- Read the directions in the attachment “Assignment Chapter 3 extra”. In summary, the assignment begins following week 3, chapter 3. You will choose 3 patterns of behavior. You can use the attached chart to track these behaviors. After you have studied how we learn and motivation in later chapters you will write a review that includes your evaluation of behaviors as routine, habit or patterns, your level of awareness, how you learned them and your motivation to do them. Upload your pattern chart and your evaluation for Nov. 23rd.
Now that you have read Chapter 3 on consciousness, let’s have some fun with what you learned about levels of consciousness. You are invited to increase your understanding of levels of consciousness by evaluating several behaviors that you will choose. Some suggestions that are common and easy to track are behaviors such as sleep, eating, studying, phone use and work. After you choose 5 behaviors you want to evaluate, guess or estimate how many hours a day you spend on these behaviors. What do you think your level of awareness is in beginning, doing and experiencing these behaviors you chose? There is a chart attached for you to use to track your time spent daily in these activities, but you can choose your own method as long as you are consistent and measure accurately. One student looked at their cell phone bill, which gave information about data use, text and calls. Keep track of the behaviors you decided on as accurately as you are able and then after one month of tracking, it is time to review.
The first question to answer after a month of tracking is to ask how accurate you were in your estimation of how much time you spend on each of the activities that you chose. If you are accurate, what does that say about your awareness? If you are not, why do you think you did not have an accurate estimation of time spent in the activity? Would any of your activities fall into the category of automatic therefore under your full awareness level of consciousness?
Next it is interesting to use critical thinking to discriminate between patterns, routines, habits and compulsive behaviors. How do your daily patterns relate to what is being taught about levels of attention and awareness, circadian rhythms and compulsive or addictive habits as understood in Chapter 3.
Now that you are more aware of some of your behaviors and maybe attitudes, are you saying, that’s just me? I’ve always been like that. I can’t change now. If you are wondering about where some of your behavior choices came from, there is a book by Gerald and Marianne Corey titled, “ I Never knew I had a choice.” This book helps you to explore and expand awareness and understanding of choices that are available, effects of childhood and adolescence as well as parents who have impacted how you have developed into who you are and the choices you now make based on your background. The book also assists in how through this increased level of awareness, you can grow and modify behaviors, attitudes and beliefs. Understanding where they came from and how they were formed can help you question and deepen, change or develop your attitudes and behaviors.
If you have a behavior that is somewhat compulsive, right about now you may be asking yourself what is the difference between a very strong routine or pattern compared to an addiction. How does one recognize addiction? Can you be obsessed with something, compulsive and not addicted? Years ago, an instructor gave us an example of a true story and asked if the man had an addiction. A man lived with his wife and children. He was active in the community as a volunteer, city councilman, church leader, coach and owned his own business. He balanced his life as a family man, community leader, financially successful businessman and recreation. Every new year’s eve, he got a room at a hotel for himself and every year he purchased cocaine, spent the weekend using and went back to his family the next day. No matter what, no matter whom in the family was ill or in the hospital, no matter who was visiting, nothing would stop him from secretly spending his New Year eve high. If anyone found out, he would lose his business, his wife and of course his status in the community. In spite of the dangers, he continued to obsess, plan for and take that day once a year to buy enough cocaine to stay high for a day. Is he addicted?
What does it really mean to be addicted to something? Can you be addicted to chocolate? Can you be addicted to food? Can you be addicted to cleaning, exercising, working, reading, cooking, baking, sex, gambling, gossiping, camping, school or studying? Don’t worry about being addicted to studying. There are no withdrawal symptoms so if you do develop a compulsion to study, it will end abruptly when you graduate.
The definition of addiction has evolved and continues to evolve. The recognition of a loss of control is one of the few criteria that have been consistent throughout history. Use of substances is represented since the beginning of time. Discovering mind-altering effects of opium, mushrooms and alcohol are as old as nature and human beings. The pattern of discovery, use for medicinal purposes, nutrition or religious purposes along with feeling good continues even today. The difference is that labs and not only nature are the source of mood altering substances. New medicines now from labs and not only natural herbs and plants first used to heal, then sometimes become abused.
Three considerations immediately enter into the definition of abuse and addiction: the social norms of religion or cultural milieu, societal laws and medical influences. For most of the substances abused, they began with having a particular medicinal purpose and being used as such, before they become abused and when enough attention is drawn to negative behaviors, problems and deaths associated with the substance, the legal powers step in and attempt to litigate change.
Historians believe that one of the first substances recognized by humans was opium, which was derived from a species of the poppy flower. In Peru, it was used to help workers and their animals climb the mountainous terrains. As early as 10,000 BC, the Greeks used it for medicinal and spiritual purposes. Early writings document over 700 medicinal purposes for opium. Opium use spread throughout Europe, the Middle East and North Africa. By the 17th century, the Turks ate it for pleasure and China as well as many other Eastern countries smoked it. If you read Homer’s “The Odyssey” and recall the reference to “a drug that had the power of robbing grief and anger of their sting and banishing all painful memories”, that was a mixture of opium and alcohol known as laudanum. Alcohol is another mind altering substance, one of the first known to human beings and it remains one of the most widely used psychoactive substances. It is still used for medicinal purposes, spiritual rituals and recreation. Medicinally families rub alcohol on sore gums from teething babies to adults. It is used as an antiseptic, sleep aid and for pain. The word alcohol comes from the Arabic word al-kuhl meaning, body eating spirit. Nicknamed spirits, some might say it changes your spirit and some may say it eats your body away. Alcohol is an example of a substance being used for medicinal purposes, then, when it was associated with enough problems as in America when society blamed alcohol for marital problems and disorderly conduct, the prohibition began.
Over the course of history, the influences of religion, cultural beliefs, industry, medical views and societal perceptions impacted laws that then criminalized some substances and their users. We are seeing in our culture, the differences in states regarding legal age for purchasing alcohol and legal use of cannabis. Culture and laws also determine funding toward creating the laws or not, determining penalties such as fines, jail time, loss of jobs or licenses and treatment. The post-prohibition grass-roots self-help group known as Alcoholics Anonymous founded in 1935, helped some people remain sober when treatment was still very limited, but alcohol was legal and easy to obtain.
The American Medical Association did not consider alcoholism a disease until 1956. When they recognized the progressive physical aspect, then it was seen as a disease. More then the alcoholism, the fact that it was associated with Wernicke-Korsakoff syndrome commonly known as wet brain along with liver damage, cancer, heart disease and ulcers gave the physical aspect that could not be ignored. The American Medical Association considered it a disease that altered the brain structure and was progressive. The diagnosis of addiction would not be used until 1987. If you are wondering what the mental health professions thought about this, the DSM first published in 1952 recognized the mood altering substances as a complication of some of the mental health diagnoses, but the mental health diagnosis would be primary. Not until 1980, in the DSM-III was substance dependence and substance abuse given separate diagnostic criteria. The use of the word addiction was not used by AMA or by the DSM until 1987 and by 1991, the AMA gave a dual medical and psychiatric disease due to the chronic and progressive nature and had found a genetic etiology to the disease.
What I find interesting about the DSM viewing mental health as primary is that treatment for mental health was put on hold until someone had at least 4 weeks of abstinence before the patient could be treated. Working in the early 1990’s, centers for addiction did not work with clients who would take medicine for their mental health since the medicine worked on their brain, altering their brain and the belief was that in recovery, no medication that altered the brain could be taken. This philosophy changed when the recognition that psychotropic medicine for mental health was not a crutch, diversion or defiance but aided the recovery, helped stabilize and led to more success with longer abstinence time, meaning fewer relapses.
How is addiction defined? The definition continues to change. In the past the definition stated the use of substances that caused loss of control, cravings or obsessions, a maladaptive pattern of use leading to social, economic, legal or family problems, increased tolerance that causes increased use, withdrawal symptoms when use slows down or stops.
What did you decide about the man who uses once a year? It is a loss of control, craving and obsessed once a year. He appears to have no problems, but if it were discovered he would lose his business, marriage and status in the community. He is not increasing his use, experiencing withdrawal symptoms and other then the once a year use, he does not have maladaptive patterns of behavior. Yet he continues the use, driven to use once a year. The disease of addiction is a progressive disease that begins with experimentation, then use, abuse and then dependence. The definition has become complicated as addiction is studied from behavioral and neurological perspectives. Brain imaging and research has brought to light the physical aspects of the disease and how the functioning of the brain is affected and changed by use of substances.
The latest diagnostic tool, DSM-V refers to behaviors and not only substances in the definition of addiction. The removal of legal problems in the DSM-V that was in older manuals was removed because one can be addicted and not have legal problems. The removal of tolerance, withdrawal and compulsive use is removed to focus on harmful consequences of repeated use or behaviors. Yes, now behaviors are recognized in addiction and not substances alone.
Not everyone agrees with the medical view of addiction. What some believed was a loss of control, a moral issue, weakness of character, vice or sin continues to be the view of some. Nick Heather is one who does not agree and has authored books to attempt to disprove the disease model. His theory is about social choice. Stanton Peel an addiction expert rejects the disease model entirely, writing also to dispel what he sees as a myth that it is a disease.
For over thirty years, I worked in a variety of settings counseling and directing programs to help individuals and family affected by addiction. One of the first jobs I worked at was an outpatient facility that did not believe in treating clients who took any medication for mental health purposes. The facility contracted with a psychiatrist who would assess clients being admitted to the program. I asked my supervisor why they went through an assessment if they would not be permitted to take a medication if the assessment did indeed diagnose them with an illness. The assessment was to rule out suicidal thoughts or intent only. I had a discussion with the director and asked why if a client was diagnosed with a mental health disorder, they would not be permitted treatment at our facility if they took medicine for their mental health. That’s the way it has always been and it is the belief that recovery is better with no medication because it would be abused. The director added that if I could prove otherwise, then a change might be considered. Some research was being done that indicated greater success rates for recovery in clients who were treated for their mental health concurrent with their addiction treatment. What was happening in the early 90’s was that the mental health treatment centers, did not want to attempt someone who was actively using and addiction centers would not treat someone taking medications. Many clients were not getting either or choosing one treatment, struggling with the need for both. When I showed the research to the director, another meeting with the psychiatrist occurred and a change was made in the policy. I wish I could tell you that it was like magic and everyone recovered. That is not the reality of addiction or recovery. Many factors influence and impact recovery. For some, recovery is a journey that will include many relapses. For some, once they stop they never use again. What came of the change was not happening only at our facility, but many. The acceptance of necessary medication is widely accepted today.
Another belief about addiction is that a person must hit a rock bottom to stop using. In other words, they have to want to quit before they can recover. I was part of a team that wrote a grant to develop what would be called treatment court. This program took men and women who were charged with a crime related to their own drug use. Their sentencing was suspended if they agreed to go to treatment. The treatment was determined by an assessment for the level of care appropriate to the intensity of their addiction, not based on the severity of their crime. The old school and traditional substance abuse counselors said this will never work. They said court ordering or letting someone off the hook will not stop them from using. They have to want to quit. Some went to rehab, then came into the partial program that I ran. Some came directly into the partial program. I partial program is an all day program that gives counseling, structure, life skills, coping skills and more. Between the program and the probation officer, the recipients were given a drug screen everyday. If they used, they were put into jail. If they did not use, they finished treatment, stayed on probation and could be with their family, get a job, go to school and move on with their life. The success rate was phenomenal. One of the things that I found interesting was that some of the participants, the first week would be disclose that they wouldn’t use while they were being tested everyday, but as soon as they were out of treatment, they would go back to using. Something happened to them, as they stayed abstinent. The more clean time they had, the less they wanted to go back to what they thought they did not want to leave. We found out that when a person is not motivated to stop using, given enough time without the substance they used and given counseling that includes coping skills and support for developing alternative goals for their life, they did not have to reach rock bottom to have a solid recovery. The program proved to be successful. No not everyone was able to make the change. Those with severe mental health struggled more, those with families who were addicts and those with strong ties they were not able to break were not successful. The mental health would be attributed to the nature impact and friends and family nurture. One thing for sure was the fact that a person does not have to hit rock bottom and can be supported in a way that leads them to want recovery.
One of the clients I was assigned, came with a flurry of calls to me from an outside agency that had referred her, the intake worker, a case manager, the psychiatrist who had assessed her and my supervisor. The client, I was told, was being very defiant and refused to admit when she began using. This information was part of any assessment and required from the addiction-licensing bureau. I met with her a couple of times before she asked me if I was going her to ask her something. She said, “is there something you want to ask me?” I asked her if there was something she wanted to tell me? Then she explained that she could not answer the question about when she first started using alcohol. She said that her mother told her that she drank when she was pregnant with her. The client recalled her mother drinking while pregnant with younger siblings. The client told me that her mother put alcohol in the baby bottle because she believed it helped that baby sleep. The client further told me that her mother put alcohol on the baby’s gums to reduce teething pain and thought nothing of giving her little ones beer with dinner. She had not been acting in defiance, but revealed that she never had a time in her life free of alcohol, not even before birth. Yes, she had fetal alcohol syndrome. The tendency to blame someone for their choice to use substances, takes on a different perspective when the history of the client is known.
I often came across what I considered a negative stigma regarding people suffering from addiction. The view was that people who use have no morals. Many counselors did not want to work with someone with addiction. I had found that the challenges I faced to help were worth the efforts. In my work, not the least of my challenges was the fact that I would be asked how much clean time I have. Since I never used, it did not take long for my clients to figure that out. Some clients insisted on another counselor. How could I understand them if I never used? Some appreciated that I was there to help. The medical director that I worked for at a psychiatric hospital had a friend who was a superintendent of a school. He had a situation that he was dealing with and needed some help. There were some students in the school with juvenile records and some with criminal records that he was required to provide education for, but could not put them in school with the main stream because the some parents were protesting. The parents did not want what they saw as a bad influence around their children. The superintendent agreed. He had a building away from the main school and set up an alternative school for these young men. They would be in school after the other students were in school, so they would not be in the community or school with the other students. I was asked to be the counselor at this alternative school. The entrance to the building was through the gym. As I was approaching on my first day, I was thinking about how difficult it could be since these were all males. Would they do better with a male counselor, someone of their race, someone younger? I stepped into the gym and several of the boys were shooting hoops. I gave a cheery hello and they ignored me. I asked how they were doing and they ignored that so I kept walking. Just as I passed them, I saw the basketball coming toward me and I turned, put my hand out to guard from getting hit and caught the ball. I proceeded to dribble the ball and noticed I was being stared at with unfriendly looks. I picked up the ball and meant to toss it toward the young men. The ball accidently went into the basket and I quickly turned not wanting the boys to see the shocked expression on my face. I continued to my office to settle in. When the teacher came in, he asked me to come to class to introduce me. They asked me if I would shoot hoops with them after lunch. I told them work comes first and their would be time for playing later. Making that basket, made a connection that opened a door for communication. These young men were not as hardcore as they were made out to be. Each had a different story, but a common element was the neglect and abuse they suffered from family. They needed a way out of the darkness, to feel hope, to feel that they had a choice and could be successful in school. They needed direction. Stereotypes are born from some truths, but they are not the whole truth. It is worth learning more to understand there is more than what is seen on the surface.
See suggestions for further reading below.
1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. American Psychiatric Association; Washington, DC, USA: 1980.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Association; Washington, DC, USA
3. Black, Claudia, “Changing Course”, “It will never happen to me” b
4. Grisel, Judith, “Never Enough”
5. Davenport-Hines R. The Pursuit of Oblivion: A Global History of Narcotics. WW Norton & Company; New York, NY, USA: 2003.
6. Hanson D. Historical Evolution of Alcohol Consumption in Society. Oxford University Press; Oxford, UK: 2013.
7. White W.L. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Chestnut Health Systems/Lighthouse Institute; Bloomington, IL, USA: 1998.