Substance Use Disorders Pattern of use leading to impairment or distress 2 Impaired control over substance use 1 Larger amounts of use over longer periods than intended tolerance 2 Desire efforts to cut down 3 Excessive time devoted to obtaining using or recovering 4 Craving matter of classical conditioning where the reward centers of your brain are stimulated after using Social impairment 1 Failed obligations at work school or home 2 Continued use despite social or interpersonal problems 3 Important activities are given up reduced because of its use Risky use 1 Use of substance in physically hazardous situations 2 Continued use despite physical or psychological problems Pharmacological criteria 1 Tolerance increased dose needed to achieve desired effect 2 Withdrawal symptoms a DT s delerium tremens shaking trembling b Hallucinations Jarrett 21 years old UMASS student once part of Halgin s class Claims he has ADHD disorganized life always forgetting losing Body builder Halgin asks about steroids he says no November he starts to look less healthy Asks Halgin if he can print a paper in his office Halgin says no he goes into a fit of rage screaming at him Halgin calls him back and calms him down o Felt abandoned in a moment of need causing his rage 225 lbs at start of therapy now down to 170 lbs Circles under his eyes depressed My life is screwed up friend was murdered on Pine St by someone who claimed to be on steroids His drug of choice Oxycontin 400 a day Purdue Farma company that produces Oxy s lied about how addictive the drug was brought to court numerous times and fined Halgin tells him he needs to go to detox inpatient program immediately and must tell his family When someone is out of control put control over them Made Jarrett call his mom and have them come into therapy Must go to the hospital tonight family comes and brings him Addicts are constantly in denial I can quit on my own Family members get caught up in this denial and often times enable it ie providing money for the addict to get one last fix Jarrett was put into a detox program ran away after three days Was then put into a 12 step program with meetings 5 times a week getting much better still sees Halgin every so often Asks Halgin if they can play racketball together wants Halgin more in his life o Can I borrow some of your ego strength o Hungry for a friend father type of relationship o Halgin believes it was not a good idea deviation from the frame o Jarrett cancels the following week Jarrett relapses another 30 day program Says he feels he let Halgin down Tells Halgin he must move to a part of the country where Oxy s were not available o Addicts if I move away the addiction stays Finally came to terms with his addiction Always a chance for relapse Comes to visit Halgin asks to see the house on Pine St where his friend was murdered reinforcement of his sobriety that chapter of his life is over Without support weekly meetings it is hard to stay sober Video Intervention Ryan addicted to Oxycontins Crushes them shoots them up Lives in suburban California Every time he waits for an Oxy it is a desperate feeling Needs it to live otherwise he will get sick withdrawals Steals for drug money Father had a bad cocaine addiction stepfather is an alcoholic Once Ryan s sister is born he feels abandoned by both his real dad and his step dad Played marching band in high school best times for him Played band in college couldn t read music struggled turning point in his life Partied more exposure to hard drugs coke meth acid pills Dropped out of college parents refuse to let him live at home with his addiction Mom caves when he bottoms out and is desperate enabling Sent to treatment twice dropped out of one and kicked out of another Severe apathy is a long term side effect of Oxycontin use It is never enough high tolerance to the drug Withdrawals irritable short fuse acts like a maniac Mom feels immobilized trying to help him stop