addiction training

1. ADDICTION
SCIENCE THEORIES AND THE COUNSELLING ROOM
© BRENT CLARK 2022
I've seen the needle and the damage done
A little part of it in everyone
But every junkie's like a settin' sun
"The Needle and the Damage Done" 1972, NeilYoung, from the album Harvest.

2. TODAYS AGENDA
To have a grounding in Current theories of addiction its consequences and to discuss the
Christian perspective
‡ History
‡ Clinical considerations
‡ Genes and Environment
‡ The Brain
‡ Types of substances
‡ Biological, social and financial costs
‡ Treatment-
‡ The Oxford Group and Christian considerations
‡ 12 steps/ CBT/ Relapse Prevention

3. WHAT IS ADDICTION?
‡ A brain disease/ dysfunction expressed as
a compulsive behaviour combined with
physiological dependence.
‡ The continued use of drugs/alcohol or the
enactment of a behaviour despite negative
consequences
‡ A chronic, potentially relapsing disorder

7. DSM-V Substance Dependence Criteria
Addiction (termed substance dependence by the American Psychiatric Association) is defined as a
maladaptive pattern of substance use leading to clinically significant impairment or distress, as
manifested by three (or more) of the following, occurring any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired
effect or
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance or
(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.

8. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance (such as visiting multiple doctors
or driving long distances), use the substance (for example, chain-smoking), or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem
that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite
recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made
worse by alcohol consumption).
Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth.
Washington, DC: American Psychiatric Association, 2000.

9. Biology/genes Environment
Biology/
Environment
Interactions
Our nature
determines our
behaviour. Our
personality traits
and abilities are in
our nature.
Our environment,
upbringing and
life experiences
determine our
behaviour. We
DUHµQXUWXUHG¶WR
behave in certain
ways.

10. POTENTIAL RISK AND PROTECTIVE
FACTORS FOR ADDICTION:

11. GENETICS
^ĐŝĞŶƚŝƐƚƐĨŝƌƐƚďĞŐĂŶĐŽŶƐŝĚĞƌŝŶŐŐĞŶĞƚŝĐƉƌĞĚŝƐƉŽƐŝƚŝŽŶƚŽĂĚĚŝĐƚŝŽŶŝŶƚŚĞϭϵϱϬ͛Ɛ
Harvard initiated a study examining incidents of substance abuse among identical
and fraternal twins. Approximately 8,000 individuals were studied, representing
1,874 sets of identical twins and 1,498 sets of fraternal twins.
10 % of the experienced an addiction, a rate only slightly higher than the national
average, with nearly double the incidence of drug addiction shared among twin
pairs in the identical twin group.
Since identical twins come from a single fertilised egg they are genetically identical.
The higher incidence of drug addiction among these pairs of twins suggests a strong
genetic component to addiction.
The HarvardTwin Study of SubstanceAbuse:WhatWe Have Learned November 2001 Harvard Review
of Psychiatry 9(6):267-79

12. ‡ Genetics are considered 50 percent of the underlying reason for alcohol use disorder.
‡ 2008 study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reviewed much of
the research on alcohol use disorder and a possible genetic contribution.
‡ The phenotypic expression of genes is complex, however.
‡ Genes that influence alcoholism may be expressed in various ways.
‡ Smaller amygdala
‡ Different warning signs:
‡ Abnormal serotonin levels
Falk, D.; Yi, H.-y.; and Hiller-Sturmhöfel, S. An Epidemiologic Analysis of Co-Occurring Alcohol and Drug Use and Disorders: Findings From the National Epidemiologic Survey of
Alcohol and Related Conditions (NESARC). Alcohol Research Health 31(2):100²110, 2008

13. ^KD͚WKdEd/͛,ZdZdZ/d^͘͘͘
Limited Impulse Control and Impulsivity
Difficulty dealing with Stress and Anxiety
Denial/Poor Self awareness
Lack of Patience
Emotional Instability ( poor attachment)
Difficulty in asking for help
Manipulative traits
NO ADDICT IS THE SAME-. THEY ARE AN INDIVIDUAL. FEARFULLY AND
WONDERFULLY MADE

14. WHAT DOES THIS DEBATE MEAN FOR
TREATMENT?
Education is important- but we don't know for sure, and therefore we need to be
͚ŵĂLJďĞ͛͘͘͘ŝŶŽƵƌƚŚŝŶŬŝŶŐĂŶĚƐŚĂƌŝŶŐ͘
People might negatively embrace the genetic theory and feel there is no way to
ĐŚĂŶŐĞ͚͘/ĂŵǁŚĂƚ/Ăŵ͛͘
There might be some drive to pass the blame onto the genes or onto the nurture.
while sensitivity is important, we must consistently remind people of their power
of agency.
Our nature determines our behaviour. Our addiction and our problems are in our
nature. We have no agency. We are trapped to family legacy
Our environment, upbringing and life experiences determine our behaviour. We
ĂƌĞ͚ŶƵƌƚƵƌĞĚ͛ƚŽƐĐƌĞǁƵƉŝŶĐĞƌƚĂŝŶǁĂLJƐ͘tĞĂƌĞƚƌĂƉƉĞĚƚŽĨĂŵŝůLJůĞŐĂĐLJ͘

15. The Brain and addiction or the Brain doing what it is
designed to do

17. The Reward Pathway
Natural Rewards- dŚĞƌĂŝŶĚŽŝŶŐǁŚĂƚŝƚ͛ƐĚĞƐŝŐŶĞĚƚŽĚŽ
Food
Sex
Water
Nurturing
Excitement/Fun
Human Connection

19. Addiction
A state in which an organism engages in a compulsive
behaviour
‡ Behaviour is reinforcing ( reward or pleasurable)
‡ Loss of limited intake
‡ The Reward Pathway gone awry
‡ A disease or a dysfunction?

20. Rat Park- Bruce Alexander
Rat Park was a series of studies into drug addiction conducted in the late 1970s and published
between 1978 and 1981 by Canadian psychologist Bruce K. Alexander and his colleagues at Simon
Fraser University in British Columbia, Canada.

22. Tolerance
A state in which an organism no
longer responds to the drug
‡ A higher dose is required to
achieve the same effect

23. Dependence
A state in which an organism functions
normally only in the presence of a drug
‡ Manifests as a physical and then
psychological disturbance when the
drug is withdrawn (withdrawal)

24. A Brain on Drugs
1-2 Min 3-4 5-6
6-7 7-8 8-9
9-10 10-20 20-30
Photo courtesy of Nora Volkow, Ph.D. Mapping cocaine binding sites in human and baboon brain in vivo. Fowler JS, Volkow ND, Wolf AP, Dewey SL, Schlyer DJ,
Macgregor RIR, Hitzemann R, Logan J, Bendreim B, Gatley ST. et al. Synapse 1989;4(4):371-377.

25. A Brain After Drugs
Normal
Cocaine Abuser (10 days)
Cocaine Abuser (100 days)
Photo courtesy of Nora Volkow, Ph.D. Volkow ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey SL. Long-term frontal brain metabolic
changes in cocaine abusers. Synapse 11:184-190, 1992; Volkow ND, Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP.
Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169-177, 1993.

26. Drugs and
Long-term
Consequences
Photo courtesy of NIDA from research conducted by
Melega WP, Raleigh MJ, Stout DB, Lacan C, Huang
SC, Phelps ME.

27. The Memory of Drugs
Nature Video Cocaine Video
Front of Brain
Back of Brain
Amygdala
not lit up
Amygdala
activated
Photo courtesy of Anna Rose Childress, Ph.D.

28. ‡ Practicing a new habit under the right conditions, can change hundreds of millions and possibly billions of
the connections between the nerve cells in our neural pathways.
‡ The human brain is made up of an estimated 100 billion neurons making a total of 100 trillion neural
connections.
‡ tŚĞŶLJŽƵĞŶŐĂŐĞŝŶƉƌĂĐƚŝĐĞƐƚŚĂƚŝŶĐƌĞĂƐĞĨĞĞůŝŶŐƐŽĨŚĂƉƉŝŶĞƐƐ͕LJŽƵŝŶĐƌĞĂƐĞĂĐƚŝǀŝƚLJŝŶLJŽƵƌďƌĂŝŶ͛ƐůĞĨƚ
prefrontal cortex.
‡ Mental activity strengthens the neural pathways in your brain associated with what you focus on with your
thoughts and feelings.
‡ As we learn a new skill we lay down a new neural pathway
‡ The more this neural pathway used the stronger it becomes and thus the habit becomes entrenched in our
behaviour, but importantly in our brain.
‡ The bigger the experience in terms of feeling the stronger the neural pathway.
‡ Automaticty now kicks in, and this automaticity is basically something becoming an unconscious habit.
͞ŶĞƵƌŽŶƐƚŚĂƚĨŝƌĞƚŽŐĞƚŚĞƌǁŝƌĞƚŽŐĞƚŚĞƌ͕͟
Donald Hebb, 1948

30. PATH OF LEAST RESISTANCE
:Neuroplasticity has the power to produce more flexible but also more rigid
behaviors
Ironically, some of our most stubborn habits and disorders are products of our
plasticity. Once a particular plastic change occurs in the brain and becomes well
ĞƐƚĂďůŝƐŚĞĚ͕ŝƚĐĂŶƉƌĞǀĞŶƚŽƚŚĞƌĐŚĂŶŐĞƐĨƌŽŵŽĐĐƵƌƌŝŶŐ͘/ƚ͛ƐďLJƵŶĚĞƌƐƚĂŶĚŝŶŐ
both the positive and negative effects of plasticity that we can truly understand
the extent of human possibilities.
To summarise
‡ As we develop habits we are creating new neural pathways that affect our
thinking feeling and action.
‡ Theses neural pathways become automatic or habits without much conscious
or sometimes no conscious thought.
‡ The process of recovery is not only chemical, ŝƚ͛Ɛ about laying down new neural
pathways that are healthy and nourishing.

31. Science has generated compelling
evidence showing that
prolonged drug use changes
the brain in fundamental
and long-lasting ways...
This is why ĂĚĚŝĐƚƐĐĂŶ͛ƚũƵƐƚƋƵŝƚ
This is why ͚treatment͛ (for most) is essential

32. GROUP DISCUSSIONS AND
FEEDBACK
‡ What do the genetic and Brain dysfunction theories bring up for us?
‡ What does the environment and Personality trait suggestions bring up for
us?

33. All: Department of Health, 2017. Drug misuse and dependence: UK guidelines on clinical management.
London: Available at: https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-
on-clinical-management

42. DUAL DIAGNOSIS
When a patient is diagnosed with both a substance abuse disorder and a mental health issue, then it is
termed a Dual Diagnosis. : Depression, Personality disorders, schizophrenia, Anxiety, ADHD, Bipolar
Research shows that those with an addiction are twice as likely to have co-existing psychological
disorders
‡ Those who have mental illness are twice as likely to struggle with addiction issues.
‡ The link between the two statistics is obvious. However, there is no clear evidence that one
causes the other.
‡ Substance use can create symptoms of other mental health Issues
‡ Many drugs have side effects that mimic psychological and mental health disorders. For
instance, long-term marijuana use has a connection with an increase in psychosis. Long-term
cocaine addiction can cause paranoia. These side effects may be permanent even after an
individual stops drug use. As a result, they must be treated as co-existing conditions.

43. TYPES OF DRUGS
Stimulants include cocaine or methamphetamines. They cause hyperactivity and increase
heart rate and brain activity.
Opioids are painkillers that also affect chemicals in the brain that regulate mood. They
can also depress or slow down the central nervous system and affect breathing.
Hallucinogens/ Psychedelics: Marijuana, psilocybin mushrooms, and LSD are all
ĐŽŶƐŝĚĞƌĞĚŚĂůůƵĐŝŶŽŐĞŶƐ͘dŚĞLJĂůƚĞƌƚŚĞƵƐĞƌ͛ƐƉĞƌĐĞƉƚŝŽŶŽĨƐƉĂĐĞ͕ƚŝŵĞ͕ĂŶĚƌĞĂůŝƚLJ͘
Interesting use for depression research ongoing.
Depressants or sedatives: dŚĞƐĞĚƌƵŐƐƐůŽǁĚŽǁŶƚŚĞŶĞƌǀŽƵƐƐLJƐƚĞŵ͘dŚĞƐĞĚƌƵŐƐĂƌĞŶ͛ƚ
always illicit. But people may get addicted to prescription medications of all kinds. If they
ǁĞƌĞŶ͛ƚƉƌĞƐĐƌŝďĞĚďLJƐŽŵĞŽŶĞĂĚĚŝĐƚĞĚƚŽŝůůŝĐŝƚĚƌƵŐƐ͕ƚŚĞLJŵĂLJĞŶĚƵƉƐƚĞĂůŝŶŐĚƌƵŐƐ
are used in ways to maintain their supply.

44. A TO Z GUIDE TO COMMON DRUGS
Alcohol ʹ Booze, Bevvies (S for a short time- then Dep)
Amphetamines - Speed, Billy, Whiz, Phet (S)
Cannabis - Dope, Hash, Weed, Pot, Skunk, Ganga, Zoot, Spliff, Green (S/Dep)
Caffeine- Coffee, (S)
Cocaine and Crack - Coke, Charlie, White, Snow, Sniff, White Lady (S)
MDMA- Ecstasy, E, Beans, Pills, Doves, Apples (S/H)
Heroin - Smack, Junk, H, Brown, Gear, Horse, Skag (Dep)
Ketamine - Green, K, Special K, Super K (S/ Diss)
Khat Qat, Quat, Chat (S)
LSD - Acid, Tabs, Trips (H)
Magic Mushrooms - Shrooms, Mushies, Magics (H)
Mephedrone - Meow Meow, M-Cat, Drone, Bubbles, Bounce (S)Nitrous Oxide-
Laughing gas, Balloons, Hippie Crack, Laughing Gas, Nos, Noz, Whippits ( Diss)
Tobacco/Nicotene - Ciggies, Fags, Tabs ( S/D)
Volatile substances (butane gas, solvents, aerosols)- (Diss/H)

45. BEHAVIOURAL
ADDICTIONS
Shopping Addiction
Eating Disorders
Exercise Addiction
Video Game Addiction
Gambling Addiction
Love Addiction
Porn Addiction
Sex Addiction
Internet Addiction
Work Addiction
Co-Dependency
Phone addiction
Etc etc etc

46. ‡ ´,ZDVSRZHUOHVVRYHUWKDWµVDV-RHZKRLV´,HQGHGXSUHODSVLQJIRU
WZRZHHNVµ:LWKLQWZRGDVKHZDVSODLQJYLGHRJDPHVDOPRVW
constantly, pausing only to sleep for a few hours each day. He stopped
eating proper meals and washed only once every three or four days. On
phone calls to his girlfriend he would lie about how much he was gaming
and try and hurry the conversation along, telling her he was about to go
to sleep when he really was playing games until six or seven in the
morning. Although KH·GEHHQLQUHFRYHUIURPGUXJDGGLFWLRQVLQFHKH
was 31, he stopped attending his Narcotics Anonymous meetings
altogether to spend more time bingeing on video games.

48. treatment

49. A Brief History of Drug and Alcohol Treatment
1750 to Early 1800s
ͻEĂƚŝǀĞŵĞƌŝĐĂŶůĐŽŚŽůŝĐŵƵƚƵĂůĂŝĚƐŽĐŝĞƚŝĞƐ;ƐŽďƌŝĞƚLJΗŝƌĐůĞƐ͞
ϭϴϬϬ͛Ɛ
ͻLodging homes for alcoholics opened in the UK
ͻNew York State Inebriate asylum opens (first rehab)
ͻFreud recommends cocaine to overcome alcoholism (later retracted)
ͻŽĚŐŝŶŐŚŽƵƐĞƐĂŶĚƐLJůƵŵƐĐůŽƐĞĂŶĚĂůĐŽŚŽůŝĐƐĂƌĞƐĞŶƚƚŽƉƐLJĐŚŝĂƚƌŝĐĂƐLJůƵŵƐĂŶĚ͚ĚƌƵŶŬƚĂŶŬƐ͛.
ͻKƉŝƵŵƵƐĞŝŶƚŚĞhǁŝĚĞƐƉƌĞĂĚ;ĞŶĚŝŶŐĂďƌƵƉƚůLJĂƚƚƵƌŶŽĨƚŚĞĞŶƚƵƌLJĂŶĚƌĞƚƵƌŶŝŶŐŝŶƚŚĞϭϵϱϬ͛ƐͿ
1900-1950
ͻCharles B Towns hospital opens in New York ($350 a day- $6000 today) Bill W was a (failing) patient here.
ͻ1906 Emmanuel clinic opens using therapeutic tools and spirituality.
ͻ1910 Law is passed that allows Sterilisation of mentally ill (including alcoholics)
ͻ1919 Morphine Clinics established
ͻ1931 and 1932 The Oxford Group forms
ͻ1935 AA formed
ͻ1946 Pre Frontal lobotomies performed to treat chronic alcoholism
ͻ1948 Minnesota model model birthed
ͻ1948- 1950- Disulfiram drugs used (Antabuse)

50. 1950-2000
ͻϭϵϱϬ͛ƐŵĞŵďĞƌƐŚŝƉƌĞĂĐŚĞƐϵϬ͕ϬϬϬ
ͻ1952 American Medical Association defines alcoholism as chronic disease with genetic,
psychosocial and environmental factors
ͻϭϵϲϬ͛ƐhĚƌƵŐŵĂƌŬĞƚŐƌŽǁƐŵŽƐƚŶŽƚĂďůLJǁŝƚŚ/ůůŝĐŝƚWŚĂƌŵĂĐĞƵƚŝĐĂůƐ
ͻ1965 Insurance companies recognise treatment for addiction
ͻ1964 Methadone introduced
ͻUK- Dangerous Drugs Act (1967) and the Misuse of Drugs Act (1971)
ͻ1968 First NHS provision for drug addiction at Bethlam Maudsley Hospitals
ͻ1982 Betty Ford Clinic founded
ͻ1982 Cocaine Anonymous founded
ͻ1987 American Medical Association calls for all substance addictions to be called diseases
ͻϭϵϴϰ^DZdƌĞĐŽǀĞƌLJĨŽƵŶĚĞĚĂƐĂ͚ŶŽŶ-ƐƉŝƌŝƚƵĂů͛ĂůƚĞƌŶĂƚŝǀĞƚŽĨĞůůŽǁƐŚŝƉƐ͘
ͻ1994 Naltrexone approved for alcoholism
2000-
ͻ2008 Insurance companies by law must all recognise addictions and mental health issues
in the U.S.

51. Principles of Effective Treatment
1. Addiction is a complex but treatable disease that affects brain function and behaviour.
2. No single treatment is appropriate for everyone.
3. Treatment needs to be readily available.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug
abuse.
5. Remaining in treatment for an adequate period of time is critical.
6. Behavioural therapiesͶincluding individual, family, or group counsellingͶare the most
commonly used forms of drug abuse treatment.
7. Medications may be an important element of treatment for many patients, especially when
combined with counselling and other behavioural therapies.
8. An individual's treatment and services plan must be assessed continually and modified as
necessary to ensure that it meets his or her changing needs.
9. Many addicted individuals also have other mental disorders.

52. 10. Medically assisted detoxification is only the first stage of addiction
treatment and by itself does little to change long-term drug abuse.
11. Treatment does not need to be voluntary to be effective.
12. Drug use during treatment must be monitored continuously, as
lapses during treatment do occur.
13. Treatment programs should test patients for the presence of
HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious
diseases as well as provide targeted risk-reduction counselling,
linking patients to treatment if necessary.

53. 2 approaches- Abstinence and Harm
reduction
Abstinence is a term used in the addictions field to describe the
process of abstaining -- meaning avoiding, or not engaging in --
certain potentially addictive substances or behaviours.
Harm reduction is a proactive approach to reducing the damage
done by alcohol, drugs, and other addictive behaviours. Often,
harm reduction strategies are used in conjunction with other
approaches, which require abstinence
Harm reduction can be utilised as a tool to enable people to reach
abstinence.
We need to be mindful of the dangers of abstinence from alcohol,
that can lead to death.

54. SCREENING/ ASSESMENT
ͻCurrent drug/ alcohol use
ͻPrimary Drug of Choice
ͻLast drink or drug
ͻTreatment history
ͻCo-occurring disorders (both physical and mental)
ͻPrescribed medication
ͻEducation and Employment Housing Circumstances
ͻSocial Functioning
ͻOffending history
ͻHousing Circumstances
ͻClients Goals
Screening- to test or examine someone or something to understand
The screening function is the process by which a client is determined to be appropriate and eligible for a
admission to a a particular programme. Taking into consideration: Physical condition/ psychological profile/
outside resources/ other factors

55. WHO alcohol
screening tool

57. Treatment Planning
ͻ Drawn up counsellor/agency and the client contract in order to meet the clients needs in line
with agencies rules.
ͻ Take full account of information taken in the assessment.
ͻ Work with the client to formulate goals, objectives, and acceptable alternatives that will
increase treatment efficacy
ͻ Consider a wide range of options utilising various modalities and formal and informal support
groups (12 step/Smart/Church/ Sport etc)
ͻ When possible give the client resources and partner with them as they navigate their daily life.
ͻ Be gentle, caring, open minded and curious. Do not overwhelm. One step at a time.
ͻ Don't be afraid to challenge thinking
ͻ Treatment plan is never static and should flex as the client grows in confidence and recovery
capital. Review.

58. Dual Diagnosis
When a patient is diagnosed with both a substance abuse disorder and a mental health issue, then it is termed
a Dual Diagnosis. : Depression, Personality disorders, schizophrenia, Anxiety, ADHD, Bipolar
Research shows that those with an addiction are twice as likely to have co-existing psychological disorders
X Those who have mental illness are twice as likely to struggle with addiction issues..
X The link between the two statistics is obvious.However, there is no clear evidence that one causes the
other.
X Drug Use Can Create Symptoms of Other Mental Health Issues
X Many drugs have side effects that mimic psychological and mental health disorders. For instance,
long-term marijuana use has a connection with an increase in psychosis. Long-term cocaine addiction
can cause paranoia. These side effects may be permanent even after an individual stops drug use. As
a result, they must be treated as co-existing conditions.
X www.youtube.com/watchv=G-2vDQOYE3s

60. External Support and Recovery
Capital
12 step fellowships
SMART RECOVERY
Faith Groups
Family
Friends
Sports/ Culture
Education
Volunteering
FUN

62. Spirituality, Faith in treatment
‡ The search for meaning
‡ The Search for purpose
‡ Development of the person
‡ Connection to something greater than self
‡ A way of Life

63. Aspects of spirituality Impacting addiction
Sense of hope and purpose
Forgiveness
Active lifestyle change
Social support
Builds self-reliance, self esteem, problem solving,
optimism, insight, decision making
Devaluation of self indulgence and sensation seeking
(Multidimensional measurement of religiousness/spirituality for use in health research, 2003)

64. Addiction as worshiping false idols
X God says, Don't have other Gods before me,
X The Israelites throughout history did this in what we most commonly think of as idolatry.
X Baal was a title and honorific meaning owner, lord͟
X ͞dŚĞLJƉƌŽŵŝƐĞĚĨƌĞĞĚŽŵ͕ďƵƚƚŚĞLJƚŚĞŵƐĞůǀĞƐĂƌĞƐůĂǀĞƐŽĨƐŝŶĂŶĚĐŽƌƌƵƉƚŝŽŶĨŽƌLJŽƵĂƌĞ
ƐůĂǀĞƚŽǁŚĂƚĞǀĞƌĐŽŶƚƌŽůƐLJŽƵ͘͟- 2 Peter 2:19
X ͞DĂŶΖƐŶĂƚƵƌĞ͕ƐŽƚŽƐƉĞĂŬ͕ŝƐĂƉĞƌƉĞƚƵĂůĨĂĐƚŽƌLJŽĨŝĚŽůƐ͘͟
͸ John Calvin
X Is the Church an Addictive Organization?
X by Anne Wilson Schaef
https://www.religion-online.org/article/is-the-church-an-addictive-organization/

65. 7 Biblical principles
1. The Bible explicitly instructs us to refrain from getting high. ͞ŽŶŽƚŐĞƚĚƌƵŶŬŽŶ
ǁŝŶĞ͕ǁŚŝĐŚůĞĂĚƐƚŽĚĞďĂƵĐŚĞƌLJ͘/ŶƐƚĞĂĚ͕ďĞĨŝůůĞĚǁŝƚŚƚŚĞ^Ɖŝƌŝƚ͟;ƉŚĞƐŝĂŶƐϱ͗ϭϴͿ͘
2. Our body is the temple of the Holy Spirit. ͞ŽLJŽƵŶŽƚŬŶŽǁƚŚĂƚLJŽƵƌďŽĚLJŝƐĂ
temple of the Holy Spirit, who is in you, whom you have received from God? You are
not your own; you were bought at a price. Therefore ŚŽŶŽƌ'ŽĚǁŝƚŚLJŽƵƌďŽĚLJ͟;ϭ
Corinthians 6:19-20).
3. We must avoid all types of wrong behaviors in order to grow. ͞ĞǀĞƌLJĐĂƌĞĨƵů͕
then, how you live Ͷ not as unwise but as wise, making the most of every
opportunity, because the days are evil. Therefore do not be foolish, but understand
ǁŚĂƚƚŚĞŽƌĚ͛ƐǁŝůůŝƐ͟;ƉŚĞƐŝĂŶƐϱ͗ϭϱ-17).
4. God wants our thought life under His control ͚For though we live in the world, we
do not wage war as the world does. The weapons we fight with are not the weapons
of the world. On the contrary, they have divine power to demolish strongholds. We
demolish arguments and every pretension that sets itself up against the knowledge of
God, and we take captive every thought to make it obedient to Christ.- 2 Corinthians
10:3-5

66. 5. The virtue of self-control is critical for a disciple of Christ͘͞But the fruit of
the Spirit is love, joy, peace, forbearance, kindness, goodness,
faithfulness, gentleness and self-control. Against such things ƚŚĞƌĞŝƐŶŽůĂǁ͟
6. God Ͷ not drugs Ͷ is the answer to the pain of life. ͞Can a mother forget
her nursing child, and not have compassion on the son of her womb? Surely
they may forget, yet I will not forget you. See, I have inscribed you on the palms
ŽĨDLJŚĂŶĚƐ͟;/Ɛ͘ϰϵ͗ϭϱ-16, NKJV). Though parents might abandon their
children, God will never leave His.
7. dŚĞƌĞ͛ƐŶŽƚŚŝŶŐďĞƚƚĞƌŝŶůŝĨĞƚŚĂŶŬŶŽǁŝŶŐ'ŽĚ͘ ͛But whatever was to my
profit I now consider loss for the sake of Christ. What is more, I consider
everything a loss compared to the -surpassing greatness of knowing Christ Jesus
my Lord, for whose sake I have lost all things. I consider them rubbish͘͢Ķ I
want to know Christ and the power of His resurrection and the fellowship of
sharing in His sufferings, becoming like Him in death, and so, somehow, to
attain to the resurrection from the dead. Ͷ Philippians 3:7-8,10-1

67. Relapse Prevention
Relapse is seen as both an outcome and a transgression in the
process of behaviour change. An initial setback or lapse may
translate into either a return to the previous problematic
behaviour, known as relapse, or the individual turning again
towards positive change, called prolapse.
A relapse often occurs in the following stages: emotional
relapse, mental relapse, and finally, physical relapse. Each
stage is characterised by feelings, thoughts, and actions that
ultimately lead to the individual returning to their old behaviour.

68. Relapse Prevention Skills
ͻAcknowledging that a lapse can be part of the recovery experience and can be used to help the recovery journey
ͻStrengthening the motivation to change throughout the change process.
ͻIdentifying high-risk situations (Triggers)
ͻDeveloping coping strategies and skills to avoid high-risk situations and to deal with them when they are unavoidable.
ͻDeveloping coping strategies and skills to deal with lapses.
ͻRecognising and implementing changes to the young person's environment and lifestyle
ͻPositive self-talk
ͻProblem-solving skills
ͻAnger and depression management
ͻCoping with craving
ͻIdentify the build-up to relapse
ͻRelaxation Skills
ͻSelf Care
ͻSupport Networks
Constant review of these elements is required.

70. 1. We admitted we were powerless over alcohol - that our lives had become
unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood
Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our
wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to
them all.
9. Made direct amends to such people wherever possible, except when to do so would
injure them or others
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as
we understood Him, praying only for knowledge of His will for us and the power to carry
that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this
message to alcoholics and to practice these principles in all our affairs
12 Steps of AA

71. ‡ Acceptance- which includes the realisation that
addiction is a chronic and progressive disease over
which one has no control
‡ Surrender- which involves giving oneself over to a
higher power, accepting the fellowship and support
structure of other recovering people.
‡ Active involvement- 12 step meeting and activities,
sponsorship, working through step work
3 foundations of the fellowship

72. BIOPSYCHOSOCIALSPIRITUAL MODEL
X Bio (physiological pathology)
X Psycho (thoughts emotions and behaviours such as psychological distress,
fear/avoidance beliefs, current coping methods and attribution)
X Social (socio-economical, socio-environmental, and cultural factors such as as work
issues, family circumstances and benefits/economics)
X Spiritual (Spirituality involves the recognition of a feeling or sense or belief that there is
something greater than myself, something more to being human than sensory
experience, and that the greater whole of which we are part is cosmic or divine in
nature.)

73. The OXFORD GROUP-
The birth of a Christian movement helping addicts for decades
X 1931-32 Rowland Hazard III, an alcoholic was treated by Carl Jung, who encouraged a religious conversion.
X ZŽǁůĂŶĚďĞĐĂŵĞĂŚƌŝƐƚŝĂŶǀŝĂdŚĞ͚KdžĨŽƌĚ'ƌŽƵƉ͛ a Christian organization first known as First Century Christian Fellowship founded by the
American Lutheran Christian priest Frank Buchman in 1921. Buchman believed that the root of all problems were the personal problems of
fear and selfishness. Further, Buchman believed that the solution to living with fear and selfishness was to surrender one's life over to God's
plan.
X 4 absolute Principles: honesty, purity, unselfishness and Love ( as a summary of the Sermon on the Mount).
X 1934 Bill W (the founder of AA) went to a Oxford Group Church and became a member. He was at the time an alcoholic, who reached
abstinence via The Oxford Groups principles and support.
X In 1939 Bill W left the Oxford Group frustrated by an instance of focussing on Spiritual/ faith matters.
X Abstinence is foundation stone of AA. Sobriety is the goal. It presents itself as a Biopsychosocial spiritual model.

74. OG Influence on 12 Steps
͞ƚŚĞĞĂƌůLJ͘͘ŐŽƚŝƚƐŝĚĞĂƐŽĨƐĞůĨ-examination, acknowledgement of character defects, restitution for harm done, and working with others
straight from the Oxford Groups and directly from Sam Shoemaker, their former leader in America, and from nowhere ĞůƐĞ͘͟
/ŶŚŝƐϭϵϲϭůĞƚƚĞƌƚŽ:ƵŶŐ͕ŝůůŶŽƚĞƐƚŚĞK'͛Ɛ͞ůĂƌŐĞĞŵƉŚĂƐŝƐƵƉŽŶƚŚĞƉƌŝŶĐŝƉůĞƐŽĨ self-survey, confession, restitution, and the giving of
ŽŶĞƐĞůĨŝŶƐĞƌǀŝĐĞƚŽŽƚŚĞƌƐ͘͟8
dŚĞϭϮ^ƚĞƉƐǁĞƌĞĂůƐŽŝŶĨůƵĞŶĐĞĚďLJƚŚĞK'͛Ɛ͞ŝǀĞWƌŽĐĞĚƵƌĞƐ͗͟Ϳ'ŝǀĞŝŶƚŽ'ŽĚ͖ ϮͿŝƐƚĞŶƚŽ'ŽĚ͛ƐĚŝƌĞĐƚŝŽŶ͕ϯͿŚĞĐŬŐƵŝĚĂŶce, 4)
Restitution, 5) Sharing for witness (how one had changed) and for confession (what one had done)10
dŚŽƵŐŚƐŚƵŶŶĞĚƚŚĞK'ƚĞƌŵ͞ƐƵƌƌĞŶĚĞƌ͕͟ŝƚŝŶĐŽƌƉŽƌĂƚĞĚŝƚƐĐŽŶĐĞƉƚŽĨƐƵƌƌĞŶĚĞƌŝŶŐŽŶĞ͛ƐůŝĨĞƚŽƚŚĞĐĂƌĞŽĨ'ŽĚŝŶ^ƚĞƉ3, ƵƐŝŶŐ͞ƚƵƌŶ
ŽǀĞƌ͟ŝŶƐƚĞĂĚ.
OG experience also contributed to various aspects of the 12 Steps, as when someone's amends going awry led to the addition of the proviso
͞ĞdžĐĞƉƚǁŚĞŶƚŽĚŽƐŽ ǁŽƵůĚŝŶũƵƌĞƚŚĞŵŽƌŽƚŚĞƌƐ͟ŝŶƚŚĞϵƚŚ^ƚĞƉ12
^ƚĞƉϭϭ͛ƐƉƌĂLJĞƌĂŶĚŵĞĚŝƚĂƚŝŽŶĚĞƌŝǀĞĨƌŽŵƐŝŵŝůĂƌK'ƉƌĂĐƚŝĐĞƐ͕ŝŶĐůƵĚŝŶŐŽďƐĞƌǀŝŶŐ Ă͞ƋƵŝĞƚƚŝŵĞ͟ĂŶĚƐĞĞŬŝŶŐ͞ŐƵŝĚĂŶĐĞ͘͟13
Oxfordites emphasized one member working with another, which Bill W. credits for the like practice in the 12th Step. Most of the OG members
were not alcoholics, and the precepts they were to follow concerned all their affairs, a concept added in Step 12 to the idea of practicing
the principles beyond the problem of drinking.

75. Scope/aims of CBT in addiction
counselling
‡ Engage and motivate people into
therapeutic programmes
‡ Placing substance misuse in a personal
context Relapse prevention for the client
(formulating)
‡ Impulse Control training
‡ Affect regulation and maintenance
strategies

76. ‡ Motivation Motivation Motivation
‡ Treatment planning
‡ High risk stimuli- internal and external
‡ RUUHFWIDXOWWKLQNLQJ¶SHRSOHZRXOGKDWH
PHVREHU·¶,cant GR«ZLWKRXWDGULQN·
‡ Identify core beliefs/ inadequacies
‡ Identify automatic thoughts
‡ Coping with Craving
‡ Identify Rationalisations- ¶,GHVHUYHRQH·¶2QH
wont KXUWµ
‡ Circumscribing lapses/ slips
Scope/aims of CBT in addiction counselling cont«

77. 0·V
MOTIVATE
MANAGE IMPULSES
MANAGE MOOD
MAINTAIN LIFESTYLE CHANGE

78. Treatment Barriers:
possible/likely setbacks
1. Client blames self:
´,·PODFNLQJSRZHUDQG,·PXVHOHVVDQZDµ
2. Therapist Blames client ( sometimes with their collision/agreement:
´RXDUHQRWPRWLYDWHGRUFRPPLWWHGFRPHEDFNZKHQRX·UHUHDGµ
i.e. stop wasting my time)
3. Therapist blames themselves: ´,·PQRJRRGDWWKLVPFOLHQWVQHYHU
VHHPWRLPSURYHµ
4. Client blames therapist ´RXGRQ·WXQGHUVWDQGme or my problems and
WKLVWUHDWPHQWLVXVHOHVVµ
5. Client Blames the world/ learned helplessness:
µQRRQHVKDGLWDVWRXJKDVPHLW·VHYHURQHHOVH VIDXOWEXWPLQHµ3RRU
PHSRRUPHSRXUPHDQRWKHU«

79. Structuring sessions- 20/20/10
20 mins: Review substance use. Give motivational
feedback. Note current concerns
20 mins: Introduce session topic ( i.e. coping with
craving) and relate to current concerns
10 mins: Assignment/ exercise for coming week
and anticipate high risk situations

80. Saying NO training- essential for every
recovering addict
‡ Say No
‡ Make direct eye contact
‡ 'RQ·WEHDIUDLGWRDVNSHUVRQWRVWRSRIIHULQJ
‡ 'RQ·WOHDYHWKHGRRURSHQIRUIXWXUHRIIHUV ,GRQ·WIHHO
like it today)
‡ Be assertive ( clear, concise, simple) not aggressive
‡ Review the affect of the above
‡ Be creative- allergy/ health reasons etc.
‡ Role play various scenarios

81. Crave surfing
Cravings last roughly 20 mins- they are psychological and physical
Help client to understand:
‡ They are very likely to occur
‡ That they rise and fall- hence the surfing
‡ That distractions are helpful
‡ Mindfulness exercises- headspace etc
‡ That we will work towards you sitting in the uncomfortable feeling
‡ Playing the tape forward
‡ 3UR·VFRQVH[HUFLVH- reframing the delusional thoughts that the answer is
substance/ behaviour
‡ That they will lessen in power over time as the new neural pathways get
laid down and walked down enough.

82. Dealing with lapses/ Relapses
X Do not judge
X 'RQ·WSDQLF
X Be open and curious and allow client to go express
the regret and pain
X Help client to understand this is an opportunity for
deeper understanding that must result in action
X 5HODSVHVGRQ·WJHQHUDOORFFXUZKHQWKHGULQNGUXJ
is taken or behaviour is enacted they are the
consequence of a chain of events. Track back and
find the gaps in structure, self care, events etc.