Crisis Intervention - Ch 11

Models of Addiction -Parental Influence Model

"if my parents use it, why can't I?"

National Comorbidity Study

1 in 13 people at some time in their life will be dependent on a substance. 1 in 6 have a problem with alchohol.

Relapse statistics

1. 90% will have a drink within 90 days 2. 45-50% revert to pretreatment drinking after one year

Doweiko rules

1. Always seek collateral information (from a spouse) 2. Until proven otherwise, always assume deception.

Areas of Confrontation

1. Experiential - a response to any discrepancy by the client. 2. Strength - focused on resources, esp if not recognized by client 3. Weakness - focused on liabilities or pathology. 4. Didactic - clarification of misinformation 5. Encouragement to action - pressing to act constructively and discouraging passivity

Family counseling with alcoholics (advantages)

1. Family can confront and support 2. Family learns how substance abuse is related to other patterns of family life 3. Children can be educated as to the part they play in the dysfunctional system

Relapse (elements)

1. Long-standing personality traits such as narcissism or dependency resurface. 2. Symptom substitution - obsessive work habits to binge eating, i.e. "dry drunk" 3. Tunnel vision - must work on global issues or will slowly drift back into addiction 4. Warning signals - when recovering dependents begin to rationalize thoughts, feelings, and behaviors that set them up to drink again.

Multivariate Diagnosis

1. Matching treatment to client. 2. Dual diagnosis - many chemical dependents have other mental illness

Intervention Strategies - Multivariate

1. Multiple interactive etiological variables combine to produce a particular individual pattern of alcoholism. 2. Treatment must be multimodal 3. Treatment outcomes vary according to social context, cultural background, treatment processes... 4. Treatment of other life problems can improve the outcomes in people with alcohol problems.

Stages of Change (Prochaska...)

1. Precontemplation - person does not recognize a problem and still uses. 2. Contemplation - still using but entertaining thoughts of quitting. 3. Determination/Preparation - person has made a decision to quit in near future. Therapist uses empathic listening, gentle confrontation, humor, scaling questions, miracle questions. **Only about 20 percent of addicted persons can be found in last 3 stages 4. Action - person takes active steps like entering treatment 5. Maintenance - at about 6 months, person has made behavior change and controlled drug use. 6. Termination - at about 5 years, person has made cognitive and emotional changes necessary to support continuing control of the drug abuse.

Aftercare

1. Provide ongoing education and info to maintain sobriety 2. Create a healthy environment reinforcing positive behavior 3. Establish extended community support 4. To serve as first line of safety when crisis occurs

Enabler Roles (Ellis)

1. Silent sufferer - achieves pathological satisfaction by being a martyr to the cause of maintaining the relationship 2. Messiah - condemns the drug use and appears to fight the addiction vigorously to save addict, but never pushes issue enough so addict will have to face consequences of actions 3. Joiner - subsidizes and attempts to control the chemical dependent by doing drugs with them or doling out money for drugs.

CRAFT

Community Reinforcement Approach and Family Training. Is about teaching family members how they can change the social environment so that they are aware of and can change inadvertent reinforcers that can trigger drinking, along with reinforcing behaviors that are related to abstinence.

Inpatient Treatment: The Minnesota Model

Components: 1. treatment uses experts from a wide variety of disciplines 2. 28 day treatment regimen **Very expensive, movement towards outpatient

Defense mechanisms

Denial Displacement Fantasy Projection Rationalization Intellectualization Minimizing Reaction Formation Regression Repression

Benjamin Rush

Father of American Psychiatry, started pushing the notion that alcoholism was a disease as early as the first part of the 19th century.

Family counseling with alcoholics (considerations)

Important considerations: 1. Family cultural background 2. Nuclear vs. blended families

ILTOT

Intensive Long Term Out Patient Treatment

Alcohol

Most harmful of all legal and illegal drugs in the UK because: 1. Duration - has longevity, legacy and history of legislative attempts to control or promote it. 2. Legality - 3. Widespread use 4. Indirect financial costs 5. Psychological costs 6. Physical costs 7. Links to crime 8. Implication in accidents 9. Suicide 10. Alcohol is a drug 11. Interpersonal relationships 12. Polyuse 13. Embroilment in controversy

Alcohol

Number one abused substance

Addiction

Physically - a cellular change that occurs with the increased use of most depressant drugs. Psychologically - the compulsion to use drugs regardless of the negative consequences

Motivational Interviewing

Puts the ball in the client's court. Used in conjunction with stages of change. Very effective

RBT

Reinforcement-Based Treatment. A combination of CM and CRA on steroids.

Set and Setting

Set - the mental and emotional state of the user, including expectations, intelligence, personality, feelings, and so on. Setting - is the social and physical environment of the user at the time of use.

STOP

Short Term Outpatient Programs

SOCRATES

Stages of Change Readiness Scale and Treatment Eagerness Scale

Alcoholics Anonymous

Started in 1934 by Bill Wilson. Today it has more than 2 million members in 100,000 groups.

URICA

University of Rhode Island Change Assessment

Contingency Management

Used for both inpatient and outpatient therapy. Based on Skinnerian operant conditioning principles. Clean urine test, person receives a reward.

Models of Addiction -Psychosocial Model

a constellation of factors such as personality, environment, and behavior are interrelated and organized so as to develop a dynamic state designated as problem-behavior proneness.

Alcoholism

a highly complex condition characterized by preoccupation with alcohol and loss of control over its consumption, so that intoxication results if drinking is begun, by chronicity, by progression, and by a tendency to relapse.

Escape to Therapy (co-dependents)

a lot of catharsis happens but little change because it would mean facing reality and making serious changes away from maladaptive coping patterns that they have established

Denial

a normal adaptive process for self-protection, but in an alcoholic it becomes rigid and maladaptive

Enabler

a person who knowingly practices specific behaviors that allow the chemical dependent to continue the abuse/addiction and not be subjected to the full negative consequences of his or her behavior. Enabling has to do with one's behavior toward a chemical dependent.

Contemporary Model

a principles-of-treatment approach that is buttressed with components of CM, CRA and RBT.

Drug

a psychoactive substance that has a direct and significant impact on the processes of the mind with respect to thinking, feeling, and acting.

Rational Recovery (CBT)

a variation of rational-emotive behavior therapy.

Models of Addiction -Moral Model

addiction is seen as a consequence of personal choice...adopted by certain religious groups and judicial system...treatment approach is to increase one's willpower.

Models of Addiction -Biopsychosocial Model

addiction is seen as having multiple determinants

Reaction Formation (co-dependents)

alcoholic becomes more irresponsible and the co-dependent becomes more responsible

Regression

alcoholics are often immature and narcissistic, with resulting behavior similar to that of emotional prepubescence

Projection

alcoholics attribute motives within themselves to significant others.

Repression

alcoholics deal with threatening and hurtful events by burying them in unconscious memory

Rationalization

alcoholics make all kinds of excuses to support their addiction

Minimizing

alcoholics play down the seriousness of the situation

Intellectualization

alcoholics speak in generalizations or theoretical terms in an impersonal manner and thereby remove themselves from hurtful feelings

Fantasy

alcoholics use fantasy to escape from a variety of threatening circumstances and emotions.

Slip

an episode of drinking following a period of abstinence

Chemical Dependent

any person who has a dependence on drugs such that the substance governs his or her life to the extent that it severely impairs the ability to function psychologically and/or physically.

Motivation and Stages of Change

based on the hypothesis that persons going through recovery go through very definite stages and will experience different kinds of characteristics and crises at each stage.

Passive Aggression (co-dependents)

behavior keeps everyone in a state of uproar

Models of Addiction -Genetic Predisposition Model

closely allied to and supports the disease model...proposes an inherited and transmitted predisposition to become a substance abuser.

Suppression (co-dependents)

codependents may suppress the problems the addict brings to the family by maintaining a "stiff upper lip" and not allowing their emotions to surface

Hypochondriasis

conversion of anger into physical complaints

Cognitive-Behavioral Therapy

disrupting the automatic thoughts and the entrenched beliefs that are triggers for starting to drink.

Dissociation (co-dependents)

distancing the problem emotionally and sometimes geographically

Models of Addiction -Behavioral Learning Model

drinking is caused and maintained by the association of alcohol intake with positive rewarding experiences (habituation is strengthened by repetitive use of alcohol to combat anxiety and alleviate stress.

Models of Addiction -Disease Model

drug use is seen as an aberrant condition afflicting otherwise healthy people and exposure leads to physiological addiction. AA rests on this foundation.

Models of Addiction -Final Common Pathway

each of the theories of drug addiction contains an element of truth and efficacy. Proposes that substance abuse is not the starting point, but a common end point of different individuals' unique patterns of growth.

Models of Addiction -Sociocultural Models

examine factors external to the individual...environment is seen as a chief contributing factor; including demographic and ethnographic variables such as race, age, socioeconomic status, employment, education...this model challenges the disease model.

Dependence

is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.

Community Reinforcement Approach (CRA)

is a comprehensive (eclectic) behavioral program that crosscuts all of the ecosystems of the individual in an attempt to rein in substance abuse.

Codependency

is based on the chemical dependent's need for care to survive and the caretaker's need to control the addict's behavior. Has to do with one's relationship to a chemical dependent

Confrontation

is simply a matter of pointing out that there is a discrepancy between what the client says and how he or she acts. A principle characteristic of confrontation is to challenge through a question that evokes an immediate feeling response. It is also direct and action oriented.

Models of Addiction -Peer-Cluster Model

links drug use to small groups of people, including pairs such as best friends or boyfriend-girlfriend, who share beliefs, attitudes, values, and a rationale for drug use.

Displacement (co-dependents)

moves feelings off the focal point of the problem, the addict's behavior, and moves them to less frightening and hurtful subject matter

Reaction Formation

occurs as a defense against perceived threat and is one of the most harmful defense mechanisms because it distances codependents from their true feelings

The Hero

oldest child who takes care of the alcoholic, the spouse, and the other children

Intellectualization (co-dependents)

order their outer world but do little for their inner world

Models of Addiction -Personality Model

posits that certain components of traits and attributes that make up the personality predispose individuals to drug abuse.

Models of Addiction -Psychoanalytic Model

posits that certain pathological personality traits established early in childhood predispose the individual to alcoholism

Models of Addiction -Gateway Model

proposes an orderly progression from one drug to another and particularly applies to young people as they move into heavier and heavier drug use.

Models of Addiction -Sanctioned-Use Model

rampant use of ritalin for hyperactivity and ADD as well as amphetamines to keep pilots awake sends a message that it is okay to medicate

Relapse

return to uncontrolled drinking

CAGE

simple four item questionaire about one's drinking history. 1. Have you ever tried to CUT down on your drinking? 2. Have you ever become ANNOYED with people criticizing your drinking? 3. Have you ever felt GUILTY about your drinking? 4. Have you ever started the day off with an EYE-opener to steady your nerves or get rid of a hangover? Yes to any 2 of these would indicate alcohol use problems.

Models of Addiction -Prescriptive Model

suggests that alcoholism begins in self-prescription and physician prescription of alcohol and other drugs as tranquilizing agents to relieve acute or chronic pain symptoms.

Repression (co-dependents)

takes dissociation a step further by burying hurtful events in unconscious memory

Addictive behaviors

term preferred by psychologists indicating abuse, dependency, and so forth, because it focuses on behavior rather than fixed categories.

Tolerance

the biological ability of the body to transform and excrete the chemical from the body and the increasing insensitivity of the central nervous system to its effects.

Abuse

the chronic, recurrent misuse of chemicals and in a 12 month period there is failure to fulfill major role obligations

Habituation

the degree to which one is accustomed to taking a certain drug

Use

the intake of a chemical substance into the body with the goal of altering one's state of consciousness.

Models of Addiction -Problem Behavior Model

the more problematic the behavior of the individual, the more likely the individual is to come into contact with people, places, and instances where drugs are available

Withdrawal

the production of physical and psychological symptoms by the body on cessation or reduction in use of the drug.

Models of Addiction -Lifestyle Model

the rewards of living in an altered state of consciousness outweigh all the costs of a destructive, drug-dependent lifestyle.

The Scapegoat

they enable the addiction by becoming another stressor that can serve as an excuse for substance abuse and by focusing the family's anger and energy away from the addict and onto themselves.

Models of Addiction -Cognitive Model

thoughts or beliefs are the primary causative factors in substance abuse.

Misuse

use of a chemical with some adverse physical, psychological, social, or legal consequence

Models of Addiction -Stress-Coping Model

use of drugs is seen as a substitute for effective behavioral and cognitive coping skills when individual is under stress.

The Lost Child

usually a middle or younger child who follows directions, handles whatever has to be handled, and adjusts to the circumstances, however dysfunctional they may be.

The Family Mascot

usually the youngest child who placates and comforts everybody in the family, makes them feel better.

Displacement

venting of hostility on a person or object neither of which deserves it