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

2. Resources https://www.drugabuse.gov/ http://www.naadac.org/

3. Article/ video on stigma

4. Chapter 2: Models of Addiction

5. 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.

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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. The history of defining alcohol/ drug problems = affects how we treat it
Socrates time were drawn by nose ring by horse around the city
Prohibition
AA/12 Traditions (self-help)
Alcoholism as a “Disease”

13. 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

16. 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.,

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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