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RecoveryPlus Workplace

Recovery Plus: Workplace wellbeing 48 September 2016 A brief overview of the neuroscience Public and professional stigma against addictive diseases is a major social problem when dealing with conditions which have traditionally been dealt with by behavioural and spiritually-based programmes. Reducing this stigma is critical, as negative attitudes damage the level and quality of patient care – and funding for prevention, education and research. There is also a great deal of misinformation about the pharmacology of addicting drugs. This picture has been changing rapidly, based on new neuroscience (brain) research which strongly indicates that the pleasure pathway – the medial forebrain bundle – of the brain is affected by all addictions, particularly in the pharmacological qualities of euphoria, craving and a theoretical concept of “drug need”. This is the psychological correlate of behavioural “impaired control”. And research technology such as brain scans – neuro imaging – is now at hand to test the theories. Everyone who cares about the victims of addiction should become more scientifically literate about the implications of new research findings. For instance, drug dependence should be ‘handled’ differently from drug abuse in terms of responsibility, culpability and treatment. This article describes those differences between chemical abuse and chemical dependency (although the Diagnostic & Statistical Manual-5 does not separate the diagnoses of substance abuse and dependence as DSM-IV did) and therapies for drug dependency. The information has important implications for prevention and education about the causes of drug problems, and how we can all best deal with them. Two critical definitions. Professionals should carry out assessments to distinguish between chemical abuse vs dependence: this directly affects what type of treatment is most effective for each client, and thus their care plan, choice of treatment unit and outcome results. To distinguish between the two is the most humane, most cost-effective and most professional course of action. Chemical abuse is intentional overuse of substances in cases of celebration, anxiety, despair or ignorance. It is about people making bad choices about using drugs. It declines with adverse consequences, supply reduction or change in drug-use environment. Dependence is “impaired control” over drug use, probably caused by a dysfunction in the brain’s pleasure pathway. This is the disease of addiction, an “I can’t stop without help” disease. It requires formal therapy and/or 12 steps and perhaps anti-craving drug therapy. Does drug abuse lead to dependence? A five-year follow-up of 1,300 men and women (Schuckit et al 2001) found that only 3% of abusers met criteria for dependence five years after being diagnosed as abusers. But many people believe that abuse usually leads to dependence. Instead, the two conditions appear to be separate. Risk of dependence. Data from the National Comorbidity Survey of 8,100 men and women aged 15-24 years old (Wagner & Anthony 2002) showed that different drugs are associated with different rates of dependence. In the 10- year study, 15-16% of cocaine users become dependent, 12-13% of alcohol users and 8% of marijuana users. Of those dependent on cocaine,


RecoveryPlus Workplace
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