The Three Circles of Addiction Recovery

The Three Circles of Addiction Recovery

The three circles is a diagram, and tool, that is encouraged by addiction therapists to help recovering addicts identify and define various gateway behavior that can lead to a relapse. First described in a 1991 publication by Sex Addicts Anonymous, the three circles have been adapted and used by treatment programmes and 12 step groups who work with people with substance addiction, as well as process addictions.

The Three Circles of Addiction Recovery

The three circles is a diagram, and tool, that is encouraged by addiction therapists to help recovering addicts identify and define various gateway behavior that can lead to a relapse. First described in a 1991 publication by Sex Addicts Anonymous, the three circles have been adapted and used by treatment programmes and 12 step groups who work with people with substance addiction, as well as process addictions.1

The Three Circles Diagram

The three circles look like a concentric, two dimensional diagram with three concentric circles, with an inner, a middle and an outer circle. Although aesthetically it looks like a target, it is more like a funnel, in that the closer the individual gets to the center, the more likely he or she is to relapse back into the addiction.

The closer he or she gets to the outer circle, and the more ground they will have to stay balanced; thereby, maintaining a sober recovery. As a visual tool, the three circles can be very useful for addicts and allow them to realize when they are facing stresses and situations that are dangerous to their maintaining recovery.

The diagnostic part is identifying that, while they have not yet relapsed, that they are in a risky situation, and that they should take action to move back to the outer circle.

Usually, the diagram is presented and discussed with those seeking recovery from an addiction. The individual uses this tool to help identify their own gateway behavior, with guidance from a rehab programme, therapists, support group members, or other individuals.

Starting from the inner circle, and working outward, the individual will want to mentally review the arc of their behavior toward active addiction. Individual instances of use or addictive behavior are reviewed and precursor behavior, situations, and/or events are identified. Along with standard

from the very beginning all the way to the current moment. Thinking about this may stir up painful thoughts or memories of events and experiences that were destructive or harmful. Sometimes it will help to write these thoughts down in order to reflect upon notable moments in which the addictive behavior was especially prominent. At this point, creating the three circles diagram can help.

Note that while there may be gradations of behavior and situations within a given circle, there is a clear delinneation between the circles. The diagram above is meant to convey that distinction.

The Inner Circle - Core Addiction Behavior

The innermost circle is where the individual will list behavior which they recognize as being a core part of the addiction. In the case of alcoholism, it is the use of alcohol. For those in Narcotics Anonymous or Alcoholics Anonymous, any mood-altering substance counts as a part of the addiction.

In general, an addict considers the day they became sober to be the last day he or she engaged in the inner circle behavior. Determining what should be listed in the inner circle could be difficult which is why it can help to have a therapist or counselor.2Typically, inner circle behavior includes substance use, or in the case of process addictions, the core addictive behavior such as gambling.

The Middle Circle

Creating the middle circle list will require the individual to shift his or her focus from behavior that were harmful to behavior that can lead to harm. These will likely not be injurious in and of themselves, but have the potential to pull the individual downwards. They are the addiction boundaries and can be referred to as gateway behavior. If not kept in check, this behavior can quickly lead a person back to the inner circle. behavior which is questionable can also be listed here and reassessed at a later time. Middle circle behavior may or may not be considered appropriate, but in any case are deemed to be risky. Examples include:

  • Procrastination, lack of structure
  • Lack of sleep, being overworked
  • Self-hate or being too critical
  • Staying in unhealthy relationships
  • Being around certain people or places
  • Feeling lonely or alone, and staying isolated
  • Feeling strong anger toward others

Middle circle behavior often come with denial, particularly because the addict may feel that some of the behavior is okay or justified. Engaging in any precipitious behavior may lead down a slippery slope to a relapse and addiction. An example of this might be when an individual believes he or she can visit the shopping mall, even though it is home to the restaurant they drank at every weekend. Or an individual who likes to stay on the computer late at night when they know they need to sleep, to be well-rested for work, and to avoid relapse into depression.

Often it is difficult for the individual to recognize or accept middle circle behavior as containing potential triggers that can quickly move them into the inner circle. On the other hand, the addict may believe they need to be actively engaged in certain behavior because they help to make them feel good and are not the actual substance. Ultimately, it is imperative for a person to acknowledge any risky behavior as being unhealthy and a challenge to their sobriety.

The Outer Circle

The Outer Circle encourages the addict to list their healthy behavior, also known as top line behavior. These are ones which exemplify their best and healthiest self, and have the ability to lead the individual away from middle and inner circle behavior. Twelve step programmes and support groups like Alcoholics Anonymous place a great emphasis on the outer circle as a method of positive reinforcement.3

Outer circle behavior help to prevent the person from approaching a situation or activity that could trigger a slip or relapse. They are things which can enhance the life of the addict as well as his or her recovery. In order to fully understand them, outer circle behavior needs to be approachable, practical, and clear, without any fantasy ideas. Ideally behavior that may already be put into practice or suggested by a therapist, support group, or partner. Examples of outer circle behavior include:

  • Attending recovery meetings
  • Calling a sponsor or sober support friend
  • Reading or journaling
  • Practicing yoga or meditation
  • Being active, excercise
  • Exploring new hobbies
  • Spending time with the right people
  • Helping other people, in particular, other addicts

The three circles diagram is not meant to be complete after an individual has listed their behavior in the respective areas. Rather, they should be regularly consulted as he or she learns more about their own behavior and the recovery process.

Customizing the Three Circles Diagram

As a visualization tool, the three circles will indicate various behavior associated with using and addiction, and that should be avoided. The diagram can be customized in different ways in order to gain a better understanding of how behavior, thought patterns, and physiological states are linked to addiction and recovery. As in the standard three circle model, the individual will list the most destructive in the inner circle, followed by those that may tempt and tease in the middle circle. The outer circle should list things that are positive and assist in maintaining recovery.

  • Outer Circle – Recovery
  • Middle Circle – Slippery Zone
  • Inner Circle – Active Addiction (Relapse)

Physical, Mental, and Emotional States

One customization of the three circles is to identify and analyze different physiological states that could essentially trigger an addiction.

Each state can be broken down into the three circles and further assessed so that the individual knows which ones are conducive to his or her sobriety and which ones are not. The physiological states, and a few examples, are as follows:

  • Physical – Health issues, eating disorders, inability to sleep, daily exercise, mindful eating, etc.
  • Mental – Ideas, thoughts, reasoning, and judgment
  • Emotional- Happiness, depressed, relaxed, manic, stressed, fearful, etc.

People, Places, and Activities

Thought patterns and behavior are not the only factors to consider when trying to manage recovery. Its alo important to have a clear delineation of how such behavior evolve, and often this has to do with people, places, and activities. Using the same three circles diagram, each category can be broken down into the aforementioned recovery, slippery zone, and active addiction circles.

  • Home life – Relationships, family, living environment, abuse, etc.
  • Work life – Overworked, underworked, unemployed, employer abuse, underpaid, like/dislike the job, etc.
  • Social life – Supportive friends, enabling friends, activities or hobbies that support and/or discourage recovery, etc.

The above customizations of the three circles are also highly encouraged to explore in treatment methods such as community reinforcement and the Minnesota Model.

Gateway Drugs

The notion that certain drugs, particularly alcohol, cannabis, and tobacco, are a precursor to other drug use was introduced in the mid 70s. It was derived after observing young people who had used legal drugs and then graduated onto illegal drugs including cannabis, cocaine, and heroin.

During the 1980s, the term gateway drug was coined and emphasized through tv adverts and printed media over the course of the next decade. With this came an abundant amount of research primarily labeled under the Gateway Hypothesis, and was meant to understand the progression of adolescent drug use by examining various factors including epidemiology, statistics, molecular biology, prevention, sociology, psychology, and animal behavior.4

Although the research is not conclusive, the theory that the use of certain drugs could increase the potential of other drug use is plausible. Medical researchers have suggested that when a young person uses cannabis, alcohol, or tobacco, biological alterations in the brain occur and make them more susceptible to further drug use.

The concept of the gateway drug has been established through observing, and surveying, first time users of different substances. Over longitudinal studies, trends have emerged; examples include:

  • A sample group study of 6,624 people who had never used illegal drugs prior to using cannabis were 44.7% more likely to try further illegal substances. Social conditions were also a factor and influenced the height of total probability.5
  • In another sample study of 27,461 people who exhibited no signs of alcoholism before using cannabis were reexamined three years later and revealed a 500% increase in alcohol dependence compared to a control group who had not consumed cannabis at all.6

Although research does show a trend with gateway drugs, it only indicates a possibility rather than a fixed outcome. This had led to plausible theories which are dominated by two concepts:

  • That biological alterations in the brain occur during early drug use, and
  • that there are similar socio-behavioral attitudes across the different types of drugs.7

Gateway Behavior in Substance Misuse

The validity of the gateway hypothesis or gateway drug theory is still uncertain. However, the premise that negative behavior will lead to worse behavior generally holds true. For example, when abusive behavior is exhibited in a relationship, and is not stopped, there is a high likelihood that the abuse will escalate. Likewise, a child who swears in a classroom may encourage the other students to swear, unless a teacher or figurehead takes action to root out the swearing behavior. This behavior may not necessarily dangerous, but they can be unwanted, and lead to a level of distress.

For substance misuse, gateway behavior can be a different kind of substance, such as drinking alcohol, when the substance of choice is cocaine. Those struggling with a cocaine addiction may find in their personal history that drinking alcohol generally came before cocaine-seeking behavior.

Early steps in the progression from recovery to relapse can be identified, such as going into a pub before consuming alcohol. Or perhaps calling in sick to work before eventually going into a pub.

Even mental states can be triggers which result in substance misuse, such as feeling angry or lonely. If those emotions were a precursor to substance misuse, then identifying them, and finding a coping strategy that leads out of the middle circle and back to

Gateway Behavior in Process Addictions

A substance addiction involves a dependency to at least one substance. It is diagnosed when an individual displays changes in their physical, emotional, and mental behavior, and they are unable to function without using.

Up until very recently, non-substance addictions were viewed as being a behavioral problem rather than an actual form of addiction.8 The American Psychiatric Association only recently included process addictions in the DSM5 diagnostic manual.

Behavioral researchers tend to believe that anything capable of stimulating a person can become addictive, and when a habit evolves into an obligation, it is to be considered an addiction. Ongoing research shows that there are certain similarities and differences between drug addiction and process addiction symptoms, yet both exhibit gateway behavior which the three circles diagram attempts to identify and address.

Process Addictions

The term process addiction is a new way of describing an addiction to a process or activity that does not include any substances such as alcohol, cigarettes, hard drugs, or in some cases medication. Rather process addiction refers to addictions like over-eating, sex, gambling, shopping, the internet, computer games, and so forth.

The difference between process addictions and substance addictions is that the former causes the individual to become addicted to the behavior or feeling which results from acting out on the process or activity. Unlike a substance addiction, there are little to no physical signs; however, there are often precursors such as depression, social anxiety, a lack of social support or self esteem, and in some cases dependency. Researcher Kimberly Young suggested in her study that people with process addictions exhibit certain symptoms that will lead to the same consequences as those who have a substance addiction.9

From a neurological standpoint, process addictions indirectly affect neurotransmitters in the brain, and have the potential to serve as reinforcers. Whereas substances have a direct affect on these areas (i.e. dopaminergic system). Furthermore, behavior associated with process addictions have been found to induce reward -like effects, similar to substances, through biochemical processes going on in the brain; it is these that can lead to the addiction.

Patients diagnosed with a process addiction, who have been observed by clinicians and researchers, are found to have criteria that is comparable to substance addictions. For instance cravings, withdrawal, excessive behavior, tolerance, loss of control, and suicidal tendencies. With these findings, it has been deemed to be appropriate to categorize such excessive behavior as a valid process addiction that requires similar treatment to that of a substance addiction.

The three circles diagram is a useful tool for anyone who may be coping with an addiction and wants to be in recovery. Gambling, sex addiction, eating disorders, to name some of the main process addictions, all have precursor thoughts and actions that can be diagnosed and actively avoided as a part of recovery.

Substance Use Disorder in the DSM5

Substance Use Disorder in the DSM5

In 2013, the most recent version of the diagnostic manual for mental disorders, the DSM-5, was released. Published by the American Psychiatric Association, the manual is a guidebook for psychiatric diagnosis in the U.S., Australia, and Canada, as well as for some psychiatrists and clinics in Europe. It had been 15 years since the last major revision of the DSM. Reception of the revision was largely positive, though with some warranted criticisms, most notably for changes in terminology. One of these changes included the criteria used to diagnose substance use disorder, aka substance dependence, alcohol disorder, alcohol dependence, also known as alcoholism and drug addiction.

Substance Use Disorder in the DSM5

In 2013, the most recent version of the diagnostic manual for mental disorders, the DSM-5, was released. Published by the American Psychiatric Association, the manual is a guidebook for psychiatric diagnosis in the U.S., Australia, and Canada, as well as for some psychiatrists and clinics in Europe. It had been 15 years since the last major revision of the DSM. Reception of the revision was largely positive, though with some warranted criticisms, most notably for changes in terminology. One of these changes included the criteria used to diagnose substance use disorder, aka substance dependence, alcohol disorder, alcohol dependence, also known as alcoholism and drug addiction.

The revisions included combining abuse and dependence criteria into a single category termed substance use disorder which was based upon findings from 200,000 participants in a national study.1 They also included the addition of cravings as a criterion and the removal of legal problems as a criterion. Cannabis and caffeine withdrawal symptoms were also added. The changes were seen as being a solution to overcoming several problems including the need for further studies on issues that lacked enough data to be relevant for clinicians.

Substance Use Disorder Defined

According to the DSM-5, a substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.2 The term substance use disorder is generalized and the actual substances have been enumerated. It should be noted that the term addiction or dependency is not found anywhere in the DSM-5. This has likely been done to decrease the potential repercussions of CMS coverage, disability, and reimbursement particularly with the Mental Health Parity and Addiction Equity Act.3

How are substance use disorders categorized?

When the categories of substance dependence and substance abuse were replaced with substance use disorder, the DSM-5 also listed the associated symptoms.These are broken down into four major groupings:

  • Impaired control
  • Social impairment
  • Risky use
  • Pharmacological criteria (i.e., tolerance)

The new DSM-5 describes a substance use disorder to follow a problematic pattern of use of an intoxicating substance which leads to significant impairment or distress. To be clinically diagnosed, the disorder should be manifested by at least two of the following with a 12 month period:

  • The substance is regularly taken in larger amounts over a longer period of time than was ever intended
  • There is a persistent desire to use or unsuccessful efforts to cut down, control, or quit the substance
  • A large amount of time is spent seeking out or using the substance, or recovering from its effects
  • The user experiences cravings or a strong urge to use
  • Recurring use of the substance results in the inability to fulfill important obligations at home, work, or school
  • Despite interpersonal or social problems, the individual continues to use
  • Social, occupational, or recreational activities are discontinued or reduced because of the substance
  • Use of the substance continues despite any knowledge of the physical or psychological effects caused or exacerbated by using
  • A tolerance has developed (see definition)
    • The need for increased amounts of the substance to achieve the desired effect
    • A diminished effect of the substance results when the same amount is used
  • A withdrawal manifests when the individual is not using (see definition)
    • The characteristic withdrawal symptom as defined by the DSM-5 for the specific substance
  • The substance, or another related one, is taken to alleviate withdrawal symptoms

According to the DSM-5 manual: two to three criteria are required to be diagnosed with a mild substance disorder; four to five criteria is moderate; and six to seven criteria, severe. The manual lists separately symptoms of an opioid disorder which are similar to the symptoms listed above.

Types of Substance Related Disorders in the DMS-5 Manual

The DSM-5 acknowledges nine different types of substances related to substance use, including:

  • Alcohol
  • Caffeine**
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives, Hypnotics, or Anxiolytics
  • Stimulants
  • Tobacco

**Although caffeine is listed in the manual, the APA does not consider it to apply to a substance use disorder.

Pathological Behaviors of a Substance Disorder

Regardless of the substance, to be diagnosed with a substance use disorder, a pathological set of behaviors must be prevalent and related to the use. These behaviors are:

Impaired Control

Impaired control can be identified in different ways. For it to be an evidentiary behavior of a substance use disorder, the individual may:

  • Use for longer periods of time, or use more than what was intended
  • Wish to reduce their intake, but be unable to do so
  • Spend excessive amounts of time getting, using, and recovering from the substance
  • Experience cravings that distract him or her from anything else

Social impairment

Social impairment is a consequence caused by repeated use of the substance. When being diagnosed with the disorder, a clinician might look for symptoms that include:

  • An increase in problems with obligations related to family, work, or school
  • Losing friendships or relationships, or arguing with family and friends about the continued use
  • Losing interest in once meaningful social or recreational activities

Risky use

This criterion is the failure to refrain from using even though it might be causing physical or psychological harm. The individual may:

  • Repeatedly use the substance during situations that are physically dangerous (i.e driving while under the influence)
  • Use even though it is causing or exacerbating psychological or physical problems

Pharmacological indicators

These are tolerance and withdrawal.Oftentimes these symptoms are indicators of an advanced disorder which usually requires clinical assistance either in an inpatient or outpatient setting.

Tolerance

This specific criterion refers to the bodies’ adjustment attempts to adapt to the regular use of a substance. Clinically known as maintaining a homeostatic balance, a tolerance happens when an individual needs to increase the amount of the substance in order the get the same effect which they are seeking. The desired effect is not necessarily the high, but could also be a precautionary measure to avoid the symptoms of a withdrawal. A tolerance varies from person to person as well as the actual substance and dosage.

Withdrawal

A withdrawal is the body’s response to a discontinuation of the drug after a tolerance has developed. The resulting symptoms are specific to the substance, but are typically unpleasant, and sometimes life threatening. If an individual is experiencing the symptoms of a withdrawal during an evaluation for diagnosing a substance use disorder, they will be diagnosed with substance use and substance withdrawal in order to effectively address the medical situation.

According to the DSM-5 Manual, if any of the aforementioned symptoms and behaviors are present, there may be diagnostic criteria for a substance use disorder.

DSM-5 and Co-Occurring Disorders

The DSM-5 notes co-occurring and substance induced mental disorders. Unlike the DSM-IV where the mental disorders were categorized as being primary or substance induced, the DSM-5 has reversed this standardization criteria.4 Now the manual discusses a flexible approach that lacks the duration requirements for specific symptoms and includes an addition of treatment approaches to specific disorders. The DSM-5 criteria for a co-occurring mental health disorder is as follows:

  • Criterion A: The disorder is representative of clinically significant symptoms of a known mental health disorder.
  •  
  • Criterion B: Evidence gathered from a physical exam, lab testing, or a medical history show one or both of the following:
    • The disorder developed during substance intoxication, or within one month of using. a withdrawal, or while taking a medication.
    • The substance has the potential to produce a mental disorder.
    •  
  • Criterion C: The disorder cannot be better explained by a mental health disorder that is not substance induced. Identifying an independent disorder might be shown through evidence that: -Suggests the disorder preceded the onset of intoxication, withdrawal, or exposure to using -A full mental disorder was prevalent for at least one month after the cessation of intoxication or acute withdrawal.
    • The DSM-5’s criterion C does not apply to any substance-induced neurocognitive disorders such as dementia or delusions, or hallucinogen persisting perception disorders, that exceed cessation, withdrawal, or intoxication.5
  • Criterion D: The mental disorder does not occur only during delirium.
  •  
  • Criterion E: The disorder causes significant impediment in important areas of functioning such as home, school, or work life.

DSM-5 in European Clinics

The DSM-5 is clinically binding for medical professionals in the U.S., Australia, and a handful of other countries. In Europe, the legally binding classification is the ICD-10, or the International Classification of Diseases 10.6 The later is the official document used by the WHO and classifies all pathologies, not only mental illnesses. Although the DSM-5 has no legal grounds in Europe, there is a major interest amongst health professionals, primarily because it continues to attract new generations of psychiatrists and psychologists around the world.

The DSM-5 is criticized for its monolithic diagnostic approach, anda seeming lack of interest in the social or psychological context of mental illnesses, in favor of scientific biological and behavioral factors. This is noticeable in the described symptoms of a substance use disorder. Unfortunately this can lead to discounting or overlooking psychotherapeutic and social reintegration practices which are effective in treatment. The DSM-5 promotes visual observation and standardized interviews using different behaviors grouped together and coined a ‘disorder’. The treatment approach has most certainly had a role in the fragmentation of psychiatry, which now includes specialized centers rather than a therapeutic alliance that has the potential to treat the whole person as well as the long term illness.

Proponents of the ICD-10 encourage EU clinicians to boycott the DSM-5 and its unilateral thinking of psychology. Alternative systems of classifications, in order to preserve homogeneity and avoid a stigmatization of labels is also promoted by critics. Currently the ICD 11 is being drafted. Health professionals are hoping that the mistakes and methodology of the DSM-5 will provide cautionary guidance to its European counterpart.

ADHD, and Substance Dependence

ADHD, and Substance Dependence

ADHD (Attention Deficit/Hyperactivity Disorder) is commonly associated with high risk behaviours including substance abuse and dependency. Similar to a genetic predisposition, ADHD and addiction are thought to be connected, either causally or co-occurring. Typically emerging in childhood, ADHD affects between 3 and 5 percent of girls and boys under the age of 12 years. A further 2 to 4 percent of adults suffer from ADHD with up to 25 percent experiencing both ADHD and substance abuse or dependency.

ADHD, and Substance Dependence

ADHD (Attention Deficit/Hyperactivity Disorder) is commonly associated with high risk behaviours including substance abuse and dependency. Similar to a genetic predisposition, ADHD and addiction are thought to be connected, either causally or co-occurring. Typically emerging in childhood, ADHD affects between 3 and 5 percent of girls and boys under the age of 12 years. A further 2 to 4 percent of adults suffer from ADHD with up to 25 percent experiencing both ADHD and substance abuse or dependency.

Such high statistical correlations has led medical professionals and researchers to study the connection between ADHD and addiction. Besides any co-occurring or causal connections, there is a concern as to whether medications used to treat ADHD could be in and of themselves addictive, thereby acting as a gateway to substance addiction and misuse.

Article Contents

This special article on ADHD and Substance Dependence (Misuse) will first describe ADHD in outline form, and then discuss recent findings regarding ADHD and Substance Abuse/Misuse/Dependence.

Attention Deficit/Hyperactivity Disorder (ADHD) and its Symptoms

Attention deficit hyperactivity disorder, also known as ADHD, is a type of brain disorder noted for ongoing patterns of impulsivity, hyperactivity, and inattention that disrupt daily functioning and overall human development.1 There are generally speaking three ADHD diagnostic criteria:

  • Inattention – When a person lacks persistence, is unable to focus, wanders off tasks, and is disorganized not from defiance or the inability to understand.
  • Hyperactivity – Constantly moving, particularly in situations that are not appropriate. Excessive fidgeting, tapping, or talking can also be described as hyperactive behaviours. In adults, severe restlessness or the inability to relax may be prominent.
  • Impulsivity – Hasty actions that are not thought through, or could be deemed risky, are considered as impulsivity. A person may also have a strong urge for immediate rewards, be socially intrusive, or fail to address long term consequences of their decisions and actions.

While inattention and hyperactivity are the primary behaviours of ADHD, children and adults can exhibit one or the other, but most experience both to some degree. It is important to note that every person does experience some amount of inattention or impulsivity, but for people who have ADHD, the behaviours are more severe, occur frequently, and can interfere with their social, familial, school, or work life.

Diagnosing ADHD requires a comprehensive assessment and evaluation by a psychologist, psychiatrist, or licensed clinician with experience in the disorder. In general, the symptoms must be chronic and long lasting. They will also impair the individual’s functioning leading to a slowed development for his or her age. Usually, children receive the diagnosis while in elementary or primary school. To be diagnosed as an adult or teen, the patient must show the symptoms were present prior to the age of 12.

Unfortunately, the symptoms of ADHD can be mistaken for emotional or disruptive problems; thus leading to unnecessary discipline. In other instances, it is left unnoticed. Both can contribute to a delay in diagnosis as well as have an impact on a person’s emotional wellbeing and self confidence.

The symptoms of ADHD can change with time, and as a person grows older. In children, hyperactivity tends to be predominating; whereas, as the child grows, inattention may takeover. Adults might experience inattention, impulsivity, and restlessness.

Origins of ADHD Diagnostics

In 1968, the Diagnostic and Statistical Manual of Mental Disorders II (DSM) first published a condition called hyperkinetic reaction of childhood. There have been reports of similar conditions and symptoms dating back to the 17th century. In the third edition of the DSM, published by the American Psychiatric Association in 1980, the term was modified into ADD or Attention Deficit Disorder. The later fourth edition again changed the term, which was reflective upon research findings. It was called Attention Deficit Hyperactivity Disorder, or ADHD. The most current and fifth edition continues to use this term and has also added three sub specifications which are:

  • Predominantly inattentive presentation
  • Predominantly hyperactive and impulsive presentation
  • Combined presentation

Males tend to exhibit both presentations; whereas females tend to exhibit the first.

Studies Comparing ADHD and Substance Abuse Disorders

Only recently has medical professional begun to take interest in the association between ADHD and substance abuse disorders. Much of the research is still ongoing as of 2017, and will be released to the educational system and community in the near future. The following are published studies that highlight ADHD and substance use.

Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders

One 2005 study assessed current treatment protocols for ADHD patients. Pharmacotherapy, including psychostimulant medications, is the mainstay of treatment. However, many medical clinicians seek different approaches to treating those with a substance abuse disorder and ADHD, particularly which do not include stimulants. This study attempts to address the correlation between the two and make recommendations for treating patients with co-occurring substance use disorders and ADHD.

The National Comorbidity Survey Replication (NCS-R) published a survey that included ADHD. It found 4.4% of US adults had ADHD. The rate of occurrence with people who had a substance use disorder and ADHD was found to be at 15.2% as compared to 5.2% of people who did not have ADHD. Furthermore in 10.8% of people who had a substance use disorder, there were enough criteria to ascertain adult ADHD, though they had not been officially diagnosed as such.2

This study goes on to discuss evidence which suggests the theory that dopamine neurotransmission dysfunction and genes associated with neurotransmitter could be partially responsible for ADHD. In particular the D2 dopamine receptor gene, the dopamine-hydroxylase gene, the dopamine transporter(DAT) gene, the SNAP-25 gene, the D4 dopamine receptor gene, in addition to others.3 The development of substance use disorders has also been linked to the same genes which indicate there could be common factors leading to the development of the co-occurring disorders.

By clinical definition, Childhood ADHD is exhibited in children prior to the age of 7, whereas substance use disorders often develop during adolescence or adulthood. Some researchers believe that substance use is a coping method or developmental interaction with symptoms of ADHD.

Furthermore the impulsivity, poor academic performance, inability to focus, and social stigmas create an opportunity for a person to have motivation for substance use, resulting in potential misuse. The risks of this development are also dependent on the severity of the symptoms, rather than only meeting the criteria of ADHD.

The study concludes with suggestions on how patients with ADHD and a substance abuse disorder should be treated. It is suggested that substance use represents an attempt to self-medicate the negative social and psychological impact of ADHD.

Medication, typically psychostimulants, are the first line of treatment because they can stimulate and balance the dopamine receptors in the brain.4 Non-stimulant medication is available, and promising, but their ability to help patients with the co-occurring disorders is unknown. Due to the addictive nature of psychostimulants, the study recommends use with caution for patients who have a substance use disorder.

A conservative approach to this treatment would be to treat the co-occurring ADHD and substance use disorder with a non stimulant medication. If a desired response is not noticeable, stimulant pharmacotherapy could be an option. Cognitive behavioural therapy, counselling, and exercise can also be valuable forms of treatment.

Correlates of co-occurring ADHD in drug-dependent subjects: Prevalence and features of substance dependence and psychiatric disorders

Another relevant study examined the prevalence and course of substance use and psychiatric disorders in people who have ADHD.[^co-occurring-adhd] Interviews on 1761 adults who had been diagnosed with a cocaine or opioid dependency had been conducted. Generalized estimating equation analysis and linear regression was used to identify correlations between ADHD diagnoses. The results suggested that people with a substance use disorder and ADHD was 5.22% versus 0.85% in people without a substance use disorder.

The study also showed in people who exhibited the symptoms of ADHD also had an earlier age of substance use, psychiatric diagnosis, and mental health hospitalizations which suggests that behavioural disorders were also an issue. The conclusions of the study suggested that in patients who had a cocaine or opioid dependence, ADHD was prevalent in addition to psychiatric co morbidity. Ideally with these results, better treatment approaches can be taken to lessen the symptoms and effects of all issues.

Does Attention-Deficit Hyperactivity Disorder Impact the Developmental Course of Drug and Alcohol Abuse and Dependence?

One of the preliminary studies on ADHD and substance use disorder examined the effects on the transitions from abuse to dependence, and between the agents of use.5A sample of 239 male and female adults who had been diagnosed with ADHD as a child, were interviewed and compared to 268 non-ADHD healthy adults.

The results showed that the subjects with ADHD had a twofold increased risk for developing a substance use disorder. Furthermore, they were more likely to make the transition from alcohol to drugs. It concluded by saying that subjects with ADHD and early alcohol use disorder were at risk for subsequent abuse that included other drugs. Such developmental pathways might be prevented by developing and implementing early intervention strategies.

Is ADHD a Risk Factor for Psychoactive Substance Use Disorders? Findings From a Four-Year Prospective Follow-up Study

Contradicting some of the aforementioned studies, a four-year follow up study was done to evaluate whether or not ADHD is a risk factor for substance use disorders in relation to psychiatric problems, family history, and adversity.6 Using different assessments, researchers examined 140 subjects with ADHD and 120 normal control subjects four years after their substance use disorder diagnosis.

The results show no difference between the rates of alcohol or drug abuse between the ADHD and control subjects. Conduct and bipolar disorders were able to predict substance use, independent of whether or not ADHD was a factor. Family history and antisocial disorders were also linked to the control group, but less in the ADHD group. Finally a family history of ADHD was not considered to be a risk for the development of a substance use disorder.

Mediating Factors to Consider

One might see potential correlations between ADHD and substance use disorders. However, this is not exclusively conclusive in any of the studies. Furthermore, it is important to acknowledge the lack of consideration in relation to a person’s childhood, family life, school life, and other socio-behavioural factors. Prior to suggesting a causal link to ADHD for an increased risk of substance use, abuse, and dependency, it is important to take into consideration all mediating circumstances that could influence a person’s decisions.

ADHD + Behaviour Disorder and/or Substance Abuse => Substance Dependence

If a person has ADHD, there is a potential that they also experience other behaviour disorders such anxiety disorders (including panic attacks, PTSD, and general anxiety), obsessive compulsive disorder, bipolar disorder, or dissociative disorders. Behavioural disorders often appear in children and can progress into adulthood. It is generally believed there is no single root cause. Rather, biological, physical, and environmental issues are thought to work simultaneously alongside risk factors such as maternal rejection, poverty, abuse, and so forth.

On the other hand, a person with a diagnosis of ADHD could turn to substance abuse as a means of coping with their symptoms of the ADHD. It is also plausible for both behavioural disorders and the substance abuse to occur at the same time. With either health issue, if left undiagnosed and untreated, there is a potential for the development of a substance use disorder.

It is also important to take note of the vicious cycles of reinforcement including the following additional compounding possibilities.

Substance Dependence + Behaviour Disorder and/or ADHD + Substance Misuse => Substance Dependence

Some adults, regardless of their gender or age, may be dependent on a substance and aggravate underlying symptoms of a behavioural disorder or ADHD. If the individual seeks out treatment for the substance abuse disorder, and is unaware of the behavioural disorder or ADHD, there is a chance that they will struggle with their sobriety because of the symptoms of the co morbid disorders. Eventually substance misuse, abuse, and dependence could arise; thus, creating a revolving circle of reinforcing destructors.

Substance Misuse + Behaviour Disorder and/or ADHD => Substance Dependence

Finally, substance misuse combined with the symptoms depression, anxiety, PTSD, OCD, bipolar disorder, ADHD, and so forth can quickly turn into a substance use disorder. The reasons for the individual using drugs or alcohol may be inherently unique, but in some way related or linked to the behavioural disorder. If undiagnosed, a repetitive cycle can ensue.

What is important to take away from here is that it is not true and accurate to say that a person with ADHD will likely experience a substance use disorder, and a person with a substance use disorder will not always have ADHD or a behavioural disorder. However, there is a probable correlation between the a behavioural and substance use disorder which is why it’s prudent to acknowledge the signs and effects of a comorbid disorder. When this is diagnosed, the patient can be treated for all relevant issues.

Conclusion: Correlation between ADHD and Substance Abuse in the Research Literature

No direct, causal connection between ADHD and substance use disorders has been established. However, there is an increased likelihood of behaviour disorders with ADHD. These behavioural or mental health issues can lead towards substance misuse, which can then turn into a substance use disorder.

Alcohol Use Disorder

Alcohol Use Disorder

According to The U.S. National Survey on Drug Use and Health in 2015, approximately 15.1 million adults, or 6.2% of the population meet the criteria for Alcohol Use Disorder.1 A further 623,000 adolescents, boys and girls between 12 and 17, live with a person who has AUD. The survey makes use of the term Alcohol Use Disorder, which might cause confusion to a reader has no medical background. This is particularly true because previous surveys used the terms alcoholismalcoholic, and alcohol abuse. To add to the confusion, popular support groups like Alcoholics Anonymous continue to use the term alcoholism in meetings, books, and manuals.

Alcohol Use Disorder

According to The U.S. National Survey on Drug Use and Health in 2015, approximately 15.1 million adults, or 6.2% of the population meet the criteria for Alcohol Use Disorder.1 A further 623,000 adolescents, boys and girls between 12 and 17, live with a person who has AUD. The survey makes use of the term Alcohol Use Disorder, which might cause confusion to a reader has no medical background. This is particularly true because previous surveys used the terms alcoholismalcoholic, and alcohol abuse. To add to the confusion, popular support groups like Alcoholics Anonymous continue to use the term alcoholism in meetings, books, and manuals.

Alcohol Use Disorder (AUD) is the most recent term used in official diagnoses from doctors and other healthcare professionals who use the DSM-5, a diagnostic manual prevalent in North America. In the past, various other terms have been used, including alcohol misuse, alcoholism, alcohol addiction, alcohol dependency, and so forth. The terms are often used interchangeably by clinicians and non-clinicians alike, but there are in fact subtle differences between them. It is important to understand what these differences are so that patients, family members, and the general public can better understand alcohol use disorders which affect themselves and their friends, family, and colleagues.

A Pattern of Alcohol Use

Alcohol use disorder is a pattern of alcohol use that involves various symptoms including, but not limited to: the inability to control alcohol consumption, being preoccupied with alcohol, the need to drink more to get the same desired effect, or going through a withdrawal when alcohol consumption is decreased or stopped.

lcohol use disorder includes different levels of unhealthy alcohol use which is defined as any type of consumption that puts an individual’s health and safety at risk, or may cause other problems. If a person’s drinking results in repeated emotional or physical distress, it is likely that he or she has an alcohol use disorder. A clinician can diagnose an AUD based upon eleven criteria in the DSM-5. Furthermore, an AUD can range from being mild,to moderate, to severe.

The latest terminology was developed to help clinicians make a more informed, and accurate, decision on their diagnosis. Furthermore, it allows the diagnosis to individualized to the patient rather than diagnosing him or her with a broader term like alcohol abuse or alcohol dependency – which were the two terms previously used in the DSM-IV. It’s worth noting that in a sample study of primary care patients who were considered to be heavy drinkers, the DSM-5’s symptoms help clinicians to diagnose 13% more patients with AUD than the previous version of the manual.2

People who have been diagnosed with an AUD may or may not require inpatient treatment. In general, those who have a moderate to severe AUD will need, or benefit from, medical assistance. In the later severity, there is a probable risk of serious withdrawal symptoms which will need to be monitored by clinicians.

Alcohol Dependency

Alcohol dependency is a term previously used by clinicians who followed earlier versions of the DSM (DSM-IV, DSM-III, etc.). The term is still used by the World Health Organization, and clinicians who refer to the ICD-10. This manual, popular in the UK and Europe, diagnoses patients with either alcohol dependence or harmful alcohol use.
Alcohol dependence is defined by the WHO and ICD-10 as:

a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.3

Earlier classification systems has called this state alcoholism, but this term is generally no longer used by medical professionals.

Categorical terms for diagnosing the severity of alcohol dependence are not present in the ICD-10; however, they do in reality exist. Clinicians are encouraged to subdivide alcohol dependence into categories of mild, moderate, or severe – as noted in the DSM-5. In general people who have mild alcohol dependency will not need an assisted medical withdrawal. Whereas those who are considered to have a severe alcohol dependency disorder will need help with a withdrawal, typically through an inpatient treatment program.

Non clinicians may also refer to alcohol dependency (or alcohol dependent) over other terms because it is thought that the term itself is less harsh than others like alcoholic. Patients themselves may too prefer the former terminology; thereby, preventing a reduction in self worth or self esteem.

Harmful Alcohol Use

Harmful alcohol use, replaces non dependent use, and is considered to be a predecessor of alcohol dependency and defined as a pattern of psychoactive substance use that is causing damage to health. Damage includes physical health problems or mental health problems. It should be noted that harmful use could have social consequences, but these in and of themselves are not sufficient enough to justify a clinical diagnosis of harmful use. The closest term to harmful alcohol use is alcohol abuse.

When a person exhibits the symptoms of harmful alcohol use, they may have already experienced some of the preeminent symptoms of mild alcohol dependency, or mild AUD. At this point, very few people will actually take note of the issue and reduce their drinking or seek out help. Family members or close friends might believe a problem exists. Depending on the circumstances of their relationship, they may or may not choose to talk with the individual who is engaging in this type of behavior.

Alcohol Misuse

The term alcohol misuse is widely used in the UK, Ireland, and parts of Europe. In general, alcohol misuse is not a familiar term in the US or Canada. It is considered to be less harsh than alcohol abuse and used by clinicians to inform their patients of a potential problem.4 Alcohol misuse refers to excessive drinking, or in which the individual is drinking more than the suggested limits which include not consuming more than 14 units of alcohol per week. When alcohol misuse is suggested, there is an increased risk for alcohol induced harm.

Alcohol Abuse

The current accepted definition of alcohol abuse is similar to alcohol dependency in that both cause harm to the individual and those closest to them. The most notable difference is that in the case of alcohol abuse, the drinker can typically put limitations on their drinking. They are not physically addicted to alcohol and will not experience a withdrawal. A tolerance could be prevalent.

Binge drinkers are considered to be a type of alcohol abuser. People who are anti-social, experience frequent anxiety, or have pleasure seeking tendencies are also common abusers of alcohol. In general, these people are unable to control their drinking once they start. The key to understanding this term is not how much alcohol is consumed, but how it affects the drinker. Alcohol abuse often exhibits signs of an AUD or alcohol dependency, but to a lesser degree. Unfortunately, most people who abuse alcohol will not admit that there could be underlying problems which causes them to drink. There is also a very low chance of getting help from a clinician or treatment center.

Alcoholism and Alcoholic

Alcoholism, or alcoholic, is a common term used worldwide. It describes an impaired ability to limit the consumption of alcohol regardless of any consequences of use. Alcoholism meets the current definition of addiction which is a complex condition (sometimes also referred to as a disease) that is manifested by compulsive substance use despite any negative or harmful consequences. 5

The term is not used by the American Psychiatric Association nor is it used by clinicians in the UK or Europe. It is a clinical term used by certain medical organizations such as The American Public Health Association, and in this case refers to alcoholism being a disease.

Just as addiction can range from mild to severe so too can alcoholism.It typically refers to a severe or extreme severity; however, related problems are likely to have occurred long before this state. Many people believe that if they are not an alcoholic they don’t need help. Furthermore, the term can be harsh to some men and women, leading them to feel upset, or ashamed about their drinking. This is one reason many clinicians elect to not use the term.

Drunk and Drunkard

A drunk, or drunkard, is a term used by non-clinicians and could even be considered slang for an alcohol abuser or alcohol dependent person, but this is not always true. A drunk may be so intoxicated with alcohol that they have lost control over their physical and cognitive functioning. Another way the term is used is when a person is considered to be drunk. In this case it is the physiological state that has been induced by alcohol. Whether or not they have a problem with alcohol is entirely circumstantial.

What is Alcoholism to the Non-Medical Community

Alcoholism is a generalized, typically broad term that may be used to describe a person who is severely dependent on alcohol. Someone who does not have a medical background may use the term to refer to a person who drinks too much, but alcoholism is much more than just that. When a person is considered to have alcoholism they will exhibit many symptoms as listed in the DSM-5.
The term alcoholic is mostly used in text published by Alcoholics Anonymous. Their book, The Big Book of AA states:

If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.

Alcoholics Anonymous and their members will not diagnose a member as being an alcoholic; rather, he or she is asked to make that decision on their own. AA meetings tend to not use the term Alcohol Use Disorder, but alcoholics with different types of severity will attend the groups.

Marijuana Use Disorder

Marijuana Use Disorder

Marijuana, also referred to as cannabis, hashish, or hash, is considered to be the most common illegal psychoactive substance in the world. The psychoactive properties are a result of the Cannabinoid delta-9-tetrahydrocannabinol (THC). The strength of marijuana is typically measured by the amount of THC concentration.

marijuana-use-disorder

Marijuana, also referred to as cannabis, hashish, or hash, is considered to be the most common illegal psychoactive substance in the world. The psychoactive properties are a result of the Cannabinoid delta-9-tetrahydrocannabinol (THC). The strength of marijuana is typically measured by the amount of THC concentration.

THC reaches the brain in minutes and binds to the Cannabinoid CB1 receptor in the brain. It activates these receptors in the mesolimbic dopamine system which is hypothesized to modulate positive rewarding effects.

In the 60s and 70s, marijuana strains were found to have between 0.4 and 1 percent of THC. Today cultivators have manipulated popular strains to contain up to 25 percent or more THC. The increase in potency has stirred a long and heated debate on whether or not it has triggered a rise in marijuana use disorders as well as neurological and psychological changes within the brain.

The legal status of marijuana use, including recreational and medical purposes, varies across the United States and internationally. Medical researchers suggest that around 10 percent of regular users develop marijuana use disorder, something that could be associated with cognitive impairment, mood disorders, psychosis, and problems within work, family, and social aspects of life.

Clinical Manifestations of Marijuana Use Disorder

A marijuana use disorder is is manifested by a persisting pattern of use that results in a significant life impairment in at least two domains with a 12 month period.1 These manifestations of impairment could include giving up activities that were once enjoyed, have problems at work, or developing health complications.

Unlike other substance use disorders in which the quantity and frequency of use is taken into consideration, marijuana use disorders are diagnosed through a very careful and precise assessment of impairments. Key diagnostic features that a clinician might assess include a patient denial of their use even when valid collateral sources (i.e. family, friends, work) of using exist and also denial even when there is contradicting evidence (i.e. urine testing).

Trends on the Prevalence of Marijuana Usage

The prevalence of marijuana usage varies greatly by country. For instance in countries where marijuana has been medicalized, regulated, or decriminalized, usage tends to be higher. Other usage elements that could be taken into consideration include culture and societal beliefs.

Marijuana Use in the US

The laws and attitudes toward marijuana usage in the US are becoming more relaxed. This shift in thinking has caused researchers to wonder whether or not the prevalence of using marijuana and marijuana use disorders have also changed.

The most recent published study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), suggests that things have altered in the 21st century.2 Her and her team interviewed over 36,000 American adults about their marijuana, alcohol, and drug use, as well as any psychiatric conditions.

Their goal was to present up to date nationally representative data on marijuana use and marijuana use disorders between 2012 and 2013, and to determine any changes between this year and 2002 and 2002 (the last study). The team used diagnostic criteria as found in the DSM-4.

What they found was that between 2012 and 2013, 9.5% of adults in the US had used marijuana in the past year, and 2.9% had a clinical diagnosis of DSM-4 marijuana use disorder. This meant approximately 3 out of 10 marijuana users, or 6,846,000 Americans, had a marijuana use disorder.

Furthermore, marijuana use and marijuana use disorder significantly increased since the 2001-2002 study. In fact is nearly doubled in marijuana use and the prevalence of a disorder was two-fold. No increase in the risk for developing a marijuana use disorder among users was found to be true; rather, it had decreased. The study suggested the increase in marijuana use disorder could be linked to the increase in users between the two studies.

This also corroborates with other reports of an increase in use which is likely related to changes in legislation as well as an increasing potency of THC. It is suggested that THC in marijuana could reinforce the effects; however, this needs further merit investigation.

Ultimately the concluding results of the study were that as marijuana usage continues to grow, so too could marijuana use disorders. Due to the lack of clinical understanding, public awareness is limited. This means that only a small number of people will actually seek out treatment.

Marijuana Use in the UK

Approximately one third of adults in the UK have tried marijuana; about 2.5 million people between the ages of 16 to 29 have used it in the past year. The latest drug report findings out the UK shows that marijuana was the most common drug used between 2015 and 2016, with 6.5% of adults using it in the past year. These results are similar to the previous years survey of 6.7%, but shows significant falls when compared to a decade ago (8.7%). Up to 37% of marijuana users were considered to use the drug frequently.

There is a lack of direct research on marijuana use disorders in the UK, or more frequently referred to as marijuana abuse and dependency. One relevant study that sought to provide clinicians with effective ways to assess and manage marijuana use disorders is that by psychiatrist Adam R Winstock. 3 He notes that the past decade has seen a dramatic shift in marijuana preparations in the UK.

What began with resinous hash has now migrated into high potency preparations that dominate the UK market. High-potency cannabis has been found to have soaring levels of THC and could be attributed to marijuana use disorders. Despite the large number of people who use marijuana on a regular basis, only 6% seek out treatment for abuse or dependency of marijuana.4
Furthermore, those who have been diagnosed with a marijuana use disorder do not list marijuana use as their most dominate complaint or concern. Rather respiratory problems, depression, anxiety, exacerbation of an underlying mental health disorder, inability to concentrate, and legal or employment problems reside above the actual use. The low levels of people seeking out treatment could be associated with a lack of awareness around marijuana use disorder and other harms.

How High-Potency Cannabis Affects the Brain

A new study published by researchers out of King’s College London suggest that smoking high-potency cannabis could be linked to changes in the white matter connections between the brain’s two hemispheres.5 High-potency cannabis has high levels of THC and is commonly smoked by marijuana users throughout the UK.

The brains of 56 people who sought out treatment for psychosis were scanned, in addition to a control group of 43 people. Researchers observed the density in the corpus callosum of the brain, or white matter tracts that extend outwards from neurons in one hemisphere into the other. When the white matter connections are damaged, the communication in between brain cells becomes impaired. This can lead to cognitive problems including memory loss and difficulty concentrating.

The study goes onto to suggest that there are significant links between how often a person smokes marijuana and how much damage has occurred to the white matter. People who smoked more frequently had a greater chance of white matter damage than those who did not smoke high-potency cannabis often, or who smoked less potent marijuana strains.

It should be noted that white matter damage was related to high-potency cannabis use regardless of psychosis symptoms being relevant. Researchers do not understand the cause and effect of this or how the relationship between high-potency cannabis and white matter originates. It is with hope further studies can corroborate with the current findings.

Marijuana Use in Canada

In Canada, marijuana is the most commonly used illegal drug. Currently recreational use is illegal; however, marijuana can be used for medicinal purposes when supported by a healthcare practitioner. The most recent study from 2012 reports that 10.6% of Canadians have used marijuana in the last year.6

Adolescents had the highest amount of use in 2009-2010 with 28% having smoked it at least one time. Growing research out of Canada indicates that chronic use of the drug could have adverse health effects including mental, physical, and cognitive impairment.

Another study published in 2012 shows that 21.6% of Canadians (or 6 million people) met the criteria for a substance use disorder.7 Alcohol was the most common (18.1%) with marijuana following suit, at 6.8%. This study was the first time marijuana abuse or dependency was assessed on a national level.

Marijuana Use in Australia

Marijuana use in Australia was not popular prior to the 1970s. Since this time, use has increased with the 1990s having the highest usage. It has since gradually decreased, but it continues to be the most used illegal drug in Australia. Similar to other countries, most users are in their 20s and 30s.

The Australian Institute of Health and Welfare cited daily usage of marijuana in 2004 at 16 percent, with most of these users around the age of 30-39. A 2007 study showed marijuana had been used at least once by a third of Australians over the age of 14. A further 1.6 millions people had used the drug within the last 12 months.

A 2016 household study of 115,000 people showed 48.1% of Australians has used marijuana in the last year.8 Of these people, 15.2% of females and 17.9% of males used the drug at least 300 days out of the year. Furthermore 5.9% of females and 6.9% of males reported being under the influence of marijuana for at least 12 hours a day.[^2017-study]

The Impact of Marijuana Use

Occasional use of marijuana is generally not considered to be harmful, however, when used there are notable changes in the body and mind. Overuse of the drug, or when used in conjunction with a mental health disorder, the effects could be substantial and even detrimental.

Physical Effects of Marijuana Use

Marijuana is most often smoked, but it can also be eaten, brewed into a tea, or inhaled through a special vaporizer. Regardless of how it enters the body, the nervous system, organs, and brain will be affected within minutes. (Eating it will take longer for the body to process the THC). The immediate effects can last between 3 and 4 hours and include:

  • Increase in heart rate
  • Increase in bleeding
  • Low blood pressure
  • Alteration in blood sugar levels
  • Shallow breathing
  • Dilated pupils and red eyes
  • Dry mouth and dizziness
  • Slowed reaction time

Marijuana use can also cause changes to the user’s mind and mood. Some effects may include:

  • A distorted sense of time
  • Paranoia
  • Anxiety
  • Depression

Long term effects of marijuana can vary and depend on whether or not the user is considered to have a marijuana use disorder, an issue that affects around 10-30% of people. Marijuana could worsen liver disease, low blood pressure, or diabetes. In men low testosterone, sperm count, and it’s quality may be decreased; of which could lead to a low libido and fertility.
Long term use has also been linked to mental illness in some users, such as:

  • Temporary hallucinations
  • Paranoia (Temporary or persistent)
  • Delusions
  • Psychosis
  • Worsening the symptoms of schizophrenia

It is important to note that the aforementioned is not exhaustive, and it is also not conclusive. Other studies that also consider underlying factors including THC levels and undiagnosed health issues, must be conducted.9

Addictiveness of Marijuana

Marijuana use can lead to a marijuana use disorder which takes the form of addiction. Not all users, including frequent users, will become addicted to the drug. Currently it is not understood why this holds true, but could be related to genetic predisposal, social environment, childhood, underlying health issues, and so forth.

A marijuana use disorder is associated with dependence and a withdrawal. People diagnosed with this disorder frequently report irritability, decreased appetite, cravings, restlessness, and sleep issues when they quit.10 These symptoms can last between one and two weeks or more.
Users who have been diagnosed with a marijuana use disorder, and have quit, report the process as being mildly uncomfortable. It cannot be compared to other disorders that include alcohol or prescription medications.

Many people who quit marijuana were found to have other emotional or mental issues going on, which may have been attributed to their use. In this case cognitive behavioral therapy, counseling, yoga, exercise, and meditation were all found to be very helpful. If a mental health disorder was prevalent, psychiatric help and medication may be recommended to the patient.

Impact of Marijuana Use on Quality of Life

The topic of marijuana and relationships is very controversial with some clinicians believing the two cannot go hand in hand; rather mixing like dynamite and a match. Thus, resulting in widespread, far reaching effects. Others believe marijuana has no effect on relationships, and then there are those that feel it will be inherently unique and dependent on a broad range of circumstances.

It can be said that this disorder, regardless of it being deemed mild, moderate, or severe, could minimize progress and growth in a relationship. A marijuana use disorder may impact:

  • The user’s personal life
  • Friendships
  • Intimacy
  • Commitments
  • Family life
  • Responsibilities
  • Work/school obligations

To what degree marijuana use remains casual in these associations remains an open, and broad, topic of debate that requires further research. It is entirely possible that other factors independently predispose a person to marijuana use disorders and negative life outcomes.

GHB Rehab in Thailand

GHB Rehab in Thailand

GHB (gamma hydroxybutyric) is a central nervous system depressant, it acts in a similar way as alcohol making users feel confident and euphoric. In higher doses it can cause drowsiness, nausea, unconsciousness and even amnesia. GHB usually comes in a liquid or crystalline form, it is a tasteless and odourless, its effects are intensified when mixed with alcohol. Because of these properties it is also a common club drug and date rape drug.

What is GHB?

GHB (gamma hydroxybutyric) is a central nervous system depressant, it acts in a similar way as alcohol making users feel confident and euphoric. In higher doses it can cause drowsiness, nausea, unconsciousness and even amnesia. GHB usually comes in a liquid or crystalline form, it is a tasteless and odourless, its effects are intensified when mixed with alcohol. Because of these properties it is also a common club drug and date rape drug.

Who Abuses GHB?

GHB abuse is relatively rare in Thailand however a growing number of addicted clients from around the world come to Thailand seeking rehab for GHB abuse. At Siam Rehab the majority of clients coming for GHB rehab come from Europe.

GHB is mainly abused by high school and college students as well as young adults that are into the club and rave scenes since it can be an alternative to ecstasy. Also in a research study done in 2005 in Los Angeles it was found that 40% of young men 18 – 22 years old who identify as gay have tried club drugs.

How to Treat GHB Addiction?

GHB addiction is treated very much like other chemical addictions unless you are heavily physically dependent on the drug. If you are physically dependent to GHP you will need to detox in your home country in a hospital or dedicated GHB detox facility prior to attending Siam Rehab Thailand. The reason for this is that once you are physically dependent to GHB you will need specialised care for the initial week or two in order to safely detox from the drug.

After the detox is completed, at Siam Rehab you will take part in group and one to one therapy as well as physical training, experiential therapy such as equine assisted therapy, art therapy, mindfulness mediation, etc. The goal will be to help you understand why you are abusing the drug and dealing with the issues that lead you to GHB addiction in the first place.

You will also take part in a programme that will explore how you will stay clean and sober afterwards which will include developing a personalized and actionable aftercare plan to give you the best chance possible at a lifetime of recovery without relapse and falling back into old behaviors.

Symptoms of GHB Use

GHB’s effects can last from 90 minutes to 3 hours depending on the amount a frequency used. Symptoms of GHB addiction can range from nausea, slow breathing, vomiting, seizures and even death in some cases.

What to Do if you are Addicted to GHB

If you are addicted to GHB or trying to help someone who is, know you are not alone and there is help available. Talk to your local general practitioner or drug and alcohol hot line. Also Siam Rehab has helped a considerable number of people looking for GHB rehab in Thailand lead clean and sober lives after treatment.

The Best Alcohol Rehab in Thailand

The Best Alcohol Rehab in Thailand

Siam rehab offers the most effective and affordable alcohol rehab in Thailand. Set in an amazing facility in the mountains of Chiang Rai, the very North of the country. Siam rehab operates a world class recovery community unlike anything available in the rest of the world with highly experienced and effective treatment team.

The Best Alcohol Rehab in Thailand

Siam rehab offers the most effective and affordable alcohol rehab in Thailand. Set in an amazing facility in the mountains of Chiang Rai, the very North of the country. Siam rehab operates a world class recovery community unlike anything available in the rest of the world with highly experienced and effective treatment team.

Alcohol Treatment Facilities

The facilities at Siam Rehab are second to none, a 30 acre remote property with mountain views and manicured tropical gardens. The facilities boast swimming pools, basketball court, spa, full gym with regulation boxing ring for Muay Thai training, meditation room, spinning class area, yoga area, multiple group and therapy rooms, private en suite accommodation and many secluded places in the gardens to read a book or reflect on the experience.
The most important factor for people suffering with alcoholism is that we are in a remote area with no access to alcohol, which helps avoid temptation and give you the time you need to deal with the issues of why you are here in the first place.

Highly Trained Addiction Treatment Staff

The staff at Siam Rehab are hand-picked for their experience and training.

  • Licensed Addiction Psychiatrist
  • Onsite nurse
  • Psychologists
  • Psychotherapists
  • Equine assisted therapist
  • Addiction Counsellors – all in recovery themselves
  • Team of support workers
  • Personal trainers
  • Massage Therapists
  • Yoga, Spinning, CrossFit, Muay Thai boxing trainers
  • Meditation instructor
  • Two Chefs and a full complement of staff serving the kitchen and dining room
  • Maids, gardeners, maintenance people, etc.

All of the staff at Siam Rehab are committed to helping you on your journey to a sober and happy life. They have the skills and experience to help you find your way and all are qualified in their respective fields. All of the primary treatment team, support workers, and physical trainers speak English.

Alcoholism Rehabilitation Programme

The Siam Rehab treatment programme is a planned and balanced mix of counselling, group and one to one with physical fitness, mindfulness meditation , equine assisted therapy and excellent nutrition.

The programme is structured to take the needs of each individual into account since it is believed that every alcoholic will need a custom tailored programme to fit their specific needs. We understand that each person is different and the physical component of the programme takes this into account. For example we don’t expect a senior to take part in the Muay Thai boxing aspect of the programme and offer other alternative forms of physical fitness to suit their individual needs.

The rounded and structured programme at Siam Rehab is designed to give you the best chance at long term sobriety and reintegration with your life back home upon return. A large part of the programme that you will go through includes a reintegration and aftercare plan since at some point you will be exposed to alcohol and you will need the tools to cope with the situation.

Affordable Treatment Programme for Alcohol Addiction

Siam Rehab is able to offer a world class programme at a fraction of the costs of western centres in the UK, USA or Australia. We are able to accomplish this goal since our overheads are drastically lower than in most client’s home country. Also our centre is not a profit first driven business. We do not receive any government subsidies so do have to charge fees, we do our best to offer a world class programme but also keep the fees to a reasonable level that many people can afford.

In fact our fees are so low you would find it difficult to spend four weeks in Asia in an equivalent resort, eating 3 meals a day and going on excursions for the rates we manage. Not counting the treatment programme which is the core of the business.

Walking around Siam Rehab you could be excused for mistaking it as a luxury resort. A stay at an equivalent addiction treatment programme in the west would easily cost you 5 or 6 times the fees at Siam Rehab and for that you would still not receive the level or service, private accommodation and treatment programme that we offer.

How Soon can I Start?

When someone makes the decision to finally break the cycle of addiction and go to treatment is it important that they do it right away before they slip back into old behaviour. Depending on availability a client can sometimes be in treatment at Siam Rehab within a few days from deciding and usually no more than a week. In order to participate in our treatment programme you will need to have a reasonable level of physical health, you need to fill in an admissions form and speak with our intake team, at this point you will have a chance to ask any questions you may have and between yourself and our intake coordinator we will decide if Siam Rehab is the most appropriate programme for your needs.

How do I get to Siam Rehab?

Most client’s at Siam Rehab come from overseas; Australia, UK, Europe, USA, Canada and expats living around Asia. Depending on where you are travelling from you will probably need to transit in Bangkok Airport for your final 1 hour and 10 minute flight to Chiang Rai. Once you are at Chiang Rai airport a member of the Siam Rehab team will meet you at arrival for the short 30 minute drive to the centre.

Call us Now!

If you have decided to change your life for the better or are looking to get help for a loved one you are in the right place. Call the best alcohol rehab centre in Thailand. One of our intake coordinators will be happy to answer all your questions and guide you through the process of being admitted to the programme. You can fill in the admissions form here and we will call you as soon as possible or feel free to call any of the numbers on the contact page, they all connect directly through to our intake coordinators in Thailand.

Best Drug Rehab in Thailand

Best Drug Rehab in Thailand

Siam Rehab is the most effective drug rehab in Thailand. The centre is set in an amazing mountain valley with beautiful jungle views in every direction. At Siam Rehab you will find a world class recovery community unlike anything available in the world. 

Best Drug Rehab in Thailand

Siam Rehab is the most effective drug rehab in Thailand. The centre is set in an amazing mountain valley with beautiful jungle views in every direction. At Siam Rehab you will find a world class recovery community unlike anything available in the world.

Drug Rehab Programme

Siam Rehab is a drug rehab programme with no equal, with some of the most highly trained staff in the world. We know we can have the nicest facilities and best location but none of that will matter if the team of doctors, psychologists, counselors, nurses and support workers are not the best available.

We have assembled a team that is near impossible to match. Partly by design and partly by luck. When we chose our location we didn’t know that just up the road was the clinic of the North of Thailand’s most experienced and qualified addiction psychiatrist. Dr. Mark, now works with us and our clients as the medical director.

The staff at Siam Rehab include

  • Licensed Addiction Psychiatrist
  • Onsite nurse
  • Psychologists
  • Psychotherapists
  • Addiction Counsellors – all in recovery themselves
  • Team of support workers
  • Personal trainers
  • Massage Therapists
  • Yoga, Spinning, CrossFit, Muay Thai boxing trainers
  • Meditation instructor
  • Two Chefs and a full complement of staff serving the kitchen and dining room
  • Maids, gardeners, maintenance people, etc.

Drug Rehab Centre Facilities

We understand that you cannot do counseling and psychotherapy 24 hours a day 7 days a week. It is ineffective and you need time to relax, reflect and decompress from the changes you are going through. You also need to time to exercise and start getting physically fit as well as mentally fit.
To achieve this balance Siam Rehab is set on a 30 acre former resort with all the facilities you would expect. Huge dining area, basketball court, swimming pool, running track, official size muay thai boxing ring, yoga area, spinning classes, dedicated meditation room where you can go when needed, multiple group therapy and one to one rooms and many secluded places amount the tropical gardens to rest or read a book.

Detox in Thailand

Some people might need a drug detox as the first stage of their treatment. At Siam Rehab we have an addiction psychiatrist on staff who will advise and manage this process. Most time this can be done onsite as an outpatient under Dr. Mark’s care while you are taking part in the programme.

Affordable Drug Rehab in Thailand Programme

We understand that getting world class treatment for a drug addiction can be expensive and for many unachievable due to the costs. At Siam Rehab we have purposefully set our location in one of the lease expensive areas of the country. This allows us to be much more affordable then similar centres in the West, often you can do a full 12 week programme at Siam Rehab for less than the fees of a 4 week programme in America, the UK, or Australia. We are able to achieve this while keeping the quality second to none due to the overheads in the area being considerably less than what you are used to. Even when factoring the costs of airfare and travel.

Getting To Siam Rehab

Thailand is a major tourist centre with the ease of travel that comes with it. Bangkok is the air transportation hub of South East Asia with multiple daily flights from just about every major city in the world. Getting to Bangkok is your first leg of the journey an reasonably simple. Once you arrive in Bangkok you will not need to change airports to Chiang Rai, just walk from the international to the domestic end to board you flight to Chiang Rai which is only a 1 hour and 15 minute flight.

When you arrive at CEI, Chiang Rai airport depending on your flight you might need to clear immigration if you haven’t already in Bangkok. We will be waiting outside the baggage area to pick you up and take you to the centre.

Ice Addiction in Australia

Ice Addiction in Australia

Ice addiction among Australians is reaching epidemic proportions and taking a devastating toll on its users, as well as their families and communities. The need for ice addiction treatment and rehab facilities is urgent, and law enforcement and health agencies are struggling to meet the demand for resources to cope with the crisis.

More Treatment Options and Less Stigma Could Ease Australia’s Ice Epidemic

Ice addiction among Australians is reaching epidemic proportions and taking a devastating toll on its users, as well as their families and communities. The need for ice addiction treatment and rehab facilities is urgent, and law enforcement and health agencies are struggling to meet the demand for resources to cope with the crisis.

Ice’s Devastating Impact on Australian Society

The Guardian recently reported that ice is the most-consumed illicit drug in Australia, with over 8 tonnes ingested between August 2016 and August 2017: more than all other hard drugs combined. Commonwealth-funded task force Cracks in the Ice reports that one in 70 Australians has used methamphetamines in the past year, and 6.3 percent of Australians over the age of 14 have used the drug in their lifetime. Ice is quickly becoming the drug of choice for habitual meth users, with a 7 percent increase from 2016 to 2017 in those who reported it as their drug of choice.

Children as young as 13 are using ice, falling victim to intergenerational drug use. And the damage that ice causes to small communities is clearly illustrated in remote areas of Australia where illegal drugs were once uncommon – in recent years, methamphetamine use in small Australian communities has climbed to 2.5 times that of large cities.

Rural Victoria’s ice problem is an example of how the drug has torn communities apart: ABC reports that ten years ago, Victoria police reported just 135 ice possession busts; that number has climbed to 6,000 this past year. Relatives of addicts are afraid to leave their houses, and those who attempt to address the problem by setting up treatment facilities are the object of anger for attracting addicts to their small towns.

But the stigma around ice use is a barrier that prevents addicts from seeking addiction treatment in Australia. In addition to packed facilities, people struggling with addiction must contend with societal attitudes that label them as weak, lazy and bad people who don’t deserve compassion. Ice addicts in Australia wait an average of ten years to get help. During that decade, they struggle through their daily tasks, which puts all Australians at risk. A recent study by SafeWorks Laboratories found that 240,000 workers in Australia attended work high on ice in 2017, some of whom work in safety-sensitive fields. Workers interviewed recall smoking ice on breaks to stay awake and trying to hide symptoms like paranoia and a lack of concentration.

How Did We Get Here?

The spread of ice in Australia has been fuelled by geopolitical and national factors. Drug distribution routes are becoming increasingly global in nature, and most ice on today’s Australian market originates in China, where it’s manufactured on a large scale and shipped through other Asia-Pacific countries. To a lesser extent, it’s also manufactured in clandestine laboratories known as “clan labs” domestically by motorcycle gangs and other criminal networks, then distributed to remote communities via Australia’s large network of deserted roads, which have earned the name “ice highways.” As such, regional communities seem to be the hardest hit – evidenced by the fact that rates of ice abuse in Western Australia are higher than the national average.

Australia’s History of Methamphetamine Addiction

Meth has been around in various forms since 1893, and was used widely by German forces in World War II to promote wakefulness and productivity. Pills containing methamphetamine were popular in the 1950s and 1960s to aid in weight control and depression, but due to its addictive properties, it’s now a controlled substance in many countries. Only one major pharmaceutical drug containing methamphetamine (Desoxyn) is currently manufactured; it’s used to treat ADHD and obesity.

Ice, also known as crystal meth, was first produced in the late 1970s. Because it’s easy and cheap to produce, criminal organizations increasingly chose to manufacture crystal meth in the 1980s, and production has only increased since. And though meth is easy to produce, because of its combination of highly volatile chemicals, meth labs are at a high risk of exploding. Street meth is particularly dangerous for drug users because the chemicals it contains vary widely, making it impossible to reliably measure its purity and strength.

The Cruel Cycle of Meth Abuse

Meth is most often heated up and smoked using a pipe, but it can also be snorted, injected, or taken in pill form. It provides a quick rush followed by an intense high, but its effects fade within four to 16 hours. Meth users will often binge on the drug, using it continuously for up to 16 days, until they no longer get a rush from the doses.

When users have binged to the point of no longer being able to experience a high, they will enter a phase called “tweaking.” During the tweaking phase, users feel empty and lose their sense of self. They perceive things that aren’t there, including bugs under their skin, which leads to uncontrollable scratching and self-mutilation. Users in this phase are often in a psychotic state characterized by sleeplessness and aggression.

After tweaking (which can last for days), users crash and become immobile. They enter into a deep sleep and wake up days later in the grips of a severe hangover. Exhaustion, dehydration and the need to relieve the symptoms in any way possible often lead to another meth binge.

If someone who has formed a dependency stops using, meth withdrawals will begin to set in. Withdrawal symptoms include intense cravings, the inability to experience pleasure and suicidal thoughts. Needless to say, this process is agonizing, which is why many habitual users turn to using again to relieve their pain. Meth addiction is an extremely difficult cycle to break, characterised by painful episodes that further incite the addict to continue using.

Short- and Long-Term Effects of Meth Use

Physiologically, a meth high results in rapid heart rate, loss of appetite, increased blood pressure, overheating, twitching and dilated pupils. Meth users experience an immediate rush upon consuming the drug. A person who is high on meth will feel more confident, powerful and energetic as dopamine floods the pleasure centres of their brain. Some users feel intense euphoria, while others are removed from their emotions.

A person who is high on meth often believes that they are smarter or more productive than others, which leads to aggressive and argumentative behaviour. Meth users can become paranoid and distance themselves from friends and family for long periods of time. While the behavioural effects of meth ultimately depend on the individual, most addicts in the throes of a high lose their grasp on reality and become unaware of how others perceive them.

The mid- to long-term effects of meth use are harrowing. Common signs that a loved one’s meth addiction is spiralling out of control include “meth sores” from picking at imaginary bugs on the skin, rapid weight loss, tooth decay, erratic sleeping patterns and hygiene and personal care issues. Meth use also makes mental health conditions like depression and anxiety much worse, and suicidal impulses among active and recovering meth users are common.

Prolonged meth use causes visible aging, and this process is mirrored within the body. Common ailments among heavy meth users include disease of the brain, heart or lungs; damaged blood vessels and permanent psychological impairment. Additionally, meth users are at risk of contracting HIV and Hepatitis B or C because of the risky behaviours meth fuels.

Long-time meth use also results in financial instability as addicts lose their jobs and attempt to procure the drug by any means necessary, including selling possessions or performing sex work. Some users will even offer up their houses as meth labs in a pinch, which makes homes permanently inhabitable and could result in deadly explosions.

Ice Overdose is a Constant Concern

In addition to all the shattering effects of meth abuse, addicts are also at a high risk of overdose. Because meth is made by many different suppliers using different materials, potency can vary, so users are never quite sure what they’re getting. The most common cause of death in relation to a meth overdose is heat stroke, causing organs to fail. Heart attack and strokes are also significant risks, as is liver failure and haemorrhage.

There is no pharmaceutical antidote, so the best thing to do is to call 911 if you suspect an overdose. Common signs to looks for include seizures, paranoia, trouble breathing, loss of consciousness, agitation and chest pain. If you or a loved one is experiencing these symptoms, seek emergency care immediately.

How Can Ice Addiction be Effectively Treated?

Perhaps the most heartbreaking part of ice addiction is the intense stigma that surrounds it. More public awareness campaigns are needed to change societal attitudes, and addicts need to know that there is no shame in seeking treatment.

Addiction is an incredibly isolating experience, which is why inpatient treatment for ice addicts has shown the best record of success. With inpatient treatment, those struggling with addiction can find a supportive community with other recovering addicts, and discuss their experiences in a safe space.

Cognitive behavioural therapy (CBT) is an evidence-based method of treatment for ice addiction. CBT helps patients learn to replace negative thought patterns with positive behaviours and coping strategies, and identify the source of their negative beliefs.

Getting the Help You Need

If your loved one is coping with an ice addiction, the most important thing you can do is encourage them to seek treatment. In some cases, you can consider arranging an assisted intervention. A counsellor can meet with your family and then speak with the addict, attempting to get them to agree to treatment. Regardless of the level of involvement you choose to have with your addicted loved one, it’s important that you take care of yourself and your family by consistently attending counselling. All too often, an addict’s inner circle becomes depleted in the process of dealing with the situation, which helps no one.

If you’re struggling with addiction and you’re ready to get help, Siam Rehab’s beautiful facility in Thailand offers a safe space where you can get back on the right track. We offer one-on-one and group counselling, mindfulness meditation and assisted detox, all in a supportive, nonjudgmental environment. Our amenities include a fitness centre, pools and nutritious, chef-cooked meals to nourish you back to health.

If you’re ready to take action to address your ice addiction, the first step is just a phone call away – contact us today to find out how we can help.

Drug and Alcohol Rehab for Couples

Drug and Alcohol Rehab for Couples

Couples have a hard time finding addiction treatment that they can attend together. Siam Rehab is one of the very few addiction treatment centres in the world willing to accept couples that are both having issues with drug or alcohol addiction.

Drug and Alcohol Rehab for Couples

Couples have a hard time finding addiction treatment that they can attend together. Siam Rehab is one of the very few addiction treatment centres in the world willing to accept couples that are both having issues with drug or alcohol addiction.

Benefits of Attending Couples Rehab for Addiction

  • If both partners are struggling with addiction and only one gets help this puts the newly sober partner at extreme risk if he or she returns to the same situation with a partner that is still struggling with their addiction.
  • Entering rehab together at the same time allows for coupes therapy to take place while the addiction is also being treated.
  • Being honest in rehab is important, it is harder to hide behind wrong beliefs and half truths when someone who knows you that well is sitting there.
  • Attending rehab together can help you form a deeper connection as well as knowing what you both went through makes it easier to understand and support each other.
  • By attending rehab together you will not only learn about your own addiction and triggers you will learn about your partners triggers and be able to better take measure to avoid the triggers and situations for both of you.
  • A positive relationship can be a strong motivating factor to stay clean and sober.
  • When attending rehab together the couples motivation is continuously reinforced by the couples commitment to one another.
  • Substance abuse makes it difficult to go back to the way things were before treatment and if only one partner went through treatment they won’t understand the changes that need to take place.
  • When couples are in recovery together they can be a great source of support and motivation for each other. For example you don’t feel like going to a meeting tonight? But your partner can insist that you come along.

When Attending Rehab together is not a Good Idea

  • If there I continuous domestic abuse then partners should not attend rehab together.
  • When one of the partners has special needs that can no be addressed at the chosen centre.
  • Only one partner is interested in getting and staying clean.
  • If you don’t plan on continuing the relationship after rehab then you probably should go alone.

Couples in Rehab Together

Siam Rehab is in a unique position to offer rehab for couples since the size of our facility allows couples their own space as well as we put couples in separate groups for part of the programme. When attending rehab often times the issues at home that the other partner is dealing with can cause a partner to discharge early. When the couple is in drug rehab together they are better suited to deal with domestic issues and problems at home together.

Conditions for being Accepted into Couples Rehab

  • Siam Rehab will accept couples when both are highly motivated to end their substance abuse and live a clean and sober life.
  • We will only accept couples that have a strong relationship and intend to continue the relationship after rehab.
  • We will not accept couples when there is ongoing domestic abuse or when one is only doing it for the partner.
  • You have to both want to get clean. We will only accept couples in a committed relationship, ie: if it is your girl/boyfriend of 2 months then we will not accept you as a couple

Coming to Couples Rehab

The initial step in coming to rehab as a couple at Siam Rehab is you will both need to fill in the admissions form separately that you can find here. You will also both need to speak to the intake coordinator privately and together.

From most places in the world it is not difficult to get to Siam Rehab in Thailand. Located in Chiang Rai we are serviced by regular flights mostly connecting in Bangkok. The centre is in a beautiful mountain valley with no temptations around. Call now to find out more about Siam Rehab’s couples rehab programme.