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Treatment Models of Addiction

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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


1
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
    Model

2
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

3
DSM-IV-TR
  • 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.

4
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
    controversial.
  • 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.

5
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.

6

The biopsychosocial model

Biological and cellular processes
Psychological processes
Social processes and contexts
7
(No Transcript)
8
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
    change

9
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
    tx)

Learning the Language, Miller page 13
10
  • Historical Perspectives

11
  • Alcohol back to 5000 BC Iran
  • Unknown to worlds indigenous people
  • Koran --- condemned wine. Alcohol from Arabic
    al-kuhul.
  • Arabian dr. discovered evaporated distilled
    spirits. Technology exceeded its grasp
  • 1575 --- distilling usedgin. Booze from Dutch
    BUSEN.
  • Great devastation from England, 1700-1750.
  • Infant mortality, crime

12
  • North America
  • More beer than water on Mayflower.
  • 18th Quakers and Methodists disapproved of hard
    liquor.
  • Male drinking cult 1725-1825 notorious.

13
  • Cocaine in Coke.
  • 1914 Harrison Act --- restricted opioids with
    (associated with Chinese) prescription for
    cocaine.
  • Marijuana (associated with Mexicans) State laws
    in southwest criminalized.
  • Teetotaler fun. T total abstinence from
    Ireland.
  • 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.

14
  • 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.
  •  

15
History of Treatment
  • William White, Slaying the Dragon. Mistreatment
    of mentally ill in asylums.
  • Hazelden
  • Peele and Fingarette addiction as bad habits.

16
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

17
2. Motivational Interviewing (MI)---William
Miller
  • 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

18
3. Solution focused therapy and Narrative
therapy
  • Miracle question
  • Narrative

19
Traditional Treatment
  • Detox
  • Outpatient
  • Inpatient
  • After care once a month

20
Harm Reduction
  •   Need for drug courts--important for family
    preservation and closely supervised treatment
  •   Miller and Rollnick motivational
  • interviewing strategies

21
  •   Traps for therapists to avoid are
  •  Premature focus, such as ones addictive
    behavior
  •  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

22
  •    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
    starting
  •    Health and skill education at schools
  •    Reducing ads
  •    Advocacy for the hiring of more school
    counselors and social workers

23
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
    you?

24
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?

25
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.

26
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?

27
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?

28
Maintenance Stage
  • Adolescent comments
  • Its been a few months Im not there yet but Im
    hanging out with some new friends

29
Resistance
  • Inevitable
  • Miller advises roll with it
  • Use reflective summarizing

30
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

31
Pitfalls (Beechem, 2002)
  • Anticipate feelings of guilt and shame
  • Ageism
  • Countertransference
  • Denial in assessment
  • Sympathy not empathy

32
Loss and grief in family members
  • Types of Guilt
  • Survivor guilt
  • Helplessness
  • Ambivalence
  • Spiritual healing
  • Strength from 12 Steps

33
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
    breath.
  • (Wilde Borsten, 1978, p.75)

34
Harm reduction
  • Needle exchange serves only 15 of drug
    injection.
  • Methadone maintenance---too low a level of the
    drug. Not legalization but middle of road.
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