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Treatment Models of Addiction


Strengths perspective strengths of clients and strengths ... Mistreatment of mentally ill in asylums. Hazelden. Peele and Fingarette: addiction as bad habits. ... – PowerPoint PPT presentation

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Title: Treatment Models of Addiction

Treatment Models of Addiction
  • Addiction affects us all. Strengths
    perspectivestrengths of clients and strengths of
    the contemporary modelsharm reduction and 12
    Step approach.
  • Rift in field over which model is true
  • Moral, Psychological model, Sociocultural model,
    Mediaca, Biopsychocial Model, and Harm Reduction

What is addiction?
  • (Latin) addictus---attached to something,
    positive. Today alcoholism called a brain
    diseaseor bad habit or sin. Addiction is the
    key, not the substance or behavior

  • Substance dependence requires 3 of following.
  • tolerance inability to stop
  • withdrawal problems excessive spending or effort
  • use more than intended obtain
  • reduced involvement continued use
  • Rigid dichotomy here between abuse and
    dependence. Addiction is a continuum. People
    move in and out of addiction.

The Disease Concept
  • Disease - as metaphor by Jellinek alcoholism is
    like a disease
  • Random House Dictionary, disease is a condition
    of the body in which this is incorrect function.
  • Oxford University Dictionary disease is absence
    of ease (in treatment disease as primary,
    progressive, chronic, and possibly fatal).
  • Illness term preferred here, less
  • Alcoholism as disease pro and con
  • Addiction is a brain disease because the
    addicted brain is changed.
  • Debate against habit, behavior, responsibility,
    mature out of.

Biopsychosocial Model
  • Why (bio), what (psycho), where (social)
  • Interactionism pain and suffering ? loss ? pain,
    stress and drinking ?
  • Family as a system, roles
  • Why need to know about addiction? 80 behind
    bars, child welfare, alcoholics at work.


The biopsychosocial model

Biological and cellular processes
Psychological processes
Social processes and contexts
(No Transcript)
Moral Psychological
  • Addict is degenerate
  • Cause is moral weakness
  • Punishment is ineffective unless tx is involved
  • Personal pathology
  • Unconscious conflicts tx ineffective
  • Personality traits some change in tx
  • Learning /behavioral
  • AOD reinforced by environment with tx some

Sociocultural Medical/Disease
  • Situation problem is addicts view
  • Cause are social forces and context
  • Tx approach cl. Change reinforcers
  • View of addict as patient
  • Cause is physiological dysfunction progressive
  • Tx includes mind, body and spirit (no specific

Learning the Language, Miller page 13
  • Historical Perspectives

  • Alcohol back to 5000 BC Iran
  • Unknown to worlds indigenous people
  • Koran --- condemned wine. Alcohol from Arabic
  • Arabian dr. discovered evaporated distilled
    spirits. Technology exceeded its grasp
  • 1575 --- distilling usedgin. Booze from Dutch
  • Great devastation from England, 1700-1750.
  • Infant mortality, crime

  • North America
  • More beer than water on Mayflower.
  • 18th Quakers and Methodists disapproved of hard
  • Male drinking cult 1725-1825 notorious.

  • Cocaine in Coke.
  • 1914 Harrison Act --- restricted opioids with
    (associated with Chinese) prescription for
  • Marijuana (associated with Mexicans) State laws
    in southwest criminalized.
  • Teetotaler fun. T total abstinence from
  • Temperance woman and suffrage movement.
  • U.S. Prohibition 1920-1933
  • Glamorized crime. Mafia/ Hollywood/Wash. DC
    link. Homicide rates increased.
  • Great Depression created need for jobs.

  • AA Getting Better. Nan Robetson.
  • Bill W. and Dr. Bob. Oxford Groups. Big Book. 1
    million members today
  • Jellinek (The Disease Concept, 1960) 5 types of
    alcoholism based on world travels
  • Alpha, Beta, Gamma , Delta, Epsilon.
  • The Disease Concept
  • 1966 AMA Alcoholism as disease.
  • Harold Hughes NIAAA.
  • Looking back on how tech gt social changes gt law.
  • Themes of Chapter dangers of potent alcohol,
    role of ethnic prejudice in shaping drug
    legislation, of mentally ill and alcoholic
    persons, unintended consequences of prohibition.

History of Treatment
  • William White, Slaying the Dragon. Mistreatment
    of mentally ill in asylums.
  • Hazelden
  • Peele and Fingarette addiction as bad habits.

Models of Strengths-Based Approaches
  • 1. Harm reduction public health model,
    prevention, outreach. 
  • Abstinence not precondition
  • Stages of Change Model
  • Precontemplation
  • Contemplation
  • Preparation
  • Actions
  • Maintenance
  • Relapse

2. Motivational Interviewing (MI)---William
  • Asking right questions Tell me about a period
    when you were doing well?
  • Smoking on a scale of 1-10 to give up smoking,
    where are you now?
  • MI Steps
  • Enhance Motivation
  • Express empathy
  • Develop discrepancy
  • Avoid argumentation
  • Roll with resistance
  • Support self-efficacy

3. Solution focused therapy and Narrative
  • Miracle question
  • Narrative

Traditional Treatment
  • Detox
  • Outpatient
  • Inpatient
  • After care once a month

Harm Reduction
  •   Need for drug courts--important for family
    preservation and closely supervised treatment
  •   Miller and Rollnick motivational
  • interviewing strategies

  •   Traps for therapists to avoid are
  •  Premature focus, such as ones addictive
  •  Confrontational/denial round between
    therapist and client
  •  Labeling trap-forcing the individual to
    accept a label alcoholic or addict
  •  Blaming trap, fallacy that is especially
    pronounced in couples counseling

  •    Primary prevention interventions to reduce
    primary risk factors such as
  •    Child abuse, early-prevention education and
    treatment programs
  •    Smoking education to keep youths from ever
  •    Health and skill education at schools
  •    Reducing ads
  •    Advocacy for the hiring of more school
    counselors and social workers

Stage-Specific Motivational Statements
  •      Stage of Change
  •      Precontemplation
  •    Goals are to establish rapport
  •    Counselor reinforces discrepancies
  •    Adolescent comment
  • My parents cant tell me what to do I
    still use and I dont see the harm in it- do

Motivational Enhancement continued
  •   Stage of change Contemplation
  •  How was life better before drug use?
  • Emphasize choices
  •   Typical questions are
  • -What do you get out of drinking?
  • -Whats the down side?

Contemplation Stage continued
  •  Adolescent comments
  •    Im on top of the world when Im high, but
    then when I come down, Im really down. It was
    better before I got started on these things.

Preparation Stage
  •   Setting date
  •   What do you think will work for you?
  •    Adolescent comments
  •   Im feeling good about setting a date to quit,
    but who knows?

Action Stage
  • Adolescent comments
  • Staying clean may be healthy, but it sure makes
    for a dull life. Maybe Ill check out one of
    those groups.
  • Therapist check out groups
  • Why dont you look at what others have done in
    this situation?

Maintenance Stage
  • Adolescent comments
  • Its been a few months Im not there yet but Im
    hanging out with some new friends

  • Inevitable
  • Miller advises roll with it
  • Use reflective summarizing

Relapse Prevention
  • Learn warning signs
  • Renew feelings that led to relapse
  • Help them renew their commitment
  • Find coping style
  • Build support systems
  • Non-confrontational approach is best

Pitfalls (Beechem, 2002)
  • Anticipate feelings of guilt and shame
  • Ageism
  • Countertransference
  • Denial in assessment
  • Sympathy not empathy

Loss and grief in family members
  • Types of Guilt
  • Survivor guilt
  • Helplessness
  • Ambivalence
  • Spiritual healing
  • Strength from 12 Steps

William Faulkner
  • Poem
  • If there be grief, then let it be but rain,
  • And this but silver grief for grievings sake
  • If these green woods be dreaming here to wake
  • Within my heart, if I should rouse again.
  • But I shall sleep, for where is any death
  • While in these blue hills slumbrous overhead
  • Im rooted like a tree? Though I be dead,
  • This earth that holds me fast will find me
  • (Wilde Borsten, 1978, p.75)

Harm reduction
  • Needle exchange serves only 15 of drug
  • Methadone maintenance---too low a level of the
    drug. Not legalization but middle of road.