11 chemical dependency


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11 chemical dependency

  1. 1. Chemical Dependency: The Crisis of Addiction Chapter Eleven
  2. 2. Background Long history of attempting to treat substance abuse. Whole economies have been founded on drug use.  Alcohol and tobacco in the United States  Volstead Act and ratification of the 18th Amendment  21st Amendment  Economic gains and burdens Prevalence Controlled use  Is this a reality for an abuser or an addict?
  3. 3. Sociocultural Determinants of Substance Abuse Set vs. setting Alcohol and drugs have culturally specific:  Rules  Sanctions  Prohibitions  Admonitions  Permissions Although there are cultural implications, do not stereotype!
  4. 4. Alcohol: Number One Abused Substance Duration Legality 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
  5. 5. 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
  6. 6. 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
  7. 7. Definitions of Commonly Used Terms 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.
  8. 8. Definitions of Commonly Used Terms 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.
  9. 9. Definitions of Commonly Used Terms 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.
  10. 10. Defense Mechanisms Denial Displacement Fantasy Projection Rationalization Intellectualization Minimizing Reaction formation Regression Repression
  11. 11. Enabling and Codependency Suppression Dissociation Repression Escape to therapy Intellectualization Displacement Reaction formation Passive aggression Hypochondriasis
  12. 12. Children in Alcoholic Families Personality Roles  The Scapegoat  The Hero  The Lost Child  The Family Mascot Family Rules in Alcoholic Families  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
  13. 13. 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
  14. 14. Treatment Approaches Alcoholics Anonymous (AA) Cognitive-Behavioral Therapy (CBT) Inpatient Treatment: The Minnesota Model Outpatient Programs Contingency Management (CM) Community Reinforcement Approach (CRA) Reinforcement-Based Treatment (RBT) Inpatient vs. Outpatient Contemporary Model
  15. 15. Intervention Strategies Motivation and Stages of Change  Precontemplation  Contemplation  Determination/Preparation  Action  Maintenance  Termination  Motivational Interviewing
  16. 16. Assessment Personality Inventories Direct Measures Parsimony Computer-Administered Direct Measures The Problem Is . . . Motivation to Change Intake Assessment Assessment of Spirituality Triage Assessment Diagnostic Intake
  17. 17. 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.
  18. 18. Principles of Treatment Treatment Techniques Treatment Goals Treatment Protocol Individual Therapy The Treatment Group Learning Relationship Skills Accepting Responsibility Getting Past Denial Confrontation
  19. 19. Principles of Treatment Limit Testing Treatment Secrets Disrupting Irrational Mental Sets Overcoming Environmental Cues That Lead to Drinking Treating the Family  Family Therapy Session  Therapy for the Children Aftercare and Relapse Prevention  Cognitive-Behavioral Boosters  Pharmacology Euphoria AAs Role in Aftercare