Substance Abuse

Confrontation

...

action stage

...

contemplation stage

...

precontemplation stage

...

preparation stage

...

Three types of AA meetings

1. Speaker meetings 2. Discussion meetings 3. Step meetings

According to Landau, 2000

90-‐95% of substance abusers, in any given year, do not seek therapy or self-‐help

MM paricipants

98% white 66% female 94% have at least one year of college

lineal perspective

A causes B

Sponsor

A person who is farther along in the process who can act as a guide. Usually available 24/7 as a first response team in case the individuals has serious urges to use again

The Twelve Steps

Created by AA, regardless of severity, everyone is instructed to follow the 12-steps 1. We admitted we were powerless over alcohol- that our lives had become unmangageable 2. Came to believe that a power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood him 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all theses defects of character. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong, promptly admitted it. 11. Sought understanding through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of theses steps, we tried to carry this message to alcoholics and proactive these principles in all our affairs.

Five Principles of Intervention

Johnson 1986 1. Meaningful persons in the life of the chemically dependent person are involved 2. All of the meaningful persons write down specific data about the events and behaviors involving the dependent person's chemical use which legitimatize their concern. 3. All of the meaningful persons tell the dependent person how they feel about what has been happening in their lives, and they do it in a nonjudgmental way 4. The victim is offered specific choices- this treatment center, that hospital 5. When the victim agrees to accept help, it is made available immediately.

Although Alcoholics Anonymous is strictly a self-‐help program

Meeting ran by members some may be health professionals, but engaging in their role as someone in recovery rather that in a clinical capacity.

self-help groups

Mental health professions will not have any direct involvement in the self-help group unless they are also in active recovery.

ARISE

Originally stood for: Albany Rochester Interventional Sequence for Engagement now stands for: A Relational Intervention Sequence for Engagement -Based on family motivation to change and is designed to get the addict individual into treatment -83% success rate of working with concerned other to help engage a substance abuse to either treatment or some type of self-help

CRAFT

Robert J Meyers developed the Community Reinforcement and Family Training Program. Bases on learning-theory CRAFT was designed for concerned significant others of individuals with alcohol/drug problems who refuse to go to treatment. This is an off-shoot of the Community Reinforcement Approach developed by Azrin. Through principles of operant conditioning, community reinforcement attempts to shift the drug user from a problematic to pleasurable lifestyle without alcohol or drugs

Alcoholics Anonymous

The most famous and most popular addictions self-‐help group. Began in the 1930's Rowland H. Sought help for alcoholism from Carl Jung, Jung believed Rowland needed spiritual help & referred him to the Oxford group (religious movement focused on self-improvement through an exploration of one's actions, making amends of wrongs, prayer and meditation. Rowland recruited Ebby T, Ebby recruited Bill W. ( a past successful stockbroker who could no longer function due to the effects of alcohol. Bill W joined oxford group. In 1935 Bill W. was introduced to Dr. Bob from their meeting the realized the importance of two alcoholics talking to each other, Dr. Bob's last drink was on 6/10/35 which is considered the birth date of AA.

First Caller

The person who contacts the therapist is told they did the right thing by calling, that ARISE method can help, they should get as many family members and concerned others to helm them, should operate with love and respect, and they do not have to deal with the alcoholic on their on anymore, 55% of alcoholics decide to come for the first session At this level the therapist attempts to increase the level of hope in the family.

Concerned Significant Others

Three main goals: 1. Attempt to get the abuser into treatment 2. Get whoever is overusing substances in the family to decrease their use 3. focuses on how CSO can enhance other problematic areas of their lives to move towards a more enjoyable life.

Al-ANon

a group geared towards the loved ones who are in a relationship to the addicted person.

system

a group of parts that come together to function as a whole when applied to families, this function occurs via the transactional patterns of family members

AA meetings new members

anyone can attend free of charge new members encouraged to attend 90 meetings in 90 days

Interventions

are meetings, usually as a surmise to the person abusing substances, where family members and friends get together and let the addicted person know their fears for them and their hopes that the person will change. Developed by Vernon Johnson in the 1960s The belief is that anyone who wants to help the addicted individual, regardless of their background or clinical training, can help that person. Interventions are based on the disease model of addictions

closed system

are more flexible where there is a clear distinction between systems. Information does not easily flow from one system to another. Tend to operate with rigid boundaries and do not readily exchange info.

sobriety coin

as you reach temporal milestones of sobriety you receive a toke, as a reminder of your accomplishment

Family Motivation to Change model

based on the notion that the family can play a key role in helping in the recovery of alcoholism for a member of the family. The abusers social network is viewed as being competent and accessible, concerned individuals who are able to help the abuse.

metacommunication

communication about communication. verbal and nonverbal messages to let each person understand how to make meaning of communication

rigid boundaries

do not let a lot of information through from system to system.

Level 1

first stage of ARISE- when the treatment professional begins to work with one or more concerned individual in regards to a substance abuser, either by phone or face-to-face

enmeshment

in subsystems with diffuse boundaries members are very connected to one another, usually over-connected in inappropriate ways. When this happens with two individuals are experiencing enmeshment

punctuation

in systems theory explores where to put a starting and ending point

clear boundary

information is allowed to move across boundaries however the information is appropriate for the context. Parents who have clear boundaries with their children will make rules, yet depending on the age of the child and situation allow flexibility.

command

it describes the relationship between the two people

Discussion Meetings

members will talk about their own experiences with addiction yet the meeting centers on a topic related to substance abuse

Speaker Meetings

occur by various members, one at a time, self-disclosing to the other participants about their own experience with addiction (tell their story)

Self-help groups

occur outside the realm of formal therapy where individuals who are dealing with a particular substance or issue come together to talk about how they are impacted on the addiction. The main benefit is being supported and helped by others

Step meetings

one of the 12 steps will be chosen as the focal point of the conversation wherein members will talk about their personal experiences trying to engage in that step.

dysfunctional

patterns are not fulfilling, the patterns if judged severe might also become problematic and conflictual.

authoritative parents

provide rules and guidance but are somewhat flexible, allowing potential negotiation, most like clear boundary

patterns

sequenced interactions that occur over time. in families patterns form and are maintained usually for lengthy periods. When these patterns are to our liking the therapist might call them functional. not in themselves problematic

homeostasis

stands for "same state" and hold that systems attempt to maintain a steady state of functioning through the use of feedback processes. This occurs through the combination of stability and change.

mutuality

system theory does not see the individual as spate from the context but an active agent in it.

open systems

systems where the boundaries are looser, where information can more readily move from one system to another most likely diffuse boundary system or clear boundary on the diffuse side of the continuum. This allows the family to more readily adapt to what the outside system need.

authoritarian parents

tells the children what the rules are and what the child is supposed to do, allowing little to no negotiation. There is most likely a rigid boundary between the parent and child system

Indulgent Parents

tend to allow their children to do whatever the children want. This may be most indicative of a diffuse boundary between parents and children

report of the message

the context

Level 3

the final stage, only 2% of families need to get to in order to motivate the alcoholic into treatment. This level includes the therapist helping family member to set limits and consequences for the dependent person, this is done in a respectful and supportive way by family members

negligent

the focus is not on the children but somewhere else. For addicted families where the addiction has become sever enough, negligent parenting may occur.

Chairperson

the person that will help facilitate the process of the intervention. Ensure that the rehersal as well as the intervention are focused on helping the person rather than turning into an attack on one person

CHAPTER 10 Cybernetics

the science of pattern and organization. Based on the works of Gregory Bateson, how systems process feedback to self-regulate,

context

the situation in which the interaction occurs

Level 2

the therapist meets with the family, usually for 2-5 sessions. These sessions may or may not include the alcoholic. most families are able to get the alcoholic into treatment while working at this stage, thus making no need to proceed onto level 3.

Diffuse boundaries

too much information flows back and forth. Families with diffuse boundaries might tend to know everyone's business

Moderation Management

views alcohol abuse as a habit, a pattern of learned behavior rather than a disease. The person is not directed to abstinence, instead treatment matching occurs where the level of treatment coincides with the level of the problem. Developed in 1994 by Audrey Kishline, based on a cognitive-behavioral approach Designed for the problem drinker, since there are more problem drinkers than alcoholics, MM has a wide catchment of potential participants free, led by volunteers some may be asked to abstain from alcohol for 30 days when they first begin, to allow them to shift out of their current problematic drinking behavior. To reflect on how it has impacted them, (Who, what , where, when) able to drink in moderation

boundaries

what separates one stystem from another system. Theya re determined by who is allowed to do what, where and when

Unilateral Family Therapy

when one or more family members engage in therapy around the substance abuse issue, but where the person who is using is not involved in the therapy. ARISE, CRAFT, & Johnson Intervention

affiliation

when two or more member get along very well with one another

universality

where the individual can take solace in knowing they are not alone in the problem and many other people experience the same thing (benefit of self-help group).

coalitions

where they actively work to focus negative energy on a third party, there may be coalitions within alliances

alliances

where they make sure that they are supporting the other person in the alliance rather than looking out for other people

subsystem

while a family is a complete system, it also has a subsystem of larger systems.

Big Book

written by the founders of AA in 1939, foundation upon which the groups operate.