foundations of addictions counseling, 1 st edition © 2009 pearson education, inc. all rights...
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Foundations of Addictions Counseling, 1st Edition
© 2009 Pearson Education, Inc.All rights reserved.
Chapter 1History and Etiological Models of Addiction
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History and Models of Addiction
A specialized field in counseling The addiction counseling field
evolved like psychology, social work
Early Practice Limited education, supervision,
ethics, and research
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Prevention in the United States
Historical approaches to prevention Alcohol’s central role in the colonies Temperance as moderation
Original goal was moderation Temperance as abstinence
Women’s Christian Temperance Movement Volstead Act and Prohibition (1920)
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U.S. Drug Laws Until 1903 cocaine was used in
soda drinks (“Coca Cola”) Pure Food and Drug Act, 1906
(labeling) The Harrison Act, 1914 (taxation of
opium and coca products) Controlled Substance Act, 1970
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Laws and Agencies
National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1971
National Institute on Drug Abuse (NIDA), 1974
The Anti-Drug Abuse Prevention Act of 1986 created the United States Office for Substance Abuse Prevention (OSAP) Later became CSAP (part of SAMHSA)
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Models for Explaining the Etiology of Addiction
The Moral Model
Psychological Models
Family Models
The Disease Model Biological Models Sociocultural
Models Multicausal
Models
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The Moral Model
Personal Choice Religious Beliefs
Sinfulness
Legal System Punishment
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Psychological Models
Cognitive-behavioral models Motivations Reinforcement (positive & negative)
Learning models Learned response
Use decreases anxiety, stress, etc. Aversion to withdrawal Physical dependence
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Biological Models
Genetic Models Statistical associations
Genetic factors
Neurobiological Models Brain chemistry
Limbic system
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Multicausal Models No single model adequately explains
addiction Syndrome model
Multiple and interacting antecedents Integral Model
Concepts from integrative medicine and transpersonal psychology
Public Health Model Agent, Host, Environment
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Useful Web Sites www.ncadi.samhsa.gov www.drugabuse.gov www.niaaa.nih.gov
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Chapter 2Substance and Process Addictions
Laura Veach and Emeline P. Hollander
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Neurobiology and Physiology Addiction
Neurobiology Brain research
Reward pathway
http://teens.drugabuse.gov/mom/tg_brainimages_fig6.html
Reward Circuit
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Reward Pathway
Ventral tegmental area NA Prefrontal Cortex
Source: http://www.drugabuse.gov/pubs/teaching/Teaching3/Teaching2.html
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Nerve Cells and Neurotransmission Neurons
100 billion nerve cells in the brain
Neurotransmitters Chemical
messengers Dopamine Neuroreceptors
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Cocaine Interfering with NeuronsWhen cocaine enters the brain, it blocks the dopamine transporter from pumping dopamine back into the transmitting neuron, flooding the synapse with dopamine. This intensifies and prolongs the stimulation of receiving neurons in the brain's pleasure circuits, causing a cocaine "high." http://teens.drugabuse.gov/mom/tg_effects.php# (http://teens.drugabuse.gov/mom/tg_brainimages_fig7.html)
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Positron emission tomography (PET) scan
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Physiological Factors
Tolerance Neuroadaptation Metabolic tolerance Pharmacodynamic tolerance
Withdrawal
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Substances of Addiction Depressants Stimulants Cannabinoids Hallucinogens Opioids
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Depressants Alcohol Sedative/Hypnotics
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Alcohol Ethanol
Proof 7% alcohol/ethanol = 14 proof 151-proof rum = ___ % ethanol?
Mood altering effects within 20 minutes Metabolized by the liver as a toxin
Intoxicated Blood alcohol concentration (BAC)
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Sedative/Hypnotics Sedative/Hypnotic drugs (CNS)
Also depress the CNS Benzodiazepines (aka “tranquilizers”)
Valium (diazepam), Xanax (alprazolam) High risk for abuse and addiction Women at risk
Barbiturates (Tuinal, Nembutal) Lethal potential
Non-barbiturates (Quaaludes)
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Stimulants Tobacco
Nicotine Ephedrine Amphetamines Ritalin Cocaine
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Ephedrine, Amphetamines, Amphetamine-like Medications
Ephedrine Legal ban in 2004 (side effects)
Amphetamines (“Speed”) Methamphetamine
Oral, snorted, smoked, injected Amphetamine-like medications Ritalin (for ADHD)
Side effects: weight loss, insomnia, hypertension, anemia
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Cocaine
Epidemics in late 1800’s, early 1900’s Use has declined since 1990’s
“Crack” cocaine Smokeable, concentrated form of cocaine Physical Dependence
(tolerance/withdrawal) Strong potential for abuse
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Cannabinoids Marijuana
Unique properties Tolerance Withdrawal Dependence Negative physical effects
Reduced lung capacity Lowered testosterone levels Racing pulse Decreased muscle strength
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Hallucinogens and Other Psychedelics
Lysergic acid derivatives (LSD) Phencyclidine (PCP) MDMA (Ectasy)
The most popular psychedelic of the 1990’s
Perception-altering properties
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Opioids
Parent of all narcotic drugs Opium
Morphine Heroin
Intravenous injection HIV Infection risks
OxyContin
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Process Addictions Ingestive addiction
Chemical dependence Process addictions
Addiction to a behavior, process, or action
Still debated Examples
Gambling, sexual addiction, work, shopping, food
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Sexual Addiction Varying definitions Sexaholics Anonymous (SA)
“Addicted to lust”, loss of control Isolation, Guilt, Depression, Emptiness
Sex Addicts Anonymous (SAA) Progressive path to increasingly
dangerous behaviors No DSM criteria for sexual addiction
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Gambling Addiction
Pathological gambling Impulse Control Disorder in DSM
Warning signs Secretiveness Extravagant expenditures Increased debt and worry over
finances Increased alcohol, drug consumption
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Work Addiction “Workaholism”
Little data available on prevalence Socially accepted, encouraged,
rewarded Self-esteem problems, inability to relax,
out of control, frenetic, unsatisfied unless doing something
Less productive than non-workaholics Perfectionistic, inefficient More research needed
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Compulsive Buying Shopaholism Consistent, repetitive purchasing
in response to stress Overspending, Indebtedness,
Bankruptcy Treatment
Teaching how to resist social forces (media, easy credit)
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Food Addiction and Disordered Eating
Eating Disorders, including: Anorexia
Compulsive self-starvation Bulimia
Compulsive cycle – eating and purging Binge Eating Disorder (no purging)
Overeaters Anonymous 10% of sufferers are male
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Useful Web Sites Alcoholics Anonymous
www.alcoholics-anonymous.org Al-Anon and Alateen
www.al-anon.org Narcotics Anonymous
www.na.org Overeaters Anonymous
www.oa.org