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