Moral / Temperance Model*Addiction as Sin or Crime Personal Irresponsibility Disease Model *Genetic and Biological Factors ** 12-Step Framework; Abstinence Education as Treatment Behavioral and Cognitive- Conditioning and Reinforcement Behavioral Models * Social Learning and Modeling Drug Expectancies and other Cognitive Factors / RP Family ModelsFamily Disease Family Systems Behavioral Marital/Family Tx Psychological / PsychoanalyticDisordered /Addictive Personalities Sociocultural ModelsCultural Factors Socioeconomics/ Social Policy Drug Subcultures Public Health ModelAgent, Host, Environment Interactions THE BIOPSYCHOSOCIAL MODEL:AN INTEGRATION MODELS OF ADDICTION: A SUMMARY Moral / Temperance ModelAddiction as Sin or Crime Personal Irresponsibility Disease Model Genetic and Biological Factors 12-Step Framework; Abstinence, Education as Treatment Psychological / PsychoanalyticDisordered /Addictive Personalities Behavioral and Cognitive-Conditioning and Behavioral Models Reinforcement Social Learning / Modeling Drug Expectancies and other Cognitive Factors / RP Family ModelsFamily Disease Family Systems Behavioral Marital/Family Therapy Sociocultural ModelsCultural Factors Socioeconomic Factors Drug Subcultures Social Policy (e.g., drug control) Public Health ModelInteractions between Agent Host Environment THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION MODELS OF ADDICTION: A SUMMARY

Psychological / PsychoanalyticDisordered /Addictive Personality Sociocultural ModelsCultural Factors Socioeconomics/ Social Policy Drug Subcultures Public Health ModelAgent, Host, Environment Interactions THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION MODELS OF ADDICTION: A SUMMARY

MODELS OF ADDICTION Assumptions of Disease Model addiction seen as a “primary” disease process alcoholics qualitatively different from non alcoholics: can’t drink in moderation central symptom of addiction is loss of control (e.g., one drink, one drunk) addiction is chronic and progressive; no cure, can only be arrested with total abstinence (e.g. progression models - Johnson…learning & seeking the mood swing; harmful dependence; drinking to feel normal)

Early identification Education about diagnosis Acceptance of disease and overcoming “denial” Abstinence 12-steps essential for real recovery Disease Model - Treatment

12 Steps of Alcoholics Anonymous 1. We admitted we were powerless over alcohol - that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

12 Steps of AA (con’t) 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take moral inventory and when we were wrong promptly admitted to it.

12 Steps of AA (con’t) 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

CRITIQUE OF DISEASE MODEL Strengths -perception shift: from sin to TX -eases guilt, self-blame -disease is a good metaphor that fits the experience - 12-step support and framework works for many (prevalence of meetings; 24-hour support…) -Other strengths? _______________________

Adoption study of Goodwin 18% probands alcoholic vs. 5% controls Twin Studies male vs. female twin pairs Metabolic Studies P3 Wave Studies Disease Model - Research Support

CRITIQUE OF DISEASE MODEL Limitations -Assumptions not all data-based addiction as “primary” loss of control chronic / progressive alcoholics qualitatively different -Dichotomous thinking dangerous; no middle ground (you’re an alcoholic or not) - Loss of control and responsibility paradox - Other flaws? ___________________

SUBSTANCE USE DISORDERS GENERAL METHODS OF TREATMENT Inpatient Detoxification and Rehabilitation Outpatient Individual, Couple, or Family Counseling Self-help Groups (Alcoholics Anonymous; NA, CA, OA, GA, Al-Anon etc.) Residential Facilities & Therapeutic Communities Medications

4 sessions in 12 weeks Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking Mobilize the person’s own commitment and motivation to change MET (Motivational Enhancement Therapy) 12 weekly sessions Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings Acceptance of the disease of alcoholism and loss of control over drinking TSF (Twelve Step Facilitation) 12 weekly sessions Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse Learn skills to achieve and maintain sobriety CBT (Cognitive Behavioral Therapy) FrequencyDescription Goal of Treatment Type of Treatment Project MATCH Treatment Conditions – Modalities You Will Learn