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Chapter 3Addictions: Theory and Treatment
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Drug Addiction
• Behavioral pattern of drug use
• Overwhelming involvement
• Securing of its supply
• Tendency to relapse after withdrawal
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Three Basic Processes
1. Tolerance• Repeated exposure results in a lesser effect
2. Physical dependence• Withdrawal syndrome
3. Psychological dependence• Observable behavior of frequently using drugs –
reinforcement plays a role with this
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Changing Views ofDrug Addiction
• Early medical models– Early theories based on physical dependencies
as the key
• Positive reinforcement model– Concepts of drugs acting as “positive
reinforcers” in psychological dependence
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The Broad Viewsof Addiction
• Is addiction caused by the substance?
• Is addiction biological?
• Is there an addictive personality?
• Is addiction a family disorder?
• Is addiction a disease?
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Assessment ofAddictive Disorders
• Psychiatric– Diagnosis for dependence– Diagnosis for substance abuse
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Dependence Criteria
1. Tolerance toward substance
2. Withdrawal syndrome
3. Substance taken in large amounts
4. Unsuccessful efforts to cut down
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Dependence Criteria, cont’d
5. Activities involved to obtain substance
6. Lifestyle is centered around obtaining substance
7. Use continues after being diagnosed
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Substance Abuse Criteria
• Pattern leads to impairment at work, school, etc.
• Increased hazards in daily situations
• Legal problems
• Continued use despite expressing the abuse factors
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Addiction Treatment
• Deciding to quit– Stages of change
• precontemplation
• contemplation
• preparation
• action
• maintenance
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Addiction Treatment, cont’d
• Deciding to quit, cont’d– Intervention– Motivational interviewing (assessment)
• Defining treatment goals– Abstinence– Controlled use
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Addiction Treatment, cont’d
• 3 treatment stages– Detoxification
• removing the offending substance from the body
– Active treatment• treating a variety of substance dependence
– Aftercare (relapse prevention)• avoiding use on a day-to-day basis through self-help
approaches
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Treatment Approaches
1. Residential treatment• Medical hospitalization
• Synanon
• Other therapeutic communities
2. Outpatient
3. Chemical dependency residency programs• Private-pay clinics
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Treatment Approaches, cont’d
4. Medication-assisted treatments• Antagonism
• Substitution
• Medically incompatible
5. Outpatient drug-free programs• Range from telephone hotlines to emergency room-
associated clinics
• Community mental health centers
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Addiction Treatment(The Big Picture in the U.S.)
• Treatment outcome data set– Over 1.5 million admissions each year– Four substances account for 90% of admissions
• alcohol 47%
• opiates 15%
• cocaine 15%
• marijuana 13%
Source: SDM HAS Annual Report
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Is Treatment Effective?
• Current belief is that treatment is ineffective
• 1990 report shows effectiveness results (Institute of Medicine)
• 1994 report (CA Department of Alcohol and Drug Programs) shows reduction of users and increased savings
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Chapter 3
Addictions: Theory and Treatment