Chapters One and Two: What is addiction & The role of the counselor

Resources https://www.drugabuse.gov/ http://www.naadac.org/ http://www.samhsa.gov/ http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf http://www.mass.gov/eohhs/gov/departments/dph/stop-addiction/current-statistics.html

Article/ video on stigma https://www.youtube.com/watch?v=IOblxl-8uF4

Chapter 2: Models of Addiction

Be careful in labeling. Take our role as professionals in the field seriously and remember impact of statements/ labels we make. Habit of seeing all using behavior as addicts. Language has changed in label and diagnoses. Habit of calling someone with a mental health or SUD by their diagnoses. IE: he’s an addict. She’s a boderline. Vs. medical field. We don’t say: “she’s a cancer” Language is changing. The DSM has moved away from substance abuse/ dependence to substance use disorder. Labels come from our biases- either good or bad. “I’m an addict” – good or bad Biases lead to lack of objectivity.

Evidence-Based diagnostic strategies and tools Various tools to help us be objective: IE: meet measurable criteria

DSM Changes from IV to 5: Encourages multiple diagnostic categories Substance Use Disorder Now speaks to a pattern of maladaptive use Craving has been added Gambling Disorder Was previously “pathological gambling” to change the stigma First acknowledgement of behavioral addiction

Substance Use Disorder Use results in significant distress or impaired functioning Physical, mental, occupational, legal, interpersonal Substance Intoxication Anyone can become intoxicated All drugs but nicotine have ability to intoxicate Substance Withdrawal Collection of symptoms that develops with the discontinuance of a substance

Substance Use Disorder- Use results in significant distress or impaired functioning Physical, mental, occupational, legal, interpersonal Substance Intoxication- acute condition from overuse of a substance causing physical, behavioral and mental impairment. IE: skills needed for driving are impaired. Anyone can become intoxicated All drugs but nicotine have ability to intoxicate Substance Withdrawal- the body’s reaction to being without the substance; withdrawal causes the body to have an opposite drug experience. IE: 1) when you stop using a stimulant- you feel depressed. 2) when you stop using a depressant, you feel more agitated. IE: withdrawal from heroin includes restless legs, muscle spasms

Levels of Use- chapter 1 Abstinence- no use Light or Moderate Use- less than 14 drinks per week At-Risk Use- 5 or more binges per month Abuse- use negatively effects your life, but not physically addicted Substance-Dependence - meets criteria for use impacting more than one area of your life and has a physical component. Hallmark is tolerance and withdrawal

We must first use an objective diagnosis or measure: What is addiction? NIH, 2014 “a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain’s structure and how it works. The changes can be long-lasting and can lead to harmful behaviors The definition or label of addiction has evolved over time.

The history of defining alcohol/ drug problems = affects how we treat it http://www.williamwhitepapers.com/pr/AddictionTreatment%26RecoveryInAmerica.pdf Socrates time were drawn by nose ring by horse around the city Prohibition AA/12 Traditions (self-help) Alcoholism as a “Disease”

Since the beginning of civilization, the treatment for people with a mental illness and addiction has been bizarre, cruel, and even deadly. These unfortunate souls were often treated as if they were possessed or even inhuman. Here are some very interesting tactics that physicians have used throughout history Tx included; spells, potions, opening the skull, electricity, asylums, imprisonment, prayer

Models of addiction come from political and social influences how we conceptualize the disease influences how we treat it (ie: disease vs. punishment vs. rehabilitation) our conceptualization or models of addiction have evolved over time (ie: from prohibition & incarceration to legalizing marijuana) Our attitudes can affect thoughts and responses. Ie: how many detoxes are too much? (ie: norcap from detox) Is someone sober if they take MAT? (ie: gavin house), insurance co’s don’t accept it as as a “relapsing “ disease.,

Moral Model 1st model of alcoholism Emphasize personal choice as the root cause Use is viewed as willful and purposeful breaking of social rules Alcoholic viewed as having a personal choice 1988 US supreme court decided alcoholism was “willful misconduct” and not a disease

Temperance Model Emphasized the moderate use of alcohol The cause of the problem was the substance itself (ie: prohibition- outlawed the substance) However, those with the problem continued to find ways to use

Characterological Model Attributes the cause of alcoholism to personality disturbances The assumption is that alcoholics are persons with certain personality traits that requires personality restructuring for a cure Treatment is psychotherapy aimed at resolved unconscious conflicts. Parts of 12-step program

Conditioning Model Based on the belief that problems with drinking are simply learned habits People learn to drink for either the rewarding factors (ie: relieve stress, or disinhibit) or the behavior is reinforced (peer pressure) Operant or Classic conditioning (negatively or positively reinforced Mistake is that behavior can Be learned or unlearned

Social Learning Model Theorists believe addictive behaviors are caused by modeling, expectancies, and lack of coping skills (environment) people use drugs from observing parents or peers in the community Skill training is a major component of recovery Philosophy of 12 step new learned behaviors

Neurobiology Model Cause is genetic (heredity) and physiological Addiction is a brain disease as a result of neurobiological mechanisms Research science documents structural changes in the brain as a result of chemical exposure MAT has evolved as a result