The Promises
(properly known as the "9th Step Promises")

If we are painstaking about this phase of our development, we will be amazed before we are half way through. We are going to know a new freedom and a new happiness. We will not regret the past nor wish to shut the door on it. We will comprehend the word serenity and we will know peace. No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and self-pity will disappear. We will lose interest in selfish things and gain interest in our fellows. Self-seeking will slip away. Our whole attitude and outlook upon life will change. Fear of people and of economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves.

Are these extravagant promises? We think not. They are being fulfilled among us—sometimes quickly, sometimes slowly. They will always materialize if we work for them. (Alcoholics Anonymous, pp. 83-84)

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Brief Denial Questionnaire:
What denial patterns do you use? (check as many as needed)

1. Avoidance: "I’ll talk about anything but my real problems!"

2. Absolute Denial: "No Not Me, I Don’t Have Problems!"

3. Minimizing: "My Problems Aren’t That Bad!"

4. Rationalizing: "If I Can Find Good Enough Reasons For My Problems, I Won’t Have To Deal With Them!"!"

5. Blaming: "If I Can Prove That My Problems Are not My Fault, I Won’t Have To Deal With Them!"

6. Comparing: "Showing That Others Are Worse Than Me Proves That I Don’t Have Serious Problems!”

7. Compliance: "I’ll Pretend To Do What You Want If You’ll Leave Me Alone!"

8. Manipulating: "I’ll Only Admit That I Have Problems If You Agree To Solve Them For Me"

9. Flight Into Health: – "Feeling Better Means That I’m Cured!"

10. Recovery By Fear: "Being Scared Of My Problems Will Make Them Go Away!"

11. Strategic Hopelessness: "Since Nothing Works, I Don’t Have To Try!"

12. Democratic Disease State: "I Have The Right To Destroy Myself & No One Has The Right To Stop Me!"

From http://www.tgorski.com/clin_mod/dmc/denial_checklist.htm

Once substance dependence develops, a progressive series of self-reinforcing symptoms begin to develop.  Two models of the progressive symptoms will be presented:   (1) The DSM-IV Progressive Symptom Model; and (2) The Biopsychosocial Progressive Symptom Model.

The DSM IV Progressive Symptom Model was developed by completing a three step procedure:

Step 1:  Analyzing the DSM-IV criteria for substance use disorders,

Step 2:  Dividing specific criteria that contained more than one identifiable symptom into separate symptoms,

Step 3:  Arranging the symptoms in a logical progression supported by both face validity and studies of widely accepted models that sequence addiction symptom development (Jellinek 1960; Glatt 1982; APA 1994, NIAAA 1995).

The Biopsychosocial Progressive Symptom Model was developed by completing the following steps:

Step 1:  Reviewing past progressive symptom model (Jellinek 1960; Glatt 1982),

Step 2:  Reviewing recent related to models of addiction containing biological, psychological, or social symptoms (Tarter et al 1988; Tabakoff 1988; NIAAA 1996; NIAAA 1995);

Step 3:  Isolating specific symptoms from all models, grouping into similar categories, and eliminating duplication; and

Step 4:  Integrating the newly identified symptoms into the The DSM-IV Progressive Symptom Model in proper order of development.

This is from T. Gorski – for more information visit www.tgorski.com

1.    Increased Tolerance (DSM-IV Criteria #1):  Tolerance is defined by either:  (1) a need for markedly increased amounts of the substance to achieve intoxication or the desired effect; or (2) a markedly diminished effect with continued use of the same amount of the substance.

2.    Withdrawal (DSM-IV Criteria #2):  Biopsychosocial withdrawal symptoms consistent with the drugs being used appear when the person attempts to stop using.  The symptoms disappear when the same or a closely related drug is taken.

3.    Self-Medication Of Withdrawal (DSM-IV Criteria #2):  Using alcohol or drugs to make the symptoms of withdrawal (dysphoria, agitation, depression, impaired mental functioning) go away.

4.    Loss of Control Over Quantity (DSM-IV Criteria #3):  Using alcohol or drugs in larger quantities than intended;  

5.    Loss of Control Over Duration (DSM-IV Criteria #3):  Using alcohol or drugs for longer periods of time than intended.

6.    Loss of Control Over Frequency (DSM-IV Criteria #3)  Using alcohol or drugs

7.    Increased Time Spent Using (DSM-IV Criteria #5):  Spending a Great deal of time getting ready to use alcohol or other drugs, using, or recovering from the effects of using.

8.    Neglect Of Life Responsibilities (DSM-IV Criteria #6):  Failing to meet major life responsibilities because of intoxication, or withdrawal.

9.    Neglect Of Life Activities (DSM-IV Criteria #6):  Neglecting or given up work, social, or recreational activities because of alcohol or drug use.

10.  Alcohol And Drug Relate Problems (DSM-IV Criteria #7):    Have You Had Any Physical, Psychological, Or Social Problems That Were Caused By Or Made Worse By Your Alcohol Or Drug Use?

11.  Desire To Cut Down (DSM-IV Criteria #4):  The desire to control the use of the substance by using smaller amount, using less frequently, or limiting time spent using.

12.  Attempts To Cut Down (DSM-IV Criteria #4):  Conscious attempts to control the use of the substance by using smaller amount, using less frequently, or limiting time spent using.

13.  Continued Use In Spite Of Problems (DSM #7):  Have You Ever Continued To Use Alcohol Or Drugs In Spite Of Knowing That They Were Causing Or Making Physical, Psychological, Or Social Problems Worse?

This is from T. Gorski – for more information visit www.tgorski.com

There are three types of Substance Related Disorders: Substance Abuse Disorders, Substance Dependence Disorders, and Substance-induced Disorders.  The Substance-induced Disorders can coexist with either Substance Abuse or Substance Dependence Disorders. (American Psychiatric Association, 1994)

1.    Substance Abuse Disorders marked by serious psychosocial problems related to alcohol and drug use that do not meet the criteria of a Substance Dependence Disorder.  Abuse Disorders may result from initial experimentation with mind altering substances, involvement in a lifestyle or subculture where alcohol and drug problems are a social norm, or as a consequence of related personality or mental disorders.  Patterns of substance abuse may be self-limiting or they may become chronic.  The severity of problems associated with substance abuse can vary in response to the seriousness of stress and related life problems.  In some cases substance abuse will progress into substance dependence.

2.    Substance Dependence Disorders marked by an abnormal biological responses to the ingestion of mind altering substances that results in progressive tolerance and withdrawal that causes a a pattern of compulsive use of the substance to develop which impairs the ability to control substance use and results in the development of substance related life problems.

3.    Substance-induced Disorders:  There are number of reversible disorders that can be caused by the frequent and heavy use of alcohol and other drugs that common that commonly coexist with substance use disorders.  These substance related disorders may be associated with either substance abuse disorders or substance dependence disorders.  If these Substance Induced Disorders are not identified and stabilized they can interfere the successful treatment of before both substance abuse and substance dependence disorders.  The Substance-induced Disorders are:  Intoxication, withdrawal, and Substance-induced Mental Disorders.

(1)   Intoxication:  Intoxication is a reversible set of substance-specific symptoms that are caused by the recent ingestion of alcohol or other drugs.  The symptoms consist of significantly maladaptive behaviors caused by impairments in the ability to think clearly, manage feelings and emotions, and self-regulate behavior.  Intoxication is often marked by severe impairments in judgment and impulse control.  The symptoms persist as long as the blood alcohol or drug level is high enough to cause them.  Different substances can cause similar symptoms or interact synergistically to create distortions of the symptoms commonly associated with each drug when used separately. (American Psychiatric Association 1994 pp. 183 – 184)

(2)   Withdrawal:  Withdrawal is a reversible set of substance- specific symptoms that are caused by the cessation or reduction in heavy and prolonged substance use.  (American Psychiatric Association 1994 pp. 184 – 187; NIAAA 1989)

(3)  Substance-induced Mental Disorders:  Substance-induced Mental Disorders are symptoms caused by the long term effects of frequent and heavy use of alcohol or other drugs.  These effects cause impairments to the brain & nervous system; impaired cognitive & affective functioning; or problems with behavioral control and regulation.  The symptoms may be related to intoxication, acute withdrawal, post acute withdrawal (PAW), or long-term brain dysfunction caused by alcohol or drug use.  PAW and long-term brain dysfunction are described as Substance-induced Persisting Disorders in DSM-IV.  (American Psychiatric Association 1994 pp. 192 – 195)  The primary Substance-induced Mental Disorders are:

·  Substance-induced Delirium:  Perceptual problems that include:  difficulty maintaining environmental awareness; difficulty focusing and sustaining attention on a task or object; difficulty shifting attention from one central focus to another; difficulty maintaining orientation tom person, place, time and context; and problems understanding and communicating ideas verbally and in writing.  The symptoms are  caused by the effects of substance use that extends beyond the period of intoxication and acute withdrawal.  There are two common types of Substance-induced Delirium – Intoxication Delirium and Withdrawal Delirium.  (American Psychiatric Association 1994 pp. 127 – 129)  If not properly treated, mild to moderate symptoms of Substance- induced Withdrawal Delirium may persist for as long a 60 to 180 days following the cessation of substance use and become worse during periods of high stress. 

·  Substance-induced Persisting Dementia:  Cognitive impairments including: memory impairments involving the impaired ability to recall previously learned information and/or learn and retain new information    (American Psychiatric Association 1994 pp. 152 – 155; NIAAA 1989b).  The most common substance-induced cognitive impairments are: 

Disturbances In Executive Functioning that make it difficult to plan, organize, sequence, abstract central organizing principles, apply past experience to current situations, and project logical consequences of current behavior into the future.

Language Disturbances (aphasia) that make it difficult to comprehend what is read and and understand complex or abstract verbal communication.

Motor Function Impairments (apraxia) resulting in problems with hand-eye and psychomotor coordination which often manifests in clumsiness, slowed reflexes, and mild disturbances in balance and gait.

Sensory Recognition Impairments (agnosia) that make it difficult to immediately recognize familiar objects by touching, hearing, or seeing them.  

·  Substance-induced Persisting Amnestic Disorder:  Memory impairments that make it difficult to learn & recall new information, recall previously learned information, or recall past events.  The memory impairments cause problems with interpersonal relationships, occupational functioning, or the performance of routine acts of daily living.  (American Psychiatric Association 1994 pp. 161 – 162)

·  Substance-induced Psychotic Disorder:  Difficulty maintaining orientation to person, place, time, and context caused predominately by hallucinations and delusions.  (American Psychiatric Association 1994 pp. 310 – 315) 

Hallucinations can occur in any sensory modality causing people to see things that aren’t there such as poorly formed shapes or shadows to detailed objects and persons (visual hallucinations);  hear things such as annoying poorly formed sounds to specific words and statements (auditory hallucinations);  feel things such as bugs crawling on them (tactile hallucinations); smell things that aren’t there (olfactory hallucinations), taste things that aren’t there (gustatory hallucinations);  

Delusions:  Delusions are strongly held beliefs not supported by evidence and not affected by the presentation of evidence that demonstrates they are not true.  Delusions may vary from mild to extreme and may include a variety of themes including:  Beliefs about wellness when when presented with evidence of the symptoms of illness;  Beliefs about normal functioning and the absence of problems when presented with evidence of dysfunction and problems;  Beliefs about past accomplishes that are grandiose and exaggerated in the absence of evidence or when presented with contradictory evidence; Beliefs about being persecution when no such persecution exists; Beliefs of religious significance such as being God or being in direct communication with God or some other spiritual or religious being in the absence of evidence.

·  Substance-induced Mood Disorder:  A disturbance in mood characterized by either:  depressed mood marked by: diminished interest in all or most activities; diminished ability to experience pleasure;  manic mood marked by an extreme elevated sense pleasure and excitement, an expansive response to others, or extremely irritable reactions to others; or Manic Depressive Swings marked by rapid and unpredictable swings between depressed moods and manic moods.  (American Psychiatric Association 1994 pp. 370 – 375)

·  Substance-induced Anxiety Disorder:  A state of excessive worry marked by a tendency to believe that negative experiences will occur in the future, difficulty controlling or distracting self from the worrying thoughts, restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating, having a tendency for the mind to go blank, irritability, severe muscle tension, and sleep disturbances that include difficulty falling, difficulty staying asleep, or restless unsatisfying sleep. (American Psychiatric Association 1994 pp. 439 – 444)

·  Substance-induced Sexual Dysfunction:  The inability to perform sexually as a result of the effects of intoxication, or withdrawal. (APA 1994 pp. 519 – 521)

·  Substance-induced Sleep Disorder:  Substance-induced Sleep Disorders (APA 1994 pp. 601-607) consist of difficulty with the sleep-wake cycle that include: insomnia marked by difficulty falling, difficulty staying asleep, or restless unsatisfying sleep (APA 1994 pp. 553 – 557); hypersomnia marked by excessive sleepiness marked by difficulty staying awake (APA 1994 pp. 557 – 562); parasomnia marked by the inappropriate activation of autonomic nervous system, motor systems, or cognitive processes during sleep, specific sleep stages, or sleep wake transitions such as nightmares, sleep terrors, excessive tossing and turning, and sleep walking. (APA 1994 pp. pp. 579 – 592)

This is from T. Gorski – for more information visit www.tgorski.com

1.    Biological Reinforcement:  Biological reinforcement that promotes continued use of alcohol and other drugs.  (NIAAA 1996)

2.    Tolerance:  Progressive tolerance that requires increased amounts to achieve the desired state of reinforcement. (DSM-IV Criteria #1)

3.    Withdrawal:  Acute & Post Acute Withdrawal Syndromes when substance use is stopped.  (DSM-IV Criteria #2)

4.    Loss of Control:  Inability to control over the quantity of substances consumed and length of substance use episodes.

5.    Inability To Abstain:  Inability to maintain long-term abstinence. 

6.    Addiction Centered Lifestyle:  The development of an addiction-centered lifestyle.  (DSM-IV Criteria #5)

7.    Addictive Lifestyle Losses:  Giving up previously valued lifestyle activities due to substance use.  (DSM-IV Criteria #6)

8.    Progressive Substance-related Problems:  The development of progressive substance-induced biopsychosocial problems.  (DSM-IV Criteria #7)

9.    Continued Use In Spite Of The Problems:  The pain caused by the problems creates craving for more drug use rather than a desire to correct the problems.  With renewed drug use awareness of the problems recedes from conscious awareness.  (DSM-IV Criteria #7)

10. Biopsychosocial Deterioration:  Progressive physical, psychological and social deterioration as a long as substance use continues which ends in serious physical illness. Serious psychiatric illness, suicide, death, or involvement in treatment.

This is from T. Gorski – for more information visit www.tgorski.com

The DSM (diagnostic and statistical manual) defines substance and dependence as the following…

DSM-IV Substance Abuse Criteria

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).
Alternatively, the symptoms have never met the criteria for substance dependence for this class of substance.

DSM-IV Substance Dependence Criteria

Addiction (termed substance dependence by the American Psychiatric Association) is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance
(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic dependence (no evidence of tolerance or withdrawal). In addition, remission categories are classified into four subtypes:

(1) full, (2) early partial, (3) sustained, and (4) sustained partial;
on the basis of whether any of the criteria for abuse or dependence have been met and over what time frame. The remission category can also be used for patients receiving agonist therapy (such as methadone maintenance) or for those living in a controlled, drug-free environment.

FAQs

A Quick Guide to Finding Effective Alcohol and Drug Addiction Treatment

If you or someone you care for is dependent on alcohol or drugs and needs treatment, it is important to know that no single treatment approach is appropriate for all individuals. Finding the right treatment program involves careful consideration of such things as the setting, length of care, philosophical approach and your or your loved one’s needs. Read more about this facility »

NIDA InfoFacts: Understanding Drug Abuse and Addiction

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives. Read more about this facility »

Goto www.NA.org for more information and literature.

click read more for a local NA website or phone number

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INFORMATION ON A.A.

Alcoholics Anonymous® is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

Read more about this facility »

SAMHSA is a government site that provides resources and information related to Substance Abuse and Mental Health issues. There is information related to trends, news articles, facilities, reports and much more. I have used this site the most for its Treatment Locators that help you search for Substance Abuse and/or Mental Health facilities by several criteria. You can also call their 24-Hour Helpline at 1-800-622-4357.

Check out their site at SAMHSA.gov

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ANONYMOUS LINKS

Cocaine Anonymous www.ca.org
 1-800- 925-6159

Al-Anon/Alateen www.al-anon.alateen.org 
1-800-425-2666

Overeaters Anonymous www.oa.org

Gamblers Anonymous www.gamblersanonymous.org
 1-888-GA-helps

Aids National Hotline 800/342-2437

Gay and Lesbian National Hotline 1-888-843-4564

State of Florida Substance Abuse Hotline 1-850-487-2920