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Jasmin Kaur Addiction Therapy-2014 Chicago, USA August 4 - 6, 2014

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Helping Clinicians Connect Understanding Addiction from the Perspective of a Drug Abuser Jasmin Kaur, Psy. D.

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Small country, 716.1 Sq Km Resident population of 3.8 million (2013) Geographical location Strict legal restrictions on drugs Recidivism rates of drug offenders ~ 27-31% Background: Singapore The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.3

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Qualitative study ~ 30 drug abusers Drug Initiation & Maintenance Motives Social Factors ~ Drug Cues Understanding Drug Abuse The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.4

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Motivation Model of Behaviour Be Healthy Setting Goals Exercise twice a week Finding Appropriate Means Overcoming sleep and waking up Ignoring Distractions & Negotiating Conflict Going for a run in the morning Taking Action Kpetz, Lejuez, Wiers, Kruglanski, 2013 The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.5

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Motivation Model of Behaviour : Drug Initiation Seeking Thrill or Belonging Setting Goals Drug Experimentation Joining a sports activity Finding Appropriate Means Potential Harm or Legal Consequences Overcoming fear of being judged Ignoring Distractions & Negotiating Conflict Consume Drugs Sign up for taekwondo class Taking Action The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.6

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Motivation Model of Behaviour : Drug Initiation Satisfy Curiosity or Belonging Setting Goals Drug Experimentation Finding Appropriate Means Potential Harm or Legal Consequences Ignoring Distractions & Negotiating Conflict Consume Drugs Taking Action The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.7

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Motivation Model of Behaviour : Drug Initiation Satisfy Curiosity Setting Goals All my friends were doing it, so I just joined in the crowd for the sake of the fun. I saw my childhood friends taking Marijuana and getting high.. I was curious, so I did not think to say no. Finding Appropriate Means Because around 15 to 16 years old, I left school and left home; I was so free. So I have nothing to do I try to smoke Cannabis had no addiction, makes you chill, relax. Ignoring Distractions & Negotiating Conflict Friends were smoking Cannabis when hanging out, I nothing to do, was bored, so just try. Heroin I just take for excitement. Taking Action The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.8

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Motivation Model of Behaviour : Drug Maintenance Drug Consumption Setting Goals Oral / Intravenous Abuse Finding Appropriate Means Potential Harm or Legal Consequences Ignoring Distractions & Negotiating Conflict Find drugs at all costs Taking Action The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.9

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Motivation Model of Behaviour : Drug Maintenance You looked worried, you looked sad. Chase the dragon and you will never forget. All your problems fly away after you smoke. Setting Goals Normally when we start I start a lot with soft drug meaning drugs that prevent you from getting caught like taking tablets, injecting tablets like Dormicum, Subutex. But after a while you start to jab and eat, then from there not shiok (good feeling) ready. Finding Appropriate Means Actually I consider stopping the drugs, but I dont know why [I still take drugs]; people say only until you kena catch (get arrested) then you will know when to stop, if not you wont really know when to stop. It is not really a habit, it is when I want to take it then I take it. Ignoring Distractions & Negotiating Conflict Sell pirated CDs to finance (my drug habit). Everyday work 2 hours, can buy heroin for 1 day. Whatever comes I will do. (Also some drug trafficking) take big amounts of drugs and resell to other people. Quick and fast money, work less hours. Taking Action The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.10

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Motivations for Continued Drug Use Leventhal & Schmitz, 2006; Oei & Morawska, 2004 Negative Expectancies Removal of withdrawal symptoms Positive Expectancies Anticipation of euphoria The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.11

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Motivations for Continued Drug Use Negative Expectancies Continued to smoke (heroin) because cannot take the withdrawal body aches, vomiting, diarrhoea, running nose). Take not because of the craving but because of withdrawal (from heroin). Another reason I go back to Heroin is because of the sakit (pain/withdrawals). If I didnt get this thing I will have the pain. Positive Expectancies Yes. I like the euphoria effect. [It's] like joy like that, because we all drug addicts have the feeling and the mind that you cannot think of anything [other than drugs] if I dont do drug I dont know what to do. And if got money also doesnt know what to do with the money, [so] then have money then just take drug. If no drug, the emptiness cannot match (nothing can match the effects given by drugs). I use Ecstasy twice a week because I just want to, its just for a moment of euphoria, like very happy. The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.12

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Drug Cues Drugs Environ ment Affect Drug stimuli The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.13

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Drug Cues Drugs Environ ment Affect Drug stimuli Feel craving when see the drugs and see people taking. Because we ever take before so we know the high, its better than anything. Nothing beats the feeling. When walking along the street going to urine supervision, meet ex-drug inmates again, talk about our past drug experiences, reminds me of taking drugs When I see aluminium foil or when I walk pass a block where last time on top got people selling, though they not necessarily have to be there anymore. Aluminium foil, whether big or small, will induce cravings. The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.14 I see heroin and my friends taking then I take because of the trigger. When get too emotional whether positive or negative feelings then will think about drugs. Automatic thinking, link emotions to drugs, memories of taking drugs come back.

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Extrinsic vs. Intrinsic Self-regulation Essential Resource-intensive Easily drained when cognitively overloaded Regulation The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.15

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No need for liking when abuser wants a drug Dislike of negative consequences but unable to stop drug use Wanting vs. Liking I have lost my job, friends, girlfriend and freedom. After first DRC already like this. I continue because I really cannot control. It is very hard to say if it is worth it because when you take drugs, you will think that this stuff is stupid but when you are taking drugs, you wont feel that it is stupid. The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.16

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Remove Drug Cues Seek Alternative Actions Reduce Cognitive Load What has helped? The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.17

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Effective coping & self-regulation strategies For new abusers - addressing underlying motivation of drug use and find alternatives to satisfy these motivations For long-term abusers, seeking alternatives to drug cue activations How Clinicians Can Connect? The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.18

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Research Team at Singapore Prison Service Natasha Lim Yan Jia Yin The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.19 Acknowledgements

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Bandura, A. (1999). Kpetz, C., Lejuez, C., Wiers, R. & Kruglanski, A. (2013) Motivation and Self-Regulation in Addiction: A Call for Convergence. Perspectives on Psychological Science, 8(3). Leventhal, A. M., & Schmitz, J. M. (2006). The Role of Drug Use Outcome Expectancies in Substance Abuse Risk: An Interactional-Transformational Model. Addictive Behaviors, 31, 2038-2062. Oei, T. P., & Morawska, A. (2004). A Cognitive Model of Binge Drinking: The Influence of Alcohol Expectancies and Drinking Refusal Self-Efficacy. Addictive Behaviors, 29(1), 159-179. Tiffany, S. T. (1999). Cognitive concepts of craving. Alcohol Research & Health, 23(3), 215-224. Tiffany, S. T. and Carter, B. L. (1998). Is craving the source of compulsive drug use? Journal of Psychopharmacology, 12(1), 23-30. doi:10.1177/026988119801200104 Vaillant, (1995) Weinstein, A. and Cox, WM. (2006) Cognitive processing of drug-related stimuli: The role of memory and attention. Journal of Psychopharmacology, 20, 850-859. The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.20

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Thank You The views expressed in this presentation are the authors only and do not necessarily represent any official view of the Singapore Prison Service or the Ministry of Home Affairs, Singapore.21

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Addiction Therapy 2015 Website: addictiontherapy.conferenceseries.com Meet the eminent gathering once again at Addiction Therapy-2015 Florida, USA August 3 - 5, 2015