Substance Abuse/Addiction

Probably one of the most loaded topics we tackle within MTB is the issue surrounding substance abuse and
addiction. According to the medical community, drinking 9 or more units of alcohol per week classifies you as an
alcoholic. Most of us will chuckle at that number, because we all know that we have had 9 drinks in one post-shift
session, nevermind a week. So here we come to look at the true definition of addiction – and the difference
between an unhealthy over-consumption socially and being a slave to a substance, mentally and physically.
Within our industry, we have a very complicated and sometimes negative relationship with substances, especially
alcohol. It is our release, our reward at the end of the shift. We make our money from selling it, restaurant profits
depend heavily on mark-ups on drinks, so we are also constantly encouraged to get that one last drink out of our
guests. Culturally, North American also have a binge-based relationship with alcohol, which differs from our friends
in Europe and abroad. If we have had a bad day, we deserve to get drunk. It’s girls’ night, let’s get smashed. But
considering how horrid we feel the next day, how unproductive, lethargic and sick we feel, does that mentality
even make sense? This conversation about how we relate to alcohol is important, related to addiction, as most
industry drug issues start with alcohol, then move on to narcotics. This is not to suggest alcohol is “bad”, or getting
drunk is “bad”. We’d all be out of job pretty fast if we removed alcohol from our lives. But perhaps, it’s time to
look at how we as an industry encourage an unhealthy use of alcohol and narcotics as a replacement to healthy
coping skills. Time as managers, employers and vendors to support the positive mental health of our people,
without the potentially dangerous effects of continued over-consumption.

Addiction:
Addiction serves a role – be it numbing pain, wanting to feel good when everything feels too much, to push bad
feelings to the side. Addiction can be a coping technique, which, at first, can seem very effective. But addiction
becomes the driving force of your life, costing you relationships, money, jobs and your own health. Current medical professionals have taken all levels of addiction and call it Substance-Use Disorder.

There are 11 symptoms of the disorder, and the symptoms are broken down into 4 categories.

Impaired Control – I CANNOT STOP

1. Amount of substance keeps increasing or using the substance lasts for longer than intended (binge drinking, “benders”)
2. Lack of success stopping, despite trying to cut down (“I’m only going out for one = 4 am blackout)
3. Heaps of time is spent thinking about getting, using and recovering from substance
4. Craving – as in intense desire for substance, physical and mental

Social Impairment – USING IS MORE IMPORTANT THAN ANYTHING

1. Recurring use results in dropping the ball in work, home, and school obligations
2. Continued use despite growing social and interpersonal problems
3. Discontinued social, work, or recreational activities due to use

Risky Use – I KNOW I SHOULDN’T

1. Use even when it becomes dangerous to the individual’s health
2. Use even when knowledge of potential physical and psychological issues is obvious

Pharmacological Criterion – HOW THE SUBSTANCE AFFECTS THE BODY

1. Tolerance – requiring a higher dose to get high or drunk. Sadly, in our community, this tolerance is considered a point of pride.
2. Withdrawal – Occurs when substance breaks down in the body. The body is used to a specific level of the
substance, and once the substance is gone, it wants more to maintain the substance’s sweet spot.

Understanding Addiction

Craving is an intense pull towards using , like a thought in the back of your head to say yes to that shot you know you don’t need or to step outside in the rain for a few puffs. Craving feels very much like it is coming from your body, not your mind. It is, in fact, both, and understanding the physical versus biological aspects of that desire is key.

Relapse is when someone returns to drug use after kicking the habit. Not surprisingly, this is not why we kick the habit in the first place, we want to quit. Understanding addiction means accepting the possibility that relapse is not only likely, but expected, and no one should feel guilty for relapsing. Recovery from any addiction, be it drugs, alcohol, gambling, sex or smoking, is very hard. But we should also not
lose sight of the fact that you can beat it, that recovery is a reality and worthy of trying, how ever many times it takes.

Emotional Regulation is the ability to work through, understand emotions, and make sense of them. A cognitive reprisal is how someone alters their interpretation of a scenario, and has huge influence on changing emotional responses. In this way, there is a relationship between how you regulate your emotions and what your cognitive interpretation of a situation is.

Coping is a response to trying to keep internal and external stressors under wraps, and while this may or may not be in response to an emotion. Substances can also be used as a coping response to unwanted feelings and sensations.

Treatment Options
One of the longest approaches, 12-step treatment came about from Alcoholics Anonymous with the goal of developing self-awareness through the role of a higher power (specifically the Christian evangelical God). Modern approaches make the distinction between traditional religion and spirituality—the former being conceptualized as an individual experience over a membership.

Self Management and Response Therapy (SMART) is proposed as an alternative treatment option to the established 12-step, and intends to provide independence from addictive behaviours through balancing thoughts, behaviours, moods, urges, and feelings.

The cognitive behavioural therapy model acknowledges how substance use is a learned behaviour, and through the positive reinforcing pharmalogical effects and the social reinforcing lifestyle – the use persists.

These different treatment styles can be demonstrated in group settings or incorporated in one on one counseling. They are by no means the only therapy options out there. But they illustrate different approaches with specific backgrounds and focuses. Current research supports principles of effective treatment, which are listed below.

Principles of Effective Treatment
1. Not one size fits all
2. Access to treatment
3. Affects all areas of life, not just tunnel vision on substance use
4. Close eye on treatment, with corrections along the course
5. Sticking it out long enough for treatment to take effect
6. Counseling and behavioural therapies
7. Integrate treatment of substances along with comorbid disorders
8. Understanding recovery requires lots of small doses of treatment – in it for the long haul.

Harm Reduction Model
While abstinence is a great aspiration, the goal and main principle of harm reduction is to avoid or minimize
further damage to the individual. Harm reduction is a divergent fork in the road from the traditional path of abstinence being the sole goal. There is a way to reduce damage that comes from use, while the individual may still be using. This model does not rest on a diagnostic categorization system and works from the stance that treatment approaches are going to look different for everyone. The approaches will be specific to the individual and community’s needs and practitioners implementing them will initiate the approach based off where the client is at that moment in time. This approach can be used as another layer to other approaches– integrating with CBT, DBT, or other therapeutic approaches. By coming from a non-judgemental stance and focusing on community integration, this perspective seeks to motivate people to reduce their high-risk behaviours.

What would harm reduction look like for our community? It can take the shape of making the choice to only having a drink when in a good mood. It can look like avoiding having a drink out of stress, sadness, or in response of pain. It can be through investing in nicotine replacement therapy devices like vaporizers to avoid the harm of cigarette smoke. It can be through the knowledge of how when drinking and doing cocaine, that the interaction of the two becomes coca-ethanol, thus the duration and intensity of cocaine is doubled. It can look like someone saying no to another drink out of wanting tomorrow’s hangover to not drag down their day.

Developmental Model
People are not passive participants in their development. Majority of our brain development happens after birth, and relies on nourishment, material security and consistent emotional nurturing to do so. We build on what comes before us, and sometimes when we are dealt a hard hand, we might not be collecting the winning pot this round. But that also means, we shouldn’t go all in on a shitty hand. Making sense of our developmental history can let us in on how we have grown, but by interacting with our environment our development does not stop.