This document discusses addiction from several perspectives: - It defines addiction and outlines several common models of understanding addiction, including moral, disease, behavioral, family systems, harm reduction, and 12-step frameworks. - It reviews common symptoms of addiction like withdrawal and signs of intoxication. Co-occurring disorders are also frequently present. - Special populations like adolescents, ethnic/racial groups, gender identities, and occupational groups may face unique risks and challenges with addiction. - Implications for practice include controversies in treatment approaches, cultural competence, identification of risk factors, and dual relationship concerns for those in recovery.

1. Addiction?
Jackie Daniels
Indiana University
danieljm@indiana.edu

2. Objectives
 Define
 Review models of Addiction
 Understand definition of addiction within
common models
 Common Symptoms and consequences
 Identify important co-occurring disorders
 Familiarize yourself: addiction within
special populations
 Implications for practice
 Case Studies

3. Models of Addiction
 Moral/ Temperance Model
◦ Sin or Crime
◦ Personal Flaw/Weakness
◦ Failure in personal responsibility (control)
 Disease of Medical
◦ Genetic and Biological Factors
 Behavioral and Cog-Bx Models
◦ Conditioning and reinforcement
◦ Social learning and modeling
◦ Drug expectancies cognitive factors
 Family
◦ Family disease and systems
◦ Behavioral and marital and family
 Harm Reduction
◦ Decrease harm created by addiction, does not necessary eliminate addictive behavior
◦ Ex: Needle exchange programs
 Life Process Model
◦ Habit, not Disease
◦ Biological factors that account for medical model are not identified
 12-Step Framework
◦ Addiction is result of spiritual malady, surrender and relationship with Higher Power, Service work and mentoring can
help avoid relapse
◦ Contains all models listed above except harm reduction (abstinence based)
◦ Terminology- Alcoholic, Addict

4. Define Addiction
 America Heritage Dictionary:
◦ Compulsive physiological and psychological need for
a habit-forming substance: a drug used in the
treatment of heroin addiction.
◦ An instance of this: a person with multiple chemical
addictions.
◦ The condition of being habitually or compulsively
occupied with or involved in something.
◦ An instance of this: had an addiction for fast cars
 Medical Model:
◦ DSM, ICD-9 Criteria
◦ the onset and development of addiction are
influenced though genetic predisposition and
environmental factors
◦ Brain Disease- Chronic, progressive and relapsing
with no cure, but treatable

5. Common
Symptoms, Consequences
Clinical signs: Withdrawal and signs of
 Physical Identification
intoxication
 Identify social predeterminates/risk in
assessment
◦ Resources (are basic needs met? i.e. food, shelter,
clean water, healthcare)
◦ Cultural and racial, ethnic discrimination
◦ Gender and Personal Identity (Female/Male, GLBT)
◦ Age (first use, stage of life)
◦ Community (social stratification)
 Corrections Populations
 Child Welfare System
 Trauma and domestic violence
 Mental Health Symptoms (Comorbidity)
 Chronic Pain

6. Co-Occurring Disorders
 Definition- Presence of mental health and substance use disorder
◦ Adults with mental illness/substance use disorders are twice as likely to
have incomes less than 150% of poverty level as adults without either
disorder
◦ Over 8.9 million persons have co-occurring disorders
 Depression and anxiety exist in 20-50% of people with
alcoholism, cocaine and other stimulant disorders
◦ Only 7.4% of individuals receive treatment for both conditions with 55.8%
receiving no treatment at all.
◦ 24% of Medicaid recipients had psychiatric conditions, cardiovascular
disease and central nervous disorders
◦ Women more at risk of anxiety, depression and substance use disorder &
history of trauma
◦ Common Co-Occuring combos:
Psychotic disorders (schizophrenia)
Mood Disorders (bipolar disorder, depression, anxiety)
Trauma (PTSD and DID)
Personality Clusters B & C
(Borderline, Antisocial, Narcissistic, Histrionic, Dependent and Avoidant)
(Kreek, et. Al, 2005, Volkow and
Li, 2005, NSDUH)

7. Addiction and Special
Populations
 Age
◦ Adolescent: Runaways, juvenile justice, comorbidity (mental health/learning disabled) children of
alcoholics, GLBT
◦ Adults- adult children of alcoholics
◦ Seniors- higher rate of Rx dependence, grief and suicide
 Ethnicity and Race
◦ Aboriginals (First Nations in US)
 Higher levels of suicide and grief, poverty
◦ Blacks
 Higher rates of FAS despite drinking less that white populations
 Higher rate of homicide and criminal justice contact
◦ Hispanic
 Mexicans and alcohol
 Puerto Ricans and illegal drug use
 Climbing Rate of HIV infection related to IV Drug Use
 Gender/Sexual identity
◦ Female
 Greater resistance from family and friends and more negative consequences associated with
treatment entry (lack of child care, job loss, and family responsibilities)
 Higher Rates of sexual abuse/trauma
 Medical problems develop much sooner, higher rates of mental health disorders, suicide
◦ Transgendered
High rates of suicidality and depression, health problems and discrimination
-NIDA

8. Special Risk
Contexts/Populations
 Occupations
◦ Military (active and veteran)
◦ Law enforcement
◦ Lawyers
◦ Medical professionals (nurse, doctor, psych)
 Geographic
◦ Rural vs. inner city
 Biological
◦ Pregnancy, IV drug users, Chronic Pain
 Psychological
◦ Co-occuring disorders
 Social
◦ Homeless, prostitutes, GLBT, Offenders

9. Implications for Practice
 Controversy of Medically-Assisted Treatment
 Dual Relationships for people in recovery
 Transference and counter-transferrence
 12-step Recovery
◦ Spiritual, not religious
◦ Legal ramifications
 Identification of risk factors
 Cultural Competency
◦ (a) Awareness of one's own cultural worldview, (b) Attitude
towards cultural differences, (c) Knowledge of different
cultural practices and worldviews, and (d) Cross-cultural
skills
◦ Developing cultural competence results in an ability to
understand, communicate with, and effectively interact with
people across cultures
 What else?

10. Case Study #1- Will
Will is a 40 year-old SWM referred for
assessment by Monroe County Probation
with repeated offenses of DUI. History of
head injury, domestic violence as a child
and family history of alcohol dependence.
Has worked in construction.
Married, divorced, full custody of son (age
2). Unstable work history, familial support.
Assessment and treatment implications
Best course of treatment

11. Case Study #2- Lori
Lori is a 19 y/o SWF self-referred to
treatment for alcohol dependence.
Extensive hx of PI arrests, family history
of cult involvement with religious
focus, child abuse and alcoholism.
Eating disorder has ruined her front
teeth. Looking for sober housing and
support, not willing to address eating
disorder. History of suicide attempt.
Assessment and treatment implications
Best course of treatment

12. THANK YOU!