Ch 22 Substance Abuse

Findings in the 2001 National Household Survey on Drug Abuse reported that percent of the population is affected by substance use. It is important when working with this population that a model is used.

7.3; biopsychosocial

Johnson (1986) came up with the which is a therapeutic approach that confronts the denial in the alcoholic unwilling to seek help on their own. A team of people come together, choose a time and location, anticipate potential excuses, chooses a chair person (usually the therapist)m and determine how they want to speak to the alcoholic. The leaders helps the team prepare what they each want to say. It's best to have this during the due to the alcoholic being sober and not having the ability to change their mind. The team demands that the alcoholic seek treatment. The therapist must be prepared for if the alcoholic and the team reacts with anger/sadness. The therapist processes with the team and will refer out to Al Anon if needed. Treatment results for this are mixed but they have found that the unilateral treatment method is more effective. can also be helpful with how it provides mutual aid support for families with a focus on how alcoholism is a disease, helping each member cope and support, and reduce enabling behaviors. It emphasizes the importance of seeing themselves as powerless over their partners actions. is another group resource founded by Bill W. & Dr. Bob that is helpful where a chairperson leads the meetings where they have one or more person tell their experiences, strength, and hope with beating alcoholism. Alcoholism in this model is seen as a disease that is beyond one's control however they need to acknowledge the damage done in relationships through the steps . In these steps a person must acknowledge that they are in the struggle against alcohol and they rely on a higher power for help. The goal of this model is and it must be continued to attend meetings. Although many people join at major lows in their life, such as when they lose their job, Al Anon helps with having family members bring the alcoholic in before it gets to that point. A support for abstaining from drinking is having a who is also a recovered alcoholic and their experiences are communicated to the person in treatment.

The intervention; morning; walk out/deny help; Al-Anon; AA; 12 Steps; powerlessness; sobriety; mentor

To sum up the whole substance abuse chapter, , a orientation, and treatment team is critical. Even if the person is not choosing to engage in treatment, the power of for change and helping should not be underestimated.

assessment; biopsychosocial orientation; multidimensional; family leverage; non-professional

The etiological components for substance use are such as familial or genetic predispositions, such as being comorbid with depression/anxiety, and where they experience pressure from peers or the community to use. They have found that with animals that they are more likely to seek alcohol if they lack the neurotransmitter . They have found with twins and adopted children that can play a risk where the behavior is learned through modeling. Defense mechanisms are usually played out to alleviate the feelings of & that a person has for engaging in the behaviors.

biological; psychological; social; serotonin; social learning; shame & guilt;

When treating for substance abuse it is important to treat through a lens. For treatment to begin, & have to acknowledge that drinking is the problem and to confront the person. The next step is to see if the drinker can engage in. or must abstain from drinking completely. The therapist will not have the ability to convince the family of either option but they will promote movement in the system by having them confront the drinking once the drinker breaks the to not drink. Sobriety will disrupt the family since old patterns are no longer useful and this may cause stress in the family. The therapist will need to acknowledge feelings and identify the family needs to help with reorganizing relationships. Its important to focus on non-alcohol related presenting problems to help the family shift from its old structure to its new one

biopsychosocial; drinker and family; controlled use; contract; balance; repressed

Treatment for alcoholics is often in a five stage process, where the person confronts the substance use, where the person no longer uses the substance and may require medical attention to help with withdrawal symptoms, where the person learns about alcohol and its effects on the body, where the person goes in individually or in a group for assistance, and. where they reintegrate with their loved ones

confrontation, detox, education, therapy, reintegration

There are several biopsychosocial models written that have been emphasized for treatment: Jellinek (1960) posited the where alcoholism is seen as a biological illness that is chronic and progressive where the person feels a loss of control and denial over use. It is treated through psychoeducation and medication; consider addiction to be a maladaptive response to underlying psychopathology. It is treated with medication and education; which recognizes how substance usage can help with regulation and self soothing for trauma survivors. Treatment includes stabilization then exploration with details from the trauma; where a person learns to cope through watching others use the substance for coping. Behavioral and cognitive interventions are utilized; where substance use is a family disease where each person is affected and plays a role in sustaining the addiction; where environmental factors such as poverty, access to substances, etc. contribute to the usage. It is important with treatment that each person in the family recognizes the they play in maintaining the substance use, taking a history of the use, and assessing biopsychosocial influences for the person using.

disease model; Psychiatric model; trauma model; systems theory model; social model; role

Children in alcoholic families usually take on one of four roles: usually the eldest child who takes parental responsibility of the other children and their sense of competence comes from it, they feel inadequate inside however tend to be high achievers outside of the home; who are the children that act out and their behavior deflects from the alcoholic's drinking problem, usually they come in due to the child's behavior and without treatment they may develop substance abuse, they may appear hostile, defiant, and angry but inside they feel hurt and guilty; who are the children that learn to disappear and withdraw from the world, they have difficulties forming relationships and appear withdrawn, they feel lonely and a sense of being unimportant; who are the children that divert the family's attention away from the family with comic relief with hyperactivity or learning disabilities. There are two other roles that usually the family adopts to in order to provide relief from stress with alcoholic individuals: who appears hostile, rejecting, and angry but often feels shame; who is super responsible, self-righteous, and keeps the family functioning, their inner feeling is anger. It is important the therapist recognizes how these roles continue to impact the system and perpetuate the alcoholism

hero; scapegoat; lost child; mascot; dependent; enabler

Many therapists miss substance use in the family due to & . It's important for the therapist to assess the role of the. , good to intervene with restricting the family. The therapist needs to assess for behavioral.physiological influences such as family history, psychological such as how one copes with it, cognitive such as expectancies and social such as interpersonal difficulties/consequences. During assessment it is important to differentiate between these three matters: a is a behavior that someone regularly engages in but has the ability to stop, are behaviors are done consistently and repetitively however the meaning for the behavior coming about in the first place disappears, with the behavior subtly escalates until it is out of control where it becomes chronic and progressive. The warning signs to watch out for with addiction include whether the person drinks or secretively; whether the person deliberately uses the alcohol to with difficult situations, feels uncomfortable on occasions when alcohol is not available; escalating consumption before a such as driving; drinking more often than in the past; drinking at odd hours of the day such as the morning.

lack of training; see the family as problematic and not see how they have structured themselves around the substance abuse; habit; compulsive act; addiction; alone; cope; risky event

Alcohol and illicit drug use disorders are more likely to effect than women. They are frequently comorbid with . Alcohol abuse is leading cause of death for . Violence is correlated with . Although there is not as much illicit drug usage, age individuals are trying it out more at alarming rates. The most abused illicit drug is with 14.6 million users. americans have a drinking problem and over prescriptions have been written for Valium and other tranquilizers. There has been a 40% jump with employees testing positive for prescription narcotics from 2005-2009. adolescents are more at risk and adolescents in mental health treatment are more likely to use,

men; mood, anxiety, and personality disorders, trauma; 16-24 year olds; alcohol abuse; children and teens; marijuana; 13 million; 60 million; white and hispanic

When treating families with substance abuse it is is important to see how the model can be helpful with getting treatment resistant alcoholics ready for treatment. Other factors that contribute to recovery include & .

social networking; family cohesion; abstinence support

Promising research has come out about marital and family interventions with assisting with substance use. Some studies found that the support of a directed treatment was taken better than the control group with results. They found that there was a decrease in use for adolescents more significantly with completing rather than individual therapy. Other motivators and supports in treatment include . It is important with adolescents to note that their treatment is usually not on their part but its important to help teach them the importance of making that help them complete developmental tasks. Research has shown that a group of people to work with, implementing techniques such as joining, reframing, enacting, and paradox help with building cohesion necessary to rebuilding relationships and hinder substance abuse. The other model that works well is where the levels of functioning for each individual, the family as a whole, and social areas that may cause risk are maintaining symptoms and addressed.

spouse driven; family therapy; community resources; voluntary; choices; selecting a specific group; systemic; multidimensional

For many families impacted by alcohol abuse they feel & . Some will live in a perpetual state of crisis while others deny that it is going on. Children may learn to ignore whats going on at home and . As these children grow up they may have unrealistic expectations for what people can give them. Many families will deny there is problem drinking until . The family will go through several stages: where the family may confront the drinker but accepts their denial of the problem; where the family members hide the problem with whats going on with the drinking by attempting to control the drinker, hiding them from the world around them; where conflict increases as the sober spouse can no longer deny or hide the problem and children are usually caught in the cycle; where the drinking spouse becomes more dysfunctional, the sober spouse takes over responsibilities and they may begin the process of separating, the drinking partner may bargain with the spouse and if they take it then the cycle starts up again; where the sober spouse becomes active and initiates legal separation and the drunk partner may respond with sobriety; where the family reorganizes and things seem to improve without the drinking spouse however the drinking spouse may try to reenter; where the if the abuser gets help and is successful that the family can recenter around reintegration

trapped & out of control; rely on themselves; something is threatening its continuation; family denies the problem; the family tries to eliminate the problem; the family becomes disorganized; first attempt at reorganizing; the family escapes the problem; family makes an attempt at reorganization a second time; the family reorganizes with the substance abuser seeking help

For the DSM V now requires symptoms to be met from a list of 11 symptoms to qualify for a substance use disorder. Dependence is no longer a diagnosis instead the substance use disorders are classified by . The DSM V has added where the same chemical elements are triggered from shopping, gambling, sexual activity, etc.

two or three; type of substance used; process addictions

When working with adult substance abuse, interventions facilitate treatment initiation among resistant substance abusers through work with one or more concerned family members. The specific models that integrate these interventions include unilateral family therapy, pressures to change (PTC), and community reinforcement and family training (CRAFT). The therapist would use to attempt to engage with the substance abusing member through motivational enhancement, communication skills training, behavioral analysis, contingency contracting, coping, self-care. Empirical research has found that PTC and CRAFT have been more effective than AL-ANON with getting people motivated to complete treatment. They also found the Behavioral Marital therapy or Behavioral Couples therapy were more effective than non couples treatment for the person engaging in substance use.

unilateral interventions; relational leverage;