Lesson One

* DISCLAIMER: This class is primarily intended for people who want to become chemical dependency counselors, or people who want to work/volunteer in the field of addictions. Therefore it’s most important that you have worked through your own problems, issues and addictions in order to assist others in this field. The best help you can ever be to anyone is a role model. Don’t fake it, they can see right through that and it helps no one. If in the course of this class you discover that you might still have some old bugaboos, issues or habits still nipping at your toes, then this is the time to seek out help for yourself and apply what you learn here for yourself before attempting to teach others how to live. Of course no one is perfect, no – not one. But the effort you’ve put into your own recovery/life will clearly show when working with others who are trying to overcome life’s threatening disease of addiction.

* An important note: I will use the words "Addict and Addiction" more often than alcoholic. In fact, if it were up to me I wouldn’t use the word alcoholic at all. Alcohol is a drug and therefore anyone using it abusively and obsessively is addicted to it, which makes them an addict to the drug of alcohol. It is very difficult to find a "pure" alcoholic these days, most people who drink like that will and do take other substances abusively. So to me the words are interchangeable and really are all about the addiction. As you read your books please keep that in mind as well.

*You will submit the answer to your questions on your own new thread. Only one student on a thread. Then submit your answer to the discussion question- in this place you can interact with each other regarding the discussion question.

Then submit a weekly journal to me. Some of the assignment may be sensitive issues for you and you should submit it in the journal. In the journal is where you can communicate with me and ask me questions.

Please, be respectful of each others feelings, thoughts and opinions when posting statements or comments to another. Do not publicly post personal information – you know- things you should only tell a therapist, counselor or a close personal friend. Thank-you.

San Bernardino County Behavioral Heath: Office of Alcohol & Drugs (OADP)

You will need to find some sort of treatment facility to go visit. Call ahead, ask when is a good time to come, tell them you are student in this class and you need to do a paper on a facility. Remember, confidentiality is of the utmost importance in the field. Do not ever use real names or describe people so well that others might figure out who they are.

Websites:

Samsha.com,

Cadee.com,

NIDA,

Todayna.org ,

Drug Enforcement Administration,

Look for Treatment facilities in your area, in your state.

Read the introduction and then Ch’s. 1, 2, 3 of "I’ll Quit Tomorrow".

Read in Serenity Principle chp. 1 & 2.

Read My Lecture Notes:

Note: You will need to print out the Feeling Chart, Denial & Delusion, Jellineck Chart, Flags, Stages of addiction, pre-disposition and Criteria for a disease, you will need to refer to these often, they are basic information.

* There is a lot of information in this first lesson, it is sitting the stage and I am giving you some charts you will use throughout the course. 　

As you read "I’ll Quit Tomorrow" you will notice that the time period of this book spans from the 1960’ to the 80’s. Some of his terminology, expressions, examples may be out dated, however, we are looking at the overall concepts and methods that were just being introduced into our society at that time. They were cutting edge and new to the field of addictions. Vernon E. Johnson and the Johnson Institute in Minneapolis, Minnesota were ahead of their time with the strategies they began to use when working with alcoholics. Please try to keep in mind that this book was selected for those reasons, there are not any new books that help explain the process of intervention, treatment and recovery any better than "I’ll Quit Tomorrow". This is the book, the model that every credible treatment facility is modeled after to this day. Also, this book is used in many other drug & alcohol studies programs across California, and across the U.S.. We will be looking specifically at the key points, methods and strategies that Mr. Johnson developed in helping a person who needs help desperately, but does not want it, to get help.

This week we will look at pre-disposition and the warning signs, "flags" that are evident as a person is on their way to addiction. We will follow two fictitious characters throughout this class from time to time, Joe and Jane. We will begin the course with the signs that a person may be "pre-disposed" to the disease of addiction.

So, let’s begin our journey with Joe; we enter his life when he is about 16 years old, add or subtract a year or two, but he is the fun guy that likes to go to parties on week-ends, probably out in the deserts, orange grooves, beaches, somewhere out where teens like to go for big parties with a keg or two. Joe and his friend Jim drink about the same amount of beer, and the next day, both are hung over something awful. Both may have been sick to their stomachs. Yet, it will be Joe who says – "that was fun, let’s do it again." Jim has learned his lesson and either won’t be drinking in the near future or will slow down quite a bit, maybe "nurse" a beer for hours. While Joe, on the other hand, despite all pain & problems will be back at it next week-end if not sooner.

Meanwhile, at one of these parties Jane spots Joe so drunk he can’t even walk! She feels compelled to help him. And so it begins. They fall in love, nobody understands him like she does. Although she suggests to him to slow down a little, she hangs in there with him. He’s told her how awful he has it at home; his dad is an abusive alcoholic, and his mom is so busy with the other kids, her jobs and house that she is too worn out to pay much attention to Joe. Joe is the fourth child in the birth order, so by the time he came along his father's drinking had progressed to a point that the whole family spent their time making sure he was enabled to continue drinking in the fashion to which he was accustomed. Joe had never known him any other way!

Jane understood, as her father wasn’t any better. He’d left her and her mother and two little bothers when she was only 7. Her mom tried to pull it together at first, working as a waitress to support them, but it just wasn’t enough. Soon, she abandoned herself to periodic drinking and went on welfare. But it’s the pain pills that help Jane’s mom most. Jane and Joe were made for each other.

By the time they were 18 & 19 they were married with a baby on the way. He’d gotten a job at the local plant working the swing shift. They lived with her mom at first and then got a little apartment just before the baby came. Now, they will get to live happily ever after, and Joe won’t spend so much time at his friend's house drinking and now smoking pot. Joe hadn’t been comfortable living with his mother-in-law, so he’d tried to stay away as much as possible. But now, now – life will be good. He did spend more time with Jane and the baby. He stayed pretty close to home most of the time. But soon, he felt deprived of much of Jane’s attention, as she was busy with the baby and tired. It wasn’t long before Joe starting resenting Jane’s attention to the baby and her lack of energy for him. This felt like the home he grew up in, where he was pushed to the side, ignored, and forgotten. So back to the buddies' houses for fun, laughs, people who will listen to him and drink/use with him. Joe & Jane begin fighting about it and that drives him away more and more.

Meanwhile, what has been happening to Joes’ addiction all this time is he went from the "normal" on the "feeling chart" to euphoric at first, (refer to your feeling chart on p.9.) He found at 16 years old that if he kept drinking on a regular basis he did not have the bad hangover anymore. His tolerance was building up. Already "pre-disposed" to the disease of addiction, he was able to drink and use more than his buddy Jim. By the time Joe was 18 he could drink all of his friends under the table! Something he was quite proud of.

Now, this is just a simple scenario, a basic- typical case. We know that there are thousands, if not millions of variations in real life. Joe could come from a perfectly normal non-drinking, church going family, as well as Jane. Jane could be the addict (the dependent) and Joe the Co-dependent. I am just using this example for simplistic reasons of explaining a process of addition.

In the beginning, some of the "flags" for Joe were his willingness to drink again despite the physical pain that accompanied his drinking. Where Jim found that it wasn’t worth it, Joe found relief. Joe had escaped some realities of life, his life, life in general, that made it all worth it. Joe also began getting in trouble at home and school, but he didn’t care. His already poor grades began to get much worse until he finally dropped out of high school.

The "Pre-disposed" symptoms were 1.) Coming from generational alcoholism, as it’s not un-common these days that an addict is probably from a long line of addicts, several generations back. 2.) Family coping skills are nil to none. 3.) His tolerance for substance was higher than the average teen. 4.) Despite negative consequences he kept on using & drinking.

* A word about tolerance here- It has been found that in people who prefer and are able to drink alcoholically they posses an enzyme that helps the liver to process alcohol much faster, much better if you will- than others. For instance, in persons of Asian decent they have found that they do not possess that enzyme, when they drink too much alcohol (other than Saki, a rice based alcohol) they become ill and do not care to pursue this drug any father. They do however, possess the enzymes that will help them process opiates. As we find that many cultures can handle what is indigenous to their region of origin. Some what of a phenomenon? No, not all that surprising.

His next "flag" was that the hangovers weren’t as bad as they were at first and he quickly learned little tricks to help them subside. His biggest "flag" was the build up in tolerance. He could drink/use more alcohol for longer periods of time. This is true with pot, speed, heroine, pills of any sort, any and all drugs. By the time Joe had married Jane he was in 2^nd stage addiction. Of course, at this point Joe will defend to his death that he could quit anytime he wanted to, but just doesn’t want to. This is a huge and very common Flag. Refer to your Jellinek chart.

Denial & Delusion

Denial is the number one obstacle to overcome in addiction. It affects both addict & family, friends, co-workers, etc. It’s a refusal to admit the truth or reality. Denial is self will run riot, blaming other people, places and things for their problems. They will seek out others to help continue their addiction pattern unwittingly. They will see using as a solution, not a problem. There’s constant accusation & projection of others as the source of the problem. They even feel they are still in control.

Delusion implies self-deception, disordered state of mind. They have a false belief regarding self or what is outside the self, despite the facts. They have terminal uniqueness, grandiose and self-indulgent delusions. They believe they are indestructible.

Click the link below to access a pdf version of the feeling chart.

See pages 9, 11, 12, 14. watch Joe's progression on the feeling chart.

Joe started at "Normal", went towards "Euphoria", and by figure V. on p. 14 Joes is starting to land more towards the "pain" side of normal.

The Stages of Addiction are: See p. 30

Phase 1. Experimentation: Pre-Alcoholic phase. Early stage A. /tolerance begins.

Phase 2. Use: Prodromal (blackout) phase, Stage B. Dependency & tolerance built up.

Phase 3. Abuse: Crucial Phase. Stage C. Total dependency. Tolerance begins to back fire.

Phase 4. Addiction: Chronic Phase, near death. Stage D. Zero Tolerance.

(Tolerance, Physical Addiction, Psychological Addiction.)

I included the Phases, Stages and names of these stages that are most used. There are these different variations. I use the terminology phases & stages interchangeably. On the test is could be worded either way, so please learn them all.

Addiction is a disease because it meets the four criteria laid down by the American Medical Society for something to be called a disease.

1. It is Primary.
2. It is Incurable
3. It is Progressive/Chronic.
4. It is Fatal.

Alcoholics Anonymous termed the disease of addiction (alcoholism) as "an obsession of the mind, coupled with an allergy of the body."

E.M. Jellinek sketched out the progression of the disease. Much of how we view addiction is due to the early work of E.M. Jellinek. Jellinek was a biostatistician and his first studies of alcoholism were published in 1952. He found similarities in many people who drank too much. He found similar patterns of how the disease progressed. We use a "U" shaped graph to help show this progression, starting on the left side and going down. See page 30 for a view of "half" of that chart, it shows some of Jellinek’s chart, that’s all we need for now. We’ll look at the other side (heading up) later on when we talk about recovery. With the Jellinek chart the bottom is the addicts’ bottom, death. Unless, however there were some sort of intervention before it got to that point. Then they begin the upward climb on the right side of the chart. Starting with top left of the chart and going down, you will observe the remarks on either side of the line.

Jellineks four phases of addiction:

1. Pre-alcoholic.
2. Prodromal.= blackouts.
3. Crucial.
4. Chronic.

On the left side at the top begins and goes down:

• Drinking/Using to relieve tension.
• Using before a function, even if alcohol or other drugs will be there. Sneaking more for yourself while you are there.
• Increase in tolerance.
• Uncomfortable in situations where there is no alcohol or other drugs.
• Continued drinking/using when others have stopped.
• Preoccupation with using begins.
• Occasional memory lapses.
• Self-esteem is beginning to sink, even though they do not see it or admit it.
• Secret irritation when drinking/using is discussed.

• LOSS OF CONTROL. (loss of predictability).
• Anticipation.
• Aggressive & extravagant behavior.
• Making excuses for drinking/using.
• Efforts to control drinking fail.
• Repeated memory lapses.
• Guilt & remorse about drinking/using.

1. Promises & resolutions fail.
2. Marked self-pity & negative thinking.
3. Loss of other interests.
4. Low Self-Esteem.
5. Tremors & early morning drinks.
6. Work & family problems.
7. Rigid.
8. Drinking/using alone.
9. Protecting supply.
10. Preoccupation with drinking/using.
11. LENGTHY INTOXICATIONS.

*If we could only pick one word to explain addiction it would be "pre-occupation." The addict is ALWAYS thinking, living and striving to find the ways and means to get more.

*Please read Ch. 2 with careful consideration to Phase 3. Johnson is now describing how the addict will begin to use their intellect to excuse their using & behaviors. Their emotional state has been pushed so far to the background the disease itself has taken over in the intellect to help itself survive. (I hope you understood that). A defense system that began in Phase 1 is now building up more steam!

Chp. 3 takes us into the horrible 4^th and final stage. Please note the comment underneath figure IX on p. 28. With so many doctors giving addicts more drugs (anti-depressants) for their drug problems it’s no wonder there are countless un-diagnosed, un-helped addicts walking around! Please see that the addict has crossed the invisible line a long time ago and does not know that they are that bad. Their defense mechanisms tell them that it is everybody else! From where we’re sitting that sounds silly and phony, however- it is so true & so sad. Read Chp. 3.

Read Chp. 1 of the Serenity Principle –

I have to tell everyone right now that I do not agree with some of the concepts or statements in the book. However, the reason I chose this book is because it has a basic premise about changing negative thinking. This is something that is fundamental in addicts. As Mr. Johnson explained so well in "I’ll Quit Tomorrow", it can be very difficult to help them shed the negative and replace it with positive thinking. This book has some excellent ideas and strategies for the counselor to help them with this. It’s not a cure all, but a small additive in the process of helping your clients, patients, residents, friends or self in the recovery process. You just might enjoy the little book for yourself!

Answer Questions:

What are the "flags", signs of alcoholism/drug addiction?

Denial is _________________________________________________

What qualifies addiction/alcoholism as a disease?

Define "Disease" of addiction.

Describe the "Feeling Chart"

Review Jellinecks’Chart. What stage would you be in if you were drinking/using before, going to a social event?

Discuss the three principles in chp. 2 that Johnson says are visible in the 3^rd stage.

What does Rigid have to do with addiction? They look pretty loose to me! Refer to your book, chp. 2. I’ll Quit Tomorrow.

Define: Predisposed, dependency, Addiction, Denial, Delusion.

What are the Stages of Addiction?

Alcoholism is the _________ largest health problem on our country today.

Directly affecting ______ & ______ million people.

In Chp. 3 it begins with the question "Why don’t they quit? Why don’t these people see what is happening to them?" The answer is ________________!

Projection is the process of _____________________________.

Discuss free floating negative feelings ..

Can the co-dependent have free floating negative feelings too?

Comment of Chp. 1 of Serenity Principal.

Discuss: "Hitting bottom"