The Disease of Addiction
At AARC, we take a very straightforward approach to addiction: it is a chronic and progressive disease.
AARC is convinced by medical evidence that addiction is a disease with serious impacts on adolescents in particular, rather than a psychological or moral affliction. The effects of addiction are biological and social, as well as psychological and spiritual. Everything we do is guided by the belief that addiction is a chronic disease, not a temporary phase that a teen is going through.
A Disease That's Spreading
Adolescent addiction in Canada is a fact of life. The statistics for youth are disturbing.
In 2012, 60% of illicit drug users were aged 15-24 (CCSA). UNICEF published a report in 2013 that stated “Canadian children 11-15 are the #1 users of cannabis in the world.”
As parents, guardians and healthcare professionals we need to be constantly aware of the dangers that addiction poses to vulnerable minds and bodies. In this section, you can research the facts about addiction, complete a checklist on addiction warning signs, find out what the disease model means for treatment, and consider the challenges that carers face when treating teens in a semi-residential setting.
Signs of Addiction
Addictive behaviour in adolescence
Adolescents are extremely unlikely to admit that they have an addiction problem. If they do admit it to themselves, they seldom ask for help. So how can parents or siblings identify addictive behaviour rather than a teenager simply ‘acting out?’
- The first place to look is in their behaviour towards other family members. Has the adolescent become very secretive, very aggressive or very reclusive? Is money going missing? Have you lost some prescription medication you were sure you had?
- Then you will probably notice physical signs. Teens may seem excessively happy or excessively sad, very alert or very subdued with no obvious cause. You may be able to smell alcohol or pot from their breath, hair or clothes.
- Socially, you may find them hanging out with much older friends, disconnecting from existing peer groups, avoiding school work and sports, and getting involved with the criminal justice system, perhaps at a low level.
- If, as a parent or sibling, you are able to get your love one to seek help at this stage, you are fortunate. It may be that your teenager is only experimenting … but you should try to support them to stop because of what is likely to follow.
You may find this checklist helpful.
There is always hope
At AARC, clients come to us after their situation is beyond control. Our clients are typically mixing different drugs and alcohol, and for most, every day. They are frequently involved in illegal activity, often petty theft, sometimes prostitution, occasionally violent crime. Some clients are suicidal, or receiving psychiatric treatment, what we call comorbidity. Many clients have left home and are struggling in school, or no longer attending. Their former relationships are often damaged beyond repair.
By the time many families contact AARC, they have often exhausted many other treatment options. They find themselves in exceptional circumstances, in need of exceptional help. AARC tries to help everyone who comes to us because we understand how devastating adolescent addiction can be; we see the damage every day. And every day we find renewed hope in the community of peer counsellors, parents, alumni and clinical staff who have seen the success of our program.
Is your child addicted?
- Do you find their explanations for irresponsible behaviour or decreasing performance to be unbelievable or implausible?
- Are they frequently dishonest?
- Has their personality changed (i.e., are there inappropriate mood swings, hostility, giddiness or irritability?)
- Has anyone expressed concern about their alcohol/drug use?
- Are they less responsible re chores, schoolwork or being on time?
- Have you found obvious signs of drug/alcohol use such as bottles, drugs, or paraphernalia?
- Have they lied about their use of alcohol or drugs?
- Have their grades dropped or is there decreased interest in school activities?
- Do they have unexplained periods of depression, anxiety or difficulty with sleep?
- Have they become withdrawn and uncommunicative?
- Do they spend a lot of time alone?
- Do they show a lack of motivation or an apathetic attitude?
- Have you noticed alcohol or pills missing from your home?
- Are you missing money, credit cards or valuables that could be converted into cash?
- Do they seem to have difficulty remembering things?
- Is there a change in their personal hygiene, dress habits or sleeping and eating habits?
- Do you ever notice physical indicators of drug/alcohol abuse (i.e., red eyes, dilated pupils, and slurred speech)?
- Have you observed irrational or explosive behaviour?
- Are they increasingly secretive about their whereabouts?
- Are there signs of medical or emotional problems, such as depression, anxiety, suicidal ideation, ulcers, or gastritis?
- Has their peer group changed to include friends that are involved in drinking, using drugs and partying?
- Do they become belligerent, angry or defensive when others express concern about their drug use?
- Are they irresponsible drivers?
If there is evidence of substance abuse and you have answered "yes" to eight to ten of these questions, it indicates that your child is exhibiting significant emotional or behavioural problems that may be related to substance abuse.
- 60% of illicit drug users are 15-24 years old[LR1] (Canadian Centre on Substance Abuse [CCSA])
- 4.4% of Canadians meet the criteria for addiction (CCSA, 2012)
- 8% of Canadian youth report alcohol or drug dependency (Health Canada, 2011)
- 1 in 6 (17%) of adolescent marijuana users become dependent (CCSA, 2006)
- 23% of Canadian youth report using marijuana on a daily or near-daily basis (CCSA, 2010)
33,650 people sought treatment for addiction in Alberta in 2012
In 2012–2013, 33,650 unique individuals accessed publicly funded specialized treatment services in Alberta; of which 83.5% were new cases.
The majority of individuals accessing treatment services (87.2%) were seeking treatment for their own substance use problems. However, 4,311 individuals accessed specialized treatment services for a friend or family member during the 2012–2013 fiscal year, which accounts for 12.8% of the entire population of unique clients.[CCSA National Treatment Indicators 2015]
According to UNICEF, Canadian children 11-15 are the #1 users of cannabis in the world
Widespread use of alcohol amongst high school students (Grades 7–12)
Based on data from the 2012–2013 Youth Smoking survey, past-year self-reported use of alcohol among students increases substantially with each grade level, from an estimated 8% among students in grade seven to 67% among those in grade 12. In 2012– 2013, the overall prevalence of alcohol use in the past 12 months decreased to 41% compared to the 45% recorded in 2010–2011.
First time using alcohol
Data from the Canadian Alcohol and Drug Use Monitoring survey (CADUMS) indicates that the average age of initiation for the consumption of alcohol was significantly delayed from 15.6 years in 2004 to 16.2 years in 2012.
Data from the 2016 National College Health Assessment Survey (Canadian Reference Group) indicates that 35% of post-secondary students drank more than four drinks on a single occasion at least once in the past two weeks. Risky drinking was more prevalent among male students (39%) than among female students (34%).
Statistical validity: Forty one Canadian postsecondary institutions self-selected to participate in the Spring 2016 ACHA National College Health Assessment and 43,780 surveys were completed by students on these campuses.
The disease model explained
In medical circles, AARC’s view of addiction is known as the disease model. The disease model of alcoholism and drug addiction says the condition is a chronic, progressive illness, similar to Type II diabetes and cardiovascular disease. In other words, once you have the disease it is irreversible. Of course, like Type II diabetes, you might have taken action prior to developing the disease of addiction, which may have allowed you to avoid it. But we are talking about adolescent clients who no longer have that option.
At the heart of this model or theory is the thought that addiction is characterized by a person’s inability to reliably control substance use. This is accompanied by an uncontrollable craving or compulsion to use substances that is derived from a physical change in brain chemistry.
The loss of control can be manifested during either a short or long period of time. In our experience, an adolescent can lose control of substance use in a very short period of time due to their immature brain development.
According to E.M. Jellinek, one of the pioneers of the disease model, the compulsion to use a substance is best described as an “urgent and overpowering desire.” (Jellinek, E. M., The Disease Concept of Alcoholism, Hillhouse, (New Haven), 1960.) It is this feeling that compels the person to do whatever it takes to obtain the object of the addiction, even when there are potential harmful consequences.
The American Society of Addiction Medicine’s (ASAM) definition of addiction (2011):
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors”.
“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”.
The disease model emphasizes that the impaired control and craving are irreversible. There is no cure for alcoholism and drug addiction; they can only be arrested.
AARC accepts that the disease model is a theory. Some suggest that the neurological damage can be reversed. Others disagree with the disease model entirely, proposing that addiction is a temporary mental state, a psychological episode or even a lifestyle choice that can be altered by the willpower of the individual or by medication. Our experience contradicts these views; addicted adolescents appear to be permanently susceptible to drugs, and individual willpower alone has never been seen to succeed long-term. Instead, they require a significant change in lifestyle that involves a change in thoughts and feelings facilitated through the 12 Steps of AA as a lifelong recovery tool.
Based on our view that addiction is a chronic illness, AARC’s expected treatment outcome is total and lifelong abstinence from all mood-altering drugs.
Adolescent brains are particularly susceptible to damage by psychoactive drugs, like cannabis and alcohol, as the structure and chemistry of the brain have not yet reached maturity. You can read more about the neuroscience of brain function in substance-abusing adolescents here.
The Canadian Centre on Substance Abuse put it this way:
[T]he scientific literature points to adolescence as a sensitive period with regard to drug reward, comorbidity, motivation and drug taking. Because the cellular adaptations associated with addiction processes occur in the same regions of the brain as those undergoing preferential maturation during adolescence, adolescence should be viewed as a period of particular vulnerability to the effects of rewarding drugs and to the development of future drug-related problems. Substance Abuse in Canada: Youth in Focus, CCSA, 2007
Non-violent de-escalation and restraint
It is in the nature of adolescent addiction that legal problems may have to be faced by clients and by AARC.
Many of our clients have criminal records, sometimes involving violence. Some are actively engaged in illegal drug activity, some have been living on the streets, some have been involved in prostitution. Many clients have developed psychological disorders or mental illness in combination with their addictions, what’s known as comorbidity; some may have attempted suicide. None of these problems is left behind when they come to AARC, therefore all AARC staff are trained in suicide intervention.
For some clients, AARC is the last resort in terms of treatment, as they may have declined, failed or actively fled all other options. Few adolescents view drugs and alcohol to be at the root of the issues they face and as a result do not seek treatment; normally, parents or family members are the ones seeking treatment on the adolescent’s behalf.
Given these exceptional circumstances, it is not possible to guarantee that clients will always treat each other with respect. It is always possible that there may be physical violence or intimidation. All AARC staff are certified to de-escalate and restrain using non-violent measures.
AARC’s treatment of adolescents always operates within the legal framework governed by federal and provincial statutes. The most important legal document that we refer to is Alberta’s Children First Act, which was proclaimed (became law) in 2014. You can read an overview here.
AARC works closely with Calgary Police Department with regard to legal questions that may arise in the treatment of clients with addiction. Other legislation that applies in some contexts of our work includes: Alberta Building Code Recovery Homes (Standata Youth Intervention Facilities); Child Youth & Family Enhancement Act Licensing Regulations; Child Care Act; Social Care Facilities Licensing Act.
As an Alberta non-profit company, AARC complies with all federal and provincial statutes related to the operation of business premises and the employment of full-time staff and volunteers. All the necessary criminal backgrounds checks, including child intervention checks, are carried out prior to any person becoming involved with the treatment of a client.
AARC accepts the risks that accompany treating clients and families. Their willingness to face these risks and complexities with confidence is a key component of its success, as evidenced by the majority of clients who in time are grateful for the intervention initiated by their families.
AARC is committed to ensuring that its model is available to clients and families in need, no matter how difficult the situation may appear.