1. Chapter Eleven: Chemical Dependency: The Crisis of Addiction

2. 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?

3. 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!

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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.

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

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

12. 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

13. 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

14. 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

15. Intervention Strategies
Motivation and Stages of Change
Precontemplation
Contemplation
Determination/Preparation
Action
Maintenance
Termination
Motivational Interviewing

16. 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

17. 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.

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

19. 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