Chapter Eleven:Chemical Dependency:TheCrisis ofAddiction
Background
Long history of attempting to treat substance abuse.Whole economies have been founded on drug use.Alcohol and tobacco in the United StatesVolstead Act and ratification of the 18thAmendment21stAmendmentEconomic gains and burdensPrevalenceControlled useIs this a reality for an abuser or an addict?
Sociocultural Determinants of SubstanceAbuse
Set vs. settingAlcohol and drugs have culturally specific:RulesSanctionsProhibitionsAdmonitionsPermissionsAlthough there are cultural implications, do not stereotype!
Alcohol: Number One AbusedSubstance
DurationLegalityWidespread useIndirect financial costsPsychological costsPhysical costsLinks to crimeImplication in accidentsSuicideAlcoholISa drugInterpersonal relationshipsPolyuseEmbroilment in controversy
Models ofAddiction
Behavioral Learning ModelBiopsychosocialModelsCognitive ModelsDisease ModelFinal Common PathwayGateway ModelGenetic Predisposition ModelLifestyle ModelMoral ModelParental Influence Model
Models ofAddiction Cont.
Peer-Cluster ModelPersonality ModelPrescriptive ModelProblem Behavior ModelPsychoanalytic ModelPsychosocial ModelSanctioned-Use ModelSociocultural ModelsStress-Coping Model
Definitions of Commonly UsedTerms
AbuseChronic, 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 hazardRecurrent legal or social problemsAddictionPhysical 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 chemicaluse.Addictive behaviorPreferred by many in the field because it focuses onbehavior.Is used to describe a broad spectrum of problematiccompulsions.AlcoholismAddiction toalcohol.
Definitions of Commonly UsedTerms Cont.
Chemical dependentAddiction todrugs.CodependentReciprocal dependency of the addict in need of care and a caretaker’s need to control the addict’sbehavior.DependenceCognitive, behavioral, and physiological symptoms indicating that the individual continues to use the substance despite significant chemical-related problems.DrugPsychoactive substance that has a direct and significant impact on the processes of the mind with respect to thinking, feeling, and acting.EnablerA person who allows the addict to continue the addiction rather than suffering the full extent of the substance-related consequences.
Definitions of Commonly Used Terms Cont.
HabituationDegree to which one is accustomed to taking a certain drug.MisuseUse of a substance with some adverse physical, psychological, social, or legal consequence.Relapse/SlipUse of a substance after a period ofabstinence.ToleranceWhen more of a substance is needed to achieve the sameeffect.UseThe intake of a chemical substance with the intent of altering one’s state ofconsciousness.WithdrawalPhysical and psychological symptoms as a result of the reduction or cessation of adrug.
Defense Mechanisms
DenialDisplacementFantasyProjectionRationalizationIntellectualizationMinimizingReaction formationRegressionRepression
Enabling and Codependency
SuppressionDissociationRepressionEscape to therapyIntellectualizationDisplacementReaction formationPassive aggressionHypochondriasis
Children in AlcoholicFamilies
Personality RolesTheScapegoatTheHeroTheLost ChildTheFamily MascotFamily Rules in Alcoholic FamiliesDo not talk/do not have problemsDo nottrustDo not feelDo not behavedifferentlyDo notblamechemical dependencyDo behave asIwantDo bebetterandmoreresponsibleDo nothave fun
Adult Children ofAlcoholics (ACOA)
FactsAddiction has a genetic componentAddictive behavior can be learnedACOA’s tend to marry addictsEmotional issuesTrustDependencyControlGuiltIdentification and expression of feelingsEffectsof childhood rolesAdaptive roles from childhood follow them intoadulthood
TreatmentApproaches
Alcoholics Anonymous (AA)Cognitive-Behavioral Therapy (CBT)Inpatient Treatment: The Minnesota ModelOutpatient ProgramsContingency Management (CM)Community Reinforcement Approach (CRA)Reinforcement-Based Treatment (RBT)Inpatientvs. OutpatientContemporary Model
InterventionStrategies
Motivation and Stages of ChangePrecontemplationContemplationDetermination/PreparationActionMaintenanceTerminationMotivationalInterviewing
Assessment
Personality InventoriesDirectMeasuresParsimonyComputer-AdministeredDirect MeasuresTheProblem Is . . .Motivationto ChangeIntakeAssessmentAssessmentof SpiritualityTriageAssessmentDiagnosticIntake
Detoxification
Can be a serious medical processAddict may be given small, controlled amount of the addicted substance to reduce severe symptomsCommon symptomsDelirium Tremens (DTs)Somatic complaintsExcessive sleepMood swingsDetoxification without treatment is nearly always futile.
Principles ofTreatment
Treatment TechniquesTreatment GoalsTreatment ProtocolIndividual TherapyThe Treatment GroupLearning Relationship SkillsAccepting ResponsibilityGetting Past DenialConfrontation
Principles ofTreatment Cont.
Limit TestingTreatment SecretsDisrupting Irrational Mental SetsOvercoming Environmental Cues That Lead to DrinkingTreating the FamilyFamily Therapy SessionTherapy for the ChildrenAftercare and Relapse PreventionCognitive-Behavioral BoostersPharmacologyEuphoriaAA's Role in Aftercare
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