Always
1. Do you think your use of (drug) was out of control? 0 1 2 3
2. Did the prospect of missing a fix (or dose) make you anxious or worried? 0 1 2 3
3. Did you worry about your use of (drug)? 0 1 2 3
4. Did you wish you could stop? 0 1 2 3
0=Not Difficult 1=Quite Difficult 2=Very difficult 3=Impossible
5. How difficult did you find it to stop or go without (drug)? 0 1 2 3
Total SDS Score:
*The higher the score, the greater the level of dependence