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Paul’s Story

Born 1971 – affluent area of Toronto
Had a nanny for his early years
Boarding school
Home for summer and Christmas vacations
One brother – Down syndrome

Vanellus Foto

visual.dichotomy

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Paul’s Story Continues

Large allowance
Started drinking alcohol in his senior year
Partied a lot and his grades suffered
Finished high school
Accepted to a university in Quebec
Started using marijuana and hashish during his 2^nd year
Cocaine and alcohol daily by 3^rd year
1993 - dropped out of university
Parents sent him to rehabilitation centres a number of times
Became estranged from his parents after failed rehab attempts

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Paul’s First Marriage

1999 – met his wife in a rehabilitation facility
Understood each other
Support for each other’s sobriety
2002 – they had twin girls
2008 – his wife left him
“Wake-up call”
2009 – joined Narcotics Anonymous
Remained estranged from his parents

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Paul’s Second Marriage

2010 – started dating Nancy
Working for a construction company
The physical work helped him stay “clean”
2012 – married a second time
2018 – work accident, fell 2 stories off scaffolding

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Paul’s Health

2018 – diagnosed with back ligament and muscle injury
Three torn discs – one quite large
Follow-up CT scan in 6 weeks
Due to substance abuse history, prescribed muscle relaxant & NSAID
Not receiving adequate pain management
Tylenol #3 prescribed only when absolutely necessary
Dispensing stipulation of 4 tablets each day

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Next Few Years

Often agitated, sweating, complaining of back pain
Self-medicating with alcohol and prescription drugs
Walk-in clinics and eventually from the streets
Long-term disability
Return to work program
Taking mother-in-law’s post-op medications
Denied having a “pill problem”
Stated he was feeling overwhelmed with everything going on in his life

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Back Muscle Anatomy

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Back Pain

When to see a doctor

Persists past a few weeks
Is severe and doesn't improve with rest
Spreads down one or both legs, especially if the pain extends

below the knee

Causes weakness, numbness or tingling in one or both legs
Is accompanied by unexplained weight loss
Causes new bowel or bladder problems
Is accompanied by a fever
Following a fall, blow to your back or other injury

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Causes of Back Pain

Muscle or ligament strain
Bulging or ruptured discs (leaking)
Arthritis
Osteoporosis

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Risk Factors for Back Injury

Age
Lack of exercise
Excessive weight
Diseases
Improper lifting
Psychological conditions (depression & anxiety will increase risk)
Smoking

https://www.ehstoday.com/health/article/21919213/niosh-releases-app-for-worker-safety-while-lifting

https://medicalxpress.com/news/2020-09-million-adults-overweight-obesity-benefit.html

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Prevention

Exercise
Build muscle strength & flexibility
Maintain a healthy weight
Quit smoking
Stand- sit- and lift smart

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What is drug addiction?

Initial decision to take drugs is voluntary.
Repeated drug use can lead to brain changes that challenge self-control & resist urges.
Addictive drugs provide a shortcut to the brain’s reward centre.
Repeated drug use overwhelms receptor cells.
The natural capacity to produce dopamine in the reward centre is reduced.
Addicts may require higher doses and quicker passage into the brain.

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The Brain’s Reward System

Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine.

The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.

The reward system may be more vulnerable, responses to stress more intense, or the formation of addictive habits quicker in some people, especially those suffering from depression, anxiety, or schizophrenia, and those with disorders like antisocial and borderline personality.

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Why?

Biology

Genes account for about half of a person’s risk for addiction
Gender, ethnicity, and presence of other mental disorders

Environment

Family & friends
Economic status & general quality of life
Peer pressure, physical & sexual abuse
Early exposure to drugs, stress, and parental guidance

Development

Genetic & environmental factors interact with critical developmental stages
The earlier drug use begins, the more likely to become addicted
Teens’ brains are still developing (decision-making, judgment, and self-control)

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Overcoming Drug Addiction

Recognize you have a problem

Decide to make a change

Committing to sobriety involves changing:

the way you deal with stress
who you allow in your life
what you do in your free time
how you think about yourself
the prescription and over-the-counter

medications you take

Treatment options:

Detoxification
Behavioural counseling
Medication
Long-term follow-up

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