Hello and welcome to my new blog for the UAB School of Nursing.
In this monthly blog, I will explore the many facets of addiction — how it impacts different populations across the lifespan, signs and symptoms of addiction, available resources and the challenges we face in the future of health care. Over the next few months, I hope to present interesting stories and facts about substance use disorders. To begin, it may be helpful to know a bit about me, Dr. Susanne Fogger. I have been a psychiatric nurse for four decades and became an addictions nurse because many of my psychiatric patients also used, abused and were addicted to substances. I found substance misuse almost always made mental health issues worse.
In the late 1980’s, I was a senior Captain in the Air Force Nurse Corps and placed in charge of a 48-bed alcohol treatment center. I was part of a team led by a PhD, Licensed Clinical Social Worker, a psychiatrist with an addictions background, a psychologist, psychiatric nurses and mental health technicians. We were providing interprofessional health care to service members of the Air Force, Marines, Navy, Army and the Coast Guard. Within this exceptional team, I learned about the psychosocial and neurobiological changes that occur with alcohol use disorders. Determined to better understand addictions, I became certified as an addiction counselor and addiction nurse. At that time, treatment was approached differently and almost exclusively followed the 12-step model. In the service, we only treated alcohol and tobacco use, as all other substance use and gender issues were incompatible with military life. We couldn’t ask about issues we suspected without serious negative consequences to our active duty patient.
Fast forward to the present. I am the School of Nursing’s content expert on addictions, and as April is Alcohol Awareness Month, I would like to touch briefly on the use of alcohol in society today. For many people, alcohol is part of the fabric of life. Even as someone who works in addictions, I enjoy a good stout or single malt on occasion. Many of us have a choice to drink a glass now and then. With a drink in hand, we celebrate the pleasure of comradery, host a party or sit quietly together as the sun sets. Life is good in those moments. Some people can enjoy a drink or two without a problem, however, others cannot afford that first sip. Some will experience a chemical change when their brain has contact with alcohol, causing over time, a loss of the ability to choose. This is the reality of an alcohol use disorder.
When people think about addictions, often they envision someone in end-stage disease process. Sick, tired and hopeless. No one sees themselves in that role, experiencing addiction, yet nearly 10 in 100 people have been or are addicted to alcohol. In the American Psychiatric Association’s Diagnostic and Statistical Manual-5, the standard classification of mental health disorders, substance use is defined and there is further classification of if it is mild, moderate or severe. However, a simpler way to recognize if someone has a substance use disorder is to consider the “4 C’s” of addiction:
- Loss of Control: Drinking more than was intended.
- Continued use despite problems: Continuing to use the substance despite personal, emotional, social and physical problems.
- Cravings: A deep hunger and desire for the substance.
- Compulsion to use: Feeling that one has to use the substance to feel “OK.”
For those outside of addiction, it is difficult to understand how someone can choose to take risks such as ingesting a pill mixed with fentanyl or drinking a high volume of alcohol. It is hard to understand the factors in play that include the often-incomprehensible reward system in the brain. The desired effect of a substance (reduction in stress and/or emotional pain, or compulsion to use) overrides the logical thinking of “This can be harmful/dangerous/deadly.” People will do many things when they feel the reward is worth the risk. Logic and rational thought are not an aspect of the equation. The moments between can be awful, having the realization that continuing to use can end in disaster. The person may feel trapped in a hopeless situation with no obvious way to escape.
Alcohol use disorders are highly inheritable increasing the risk of developing the disorder, once the pathways to the reward center are established. Repeated alcohol use changes the brain. Rational thought can be distorted to support the continued use despite negative consequences, loss of control, cravings and intense compulsion to use, which are components of addiction. In addition, many people also face further difficulties such as depression, suicidal thoughts or struggle with a history of abuse. People have a much higher risk of suicide when disinhibited by the drug.
For someone facing addiction, just breaking the cycle and choosing to do something different often takes a realization that one’s own thoughts are harmful. Finding life without alcohol can be a struggle, as triggers may ignite the compulsion to use, undermining the determination to remain abstinent. Learning new ways to manage emotions and cope with the stress of life is a major aspect of recovery.
When speaking about addiction, it is important to have the right frame of mind and vocabulary. Awareness of the correct terms can help reduce the stigma of substance use.
Here are a few terms to start.
- The term “addict” carries with it a negative stereotype. Instead, the preferred terminology is “a person with an addiction to (substance).” By using people-first terminology, it separates the individual from the disease and acknowledges a chance for change.
- Using the term “clean” for someone who has ceased use of a substance also perpetuates the negative stereotype that if they use, they are “dirty.” Instead, it is preferred to say the person is substance-free or their drug screen was either negative or positive. These terms reduce stigma around substance use.
- Acknowledge that overcoming addiction is a daily process. For an individual working to overcome addiction, changing the basic thought from “I am not in in control when I have …” to “I cannot use (substance) today” can help make that task more manageable.
A chronic illnesses, people recovering from alcohol used disorders can have times of remission and acute flairs of illness. A few are able to stop using and never use again. However, as stress makes everything worse, people in recovery are at increased risk of returning to use during these times.
So, how can you make a difference? Become aware of your own attitudes about people with substance use disorders. Help spread the word that recovery is possible and treatment does work. The first step can begin with a small decision.
In closing, be kind today, one never knows when a warm smile and positive attitude makes a difference.
For additional information on addictions: Substance Abuse and Mental Health Services Administration’s website: https://www.samhsa.gov/
National Alliance of Advocates for buprenorphine treatment; the words we use matter. (June, 2008). Reducing Stigma through language. Retrieved from www.naabt.org/language