Daniel Selva
Mphil Scholar
Dept. of PSW, NIMHANS
Order of Presentation
Meaning & Definition
Prevalence
Types of Addiction disorders
Diagnostic Criteria
Theoretical Perspectives
Psycho social intervention for substance use disorder
Conclusion
Introduction
Addiction is a treatable, chronic medical disease
involving complex interactions among brain circuits,
genetics, the environment, and an individual’s life
experiences. People with addiction use substances or
engage in behaviours that become compulsive and
often continue despite harmful consequences.
(American Society of Addiction Medicine ASAM)
Addiction is a complex condition, a brain disease that is
manifested by compulsive substance use despite
harmful consequence (American Psychiatric
Association APA)
According to the National Institute on Drug Abuse
(NIDA), people begin taking drugs for a variety of
reasons, including:
to feel good — feeling of pleasure, “high”
to feel better — e.g., relieve stress
to do better — improve performance
curiosity and peer pressure
Prevalence
Alcohol Use in India
Cannabis Use in India
14.6 % 2.8%
16 3.1
CRORE CRORE
USERS USERS
72
L AKH 0.66%
5.7
CRORE 5.2% PROBLEM
USERS
PROBLEM
USERS
25
L AKH
DEPENDENT 0.25%
2.9
CRORE USERS
DEPENDENT 2.7%
USERS
BHANG 40
L AKH
CHARAS /
GANJ A 50
L AKH
MAGNITUDE OF
SUBSTANCE USE
IN INDIA 2019
Opioid Use in India Inhalant Use in India
2.1 %
2.3
CRORE
USERS 0.7 %
77
0.70 %
77
L AKH
PROBLEM L AKH
USERS USERS
28
L AKH
0.26 %
22
DEPENDENT
USERS L AKH .21 %
PROBLEM
USERS
8.5
L AKH
OPIUM 11
L AKH DEPENDENT .08 %
USERS
HEROIN
63
L AKH
51
L AKH
PHARMA
OPIOIDS 25
L AKH
26 MAGNITUDE OF
L AKH
SUBSTANCE USE
IN INDIA 2019
PREVALENCE OF CURRENT ALCOHOL USE IN
DIFFERENT POPULATION GROUPS (%)
MAGNITUDE OF
SUBSTANCE USE
IN INDIA 2019
PREVALENCE OF GLOBAL LEVEL
PREVALENCE OF ILLCIT DRUG USE
8
COMPARISON OF GLOBAL, ASIAN AND NATIONAL (INDIA) ESTIMATES ) (IN %)
World Asia India
Drug Category (15-64 years ) (15-64 years ) (10-75 years )
Cannabis 3.9 1.9 1.2
Opioids 0.70 0.46 2.06
Cocaine 0.37 0.03 0.11
A TS 0.70 0.59 0.18
MAGNITUDE OF
SUBSTANCE USE
IN INDIA 2019
Types of Addiction
Substance Addiction Behaviour Addiction
o Alcohol
o Gambling
o Tobacco
o Internet addiction
o Benzodiazepines
o Compulsive eating
o Stimulants
o Cannabis o Video game addiction
o Opioids o Shopping addiction
o Inhalants
o Sex addiction
o Cocaine
o Other drugs
Common drinking patterns
Abstainers
: Do not consume alcohol
Low – risk drinkers: Consume 1-2 drinks per day,
no more than 9 per week
Problem drinkers: Consume more than 21 drinks
per week
Alcohol dependent drinkers: Cannot stop drinking
once they start
Binge drinkers: Consume 5 or more drinks per
occasion
Dependence Criteria (DSM 5)–
at least 2 in past 12 months
1.
Larger quantity/ longer duration of use
Impaired
2. Persistent desire or inability to cut down or control use
control
3. Salience
4. Craving
5. Inability to fulfill major role obligations
6. Continued use despite having persistent or recurrent Social
social or interpersonal problems exaggerated by drug
use Impairment
7. Important and meaningful social and recreational
activities may be given up
or reduced because of substance use Risky use
8. Repeated use of substances in physically dangerous
situations
9. Use despite knowledge of harm
Pharmacological
10. Tolerance
indicators
11. Withdrawal symptoms
DSM 4 categories
Symptoms of substance use disorder are grouped into four
categories:
Impaired control: a craving or strong urge to use the substance;
desire or failed attempts to cut down or control substance use
Social problems: substance use causes failure to complete
major tasks at work, school or home; social, work or leisure
activities are given up or cut back because of substance use
Risky use: substance is used in risky settings; continued use
despite known problems
Drug effects: tolerance (need for larger amounts to get the same
effect); withdrawal symptoms (different for each substance)
Theoretical Perspectives
Theory Processes
1. Social Control
Bonding or cohesion/support
Structure or monitoring
Goal direction (From family, friends, school,
work, religion)
2.Behavioural Involvement in protective activities (Effective
Economics/Behavioural Choice rewards from family, friends, school, work,
religion, physical activity)
3. Social Learning Observation and imitation of
family/peer/community norms and models
Expectations of positive and negative
consequences
4. Stress and Coping Identifying high-risk situations and stressors
Building self-efficacy and self-confidence
Developing effective coping skills
(Rudolf H. Moos 2007 )
Psychosocial interventions
Motivational interviewing is a collaborative
conversation style aimed at strengthening a person’s
motivation and commitment to change (Miller and
Rollnick, 2013). It is used in many situations where
someone needs to be helped to take a decision, and it
can be provided by therapists, counsellors or other
specially trained professionals.
Brief interventions use the collaborative
conversation style of motivational interviewing to
address problematic or risky drug use, but are
delivered in a shorter timeframe, ranging from 5–30
minutes.
Based on the ‘5As’ — ask, advise, assess, assist and
arrange — they are delivered by professionals
including physicians, nurses and other healthcare
workers (Babor et al., 2007).
Self-help groups are voluntarily not-for-profit
organisations where people meet to discuss and
address shared addiction problems and to provide
support for each other, with senior members often
mentoring or ‘sponsoring’ new ones. Self-help groups
are usually led by former drug users or other peers in a
range of places within the community, and in
healthcare and prison settings.
Family therapy is used to treat drug use and the
problem behaviours that can be associated with it,
especially during adolescence, such as psychiatric
symptoms, problems at school, delinquency and
high-risk sexual behaviour. Family therapy can be
delivered by specialists in outpatient settings, and can
also be provided in the patient’s home.
Cognitive behavioural therapy (CBT) helps clients to build
self-confidence and address the thoughts that are believed
to be at the root of their drug problems, and learn to
recognise and handle what triggers them. Following a
diagnosis of drug dependence, cognitive therapies are
delivered by licensed psychotherapists in outpatient
settings, and sessions can also be available in residential
treatment facilities and prisons.
Harm reduction approaches
Compared with opioid use disorders, the development of
harm reduction strategies for psycho-stimulant users is
much less advanced. In situations where psycho-
stimulants are injected, providing clean injection
equipment, education and encouragement to switch to
non-injection routes of administration may be useful. The
high risk sexual behaviour associated with psycho-
stimulant use.
Relapse prevention (RP) is an important component of
alcoholism treatment. The RP model proposed by Marlatt
and Gordon suggests that both immediate determinants
(e.g., high-risk situations, coping skills, outcome
expectancies, and the abstinence violation effect) and covert
antecedents (e.g., lifestyle factors and urges and cravings)
can contribute to relapse. The RP model also incorporates
numerous specific and global intervention strategies that
allow therapist and client to address each step of the
relapse process.
Conclusion
• There is an increased potential role for social work in
developing policy and delivering addiction-related treatment
services.
• Current social work education does not emphasize knowledge
needed by social workers for this role.
• Evidence-based psychosocial practices for SUD exist that
should be part of a social work practice armamentarium.
• There is a need for curriculum development for social workers
in addiction.
• The evidence-base would be improved by greater social work
research involvement in looking at how EBPs apply across
communities and populations.
• It would also be improved by greater social work research
involvement in developing, tailoring, and testing interventions.
Reference
Drug Alcohol Depend. Author manuscript; available in PMC
2007 June 22.
Relapse Prevention: Marlatt’s Cognitive-Behavioral Model,
Mary E. Larimer, Ph.D., Rebekka S -Vol. 23, No. 2, 1999
Magnitude Of Substance Use In India Report 2019
Theory-Based Active Ingredients of Effective Treatments for
Substance Use Disorders, Rudolf H. Moos - Drug Alcohol
Depend. 2007 May 11; 88(2-3): 109–121.
https://www.psychiatry.org/patients-
families/addiction/what-is-addiction - American Psychiatric
Association (APA)
DSM 5 & ICD 10
