Sociology of Substance Abuse Final

Synanon

A residential drug rehabilitation program established by Charles Dederich that became very successful in the 1970s Believed that since an opioid addict is never cured recovery is an ongoing process Therefore the addict had to stay affiliated with the Synanon program by continuing to live in or near it In-patient treatment, involved an "open-door policy" whereby patients were free to leave at any time Addicts were expected to work and keep busy in the program Recovering addicts made up the staff Group encounters occurred several times a week that could be psychologically brutal to break down the defenses and encourage expression of emotions There were some concerns by the early 1980s that Synanon had become like a cult centered on the leader Charles Dederich was disbanded in 1991 for financial reasons

Attempts to reorganize in spite of the problem stage 4

A family cannot stay in a state of disequilibrium for long. It either has to break apart or establish a new equilibrium that allows the family to function even though one of its members is an alcoholic If the family stays together its members must adapt new roles, rules, and rituals to restore equilibrium

Self-help groups

Addicts who join twelve step programs have a better chance for recovery since it provides them with hope and support Family members can get involved in twelve step groups such as Al-Anon, Alateen, or Nar-Anon

similar

College students have_____Patterns of substance abuse as their peers who are not attending college

drug education programs that have been successful

DARE (drug awareness resistance education) SADD (student against destructive decisions)

In alcoholic families, covert rules include:

Don't talk Don't trust Don't feel

Peer Programs

Drug education programs which involve peers rather than teachers that have proven to be effective. teaching and modeling responsible behavior rather than drug information is the focus

Family therapy

Family involvement in the recovery process is essential A therapeutic setting allows family members to get their feelings out in the open and deal with their problem

more

Female alcoholics are____ susceptible than male alcoholics are to medical complications

Family rituals

Formal patterns of behavior that are associated with certain occasions which are prescribed, exact, and precise, and generally involve the ceremonial use of leisure time (such as holidays, mealtimes, family outings, vacations, evenings, weekends, having visitors, etc)

Efforts to escape stage 5

If the alcoholic does not get into recovery, the disease will progress even further and will eventually disrupt the new equilibrium that the family established and there may be a divorce or separation

Individual counseling

Involves interviews between the addict and the counselor The counselor and the addict work together to Define problems Look for solutions Identify sources This approach is objective and non-threatening The goal is to get the client to make the necessary connection between the disease and his/her problems Since alcoholism and other addictions are not curable but are treatable, the counselor does not cure the addict but can guide, support, encourage, and educate the addict so that he/she is in a better position to be successfully treated While the work of the counselor is essential, it is the client who must actually do the work of recovery

Group therapy

Involves the use of any group experience to produce change in its members Feedback from the group can be very effective Counselors also play an important role in group therapy

Employee Assistance Programs

Many businesses have established work-based programs which could identify addiction problems and initiate treatment These are referred to as Employee Assistance Programs (EAP) and they can work in two ways Having trained in-house counselors that are employed by the company Contracting outside groups for these services

methadone maintenance

Methadone is a synthetic opiate that was approved in 1973 which can be a substitute for opium based drugs It stabilizes the level of opiates in the bloodstream (prevents withdrawal and craving) but does not produce a comparable euphoria or high It is very effective if taken orally and has a long duration of action so it can be taken less often without causing withdrawal symptoms When withdrawal does occur the symptoms are less severe This drug is used to treat heroin and other opioid addicts because it also tends to block the pleasure feelings of opioids because it leads to an increased tolerance so usual drug doses would have little effect This drug is taken orally at a clinic under medical supervision and ideally counseling would also be provided

current methods of pharmacotherapy

Methadone maintenance Naltrexone Therapy Buprenorphine

Preliminary or Introductory Phase

Occurs when they realize that they have a problem with alcohol or other drugs They know they have problems and want help but do not want to stop drinking or using With this attitude, treatment is impossible But a good counselor can, by being open, honest, and patient, get the addict to see reality by presenting it in a non-threatening way

Continuing treatment phase

Once addicts have learned new skills that are needed for recovery they are able to move to this next stage The counselor ceases being a guide and becomes someone they can check on things with Addicts must always remain aware that they continue to be addicts even while in recovery Continued attendance at 12 step meetings can help to prevent a relapse

Active treatment phase

Once the addict admits the problem, he/she may feels quite helpless All the old defenses and excuses don't apply anymore In this phase the role of the counselor is to guide the addict through treatment The first task: staying sober one day at a time The counselor explains to them that treating the addiction should be their first priority. It should be treated as the primary illness Counselors generally recommend that they get involved in twelve step programs such as AA or NA

Family rules

Outline what has to be done, how it will be done, and when and where it will be done in the family. These rules are enacted through the family's roles.

There are three phases of recovery

Preliminary or Introductory Phase, Active Treatment Phase, Continuing Treatment Phase

At the turn of the 20th century, treatment for opium or morphine addiction involved several methods:

Reducing morphine intake slowly Reducing morphine intake more rapidly Using high doses of drugs such as bella donna Providing "social adjustment" treatment for those who were thought to be incurable, which involves maintenance on an opiate drug (such as morphine) indefinitely Morphine addicts were generally treated by: private physicians public narcotics clinics

Family reorganization stage 6

Reorganization of part of the family When a separation or divorce occurs the family must reorganize without the alcoholic The family develops behaviors and role relationships without the alcoholic Recovery and reorganization of the entire family If the alcoholic gets into recovery the family's role relationships and behaviors must be completely redefined to accomodate a recovering alcoholic It is important because of this that the entire family receive counseling along with the alcoholic as he/she recovers Without counseling sometimes the family is unable to restore equilibrium after recovery and the marriage breaks down after that

Covert rules

Rules that are not consciously recognized but are in operation nonetheless

Taking large doses of DXM can cause

Seizures irregular heartbeat respiratory distress

Acamprosate

Sold as Camporal - approved in 2004 for treatment of alcohol addiction Appears to modulate or normalize alcohol-disrupted brain activity and reduces the craving

Topiramate

Sold as Topamax Has already been approved as an anti-epileptic medication It is currently in clinical trials for alcoholism treatment where it was found to reduce alcohol cravings

2

Studies show that if a family of a recovering addict doesn't get involved in treatment within _______ years of the addicts recovery, there can be a relapse, divorce, or acting out child

Residential (in-patient) treatment programs

Synanon Daytop Village Phoenix House Odyssey House Gateway Foundation

Disorganization and chaos stage 3

The drinking continues to get worse and the families equilibrium breaks down The spouse had given up hope that the drinking will stop Children become torn in their loyalties between the mother and father The spouse now looks at her own behavior and begins to wonder if she's going crazy She finds herself unable to control her nagging and feels self-loathing for her inability to put her family back to normal The sexual and emotional relationship with the spouse is deteriorating The effects on the children are becoming more severe There is complete chaos in the family

Detoxification

The first task in treating alcoholism and other addictions is

Attempts to Eliminate the Problem stage 2

The spouse finally has to admit that there is a real problem Family members attempt to figure out why the excessive drinking occurs and then work to eliminate the drinking problem They try to do this through words and actions Words: involve lecturing, nagging, cajoling, begging, and threatening the alcoholic Actions: Hide the liquor from the alcoholic They pour the liquor down the drain They don't allow it in the house They withhold money Something about drinking with the alcoholic at home None of these words and actions work however and the alcoholism continues to progress The family is still trying to appear normal and play normal family roles They also cover up for the alcoholic and lie about the problem to others

Denial (attempts to deny the problem) stage 1

The spouse's excessive drinking causes embarrassment and even humiliation Spouse tries to discuss the behavior to get the alcoholic to drink less Drinking behavior may improve briefly and then go back to the way it was The spouse of the alcoholic copes with each episode of excessive drinking but doesn't acknowledge that it could indicate alcoholism. Instead she makes excuses for him.

Outpatient Treatment Programs

These are often associated with community mental health centers This is the most popular form of drug treatment Services include Individual counseling Group therapy Family counseling Vocational counseling Counselors are more likely to be professional psychologists, social workers, or trained vocational rehabilitation counselors Clients are less likely to be heroin addicts and more likely to be marijuana or multiple drug abusers People tend to get involved in these programs earlier in their drug use that those who enter residential treatment, so this may facilitate success rates

Overt rules

These are rules that are specifically recognized and understood by all family members

Daytop Village,Phoenix House, Odyssey House, Gateway Foundation differ from Synanon in the following way

They do not use psychologically brutal encounter methods The goal is to return clients to society Most of staff consists of recovering alcoholics and addicts Group encounter sessions are important as is keeping clients busy

Naltrexone Therapy

Was approved in 1985 It is an opiate antagonist, which precipitates withdrawal immediately and eliminates the effects of the opioid drug by blocking opioid receptors It provided no narcotic effect and cravings for narcotics may continue during treatment This type of therapy would work only for highly motivated clients who tend to relapse impulsively

Buprenorphine

Was approved in 2002 which like methadone, stabilizes the level of opiates in the bloodstream but doesn't produce a comparable high There is less risk of addiction and overdose and can be prescribed in the privacy of a doctor's office Suboxone contains a combination of Buprenorphine and Naloxone (Narcan) and relieves the effects of opioid drugs Naloxone (Narcan) is an opioid antagonist used for emergency treatment for a known or suspected opioid overdose

Naltrexone

Was first used to treat opiate addiction In 2005 it was approved for treatment of alcoholism as Vivitrol It blocks opioid receptors in the brain resulting in reduced craving and reward in response to drinking alcohol and blocks the high

Educational programs

Whereby addicts learn about their disease and how it has affected them and their families

Alcoholism and other addictions are considered to be

a family illness because all family members are affected by it

adolescent alcohol abuse can go without being diagnosed for 6 years because

adolescents are good at hiding their problems, parents avoid recognizing, alcohol is easy to get

less

african american students drink _____ than white students

two federal treatment facilities for opiate addiction were established in Kentucky and Texas.

after prohibition in 1933 Addicts would: Be gradually withdrawn from morphine Work on a farm at the facility Undergo psychotherapy Participate in tests and research experiments Stay at the treatment facility for up to a year Unfortunately the relapse rate was 80%

adolescents

alcohol is the most commonly abused drug among ______

NOT

alcohol use on college campuses has __ declined

primary prevention

begins before drug use has occurred and includes edu and info programs, is aimed at young people who have not yet gotten invomved with drugs, tries to promote abstinence or show young people how to look at drugs from a larger perspective

10-20

between _____ % of all adolescents between 13 and 17 are problem drinkers

Early intervention programs

can involve providing counseling education and support to children from dysfunctional families once they have been identified, can teach children how to deal with their situation their feelings and how to develop better self-esteem

far less likely

college student are _____ to be smokers than those who do not attend

only slightly more likely; far more likely

college students are _____ to be drinkers and _____ to be heavy drinkers

the more frequently students report binge drinking the mkre likely they will encounter negative consequences like

decline in academic performance and class attendance, suicidal feelings, fights, trouble with campus authorities, hving been taken advantage of sexually or taking advantage of someone else sexually, damaged property

elderly alcohol abuse is ignored due to

denial, feeling too old, discomfort felt by children reversing roles

women college students

drink less per drinking occasion, drink less frequently than men, same proportion, less likely to use illicit substances, use tranquilizers same rate, more likely to ve daily smokers than men

prescription drugs

elderly are very likely to abuse

5x

elderly men are ___ more likely than elderly women to be alcoholics

Values clarification programs

emphasize analyzing and clarifying values and developing decision making skills such as: social skills, communication skills, social competence, how to be able to cope with peer pressure and how to say no to drugs, utilizing alternatives to drug use which involve natural ways to feel good

more likely

female alcoholics are __ than male alcoholics to drink at home rather than in bars

negatively

female alcoholics are perceived more ____ than male alcoholics

the rates of entrance retention and completion of treatment are significantly lower than male alcoholics rates

female alcoholics have been considered to be much more difficult to burn cover than male alcoholics probably because

Joan Jackson

first person to do research on the stages that a family goes through when one of its members is an alcoholic - interviewed alcoholic's wives

later and more rapidly

for women the alcoholism appears ____ and progresses ______ than for men

adolescent alcoholism no differences

gender and income

effects of antabuse

has this drug in his/her body and then drinks alcohol, they will have a physical reaction which includes Throbbing head and neck Difficulty breathing Nausea Vomiting Feeling flushed Sweating Rapid heartbeat Weakness Vertigo This happens because the drug blocks the enzyme (aldehyde dehydrogenase) that breaks down acetaldehyde A toxic amount of acetaldehyde remains in the body which is why the person feels so ill

elderly widowers over 65

highest risk population

9x

if the wife is an alcoholic there is a ___ greater chance of divorce than is the case if the husband is the alcoholic

5.5

in the 1960s there were ____ men alcoholics to one woman alcoholic

Parent programs

information programs, parenting skills classes, Parent support groups

Antabuse

is sometimes used in the treatment of alcoholism It is the trade name for the generic drug disulfiram that was accidentally discovered in Denmark in the late 1940s and was approved for treatment of alcoholism in 1949

20%

it is estimated that _____ of the elderly have a significant alcohol problem

driving while impaired

leading cause of death of people 16-24

more likely

male alcoholics are ___ Gregarious sociable alcoholics are _____ to be solitary drinkers

highest

male athletes in fraternities have the ___ level of heavy alcohol abuse among college students

any change in one part of the system that disrupts the equilibrium will

necessitate changes in the other parts of the system in order to restore equilibrium

2

now there are ___ men alcoholics to one woman alcoholic and its 1-1 among young adults

secondary prevention

occurs during early stages of drug use, aims to prevent harmful drug use and abuse, aims to encourage abstinence from drugs that are more dangerous than those already used

tertiary prevention

occurs during the later stages of drug use, deals with the prevention of drug relapse, often involves follow-up programs after treatment

only 15%

of college students are non-drinkers

24%

of college students who drink, ____ are frequent drinkers

problems related to elderly prescription drug abuse

over-prescriptiom metabolization variety from different doctors combination with alcohol forgetfulness drug sharing

Abuse of prescription drugs includes

pain medication such as Vicodin and OxyContin, stimulants such as medications prescribed for ADD such as ritalin Adderall and Concerta, tranquilizers like Xanax, over the counter clock in cold medications containing dextromethorphan DXM

substance abuse prevention programs- 3 stages

primary prevention, secondary prevention, tertiary prevention

earlier a child begins drinking

the earlier they will develop a drinking problem Because the teens and preteens possess lower overall tolerance to alcohol than adults do in the physical and emotional damage caused by alcohol and he didn't preteen abusers seem to occur sooner than in adults

alcoholic women then is the case for alcoholic men

there is a tendency for professionals as well as family and friends to avoid viewing alcoholism as the primary problem in ___

Community programs and activities for young people

they provide many activities to keep kids occupied in a constructive way and to give them a sense of accomplishment and self-esteem

adolescents turn to drinking because

they want to feel grown up, peer pressure, rebellion, boredom, social reasons, relax, escape, effects

Formal roles

those roles that are affected by the individual's age, sex, and structure of the family

Informal roles

those roles that serve to regulate tension and therefore help to maintain equilibrium in the family

lower levels

traditionally black colleges have significantly ___ of alcohol and other drug use

greater

women entering treatment often have experienced recent episodes of violence to a _____ extent than is true for men

they fear of losing their children

women refrain from treatment because

the greater stigma taht female alcoholics experience

women tend to go to treatment later than men do because of