The essential feature of addiction is the maladaptive pattern of substance use (or other behaviors), manifesting in cognitive, behavioral, and physiological symptoms, in which the individual continues using the substance despite problems or negative consequences associated with use.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a list of diagnostic criteria for a Substance Use Disorder (SUD). Those suffering from an SUD will show at least 2 of the following:

• Higher frequency or amount of use than intended.
• Desire to stop using but previous unsuccessful attempts to do so.
• Large amounts of time spent getting or using the drug (or recovering from the effects of use).
• Continued use even when social, personal, or professional problems arise as a result.
• Prioritization of use above social, occupational, or recreational activities.
• Use even in situations that may cause a physical hazard, such as driving.
• Continued use in the presence of another physical or psychological problem and knowing that problem is either caused or exacerbated by use (e.g. diabetes in the context of heavy alcohol use).
• Changed perception of benefit to risk associated with use.
• Perception that use-related problems stem from other causes.
• Craving, or an intense desire or urge to use. Craving is associated with activation of specific reward structures within the brain (APA, 2013).
• Tolerance, which can manifest as 1) needing more and more to get the same effects or 2) decreased effects when using the same substance.
• Withdrawal syndrome upon cessation of use or taking the drug to avoid or stop withdrawal.

Physical dependence occurs through the process of neuro-adaptation, in which the brain and body begin become accustomed to the changes the substance effects and normalize to them so that the user begins feeling abnormal in the absence of the drug. It is often accompanied by tolerance, in which higher doses of a substance are needed to achieve the desired effect.

An individual who is physically dependent on a substance will experience withdrawal symptoms when it is abruptly discontinued.

Different substances bring different withdrawal effects and symptoms, experienced on a continuum from mild to severe. The substance causes one effect, adaptation occurs, and an abrupt discontinuation of use creates the opposite effect.

For example, when alcohol, which has a depressant effect, is discontinued, there is a rebound effect in which the central nervous system becomes hyperactive. For stimulants, such as cocaine, depression is common withdrawal effect.

While physical dependence is an aspect of addiction, it need not be experienced to have what is diagnostically labeled a “substance use disorder.”

Many prescription medications have the potential to become addicting.

Tolerance can develop over time, and withdrawal symptoms can occur when abruptly stopping the medication. Withdrawal symptoms vary depending on the class of substance.

Physiological withdrawal signs are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics.

If an individual, in the course of medical treatment, experiences tolerance and withdrawal in the absence of other symptoms, and medications were taken as prescribed, then the diagnosis of a “substance use disorder” would be inappropriate. However, if medications were not taken as prescribed and are coupled with other behaviors associated with compulsive use or drug-seeking, then a diagnosis of a substance use disorder may be appropriate.

Unfortunately, abuse of controlled prescription drugs (CPDs) is the fastest growing drug problem in the United States, with prevalence rates of abuse second only to marijuana.

Opioid pain relievers are the most commonly abused CPD and most often seen in cases of overdose. Between 2007 and 2010, CPD-related treatment admissions rose 68%, and between 2006 and 2010 opiate-related treatment admissions rose 98% (DEA, 2013).

Easy access to CPDs is contributing to this increase, with legitimate pharmaceutical distribution to pharmacies, hospitals, medical providers, and teaching institutions, thereby increasing risk for illegal diversion. To address this epidemic, efforts are being made to increase public awareness about risks associated with non-medical prescription drug use.

There are many influences in one’s environment, including:

• Social network.
• Socioeconomic status.
• Stress.
• Parental involvement.
• Personal history, such as:
• Physical or sexual abuse.
• Neglect.
• Trauma.

Three main attributes influence the likelihood that someone will engage in a specific behavior:

• Capability: the physical or psychological capacity to engage in behavior (e.g. the ability to understand health messages).
• Motivation: the mental process that guides behavior, both automatic (e.g. euphoria after ingesting cocaine) and reflective (e.g. attitude that marijuana is harmless).
• Opportunity, referring to environmental factors that either promote or constrain behavior, includes:
• The physical environment (e.g. how easy is is to get the substance).
• Social factors (e.g. attitudes of friends and family).

The question “what causes addiction” is an extremely complicated one. While the above factors are known to influence one’s propensity for addiction, the reasons behind each individual’s substance use are varied and complicated.

Without treatment, addiction can result in premature death or disability. Unfortunately, only about 1 in 10 individuals needing treatment receive it (CASA, 2012).

Effective drug abuse treatment addresses not only the substance use but also other associated problems, such as:

• Medical issues.
• Co-occurring psychological issues.
• Social, legal, and vocational concerns.

Two Main Treatment Components-

Behavioral Therapies

These outward behavior-focused therapies address:

• Motivation to change.
• Skill development for problem-solving and coping with urges.
• Promotion of alternative activities.
• Facilitation of improved interpersonal relationships.

Pharmacological Treatments

This type of treatment will help:

• Counter substance effects.
• Relieve withdrawal symptoms.
• Reduce cravings.

It’s important to understand that not all treatment centers are alike, and what may work for one may not be desirable to another. For this reason, it’s important to know what’s important to you if you’re seeking treatment. Consider duration of stay, amenities, type of facility, etc.

Also, note that treatment centers vary to include individual considerations, such as:

• Age.
• Gender.
• Ethnicity.
• Sexual orientation.
• Culture.

Doing research ahead of time and ensuring that the treatment provider can address your needs will help ensure success and reduce the risk of relapse.

Research indicates that treatments combining both behavioral and pharmacological components may be optimal. Effective treatment extends beyond medically assisted detoxification and encourages individuals to remain in treatment for an adequate period of time and develop the skills necessary to maintain sobriety after treatment terminates.

These aftercare Treatment Recomendations include:

• Recovery Coaching
• Substance Abuse Counseling
• Peer-Mentoirng 
• Family Engagement
• Case Management

Addressing other co-occurring mental health conditions is also critical success factor.

Mutual support groups, such as Alcoholics Anonymous, have been a cornerstone of addiction treatment.

Withdrawal describes the various symptoms that occur after a person abruptly reduces or stops long-term use of a drug. Length of withdrawal and symptoms vary with the type of drug.

For example, physical symptoms of heroin withdrawal may include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. These physical symptoms may last for several days, but the general depression, or dysphoria (opposite of euphoria), that often accompanies heroin withdrawal may last for weeks. In many cases, withdrawal can easily be treated with medications to ease the symptoms, but treating withdrawal is not the same as treating addiction.

Recovery from drug abuse or dependence means finding a way to stay drug-free while changing your attitudes and behaviors. In recovery, you work to restore relationships with your family and friends and with people at your job or school.

To help stay drug-free after treatment, you can find things to do, such as sports or volunteer work. Stay away from friends or family members who use drugs. Learn how to say "no" to alcohol and drugs.

Support

An important part of recovery is being sure you have support. You can:

• Develop and use social support and support groups. Support comes in many forms. You can find it ithrough Certified Recovery Coaching or Addiction Counselors, in 12-step groups, and in your relationships with family and friends. You can make support groups more helpful by being an active member.
• Connect with family and friends. They can help you by encouraging positive steps. But you have to be honest about your problems.
• Take part in recovery group activities. You may have used drugs to make friends or be with a social group. Your counselor or doctor can help you learn skills to make friends without using drugs.
• Find a sponsor, and work with this person. A sponsor is someone who has been in recovery for a long time and helps you stay drug-free.

A good recovery coach is a leader, a mentor, a partner, a therapist, a spiritual guide and a cheerleader. A coach will do just about anything to help a client stay sober and to build a life that is meaningful and enjoyable. A coach wants the client to be more than just sober.In addition, the therapeutic relationship can encourage us and hold us to a greater level of accountability.

Recovering from a drug or alcohol addiction is something addicts need to work on daily. It can be compared to a chronic disease like diabetes, which requires constant monitoring to ensure the affected person is maintaining their health. It’s not something that should be faced alone.

The good news is that help and support are available to those in recovery. A sponsor from a 12-Step program, a recovery coach or an addiction counselor can provide assistance to people who want to live a sober lifestyle. How do you know which one is right for you? Consider Skills in the Key of Life - Bernie Tiger is a Substance Abuse Counselor and a Recovery Coach!

We see many “seasoned” clients and are pleased to state that our retention of clients is very high. Many clients comment that they’ve been searching for a service like LSK – a place where they receive competent care and feel deeply connected to the counselor. We strongly believe in our clients at LSK, and that our expertise is not only a product of our training and experience, but the result of spending years listening to what clients really want.

Initial complimentary meet & greet (in person or virtual) – this is the time were we both can evaluate whether we are a good fit.  One of the most important things is compatibility in a coaching relationship.  In this initial session we will also go over the fee schedule/packages that best suits your individual needs; as well we go over the coaching/counselor contract.

In the first coaching session we will go over any assessments that are needed, find out where you are at in your recovery/addiction – and look at ways of reaching your ultimate goal.  In the beginning, we will be focusing on coping skills, and dealing with triggers.  Balance is key, and we work together to find the perfect balance for YOU.