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

2. Costs Long history of attempting to treat substance abuse.
Whole economies have been founded on drug use.
Big business for legal and illegal drugs
Big business for drug-related medical care
Lost productivity
Murders, fractured families, suicide
Insurance, property crime, law enforcement
Treatment

3. Prevalence in US 10% of those who drink, consume 50% of the alcohol
16M people who are heavy drinkers
55M binge drinkers (5 or more drinks at one setting)
18.7M who need treatment for alcohol use
22M who need treatment for legal and illegal drugs
71.5 M Tobacco use
Controlled use
Is this a reality for an abuser or an addict?

4. Prevalence in US Drug-abusing behavior in 15-54 year age group
1 in 13 will become dependent on controlled substance
1 in 6 will become dependent on alcohol

5. Sociocultural Determinants of Substance Abuse
Set vs. setting - have a great effect on the behavior of the drug used
Set = the mental and emotional state of the user
- including expectations, intelligence, personality, feelings, and so on
Setting = the social and physical environment of the user at the time of use
-immediate surrounding, such as a living room, bar, legal and religious perspective

6. Sociocultural Determinants of Substance Abuse
Alcohol and drugs have culturally specific:
Rules
Sanctions
Prohibitions
Admonitions
Permissions
Although there are cultural implications, do not stereotype!

7. Alcohol: Number One Abused Substance
Duration (longevity, legacy, and history)
Legality (limited conditions for jail)
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 (physical or mental disease?)

8. 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

9. 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

10. Definitions of Commonly Used Terms (Pg. 354-356)
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.

11. 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.

12. 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.

13. Defense Mechanisms (pg. 356-357)
Denial - (refuse to acknowledge)
Displacement - (venting toward another)
Fantasy - Escape
Projection - (Attribute motives to others)
Rationalization (Excuses)
Intellectualization (impersonalization)
Minimizing (Play down the seriousness)
Reaction formation (defense against perceived threat)
Regression (reverting back)
Repression (burying in unconscious)

14. Enabling and Codependency
Enabling - has to do with one's behavior toward a chemical dependent.
Codependency - has to do with one's relationship to the chemical dependent

15. Enabling and Codependency
Suppression (stiff upper lip)
Dissociation (distancing)
Repression (bury in unconscious memory)
Escape to therapy (catharsis, but no change)
Intellectualization (distance with details/control)
Displacement (moving feelings elsewhere)
Reaction formation (taking over for the addict)
Passive aggression (covert behavior)
Hypochondriasis (converts anger into physical complaints)

16. Children in Alcoholic Families
Personality Roles
The Scapegoat (acting out child)
The Hero (the little adult)
The Lost Child (adjusts without feelings)
The Family Mascot (placates and comforts everyone)
Family Rules in Alcoholic Families - that children have to adopt to survive)
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

17. 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
(heroes, lost child, placaters, family mascots, acting-out)

18. Treatment Approaches Alcoholics Anonymous (AA) (pg. 365 - 12 Steps)
Cognitive-Behavioral Therapy (CBT) (Stinking-thinking)
Inpatient Treatment: The Minnesota Model (28 days)
Outpatient Programs (1-2 times per week, with much criticism)
Contingency Management (CM) (reward/reinforcement based)

19. Intervention Strategies
Motivation and Stages of Change
Precontemplation (using but seen as a problem)
Contemplation (using but thinking about it)
Determination/Preparation (quit in the future)
Action (taking active steps/treatment)
Maintenance - about 6 months (behavior change with continued work)
Termination - about 5 years (cognitive and emotional changes, support system in place)

20. Assessment Personality Inventories Direct Measures
Parsimony (simple questions)
Computer-Administered Direct Measures
The Problem Is (double what ever the person self reports)
Motivation to Change (instruments)
Intake Assessment
Assessment of Spirituality
Triage Assessment (seek collateral info. and assume deception)
Diagnostic Intake (formal clinical assessment)

21. 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.

22. Principles of Treatment
Treatment Techniques (solution-focused, 12 step, cognitive behavioral, reinforcement based, rational-emotive behavioral)
Treatment Goals (actions)
Treatment Protocol (schedule in activities)
Individual Therapy
The Treatment Group
Learning Relationship Skills
Accepting Responsibility ("what part did you play")
Getting Past Denial (1. presence and magnitude, 2. life problems)
Confrontation (potent, but dangerous)

23. Principles of Treatment Cont.
Overcoming Environmental Cues That Lead to Drinking (playmates and playgrounds)
Treating the Family
Family Therapy Session
Therapy for the Children
Aftercare and Relapse Prevention
Cognitive-Behavioral Boosters (statements, messages)
Pharmacology
Euphoria (over kill)
AA's Role in Aftercare