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Substance Use and Abuse: Everything Matters



Substance Use and Abuse provides both students and practitioners in the field of addiction counselling with a foundational knowledge of psychoactive drugs. With its emphasis on the bio-psycho-social components of addiction, this text is essential reading for both beginning and experienced addiction counsellors and social workers. Among the critical topics discussed are concepts and theories of addiction, the major types of psychoactive substances, treatment options and resources, and numerous prevention strategies. The book concludes with an informative chapter on the legal, ethical, and practice requirements for becoming a competent addiction counsellor. This thoroughly updated second edition reflects contemporary issues and recent advances in the field of addiction counselling. New sections examine fetal alcohol spectrum disorder and solvent abuse syndrome, drug treatment courts, various new drugs including bath salts and synthetic cannabis, and emerging treatment options such as internet counselling, narrative therapy, and e-cigarettes. Substance Use and Abuse is a timely and much-needed resource for both students and counsellors seeking to treat individuals dealing with addiction.
Rick Csiernik, BSc, MSW, PhD
1. Fundamental Concepts
1.1 Conceptualizing Addiction
1.2 Pharmacological Foundations
1.3 Pharmacokinetics
1.4 Incidence of Drug Use and Economic Implications
2. Theories on Addiction
2.1 Moral Model
2.2 Biological Theories
2.3 Psychological Theories
2.4 Sociological Theories
3. Psychoactive Substances of Use and Abuse
3.1 Depressants
3.2 Opioids
3.3 Stimulants
3.4 Hallucinogens
3.5 Psychotherapeutic Agents
3.6 Final Considerations
4. Treatment Options
4.1 Pharmacological Treatment
4.2 Individual Counselling
4.3 Intervention
4.4 Group Counselling
4.5 Family Counselling
4.6 Behaviourial Counselling
4.7 Harm Reduction
4.8 The Transtheoretical Model of Change
4.9 Motivational Interviewing
4.10 Mutual Aid/Self-Help
4.11 Internet Counselling
4.12 Conclusion
5. Treatment Resources
5.1 Assessment and Referral
5.2 Case Management
5.3 Addiction Specific Resources
5.4 Inpatient versus Community-Based Outpatient Care
5.5 Adjunct Resources
5.6 Relapse Prevention
6. Prevention
6.1 Introduction
6.2 Program Component Options
6.3 Effective Programming
6.4 Ineffective Programming
6.5 Family Programming
6.6 What Works
6.7 What To Do
7. Counsellor Considerations
7.1 Psychoactive Drugs and the Law
7.2 Ethical Considerations
7.3 Practice Considerations: Addiction Counsellor Competencies
7.4 Concluding Thoughts
Appendix A. A History of Psychoactive Drugs in Canada
Appendix B. A Global History of Psychoactive Drugs
The preface of the first edition of Introduction to Substance Use and Abuse: Everything Matters
began with this statement to contextualize drug use in our society:
Select any day, of any week, of any month of any year and read any major media source on any
continent and you will find at least one article, typically within the first three pages, or first five
minutes of the broadcast, pertaining to psychoactive drugs:
Addict's body to be exhumed for new tests
The Guardian, Manchester United Kingdom, Saturday February 14, 2004
'War on drugs' not meant to be won
Norwich Bulletin, Connecticut, United States, Monday June 6, 2005
West Africa new hub for drug-trafficking networks
Mail and Guardian, Johannesburg, South Africa, Saturday, May 13, 2006
Prince uses speech to talk about his alcohol problem
The Japan Times, Tokyo, Japan Sunday, July 8, 2007
Authorities smash drug ring with Hezbollah ties
Colombia Reports, Medellin, Colombia Tuesday, October 21, 2008
Australians arrested in global drug swoop
Sydney Morning Herald, Sydney, Australia, Thursday, April 9, 2009
Quebec's landmark heroin study in jeopardy
The Globe and Mail, Toronto, Ontario, Wednesday August 26, 2009.
Unfortunately, for the second edition the same can be done just as easily for every day of the
week within a single year:
Nigeria: Still On the Tobacco Control Bill
All Africa, Johannesburg, South Africa, Sunday March 15 2015
Saudi Arabia beheads four men for smuggling drugs
Aljazeera, Doha, Qatar, Monday 18 August 2014
Drug Treatment Court is Proof People Care
The Spectator, Hamilton, Ontario, Tuesday February 17, 2015
Senate Bill Would End Federal Prohibition on Medical Marijuana
The Washington Post, Washington, United States, Wednesday March 11 2015
Ban alcohol firms from sponsoring sports clubs and events, doctors urge
The Guardian, London, England, Thursday December 25 2014
Drugs bound for Future Music Festival seized by Queensland anti-bikie squad
The Sydney Morning Herald, Sydney, Australia, Friday March 6, 2015
Ottawa rejects marijuana firm CEN Biotech’s licence application
The Globe and Mail, Toronto, Ontario, Saturday February 14, 2015
When it comes to addiction everything does truly matter and everything is connected and
thus has an impact upon the drugs we use, misuse and abuse. The everything includes our
physiology and biological make up, our psychological well being, our connections to our
immediate environment, how much money our parents earned in the labour market, if we were
raised in a single parent family, our immediate community in which we live and work and even the
continent of our birth. All these and more items factor into what we deem as appropriate, what is
legal, what is illicit and what is functional and necessary when it comes to taking or avoiding
psychoactive substances. Psychoactive drugs are an integral part of the human experience, in use
before we as a species even had any formal written language and once we learned to read and
write became a topic as prominent in literature and media as aggression and sexuality. Drugs
define us in so many ways but even here they extend beyond the scope of humanity as illustrated
by the infamous YouTube drunken elephant video
v=AmQPwgV-WbQ and closer to home, drunk squirrels:
As evidenced by the headlines above taken from newspapers from every continent, save
Antarctica, not once but now twice, psychoactive drugs are a global phenomenon. The issue of
addiction, even though the concept is relatively new for helping professionals, predates recorded
history. Every culture we know has had or does have a very specific relationship with one or more
psychoactive drugs and most include some level of tragedy directly related to these substances.
The contemporary global drug trade keeps some national economies afloat and in some developed
nations has created significant economies around both rehabilitation and incarceration.
Historically drugs have been a component of the slave trade, have been responsible for the
creation of national boundaries and have been instrumental in the creation of cultural identities.
Psychoactive substances sustain us, they provide us euphoria and are integral to our concepts of
recreation and celebration, they ease the pain of our loved ones when they are terminally ill yet
can shorten our lives such that issues of aging are never even a consideration. Thus, what can our
response be in the 21st century to something as integrated into our lives and culture as is the use of
Our first step must be to enhance our knowledge of this global phenomenon and that is
what this book attempts to provide, a fundamental working knowledge of the world of
psychoactive drugs. Substance Use and Abuse: Everything Matters: will introduce you to the
foundations you need to understand in regards to the bio-psycho-social phenomenon that is
addiction, to its prevalence, why it arises, the range of psychoactive drugs ingested and how they
affect the users and the users’ environment. The range of treatment options from pharmacological
treatments to harm reduction to self-help mutual aid are discussed followed by an examination of
treatment resources required to comprehensively and holistically assist those with addiction
issues. Ideas concerning best practices in prevention are followed by a review of legal, ethical and
competency issues of which those working in the addiction field need to be cognizant. The book
concludes with two appendices, one tracing the history of drug use in Canada, the other looking
at global events beginning in 50000 BCE when soil samples indicate that Neanderthals living in
Northern Iraq were already using plants with amphetamine-like effects to 2015 when David Wilks,
MP for the riding of Kootenay-Columbia rose in the House of Commons and became the first MP
in Canadian history to publically acknowledge his history of drug abuse and recovery. Throughout
the book you will be introduced not only to how everything matters when it comes to the process
of developing an addiction but also to how everything matters with regards to how we respond to
the issues raised by this process.
Rick Csiernik
Hamilton, Ontario
April 2015
I would like to begin by acknowledging all of you who have the desire to do this difficult work in
a field and with a population that remains marginalized and oppressed even in the most open of
societies. I want to thank Dr. Susan Silva Wayne for her ongoing support of my work in this area
of practice along with all the staff at Canadian Scholars Press for turning thoughts and ideas into
substance particularly Daniella Balabuk, Nicholas Cameron, Caley Clements, Emma Johnson,
Emma Waghorn and Natalie Garriga. I would like to thank the reviewers of the first edition
Kristen Buscaglia, Phil Durrant and Heidi Stanley who provided feedback and insights to enhance
and refine the manuscript along with Derek Chechak for his assistance with revisions to the
second edition and of course Deborah, Alex and Ben for giving me the space and time to do the
work and through their ongoing unintended inspiration.
We are all insecure at times...
We are all afraid at times...
However, it is what we do with our insecurities and with our fears that define us and allow
us to make the impact upon the world that we all need to so that our labours, our lives,
have meaning...
... Yet, leaders within the wider landscape of substance-use treatment are currently concerned with a 'troubling disconnect' (Chapnick, 2014, p. 6) that exists between two predominant, but conflicting practice models. In one model, people with substance-use problems are regarded as a decidedly heterogeneous group, whose recovery plans ought to be individualized, created in collaboration with their care providers, and drawn from a variety of current, empirically supported, public health-based treatment alternatives (Csiernik, 2016). These options may include pharmacotherapies, harm reduction, various individual counseling modalities, in addition to, or instead of abstinence, monitoring, and 12-step facilitation, or any combination of these (Csiernik, 2016;Urbanoski, 2014). ...
... In one model, people with substance-use problems are regarded as a decidedly heterogeneous group, whose recovery plans ought to be individualized, created in collaboration with their care providers, and drawn from a variety of current, empirically supported, public health-based treatment alternatives (Csiernik, 2016). These options may include pharmacotherapies, harm reduction, various individual counseling modalities, in addition to, or instead of abstinence, monitoring, and 12-step facilitation, or any combination of these (Csiernik, 2016;Urbanoski, 2014). The other approach is based upon a historical, standardized, and proscribed treatment model centered on abstinence, 12-step facilitation, and compliance monitoring (Csiernik, Rowe, & Watkin, 2017 The 12-step facilitation activities, the mainstay of the imposed treatment model, have unarguably proven helpful for many people. ...
Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs.
... Research has found that early substance use not only establishes patterns for subsequent usage (Danielsson et al. 2010), but that it increases the risk of suicide attempts (Bossarte and Swahn 2011), sexually transmitted infections, early pregnancy, and criminal convictions (Odjers et al. 2008). Delaying the onset of initial substance use is associated with reduced life-long may reduce as well as with reduced risk of developing severe substance-related problems (Csiernik 2016). However, while prevention is desirable, it is not always possible. ...
... Research indicates that even delaying alcohol use onset to age thirteen can significantly reduce the risk of severe alcohol problems in later adolescence and that subsequent delays in onset of use provide additional protection from later problems such as committing a crime or contracting a sexually transmitted disease (Csiernik 2016;Odjers et al. 2008;Werch et al. 2003). The study's findings also suggest that early initiation of alcohol and other drugs may also be related to increased risk of homelessness. ...
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Substance use is common among homeless and precariously housed youth, yet few longitudinal studies track their usage over time. This paper analyzes data from a study of 187 youth and reports on their substance usage in the preceding month, year, and over their lifetime. The results are compared within the sample by sex and against a sample of similarly located housed youth. Findings suggest that female homeless and precariously housed youth report lower substance use, but that with interventions substance use decreases for both sexes. Compared to housed youth, those who are homeless and precariously housed begin substance use at a significantly younger age.
... Thus, in our view, a bio-scientific, evidence-based approach to drug policy is limiting as it runs counter to a holistic understanding of drug addiction as a biopsychosocial condition and not merely as a biological dysfunction, necessitating not only biological initiatives for reducing adverse effects related to drug misuse, but also a focus on psychological and social factors as well as structural issues premised on the social determinants of health (Csiernik, 2021;Hedrich & Hartnoll, 2021). The Canadian Association of Social Workers (2020) stated that: ...
... Content and modes of delivery of drug education programs are considerably various. Some programs contain knowledge about drugs, while some are about delaying or reducing use, the others are about reducing abuse and minimizing the harms related with the use [34]. ...
Full-text available
Drug education in school is one of the efforts of the government for eradicating drug abuse among young children in educational institutions. Teachers play significant role in drug prevention because they spend much of their time with students at school. The objective of this study is to highlight the teachers` self-efficacy and its impact on level of drug abuse in Malaysian schools. This study employed a qualitative approach acquired through secondary data with literature review.. The study showed that teachers` self-efficacy has contributed to the quality of drug education among students due to dominant components, such as: (1) Teaching performance in the classroom; (2) Developing cooperative learning; (3) Teachers` personal involvement; (4) Teachers` training; and (5) Students` engagement in drug prevention. As the conclusion, teachers` self-efficacy is a critical determinant factor to improve the quality drug education, especially in classroom situation. The 5 aspects also determine level of teachers` self-efficacy. The higher the self-efficacy, the more quality drug abuse prevention are found among students. The recommendation of this study is that the government body should actively encourage training`s program for teachers in drug prevention. It also suggests to find out the empirical data for teacher`s self-efficacy in drug education for following studies.
... To this end, treatment is indeed cost-effective as compared to the cost of untreated and perpetuated substance abuse. Research in the US has shown that for every invested dollar in drug-related treatment, there is an approximate $4-$12 return in reduced crime and healthcare costs [9]. ...
Full-text available
This opinion paper briefly discusses some of the financial incentives of ensuring adequate public funding for substance abuse treatment amidst ensuing cutbacks on treatment costs. Article published in Open Access Journal of Addiction and Psychology, 3(5): OAJAP.MS.ID.000573. DOI: 10.33552/OAJAP.2020.03.000573. ISSN: 2641-6271.
... Family involvement can be essential to establishing and sustaining recovery but may also be a hindrance to recovery. This hindrance may occur as a way of maintaining the patterns established within the family system to continue functioning in homeostasis during the dysfunction that addiction in the family results in (Csiernik, 2016). ...
Substance use and addiction constitute a prominent factor contributing to families becoming engaged in the child welfare system. Nine key informants, four supervisors and five front line staff, from five different child welfare organizations across Ontario, Canada provided insights into the training they have received during their careers and what additional training they would value to enhance their ability to deal with this issue. The importance of this was highlighted as the majority of service users on participants’ caseloads were reported to have addiction issues. Study participants also reported that the training they had received from their organizations did not fully prepare them to work with this issue that was so prominent in their clients’ lives. All nine key informants indicated that they required additional training and education to better meet the primary mandate of child welfare: to keep children safe.
... Low reported prevalence rates of substance abuse among Canadian university students may be due in part to studies that typically relied on students to self-report, which may have caused underreporting as students often lack awareness of problematic substance use (Robinson et al., 2016). The ACHA-NCHA findings indicated that only 1.3% of participants reported a substance abuse issue, well below nationally reported levels (Csiernik, 2016). This was despite reports that 69.3% of students in the study used alcohol and 17.9% used marijuana within a 30-day period (ACHA, 2016). ...
... Content and modes of delivery of drug education programs vary considerably. Some programs provide knowledge about drugs, some on delaying or reducing use, while others focus on reducing abuse and minimizing the harms associated with use (Csiernik 2016;Cuijpers 2003;Paglia and Room 1999). The approaches to drug education can be placed into four general categories: information/knowledge models, values/decision-making models, social competency models, and harm minimization/harm reduction models (Hawthorne 2001). ...
Full-text available
School-based drug education initiatives are designed and marketed to prevent substance use and misuse. Over the past several decades, school-based drug education has evolved from delivering only information about drugs and the negative outcomes of their use to a multi-faceted, interactive approach, with several programs now using a combination of information, decision-making, social competency and to a lesser extent, harm minimization. Our study using a case study of a sample of Ontario, Canada elementary schools, found that the majority of programs that are being offered are selected less by empirically supported outcome studies than popular belief and marketing. Based on our findings we recommend that a consistent set of criteria be established based upon best practices to assist educational decision makers select prevention programs rather than allowing marketing or ideological positions govern what is delivered.
... Next to caffeine, alcohol is the second most commonly used psychoactive substance globally (Csiernik, 2016). A public health objective of the World Health Organisation (WHO) is to reduce the health burden caused by the harmful use of alcohol (WHO, 2011). ...
Full-text available
This study explored the perceptions of psychiatric in-patients concerning their use of alcohol in a context of community living. A total of 70 psychiatric in-patients at an Ethiopian hospital were the informants in this study (males = 73%; females = 27%, majority diagnosis schizophrenia = 63%). The patients completed a structured interview on possible reasons for and effects associated with alcohol use in psychiatric illness. These were thematically analysed. The patients cited positive features when using alcohol to include keeping one warm, acting as a digestive, controlling the side effects of psychotropic drugs, alleviating boredom or anxiety and improving one’s mood. They noted negative aspects of alcohol consumption as being the risk of bodily harm, absenteeism from work, familial neglect and a loss of control of one’s life. Some patients believed that the use of alcohol while they were under psychiatric care carried the risk of social exclusion and discrimination; yet they also believed that abstinence from alcohol would be difficult for them
Full-text available
The Semasiological Analysis of Common LSD Jargon in Turkish and German // EN: Jargon, that serves different purposes and functions, is also often used in terms of narcotic substances. Prior studies within this very analysis have shown that there is remarkable amount of common jargon samples, which are in German and in Turkish, and they are used in the same meanings in two different languages of two particular language family. Language, just like culture, is formed by a social group (tribe, society, folk, nation…) and jargons within languages are formed by the society, which is constituted by its gathered speakers, as well. In the meantime, a correlative relation (loop) occurs inevitably between culture and language, and the language comes into existence with a culture, identity and moral reflecting characteristics. Concepts in this study, which belong to the common LSD jargon of both languages, were examined semiotically, semantically and culturally to determine how and relative to what they are formed. They were also approached in terms of Kant’s judgement categories. Motivations in the jargon-forming (“naming”) process were established starting from the concept, conceptual meaning, jargon meaning and their relations between each other. ---***---***--- TR: Farklı amaç ve işlevlere hizmet eden jargon, uyuşturucu maddeler bağlamında da sıklıkla kullanılmaktadır. Bu inceleme kapsamında yapılan önsel çalışmalarda LSD (liserjik asit dietilamid) maddesi için Almanca ve Türkçede kayda değer miktarda ortak jargon örneği bulunduğu, bunların iki ayrı dil ailesindeki iki farklı dilde de aynı anlamlarda kullanıldığı görülmüştür. Dil, tıpkı kültür gibi, sosyal bir grup (kavim, toplum, halk, millet…) tarafından şekillendirilmekte ve bir dilin içerisinde yer alan jargonlar da, konuşucularının bir araya gelerek oluşturduğu topluluk tarafından biçimlendirilmektedir. Bu sırada kaçınılmaz olarak kültür ve dil arasında karşılıklı bir ilişki (döngü) oluşmakta, dil; kültürü, kimliği ve değerleri yansıtan bir nitelikle var olmaktadır. Yapılan çalışmada; her iki dildeki ortak LSD jargonuna ait kavramlar, nasıl ve neye göre oluşturulduklarının tespit edilebilmesi için; göstergebilimsel, anlambilimsel ve kültürel olarak incelenmiş, ayrıca Kant’ın değerlendirme kategorileri bağlamında ele alınmıştır. Kavram, kelime anlamı ve jargon anlamı ile bunların birbirleri arasındaki ilişkiden hareketle jargon oluşturma (“adlandırma”) sürecindeki etkenler tespit edilmiştir.
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