Cap Psych Pod Episode 3: Alcoholism and Addiction
/Today we're joined by Matthew Champ, Registered Psychotherapist. Matthew studied criminology and psychology in university with a focus on addictions and substance abuse. He has been involved in the mental health counseling field since 2010 and has been at our clinic for just about two years now. Matthew has worked with people from all walks of lives, ages, and backgrounds including both institutional and private settings. Today we'll be covering some specific questions on the topic of addiction, including the stages of addiction as well as the 5 D’s of alcoholism. Matthew thanks so much for joining us today!
M: Thanks for having me.
K: No problem! So, just before we jump into some specifics, can you tell us what exactly addiction is?
M: Yeah, that's a big question- what is addiction, right? Because there's so much that goes into addiction. Addiction for the most part is a chronic relapsing disorder characterized by compulsive drug seeking; its continued drug use despite harmful consequences, and it has long lasting changes in the brain. So it’s a little bit of a brain disorder as well as a mental illness at the same time. We have these intense cravings but we lose our control over our ability to moderate how much we're using. That's the textbook definition of addiction, but there's so much more that can go into addiction.
There's a journalist by the name of Johann Hari and he did this amazing Ted talk called “Everything you think you know about addiction is wrong.” Have you heard of that Ted Talk, Kristin?
K: I haven't, no, but that's definitely something that I can link if anyone’s interested.
M: Perfect, because it's fantastic. He talks about addiction being a lack of community, a lack of support, a lack of resource because addiction often times is steeped in shame; it's steeped in stigma, avoidance and isolation so ultimately whether we're talking about addiction to substances like cocaine, alcohol or indamines, he would be looking at this [and] going “well let's talk about addictions to things like sex or screen time on our phones.” You know, for some people it's addiction to food or to working out and exercise 'cause we can technically become addicted to almost anything. Ultimately, addiction is when we separate ourselves from our community so it's a really interesting concept that he talks about there. He kind of takes the textbook definition of addiction and he expands on it by bringing community and our need as a society to really help each other out into the the picture and it's a really interesting Ted Talk to explore what addiction is past that textbook [definition].
K: It's interesting, whenever I hear addiction I never think of phones or anything like that. In my head, it's always drugs or alcohol- so it's interesting that you bring that up. I'm sure a lot of people probably feel the same way.
M: Absolutely, you know, we live in a world now [where] our phones are so important to us, right? We go everywhere with them- when I leave the house it’s always like “OK, I’ve got my phone, I’ve got my keys, I’ve got my wallet.” Ten years ago it was like “I’ve got my wallet and my keys.” In the last ten years even, we've gotten to the point where we're so dependent on having our phones where when we get into situations where we're bored, we pull out our phones. We will sit on a bus and we'll sit there on our phones rather than engage with the world around us. You go to the mall (well, not in the last two years obviously with Covid), you go to the mall and go to a food court and you see people off in their little corners at their tables and they just all on their phones. So yeah, addiction ends up becoming that compulsive seeking for that dopamine release, and we can get that through any time phone goes off, we get that through that burn that we get at the gym, we get that through anything really that's not just alcohol or drugs. I'm glad we were able to actually touch on that because it wasn't really until the last 10 years that we started seeing people being flagged as having screen addictions and phone addictions. Even over the last 20 years, pornography addictions with the access of the screen and the internet, that's made those types of addictions even more prominent in our day-to-day society.
K: Definitely! So, can you walk us through the different stages of addiction?
M: Yeah, absolutely. Let's not actually call it the stages of addiction- let's call the stages of use because addiction is only one stage in the stages of use. If you were to Google “what are the stages of of use” or “stages of addiction,” you're going to find people will often say that there are four stages. They'll say experimentation, regular use, high risk use, then addiction. I think that we should actually be breaking it down into about 6 steps.
There are six stages, really, I think that are out there because we have to recognize that not everybody is a user, right? So, for talking about stages of use we have to start with the first stage: non-use. Some people don't drink alcohol, some people don't smoke marijuana, lots of people don't smoke cigarettes or use cocaine, so we do have to start off with that non-use stage because that is number one. From there, the first reason that people typically start to use is they experiment with something, right? So, you know, they either hear about it from a friend or they see it whether it's in media or with marijuana recently being legalized in Canada suddenly it's like oh, well there are now stores on every single block that I can go and try this.
K: Multiple stores on every single block.
M: Not everybody here might be living in the Ottawa area but it’s so funny if you go down Richmond St through Westboro, there is literally a block where there are four pot shops within a block and a shop where you can go get your bongs, rolling papers and vape stuff across the street. How do you all stay in business when you're in direct competition with each other?
K: Yeah, even close to our office, on Hazeldean Road there are three strip malls in a row that have a shop in them.
M: It’s funny because you’re now driving past more pot shops than you are beer stores or liquor stores. But, seeing all those pot shops leads to that curiosity, right? So, why do people start to use? They start to use because they’re curious. No one ever picks up a substance or a drug and says “I can't wait to be addicted to this,” right? So we start with that idea, “I’m just going to try and see how it makes me feel.” Usually experimentation then, before even leading into regular use, it goes into social use. A lot of times, you go and you try a substance; maybe for a teenager it’s trying alcohol, maybe for someone else it's trying pot, or you know, maybe even trying MDMA or cocaine or speed or another street drug. At first, it starts off as kind of a ‘fun’ thing to do. When is it fun to do? When we’re being social, so drinks at parties, smoking weed with your buddies, when you're at a party, cocaine is sometimes that bump that people use just to get them through the next hump of “I can now go and have five more beers.” and so well that might be a binge, someone might actually just put that binge into social use. They're only using or only bingeing when they go to parties, and that might be very rare.
There are some people that I’ll work with who go to parties every single week, and that's where their main drug use is, so it’s no longer “social” as much as it is the next stage of habitual use. Now it's “anytime I go to a party I'm using it, and I'm going to parties all the time,” or “I'm having a drink every single night with dinner,” or “I'm smoking weed every single night before I go to bed.” Habitual use doesn't necessarily mean that we're using it to get intoxicated. A glass of wine at dinner or a beer at dinner is not going to lead to intoxication for the average person. Smoking a joint before going to bed may be more medical than it is drug seeking. We can look at that habit and [see] that there's a habit, but that habit doesn't necessarily mean that we are over using or indulging to do damage. Once we realize that there is a habit forming, we have to be very wary of it because it's very easy for habit to slip into abuse.
Abusive use is our next stage. Abusive use is ultimately “I am using to get intoxicated.” I may not necessarily be chemically dependent on this substance, but I'm now drinking three or four beers every single night to get a buzz, or I am now smoking weed to be high, or I am using to feel that rush- to get that dopamine release. This is also an interesting stage because you can be in abuse stage while you are experimenting, while you're in a social stage, or while you're in the habitual stage because of binges. If we're saying that someone is a social user and they only go out to a party once every two or three months, and they use then; but when they do use, they get rip roaring drunk or high out of their minds, we would then say in this moment of use, you are in the abusive stage because you're doing this to be intoxicated.
Now, there comes a fine line of abuse leading potentially to addiction. Not for everybody, but it can for some people because the biggest difference between abuse and addiction is the need. The abuse is the the want. “I want to be intoxicated” versus addiction becomes that need. “I need to be intoxicated; I work more at my baseline when I am high or when I am drunk” and it becomes that idea of abuse may be impacting our lives with harmful consequences because of hangovers, but addiction would be “I need to get through my day by being drunk,” or “I can't go to work without being drunk,” “I can't sit with a family without being drunk,” “I can't take care of my kid without being drunk.” It starts to take over that person's life and it's no longer a choice. It becomes that necessity and that dependence part.
The biggest thing here is acknowledging that when we're in an abusive stage of alcohol use or substance abuse, we really want to be checking in to make sure that “I don't actually need this.” Once we hit that need, well then it becomes hard to stop; now our brain has started to change, our body has started to change physiologically to that response, and now we're only getting our big dopamine or serotonin releases when we use our substances and not when we are doing the things that would normally release dopamine for the average person.
I used to do these prevention presentations and I built a curriculum a few years ago that was working with a lot of grade seven and eight students and when I was explaining the difference between substance abuse and addiction to them, I would often talk about things that normally produce dopamine. If we go back in evolution days to caveman days, dopamine was released when we did something to survive. You drink some water, you survive. You eat some food, you survive. You have a good sleep, you survive. That’s what allowed our brains to release dopamine to make us feel good, like “Hey, you're surviving! Have some of this ‘feel good juice’ and feel good.” But as our brains have evolved and as our world has become a world of stimulation, everything kind of releases dopamine- just different levels of it. Living in Ottawa, we've got a lot of Ottawa Senators fans here and if you're watching a Senators game and they score, your dopamine gets released and you feel good. If the Senators win, you feel even better because you get a lot more dopamine. We have so many more food options; we don't have to eat the same thing over and over again so if pizza is your favorite food and you sit down and have pizza your brain explodes with dopamine and it feels fantastic. Maybe you love to travel, so going to a new place you've never been before, your brain explodes with dopamine and we feel good. Where addiction comes in is addiction takes down that dopamine release for everyday things and ultimately makes us dependent on getting our dopamine from our substance use or abuse. It's a really kind of interesting thing that our brain does there, when we hit that addiction stage.
I know that I've already thrown one YouTube video at at y'all to take a look at, but if you want a really good picture as to the stages of use that lead up to addiction, I would highly encourage you to watch this video by Film Bilder. It's a very sad, depressing little cartoon but it's so fascinating in its simplicity that I encourage pretty much anybody to watch it if they want to have a good understanding of what addiction looks like.
K: I've heard you talk about the 5 D’s of alcoholism- can you walk us through what those are?
M: Yeah, absolutely. I’ve talked about the 5 D’s lot with clients because the 5 D’s are simple. A lot of times when we're doing recovery work with addicts, it seems very complicated and complex, because ultimately the emotions are complicated and complex, the state of mental wellness is complicated and complex, so I like to do something very simple to start which is to acknowledged five different ways to manage cravings without it being too hard. Having them all start with D is fantastic because it makes it a little bit easier to remember. If you're a client of mine, I'm sure you've heard me mention the 5 D’s before.
The first one I actually want to focus on is not usually the first one I talk about with clients but it’s deep breathing. The reason that I bring up deep breathing first is [because] I believe that therapy is a huge piece of learning mindfulness for oneself, and I think that mindfulness is probably one of the biggest things that our society has kind of thrown behind because we're all either future oriented or past focused. Mindfulness is ultimately bringing ourselves back into present; bringing ourselves back into the “now.” When it comes to addiction, a lot of times there's a lot of shame built around it and there's a lot of stigma and taboo around it where people automatically assume the worst thing about someone when they hear the word addiction. By deep breathing, it allows the person not to be focusing on the past or the future but to be focusing on the present. It helps us slow down our hearts, and when we slow down our heart what we're doing is we're slowing down how fast the blood is rushing through our body; we’re slowing down our stress response. Taking the time to sit down, close your eyes, do that deep breath in through your nose for 5-6 seconds, hold it for a couple of beats, and then exhale through your mouth for about 5 seconds as well, and then a hold before repeating is going to allow us to focus the mind, focus our energy for actually managing the cravings. Deep breathing is very important.
The second D that we need to kind of then put into play is delay; can we delay our craving? Perhaps you're someone who is what we call a “functional alcoholic.” A functional alcoholic would be someone who can go to work; they have a job, they have a family, they've got other things going on, but when they're not doing those priorities they are drinking and drinking to a state of intoxication. Maybe it's that they get home from work everyday at 4:00 PM and their first beer is cracked at 4:05 PM. The big thing is the delay- how long can I delay the start of my use, because by delaying the start of our use we actually do reduce the amount of harm that we're ingesting in that day. Maybe it’s a reduction of a grand total of 1 beer in the long run, or one use. Maybe it becomes a reduction of two or three, and if that still leads to intoxication, that tipsy feeling or that buzzed feeling that the individual is looking for, we do know that simply reducing the amount that we ingest means that we've reduced the amount of harm that we are potentially facing. I always encourage people to start with 5 minutes or 10 minutes. If you get that craving right away, you say “I'm going to wait 10 minutes.”
That's where we can throw in our third D which is distraction; what can I do to distract myself for the next 10 minutes or 15 minutes? The hope is that come the end of 10 minutes, the cravings have dropped a little bit and maybe the distraction has kicked in so that way we're not necessarily as tempted to go straight to the fridge and crack open the drink or it allows us to reset that delay for another 10 minutes. I encourage people to find useful and productive things as distractions- for some people it might simply be sitting down and watching something on Netflix- if we sit down and watch something for 25 minutes, hey, we’ve delayed that use for 25 minutes and we’ve distracted our mind for that time. Perhaps it’s distracting ourself by going for a walk, maybe we’ve got a kid in the house so we’re going to do some colouring with the kid and distract ourself with our other priorities. Maybe it’s distraction through music or taking a hot shower or a hot bath and pampering yourself a little bit. Maybe it’s simply going upstairs and reading for a little bit or doing a workout or an exercise; anything that’s going to allow you to get a little bit of a dopamine release without necessarily feeling like you need to continue using.
From there, we go into drinking water- drinking cold water. That's going to help calm down our heart as well. It's going to kind of come back into us and go ‘we are consuming something.’ For some people that I work with, I’ll tell them to keep a tub of vanilla ice cream in the freezer and anytime they get a craving, going take a scoop of vanilla ice cream and let that cold, sweet ice cream kind of trickle down the back their throat. It's going to help slow down the heart rate with how cool it is, it's going to slow down our thoughts, and it's also going to just allow us to feel a little bit better. It’s a nice way of having another distraction or delay in play.
The fifth D, which is probably the most important D is discussion. This allows us to have some semblance of accountability and community. If we go back to that “what is addiction” [question], and we say “well, addiction is the absence of community.” How do we combat addiction then? It’s when we build ourselves up with a support network, we build ourselves up with people who aren't going to judge us for having a substance abuse problem or an addiction issue . We have a support network [for when you say] “I've got a big craving I've just tried distraction, delay, deep breathing and drinking water or eating a little bit of ice cream and I'm still feeling this intense urge or this craving” Who do I have that I can call? Who do I have that I can send a text message, or send an email to and say “Hey, I'm struggling right now and I could just use an ear or use someone just to know what I'm going through”? That gives us that little piece of accountability so that other people are invested in our wellness as well. This is why, if you think about resources like Alcoholics Anonymous for example, the sponsor program is such a huge part of that program because it's about “hey- you have a craving, it's hard to deal with this on your own, you've now got someone you can call, you’ve now got someone who can help talk you off the ledge and you’ve got someone with that lived experience to be able to help talk you off the ledge.”
Very simply put, we do deep breathing, we delay, we distract, we drink cold water and we have discussion. Those are the first really simple steps in managing our cravings when it comes to substance abuse and addiction.
K: That's a great start -I'm sure we could circle back and talk about this for hours.
M: Absolutely. I know that that was the big last question you had for me, but I do want to give some resources around addiction or substance abuse issues.
You can obviously reach out to Capital Psychological- I'm not the only person here that has a background in working with people who are living with addictions. There are some therapists that can take people on pretty soon.
We also have to recognize that therapy is expensive and usually going hand in hand with addiction is financial issues as well. Actually, side note- when we were talking about all the different things that people can become addicted to, we totally forgot gambling which is huge. It's hard for someone who might be living with a gambling addiction to be able to go “well, can I afford therapy?” [or] to focus on therapy when all of their money has gone into their gambling addiction, so there are a lot of other resources that I want to give that are out there. I believe that our duty as therapists or mental health workers is to ensure that our clients are better off after we've talked to them than before we talked to them, and part of that also means understanding the financial pressures.
Ottawa has a number really great resources for people who are living with addictions. Outside of Alcoholics Anonymous or Smart Recovery, which are both support groups. AA does the 12 step program, which is highly steamed in Evangelical Christianity, so that really pushes some people away from wanting to get into it. Smart Recovery has become a very good alternative to that. I always joke that Alcoholics Anonymous was made by middle class, middle aged white dudes for other middle class, middle age white dudes (that’s a generalization of AA). Smart Recovery has been a really good diverse counter to AA for a lot of people and I've seen a lot of good success with Smart Recovery groups. I believe that there's a good one that's being run out of the Royal Ottawa right now.
Speaking of the Royal Ottawa Hospital, they have an amazing concurrent disorders program that is 100% free- all you need to do is call up the Royal Ottawa, ask to be transferred to the concurrent disorders program and they will have you go in, do an intake and you can either do inpatient or outpatient there, but it is an intensive program- it's usually four to six weeks and it's every day all day.
We in Ottawa have as well OARS, I guess it's now called SAR which is the you know Ottawa Addiction Referral Services, so if you don't know where to go, you can call up SAR- they’re attached the Ottawa Withdrawal Management Clinic down on Montreal Rd. What they'll do is they'll do a long assessment with you. After that assessment, they will provide you with options that fit within your budget or fit within where your addiction actually currently lies.
They might recommend something like Rideauwood Addiction and Family Services, which have programs for pretty much anyone between the ages of 8 and 98. They've got programs for family, for children, teenagers, they've got a school based program, they've got an adult program, they've got a drug treatment court. They also have a gambling program, which is why I wanted to bring them up because there aren't a lot of gambling programs in Ottawa, but they are one of the few gambling programs that is completely covered by the government.
They might refer someone under the age of 24 to the Dave Smith Treatment Centre. That's an inpatient treatment centre for youth and young adults who are struggling.
We also have the Mental Health Crisis Line. The Mental Health Crisis Line (613-238-3311) is a 24/7 line and they will be able to connect you with other resources as well.
If you're looking at going into actual in-person treatment rehabilitation, Merrickville has an amazing program called Newgate 180. That one is not free, unfortunately, but it's just a spectrum of different resources available.
A big one for parents who might have youth or young adults in the family who are living or struggling with substance abuse is The Parent’s Lifeline of Eastern Ontario. This is such a fantastic organization; it is run by other parents who have had children with either serious mental health issues or serious addiction and substance abuse issues. They have a 24/7 crisis line- I believe the number is 613-321-3211. They also have a youth group for these youth who might be suffering from substance abuse issues or mental health and mental wellness issues. They have one-on-one counseling available as well. A lot of great resources there at PLEO.on.ca.
That's just a start of some resources that are available. If anybody doesn't see their demographic being met in any of those resources, feel free to reach out to Capital Psychological and let us know and I will always be able to provide you with more resources along that path as well.
K: Perfect, that's awesome. Thank you for sharing those. I'm sure that's going to be super helpful.
M: I hope so. And if you're listening to listen you're like “I don't have a problem with substance use or abuse or or addiction” that's fantastic, my one big take away for you would be don't judge those that are living with it. Like I said off the top, nobody wakes up one day it goes “I can't wait to become an addict.” Addiction takes time to formulate. We look at the criminalization of drugs and the war on drugs and there are a lot of political reasons as to why drugs have been criminalized, and not a lot of good health reasons as to why drugs have been criminalized.
It's really important to remember that these are people who are living with health issues. It's interesting, I've used the word “addiction” and “addict” a lot today, but I'm usually very hesitant to use that word because of the stigma that comes with it. I don't like using the word relapse either, because relapse is a word that ultimately means “okay, well we're back to zero.” When I think about addiction or life as a race, I think of it like a marathon; if you're running a marathon and you happen to stumble at mile 11, you don't go back to the beginning and start over again- you stand up, you pick yourself up, you dust yourself off, and you keep running. When you finish the marathon, you go “Hey, I ran an entire marathon and I only fell one time” or “I only fell four times.” Even if you fell 10 times, you still completed that marathon and that's a huge thing to be supportive of rather than going “Oh, well you've just thrown away a year sobriety by making a mistake.” I try to be very careful around my language when I'm working with clients one-on-one. I used the words “addiction” and “addict” today because we are talking about addiction as a whole but it is something to kind of check ourselves around how we speak and the words we use. The words we use really do have a lot of power when it comes to managing the stigma of substance abuse.
Thank you so much again to Matthew for all of the information on alcoholism and substance use/ abuse. Like Matthew said, if anybody needs any more information, they can definitely reach out to our office through the “CONTACT US” page on our website. There, you can also reach out if you would like to book an appointment with Matthew or any of our other therapists.
