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Chapter Eleven: Chemical Dependency: The Crisis of Addiction.

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Presentation on theme: "Chapter Eleven: Chemical Dependency: The Crisis of Addiction."— Presentation transcript:

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 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 )  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 )  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 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


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