Presentation on theme: "Chapter Eleven: Chemical Dependency: The Crisis of Addiction"— Presentation transcript:
1Chapter Eleven: Chemical Dependency: The Crisis of Addiction
2Costs Long history of attempting to treat substance abuse. Whole economies have been founded on drug use.Big business for legal and illegal drugsBig business for drug-related medical careLost productivityMurders, fractured families, suicideInsurance, property crime, law enforcementTreatment
3Prevalence in US 10% of those who drink, consume 50% of the alcohol 16M people who are heavy drinkers55M binge drinkers (5 or more drinks at one setting)18.7M who need treatment for alcohol use22M who need treatment for legal and illegal drugs71.5 M Tobacco useControlled useIs this a reality for an abuser or an addict?
4Prevalence in US Drug-abusing behavior in 15-54 year age group 1 in 13 will become dependent on controlled substance1 in 6 will become dependent on alcohol
5Sociocultural Determinants of Substance Abuse Set vs. setting - have a great effect on the behavior of the drug usedSet = the mental and emotional state of the user- including expectations, intelligence, personality, feelings, and so onSetting = 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
6Sociocultural Determinants of Substance Abuse Alcohol and drugs have culturally specific:RulesSanctionsProhibitionsAdmonitionsPermissionsAlthough there are cultural implications, do not stereotype!
7Alcohol: Number One Abused Substance Duration (longevity, legacy, and history)Legality (limited conditions for jail)Widespread useIndirect financial costsPsychological costsPhysical costsLinks to crimeImplication in accidentsSuicideAlcohol IS a drugInterpersonal relationshipsPolyuseEmbroilment in controversy (physical or mental disease?)
8Models of Addiction Behavioral Learning Model Biopsychosocial Models Cognitive ModelsDisease ModelFinal Common PathwayGateway ModelGenetic Predisposition ModelLifestyle ModelMoral ModelParental Influence Model
9Models of Addiction Cont. Peer-Cluster ModelPersonality ModelPrescriptive ModelProblem Behavior ModelPsychoanalytic ModelPsychosocial ModelSanctioned-Use ModelSociocultural ModelsStress-Coping Model
10Definitions of Commonly Used Terms (Pg. 354-356) 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 chemical use.Addictive behaviorPreferred by many in the field because it focuses on behavior.Is used to describe a broad spectrum of problematic compulsions.AlcoholismAddiction to alcohol.
11Definitions of Commonly Used Terms Cont. Chemical dependentAddiction to drugs.CodependentReciprocal dependency of the addict in need of care and a caretaker’s need to control the addict’s behavior.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.
12Definitions 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 of abstinence.ToleranceWhen more of a substance is needed to achieve the same effect.UseThe intake of a chemical substance with the intent of altering one’s state of consciousness.WithdrawalPhysical and psychological symptoms as a result of the reduction or cessation of a drug.
13Defense Mechanisms (pg. 356-357) Denial - (refuse to acknowledge)Displacement - (venting toward another)Fantasy - EscapeProjection - (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)
14Enabling 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
15Enabling 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)
16Children in Alcoholic Families Personality RolesThe 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 problemsDo not trustDo not feelDo not behave differentlyDo not blame chemical dependencyDo behave as I wantDo be better and more responsibleDo not have fun
17Adult Children of Alcoholics (ACOA) FactsAddiction has a genetic componentAddictive behavior can be learnedACOA’s tend to marry addictsEmotional issuesTrustDependencyControlGuiltIdentification and expression of feelingsEffects of childhood rolesAdaptive roles from childhood follow them into adulthood(heroes, lost child, placaters, family mascots, acting-out)
18Treatment 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)
19Intervention Strategies Motivation and Stages of ChangePrecontemplation (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)
20Assessment Personality Inventories Direct Measures Parsimony (simple questions)Computer-Administered Direct MeasuresThe Problem Is (double what ever the person self reports)Motivation to Change (instruments)Intake AssessmentAssessment of SpiritualityTriage Assessment (seek collateral info. and assume deception)Diagnostic Intake (formal clinical assessment)
21Detoxification Can be a serious medical process Addict 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.
22Principles of Treatment Treatment Techniques (solution-focused, 12 step, cognitive behavioral, reinforcement based, rational-emotive behavioral)Treatment Goals (actions)Treatment Protocol (schedule in activities)Individual TherapyThe Treatment GroupLearning Relationship SkillsAccepting Responsibility ("what part did you play")Getting Past Denial (1. presence and magnitude, 2. life problems)Confrontation (potent, but dangerous)
23Principles of Treatment Cont. Overcoming Environmental Cues That Lead to Drinking (playmates and playgrounds)Treating the FamilyFamily Therapy SessionTherapy for the ChildrenAftercare and Relapse PreventionCognitive-Behavioral Boosters (statements, messages)PharmacologyEuphoria (over kill)AA's Role in Aftercare