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 down3. Excessive time devoted to obtaining, using or recovering4. 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 home2. Continued use despite social or interpersonal problems3. Important activities are given up/reduced because of its use- Risky use:1. Use of substance in physically hazardous situations2. Continued use despite physical or psychological problems- Pharmacological criteria:1. Tolerance (increased dose needed to achieve desired effect)2. Withdrawal symptomsa. DT’s (delerium tremens) = shaking/tremblingb. HallucinationsJarrett- 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 downo 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 lifeo “Can I borrow some of your ego strength”o Hungry for a friend/father type of relationshipo Halgin believes it was not a good idea  deviation from the frameo 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 availableo 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 soberVideo (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 inhis 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