five questions : what is addiction? how do addicts differ from others?
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FIVE QUESTIONS : What is addiction? How do addicts differ from others? What thinking causes addiction? 4. What cultures cause addiction? Is addiction decreasing/increasing?. MODELS OF ADDICTION. Disease Model of Addiction. Inbred/biological Loss of control Lifelong/permanent - PowerPoint PPT PresentationTRANSCRIPT
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FIVE QUESTIONS:
1. What is addiction?
2. How do addicts differ from others?
3. What thinking causes addiction?
4. What cultures cause addiction?
5. Is addiction decreasing/increasing?
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MODELSOF
ADDICTION
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Disease Model of Addiction
Inbred/biological
Loss of control
Lifelong/permanent
Inevitable progression
Requires medical/spiritual treatment
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Neurochemical Model
Addiction operates through dopamine
Drugs elevate dopamine pleasure
Neuroadaptation dependence
Requires treatment chemical blocks
Leshner: “It's a myth that millions of people get better by themselves.”
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ADDICTION IS…
Understanding brain chemistry, not building up
willpower, is the key to preventing adolescent alcohol
and other drug addiction.
Source:
Nora Volkow, director, National Institute of Drug Abuse (NIDA).
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Cognitive-Behavioral Model
Alter thinking action
Present oriented
Skills oriented
- internal/cognitive
- external/practical
Coping/problem solving
- applied to substance abuse
- dysfunctional thinking cycle
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THE CONCEPT OF
ADDICTION
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Which drugs are addictive?
Problems with the
Addiction Concept
ILLICIT cocaine marijuana
LEGAL nicotine caffeine antidepressants
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hospital patients
the clinical bias
Vietnam
Are Addictive Drugs
Always Addictive
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What Happened in Vietnam?
Of all those addicted…
60% used narcotics stateside
12% re-addicted any time
6% addicted after three years
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What is Addiction?
Source:Stanton Peele, Diseasing of America,
San Francisco: Jossey-Bass.
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Vietnam
vs.
Home Environments
Fear and privation
-Control
-Positive options
-Social support
-Values of moderation
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Addictive Criteria
Absorbing
Predictable
Sense of control / value
Illusory
Deepening / worsening
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Gambling Example
Absorbing activity
“Predictable”
Sense of value and control
Growing penalties
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ADDICTION IS…
an absorbing activity that provides essential emotional
rewards otherwise not available to one that entails
growing life detriments.
Source:Stanton Peele, The Meaning of Addiction,
San Francisco: Jossey-Bass.
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Sources of Addiction
Stressed environments
Lack of satisfaction
Lack of moderating influences
Lack of coping skills
Lack of self-efficacy
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HOW CAN LOVE BE
ADDICTIVE?
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Causes of Relapse
Two factors predicted relapse
following treatment:
“lack of coping skills and belief in
the disease model of alcoholism.”
Source:Miller, W.R., Westerberg, V.S., Harris, R.J., et al. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-171.
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NATURAL RECOVERY &THE PROCESS OF CHANGE
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Lifetime, Past Month, Ages 12+: Percentages, 2002
Illicit Drug Use
Lifetime Last Month Last Month/Lifetime
Cocaine 15 1 7
Crack 3 .3 9
Heroin 2 .1 6
Source: SAMHSA (2003, Table 1.1B)
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Addiction and Age
Age16-1718-2526-2930-3435-3940-4445-4950-5455-5960-6465+
% Abuse/Dep172215121198734
1
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NESARC
2001-2002 National Epidemiologic
Survey on Alcohol and Related
Conditions (NESARC) :
43,093 in-person interviews
4422 DSM-IV alcohol dependent
Source:Dawson, D.A., Grant, B.F., Stinson, F.S., & Chou, P.S., et al. (2005). Recovery from DSM-IV
alcohol dependence: United States, 2001-2002. Addiction, 100, 281-292.
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NESARC Past-Year ImprovementAmong Alcoholics
(columns percentaged)
Treated UntreatedPast Year Status (n=1,205) (n=3,217)
Dependent 28 24
Abstinent 35 12
Drinking w/o dependence 36 64 Source: Dawson et al. (2005)
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Summarizing NESARC
Most alcoholics untreated
Treated alcoholics do no better
Most alcoholics cut back drinking
What were these people thinking?
Implications for treatment/policy
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HARM REDUCTION THERAPY
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What is harm
reduction?
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Principles of Harm Reduction
Consequences of behavior
Non-abstinence outcomes
Client-centered
Low threshold / low commitment
Pragmatic
Marlatt, A. (1996). Harm reduction: Come as you are. Addictive Behavior, 21, 779-788.
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Is harm reduction
accepted?
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Why not?
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SCIENTIFIC RESEARCH ON ALCOHOLISM
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EFFECTIVE THERAPIES
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Effective Alcoholism Treatments CES *
Severity
Brief interventions 390 2.47
Motivational enhancement 189 2.72
GABA (Acamprosate) 116 3.80
Community reinforcement 110 3.43
Self-help manual 110 2.59
*Cumulative Evidence ScoreSource: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon.
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Ineffective Alcoholism Treatments CES*
Severity
Twelve-step facilitation -82 3.67
Alcoholics Anonymous -94 3.14
Confrontational counseling -183 3.00
General alcoholism counseling -284 3.22
Education (tapes, lectures) -443 2.44
* Cumulative evidence scoreSource: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon. (3rd Ed.).
Boston: Allyn and Bacon.
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HOW DO PEOPLE REALLY CHANGE?
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BI/MI – What Is Common?
Minimal time in therapy
You must change
True to your values
Self-efficacy
Harm reduction
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Patient Resources + Outcomes Treatment or No
Stable marriage
Social/community stability
Higher socioeconomic functioning
Higher intellectual functioning
Employment - Job skills
Motivation to change
Ability to cope with stress
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A Different View of Addiction
People change the more resources they have
They are helped by summoning the resources they possess
Treatment assists by helping them gather resources
Treatment not essential
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Assessing Resources:
Intimacy and supportive relations
Work skills and accomplishments
Activities and interests
Coping with your world
Coping with yourself
Beating previous addictions
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Stages of Change:How People Really Do It
Believe that the addictive involvement violates more important values.
Want to quit/ and believe you can.
Develop alternative rewards that are more meaningful than addiction.
Find/develop resources in life to maintain rewards.
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Stages of Change:How People Really Do It
(continued)
Rely on friends, family, and groups to help support the change in behavior.
Avoid situations and ways of thinking that provoke relapse.
Eventually develop a new self-image, a view of oneself as a former addict.
Develop higher goals than addiction.
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ARE ALL SOCIETIES EQUAL? ALCOHOL
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Alcohol and ModerationIreland vs. Italy
Ireland 2 48 Italy 42 11
% of men whoDrink every day Binge 1+/week
Source: European Comparative Alcohol Study
Norstöm, T. (Ed.). (2002). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm: SW: National Institute of Public Health, pp. 196-205.
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Drunken 15-16 year olds
Country % Drunk 10+/year
Denmark 39Finland 29U.K. 28Ireland 27Iceland 19
+ + +Greece 4Malta 4Portugal 4France 3Italy 2
Source: Plant, M., & Miller, P. (2001). Young people and
alcohol. Alcohol & Alcoholism, 36, 513-515.
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Non-Temperance Recipe
Regular consumption
With meals
Across gender, age groups
Drinking + / drunkenness -
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Model for Moderation
Drinking is regular, accepted
Bad drinking, good drinking taught
Bad behavior not excused by drinking
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PROTECTING AMERICAN YOUTH
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Monitoring the Future 2004Drinking by U.S. H.S. Seniors
Behavior
Drank in last year 71%
Drunk in last year 52%
Drunk in last month 33%
Attitudes
Disapprove of 1 or 2 drinks/daily 76%
Disapprove 5+ drinks weekends 66%
Source: Johnston, L.D.. National Results on Adolescent Drug Use: Overview of Key Findings, 2004. Bethesda,
MD: National Institute on Drug Use, 2005.
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What are kids most likely to be addicted to?
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Are children not sufficiently protected?
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Heavily protected
Echo boomers are the most watched-over
generation in history. Most have never
ridden a bike without a helmet, ridden in a
car without a seat belt, or eaten in a
cafeteria that serves peanut butter.
Source: 60 Minutes, “The Echo Boomers”
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Not independent
“Sometimes, they don't know what to do if
they're just left outside and you say, ‘Well,
just do something by yourself for a while’
They'll look around stunned.”
Source: 60 Minutes, “The Echo Boomers”
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Not independent
"Parents feel as if they're holding onto a piece of
Baccarat crystal or something that could
somehow shatter at any point. They have a sense
their kids are fragile. Parents therefore are
protecting them, inflating their egos, massaging
them, fighting their battles for them."
Source: 60 Minutes, “The Echo Boomers”
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Immediate gratification
“Everything has to be immediate, like a video game.
And they have a lot of trouble doing things in a
stepwise fashion, delaying gratification.”
Source: 60 Minutes, “The Echo Boomers”