Substance abuse exam 1

Harm reduction defined

"any positive change"

Harm reduction forms

"meet the client where the client is."

Treatment Trends

-Prescription drug use an increasing problem, currently have an opioid epidemic -Harm reduction recognized as important to save lives; public health approach -Acceptability of non-abstinence based treatment programs -Belief that punitive laws cause harm -Majority of Americans favor treatment over jail -De-emphasis on incarceration, reentry programming -Drug courts, mental health courts - promote decarceration and treatment in the community -Attention to co-occurring disorders and extensive use of prescribed medications to reduce craving (MAT - Medication Assisted Treatment

Nature of Addiction

1 in 10 people who use a substance become addicted

Two Approaches to Treatment

1. traditional 2. strengths based

Addiction and prison numbers

1.5 million prison inmates met the DSM criteria for substance use disorder 80% of people behind bars have problems, pervasive in child welfare system, alcoholism in the workplace. 71% of social workers worked with clients with substance use disorders in the past year.

economic cost for drug misuse

193 billion

Drug Arrests

1970 - over 322 thousand arrests. 1980 - over 470 thousand arrests. 1990 - over one million arrests. 2000 - over 1.3 million arrests. 2010 - over 1.6 million arrests.

Controlled Substance Act of 1970

1970 Controlled Substances Act: classified drugs according to legitimate medical uses and potential for abuse and dependence Law enforcement today relies on those classifications This act also set standard for penalties for drug manufacture and trafficking

economic cost for alcohol misuse

235 billion

Vaillant's Research

40 year longitudinal study—those who were in recovery in middle age were found to have had: personal willpower, church/group membership (AA), stable marital relationship, hobbies

12 step approach

A 12-step substance abuse recovery program designed to assist people in admitting they have a problem and taking steps toward lifelong sobriety

Narcotics Anonymous

A free, self help program of addiction recovery. It uses a 12-step program, promotes personal growth, and leads to the person's helping others to recover

Jellinek (The Disease Concept, 1960) - 5 types of alcoholism based on world travels

Alpha, Beta, Gamma , Delta, Epsilon. Jellinek Curve -only depicts the Gamma alcoholic

Strengths-based

Bio-Continuum Psycho-Strengths-motivation Social-Holistic family as resource

Traditional

Bio-Dichotomy Psycho-Problems mandate—one size fits all Social-Identify family dysfunction

Strengths-based treatment approach endorsed by UN

Case management Community resources for long-term care Interventions relate to personal needs in society—mental health care, housing Success measured in drinking, using less, not total abstinence (Harm Reduction)

Early 1900s

Cocaine in Coke Columbia is the world's leading producer of cocaine Tobacco outlawed for brief period. 1914 Harrison Act --- restricted opioids (associated with Chinese individuals) cocaine must now be prescribed. 90% of the world's heroin comes from Afghanistan Marijuana (associated with Hispanics) State laws in southwest criminalized. Marijuana introduced into the "New World" by the Spaniards.

Treatment History continued

Combination of Jellinek's work and AA = Disease Concept of Alcoholism. 1951 - WHO acknowledged alcoholism as a medical problem 1956 - AMA declared alcoholism an illness 1966 - declared it a disease Hazelden adapted 12 Step approach - Minnesota Model Psychology, therapy, spirituality, group based treatment Harold Hughes - Hughes Act (1970)- founded National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institute on Drug Abuse (NIDA)

The Project Match research

Directed by NIAAA - 2,000 clients over 8 years (largest trial of psychotherapies) What works? 12 step facilitation, cognitive, motivational enhancement therapy (MET) MET most effective for those with low motivation, 12 Step with religious persons, cognitive for persons with psychopathology Criticism: lack of a control group. MET, a shorter intervention. Models only tested on alcoholic clients (selection bias). Project MATCH confirms the effectiveness of diverse treatments. New measure for recovery is improvement, not total abstinence.

Temperance Movement 1820s-1930s

Drinking became a disruptive force. Dr. Benjamin Rush (Surgeon General) - Suggested medical treatment for chronic "inebriates" Temperence movement was about moderation Control of spirits - ban of spirits (ban whiskey in NE) 1830's - Teetotalism - complete abstinence -Teetotaler T =total abstinence, from Ireland. Temperance woman for women's suffrage and ban on distilled beverages. Women's sufferage and prohibition intertwined

Drug Background

Drugs used freely in most of America until the early 1900s. 19th century: opium, morphine, marijuana, heroin, and cocaine could be obtained easily without prescription. Marijuana in the 1800s: used by physicians as a general all-purpose medication Nonmedical use of marijuana increased in the 1920s, probably in part a reaction to alcohol Prohibition.

Early History - Cultural Traditions

Greek - wine making common. Known for their temperance of all things, avoid excess Islam - Condemned all consumption Rome - Self-indulgence Vomitorium European Context Distillation of spirits (Gin) led to epidemic in England Great devastation from England, 1700-1750. Infant mortality, crime Legislation passed discouraging use

History of Addiction Treatment

Mentally ill/alcoholics placed in asylums. Seen as hopeless End of prohibition - shift from sin to sick. Alcoholics Anonymous

Colonial America

More beer than water on Mayflower. Alcohol used for a variety of reasons A solvent, antiseptics, protection against disease. Slaves forbidden to drink except on special occasions Taught binging. Puritan traditions Puritans saw alcohol as blessing from God Punishment for the "drunkards" Began the punitive approach to alcoholism Evolved into the temperance movement

Strengths Perspective -Six critical elements conducive to recovery:

Person is not the illness, need for control/choice, hope, purpose, achievement, presence of one key person to help.

Modern War on Drugs

President Johnson—War on Poverty Nixon through the Bushes—war on drugs 2/3rds of the $ goes towards police 1960's heroin horror stories 1980's crack cocaine epidemic 2000's methamphetamine Attacks directed toward poor, minorities. Prescription drug epidemic different?

U.S. Prohibition 1920-1933

Prohibition, the "Noble Experiment" was a failure Gave drinking allure of the forbidden Increased organized crime Corruption of police and politicians Criminalization of normal citizens Homicide rates increased. Great Depression created need for jobs. Double Cross - Kennedy family involvement in transporting liquor to mob bosses. Attorney General Robert Kennedy prosecution of key mafia leaders

Marijuana and the Law

Pure Food and Drug Act 1906 Required that certain special drugs, including cannabis, be accurately labelled with contents. Previously, many drugs had been sold as patent medicines with secret ingredients or misleading labels 1914 Harrison Act Prohibition-1920-1933 1936 Reefer Madness 1937 Marijuana Tax Act effectively made possession or transfer of cannabis illegal throughout the United States under federal law

Biopsychosocial-spiritual Model

Why (bio), what (psycho), where (social)

early history

Wine being made in the Middle East as early as 5000 B.C. Chemical analysis on pottery from China - 7000 B.C. Alcohol and Religion Koran - condemned wine. Bible - Old Testament drinking by Hebrews Arabian Dr. (Zakariya Razi) discovered evaporated distilled spirits in the 10th century. Alcohol come from Arabic al-kuhul Technology exceeded its grasp

Alcoholics Anonymous

a support group of recovering alcoholics who give support and encouragement to help other alcoholics to stop drinking

Concept of addiction

addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry

disease

as metaphor by jellinek: "alcoholism is like a disease"

American Heritage Dictionary

disease is a condition or tendency regarded as abnormal or harmful

Oxford

disease is absence of ease

behavioral addictions

eating, shopping, video games

addiction

having given over or awarded to someone or being attached to a person or cause pattern of compulsive use; loss of control over a substance of behavior

withdrawal

illness that occurs with a cessation or decrease in use of drug

tolerance

increased amounts of a drug needed to achieve intoxication, or drug effect with continued use the same amount of a drug

Strengths perspective defined

instead of focusing on clients problems and deficits, center on clients abilities, talents, and resources

Where different substances (marijuana, cocaine, opiates) originated or are produced

marijuana- introduces into the "New World" by Spaniards cocaine - Columbia opiates- Chinese

Understand the various differences between the DSM IV and the DSM 5

no longer dichotomy between abuse and dependence addiction over dependence, now seen as a continuum -gambling now addiction

illness

term preferred here, less controversial, less medical

psychological dependence

the emotional state of craving a drug either for its positive effect or to avoid negative effects associated with its abuse

craving

typically a strong or intense desire to use a drug

Substances:

used for a variety of reasons in different cultures for thousands of years