Lesson 1: Introduction to the Course


Attention

Personality tests allow us to develop an understanding of ourselves that we can apply to our personal and work lives.

This test is based upon one of the most famous personality tests, the Myers-Briggs Typology. Take this test prior to starting this Lesson, you will apply the results in this Lesson.

Click here to take the Jung Typology Test!


Learning Outcomes

Upon completion of this lesson's material, students will be able

  • Be able to state course expectations for participation in lessons with respect to Discussions, Tests and Assignments
  • Understand what they need to help a person with substance use issues
  • Be able to state what MHRT/Cs can do to help persons with Substances Use Disorders (SUDS)
  • Be able to state factors from their own experience, personality, training that will help and hinder their work with clients with SUDS
  • Understand what supervision can do to help them in their work
  • Know when to ask for help

Teaching

This course has a digital textbook, or eBook. The book is available in Kindle format. Luckily, there is a Kindle App for the iPad. You will need to download this app from the iTunes U course in order to read the textbook for this class.

The textbook for this class is:

Heilig, M. (2015). The Thirteenth Step: Addiction in the Age of Brain Science .Columbia University Press, NY

To purchase this book you will need to click HERE and purchase the Kindle version of the book and have it delivered to your device. (Note: you are free to buy the print verion of this book as well.)

If you do not have a credit card to purchase books on Amazon, you can buy a gift card from many retailers and use that.

This class will have fifteen content sections.

Each content section will have learning objectives, instructional materials and evaluative activities including Discussions, Tests and Assignments. There will be a final Special Assignment. Final grade will be a summation of points earned on all evaluative activities.

Each evaluative activity will have different due dates and the student is responsible for submitting work by the due date.
The expectation for all class participation, especially in Discussions, is open sharing, mutual respect and confidentiality

Reading
Chapter 1 in The 13th Step

Multidimensional Nature of Substance Use

Substance use becomes a concern when it causes distress and/or dysfunction (DSM V, p. 20: "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above.")

If substance use is NOT causing distress or dysfunction (potential or current) it is not a concern for us as helpers. Examples of use that is not a concern is the normal recreational use of alcohol or marijuana in States where it has been legalized. But even such use may eventually cause problems with anxiety, depression, impaired driving, missing work, family conflict. One thing that we do as professionals is to assess whether substance use is within non-problematic boundaries or whether it has progressed to a problem level.
Substance use like other human behaviors is multidimensional having genetic, neurophysiological, psychological, socio-cultural and spiritual determinants

When does Substance Use become a concern?

Substance use usually must be heavy and prolonged to cause problems. This is because substance use disorders are brain disorders resulting from changes that take place in the brain due to the chemical effects of substances on the brain.

The first change that takes place is to change how the person is functioning here and now. This happens even with a single use of the chemical and is one of the reasons people use substances. For example, a single drink of alcohol causes disinhibition so that a person is more sociable and less reserved (this is caused by changes in the frontal lobe of the brain). Most people like this effect and that’s why alcohol is used at parties. But sometimes this disinhibition causes problems (saying something you shouldn’t) and the person may learn to be more careful with their drinking.

At a higher level of substance use, we may see cognitive and emotional changes that also result in problems. For example, a person who drinks and drives and is stopped by police because of impairment. Or a person who smokes a lot of marijuana and starts to have memory problems. Or a person who becomes depressed or anxious or angry due to substance use and starts to have problems in relationships or daily function. In these cases also, the person may spontaneously decide to change. Friends and relatives may encourage change and be heeded.

We are not yet talking about addiction.

At a higher level of use there is an alteration of brain sensitivity to the chemical so that it takes more to achieve the same effect. This is called tolerance.  After this change, the brain may begin to be unable to function normally without the substance and the person may experience extreme distress if deprived of the substance. This is called withdrawal. When these changes take place, we are in the realm of addiction where the person loses control of his or her behavior. It becomes harder and harder to make changes even when the person knows they should and wants to. Most people who have been daily cigarette smokers know how this works and that’s why tobacco is considered to be so addictive. The sad fact is that without medical help, most people can’t quit at this point and even with help it may not work well without repeated episodes of treatment. With cigarettes, almost half of daily smokers are unable to quit even though they want to quit and try to quit multiple times. In fact, the average number of quit attempts before a smoker succeeds is seven.

Scientists believe that some brains are genetically programmed to be susceptible to the effects of substances. And that without this genetic predisposition, the development of addiction is unlikely. But there probably still are cases where simply using too much of the substance can cause the brain changes that result in problems. However, we will come to discover as we study the various problems that people have with substances and the underlying brain physiology that the likelihood of people using too much of a substance is also mostly determined by genes.

Once problems have developed in the brain, stopping use of the substance becomes very difficult and the changes in the brain make relapse probable even though the person is motivated to stop.

All of this calls into question the frequent belief that all addicts need is to use their will power and that they don’t do that because they are still enjoying their substances. They may indeed feel that they can’t live without the substance but usually any real enjoyment is only a dim memory of the distant past.

When are human problems not psychiatric disorders?

An expectable or culturally approved response to a common stressor or loss, such as grief over the death of a loved one, is not a mental disorder. Such grief may become a mental disorder if it is too severe or too prolonged.
Socially deviant behavior (e.g. political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual. In fact, deviance may actually be “healthy” if the culture in which it occurs is sick. For example, in the Soviet Union of the 1970’s, dissidents who believed in freedom of speech, were labelled mentally ill and sent to camps to be reformed. Or in the American South of the 1960’s, people who supported civil rights were seen as trouble makers and deviants. Before 1970, gays and lesbians were seen as sexually deviant and homosexuality was in DSM I and II as a psychiatric disorder.  When psychiatrists began to see that gays and lesbians could have healthy sexual relationships within the context of their orientation, homosexuality was removed from DSM III as a disorder.
Consider this: are there aspects of substance use that might fall under the DSM exceptions of “expectable or culturally approved response” or “socially deviant behavior”? For example, can an illegal substance be used in a healthy way? (hint: how about the use of peyote by native Americans in their religious ceremonies?)

Values Associated with this Work

Understanding and helping people who are having problems in living presumes a compassionate, non-judgmental willingness to learn. This is especially true for substance related problems which tend to evoke judgement and condemnation because of their frequent association with socially unacceptable behavior.

We have to make the distinction between addiction --- which is a medical problem, a brain disease--- and the behavior which addicted people may engage in. Because their brains are impaired and they are driven by the need to keep the addictive chemical flowing, people who are addicted may be impulsive and show poor judgement and irresponsibility. They may engage in illegal or immoral behavior. But once the underlying disease is medically managed and the person begins to recover, the problem behavior will stop. So the basic issue is not a criminal justice or moral matter but a public health concern calling for education, prevention and treatment. With these public health initiatives, the blight of addiction will disappear from our society just as malaria and yellow fever disappeared with the drying up of the swamps that harbored mosquitoes and the development of appropriate treatments. As we will see, when we study Opiate Use Disorder, simply substituting a safer, more long-acting opiate may result in significantly lower levels of distress and dysfunction so that the addict is able to resume normal life activities. But eventually, we may be able to make genetic changes in embryos and even in adults that will end the addictive cycle in the brain.
This course will provide the foundation for understanding substance use from the perspective of scientist/practitioner: a helper who keeps on learning as much as s/he can in order to have accurate, empirically grounded understanding that enables helping the other to actualize their full human potential.
The expectation is that each student will become a skilled helper by learning certain skills:

  • Empathy
  • Unconditional Positive Regard
  • Congruence

Click HERE for an explanation of Carl Rogers' concepts of "Empathy, Unconditional Positive Regard, and Congruence"

Click HERE to watch this video directly on YouTube

These characteristics can also be summarized as faith, hope and love or the development of mutual trust, expecting and working for the best and putting the other person first

Models of Helping

There are different models of helping.

The "expert" knows best and the helpee is wise to follow their orders (e.g. doctors and lawyers).
The "technician" has special knowledge (e.g. computer repair person) and the helpee hires them for their knowledge and judges their work by the results.
The "coach" knows how to play the game and enables us to do our best and is judged by whether we win the game.
The "fellow sufferer" has been through the same things we are experiencing and can empathize and suggest steps to recovery.
The "friend" cares for us personally and stays by our side until we have what we need.
As you can see, The MHRT/C may partake a little of each model.

Here is what the State of Maine will consider you competent to do as an MHRT/C
http://muskie.usm.maine.edu/cfl/MHRTCOverview.html

What are your strengths and areas of needed growth for helping? Personality tests, such as the Typology test you took in the Attention section of this Lesson, help you to identify your own personal preferences, strengths, and needs. Additionally, you would also consider experiences you have had and what those experiences have taught you.
You are continually developing as a helper from novice to skilled.

Your strengths and needs

What are your strengths and areas of needed growth for helping?

A strength that you want in order to help people with substance issues is the ability to see the world through the eyes of the person you are helping. This takes practice and careful listening and the ability to lay our prejudices aside even when we consider them justified by our life experiences. Remember, it is not your life experience but that of the person you are helping which is primary. Your experiences may get in the way of hearing and understanding the other person and only become helpful when the other person has been thoroughly heard and valued.

Another strength for this kind of work is keeping an open mind to learn new things. In order to treat substance use disorders, you will need to keep on learning the rest of your life. Every day, we are gaining new knowledge that is opening doors to recovery
Personality tests, such as the Typology test you took in the Attention section of this Lesson, help you to identify your own personal preferences, strengths, and needs. What kind of person are you? Do you have the kind of personality that makes for a good helper?
Additionally, you would also consider experiences you have had and what those experiences have taught you. Take a moment to think about your personal life experiences. Have they made you hopeful or cynical? Supportive or judgmental? Willing to see the best in a troubled soul or thinking that people have brought their troubles on themselves?

You are continually developing as a helper from novice to skilled. Most of you are just beginning and that is good because you can open your hearts and minds to continual growth.

Supervision

In this regard, you need someone who understands the work that you are attempting to do and who also understands you and your level of skill. This person, as your supervisor, can help you do your best work. He or she can oversee your growth from beginner to master helper.

  • Your supervisor also is legally responsible for what you do with clients and is expected to help you do competent and appropriate work for the client that will result in a good outcome.
  • Your supervisor helps you to stay within the law as far as confidentiality, mandated reporting and other issues
  • Your supervisor helps you with difficult and/or dissatisfied clients and provides objective correction when necessary
  • Your supervisor can help you make the right decision when your client is a danger to him/herself or other people

Assessment

Lesson 1 Quiz

Taking into consideration the results of your Typology test (see the Attention section) and experiences you have had in the past five years, consider what it takes to help a person with substance use issues and also what strengths and areas of needed growth you have and what you expect to do as an MHRT/C to help with these issues.

Answer the following question with a paragraph for each:

  1. What does it take to be a helper? (25 points)
  2. List your strengths (10 points) and needs for growth (15 points).
  3. List your expectations as to your helping role as an MHRT/C or whatever other professional role you expect to fill. What will you do to help people with Substance Use Disorders (5 points for each item up to 25 points)?
  4. Finally, bring all three together by detailing how you hope your supervisor can help you do all three things. (5 points for each thing your supervisor will help you with up to 25 points)

Lesson 1 Discussion

According to the DSM, some behaviors do not meet the criteria of "Mental Disorder” because they are considered an "expectable or culturally approved response" or a “socially deviant behavior” (see the Lesson for a discussion of what “social deviance” means) that does not occur because of an underlying psychiatric dysfunction.

Describe an example of the use of a substance that would fit into one of these categories and thus would not be considered a psychiatric problem. Explain why the culturally approved or socially deviant substance use is not a substance use disorder and does not require treatment.

When would such use cross the boundary and actually become a substance use disorder?

 

For full credit on the graded discussions you have to post ONE response to the discussion prompt in the lesson and reply to at least TWO others' posts...this is a total of THREE posts, minimum. You are, of course, encouraged to participate much more.

These instructions apply to all graded discussions, they will not be repeated.