Week 6 Discussion: Addiction

Chapter Eleven: Chemical Dependency: The Crisis of Addiction

Background  Long history of attempting to treat substance abuse.  Whole economies have been founded on drug use.

 Alcohol and tobacco in the United States  Volstead Act and ratification of the 18th Amendment  21st Amendment  Economic gains and burdens

 Prevalence  Controlled use

 Is this a reality for an abuser or an addict?

Sociocultural Determinants of Substance Abuse

 Set vs. setting  Alcohol and drugs have culturally specific:

 Rules  Sanctions  Prohibitions  Admonitions  Permissions

 Although there are cultural implications, do not stereotype!

Alcohol: Number One Abused Substance

 Duration  Legality  Widespread use  Indirect financial costs  Psychological costs  Physical costs  Links to crime  Implication in accidents  Suicide  Alcohol IS a drug  Interpersonal relationships  Polyuse  Embroilment in controversy

Models of Addiction  Behavioral Learning Model  Biopsychosocial Models  Cognitive Models  Disease Model  Final Common Pathway  Gateway Model  Genetic Predisposition Model  Lifestyle Model  Moral Model  Parental Influence Model

Models of Addiction Cont.  Peer-Cluster Model  Personality Model  Prescriptive Model  Problem Behavior Model  Psychoanalytic Model  Psychosocial Model  Sanctioned-Use Model  Sociocultural Models  Stress-Coping Model

Definitions of Commonly Used Terms  Abuse

 Chronic, recurrent misuse of chemicals.  One or more of the following occur in a maladaptive pattern during a 12 month

period:  Failure to fulfill major role obligations (work, school, or family)  Physical impairment that creates a hazard  Recurrent legal or social problems

 Addiction  Physical reactions include the development of tolerance and withdrawal.  Psychologically, it is the compulsion to use drugs regardless of the negative

consequences.  Progressive, potentially fatal, and marked by preoccupation with chemical use.

 Addictive behavior  Preferred by many in the field because it focuses on behavior.  Is used to describe a broad spectrum of problematic compulsions.

 Alcoholism  Addiction to alcohol.

Definitions of Commonly Used Terms Cont.  Chemical dependent

 Addiction to drugs.

 Codependent  Reciprocal dependency of the addict in need of care and a caretaker’s need to

control the addict’s behavior.

 Dependence  Cognitive, behavioral, and physiological symptoms indicating that the

individual continues to use the substance despite significant chemical-related problems.

 Drug  Psychoactive substance that has a direct and significant impact on the processes

of the mind with respect to thinking, feeling, and acting.

 Enabler  A person who allows the addict to continue the addiction rather than suffering

the full extent of the substance-related consequences.

Definitions of Commonly Used Terms Cont.  Habituation

 Degree to which one is accustomed to taking a certain drug.

 Misuse  Use of a substance with some adverse physical, psychological, social, or legal

consequence.

 Relapse/Slip  Use of a substance after a period of abstinence.

 Tolerance  When more of a substance is needed to achieve the same effect.

 Use  The intake of a chemical substance with the intent of altering one’s state of

consciousness.

 Withdrawal  Physical and psychological symptoms as a result of the reduction or cessation of a

drug.

Defense Mechanisms  Denial  Displacement  Fantasy  Projection  Rationalization  Intellectualization  Minimizing  Reaction formation  Regression  Repression

Enabling and Codependency  Suppression  Dissociation  Repression  Escape to therapy  Intellectualization  Displacement  Reaction formation  Passive aggression  Hypochondriasis

Children in Alcoholic Families  Personality Roles

 The Scapegoat  The Hero  The Lost Child  The Family Mascot

 Family Rules in Alcoholic Families  Do not talk/do not have problems  Do not trust  Do not feel  Do not behave differently  Do not blame chemical dependency  Do behave as I want  Do be better and more responsible  Do not have fun

Adult Children of Alcoholics (ACOA)  Facts

 Addiction has a genetic component  Addictive behavior can be learned  ACOA’s tend to marry addicts

 Emotional issues  Trust  Dependency  Control  Guilt  Identification and expression of feelings

 Effects of childhood roles  Adaptive roles from childhood follow them into adulthood

Treatment Approaches  Alcoholics Anonymous (AA)  Cognitive-Behavioral Therapy (CBT)  Inpatient Treatment: The Minnesota Model  Outpatient Programs  Contingency Management (CM)  Community Reinforcement Approach (CRA)  Reinforcement-Based Treatment (RBT)  Inpatient vs. Outpatient  Contemporary Model

Intervention Strategies  Motivation and Stages of Change

 Precontemplation  Contemplation  Determination/Preparation  Action  Maintenance  Termination  Motivational Interviewing

Assessment  Personality Inventories  Direct Measures  Parsimony  Computer-Administered Direct Measures  The Problem Is . . .  Motivation to Change  Intake Assessment  Assessment of Spirituality  Triage Assessment  Diagnostic Intake

Detoxification  Can be a serious medical process  Addict may be given small, controlled amount of the

addicted substance to reduce severe symptoms  Common symptoms

 Delirium Tremens (DTs)  Somatic complaints  Excessive sleep  Mood swings

 Detoxification without treatment is nearly always futile.

Principles of Treatment  Treatment Techniques  Treatment Goals  Treatment Protocol  Individual Therapy  The Treatment Group  Learning Relationship Skills  Accepting Responsibility  Getting Past Denial  Confrontation

Principles of Treatment Cont.  Limit Testing  Treatment Secrets  Disrupting Irrational Mental Sets  Overcoming Environmental Cues That Lead to Drinking  Treating the Family

 Family Therapy Session  Therapy for the Children

 Aftercare and Relapse Prevention  Cognitive-Behavioral Boosters  Pharmacology

 Euphoria  AA's Role in Aftercare