Crisis intervention strategies chapter 11

Chapter Eleven: Chemical
Dependency:
The Crisis of Addiction


Costs
• Long history of attempting to treat substance
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abuse.
Whole economies have been founded on
drug use.
Big business for legal and illegal drugs
Big business for drug-related medical care
Lost productivity
Murders, fractured families, suicide
Insurance, property crime, law enforcement
Treatment


Prevalence in US
• 10% of those who drink, consume 50% of the
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alcohol
16M people who are heavy drinkers
55M binge drinkers (5 or more drinks at one
setting)
18.7M who need treatment for alcohol use
22M who need treatment for legal and illegal
drugs
71.5 M Tobacco use
Controlled use
• Is this a reality for an abuser or an addict?


Prevalence in US
Drug-abusing behavior in 15-54 year age
group
•1 in 13 will become dependent on controlled
substance
•1 in 6 will become dependent on alcohol


Sociocultural Determinants of
Substance Abuse
• Set vs. setting - have a great effect on the
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behavior of the drug used
Set = the mental and emotional state of the
user
- including expectations, intelligence,
personality, feelings, and so on
Setting = the social and physical
environment of the user at the time of use
-immediate surrounding, such as a living
room, bar, legal and religious perspective


Sociocultural Determinants of
Substance Abuse
• Alcohol and drugs have culturally specific:
• Rules
• Sanctions
• Prohibitions
• Admonitions
• Permissions

• Although there are cultural implications, do

not stereotype!


Alcohol: Number One Abused
Substance
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Duration (longevity, legacy, and history)
Legality (limited conditions for jail)
Widespread use
Indirect financial costs
Psychological costs
Physical costs
Links to crime
Implication in accidents
Suicide
Alcohol IS a drug
Interpersonal relationships
Polyuse
Embroilment in controversy (physical or mental
disease?)


Models of Addiction

• Behavioral Learning Model
• Biopsychosocial Models
• Cognitive Models
• Disease Model
• Genetic Predisposition Model
• Lifestyle Model
• Moral Model
• Parental Influence Model


Models of Addiction
Cont.
• Peer-Cluster Model
• Personality Model
• Prescriptive Model
• Problem Behavior Model
• Psychoanalytic Model
• Psychosocial Model
• Sanctioned-Use Model
• Sociocultural Models
• Stress-Coping Model


Definitions of Commonly Used Terms (Pg.
354-356)
• Abuse

• Chronic, recurrent misuse of chemicals.
• One or more of the following occur in a maladaptive pattern

during a 12 month period:
• Failure to fulfill major role obligations (work, school, or family)
• Physical impairment that creates a hazard
• Recurrent legal or social problems

• Addiction

• Physical reactions include the development of tolerance and

withdrawal.
• Psychologically, it is the compulsion to use drugs regardless of
the negative consequences.
• Progressive, potentially fatal, and marked by preoccupation with
chemical use.

• Addictive behavior

• Preferred by many in the field because it focuses on behavior.
• Is used to describe a broad spectrum of problematic compulsions.

• Alcoholism

• Addiction to alcohol.


Definitions of Commonly Used Terms
Cont.
• Chemical dependent
• Addiction to drugs.

• Codependent

• Reciprocal dependency of the addict in need of care and a

caretaker’s need to control the addict’s behavior.

• Dependence

• Cognitive, behavioral, and physiological symptoms indicating

that the individual continues to use the substance despite
significant chemical-related problems.

• Drug

• Psychoactive substance that has a direct and significant impact

on the processes of the mind with respect to thinking, feeling,
and acting.

• Enabler

• A person who allows the addict to continue the addiction rather

than suffering the full extent of the substance-related
consequences.


Definitions of Commonly Used Terms
Cont.

• Habituation
• Degree to which one is accustomed to taking a certain drug.

• Misuse
• Use of a substance with some adverse physical, psychological,

social, or legal consequence.

• Relapse/Slip
• Use of a substance after a period of abstinence.

• Tolerance
• When more of a substance is needed to achieve the same effect.

• Use
• The intake of a chemical substance with the intent of altering

one’s state of consciousness.

• Withdrawal
• Physical and psychological symptoms as a result of the reduction

or cessation of a drug.


Defense Mechanisms (pg.
356-357)
Denial - (refuse to acknowledge)
Displacement - (venting toward another)
Fantasy - Escape

Projection - (Attribute motives to others)
Rationalization (Excuses)
Intellectualization (impersonalization)
Minimizing (Play down the seriousness)
Reaction formation (defense against perceived
threat)
• Regression (reverting back)
• Repression (burying in unconscious)
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Enabling and
Codependency
Enabling - has to do with one's behavior
toward a chemical dependent.
Codependency - has to do with one's
relationship to the chemical dependent


Enabling and
Codependency
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Suppression (stiff upper lip)
Dissociation (distancing)
Repression (bury in unconscious memory)
Escape to therapy (catharsis, but no change)
Intellectualization (distance with
details/control)
Displacement (moving feelings elsewhere)
Reaction formation (taking over for the
addict)
Passive aggression (covert behavior)
Hypochondriasis (converts anger into
physical complaints)


Children in Alcoholic
Families
• Personality Roles
• The
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Scapegoat (acting out child)
Hero (the little adult)
Lost Child (adjusts without feelings)
Family Mascot (placates and comforts everyone)

• Family Rules in Alcoholic Families - that

children have to adopt to survive)
• Do not talk/do not have problems
• Do not trust
• Do not feel
• Do not behave differently
• Do not blame chemical dependency
• Do behave as I want
• Do be better and more responsible
• Do not have fun


Adult Children of Alcoholics
(ACOA)
• Facts
• Addiction has a genetic component
• Addictive behavior can be learned
• ACOA’s tend to marry addicts

• Emotional issues
• Trust
• Dependency
• Control
• Guilt

• Identification and expression of feelings

• Effects of childhood roles
• Adaptive roles from childhood follow them into adulthood
• (heroes, lost child, placaters, family mascots, acting-out)


Treatment Approaches
• Alcoholics Anonymous (AA) (pg. 365 •
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12 Steps)
Cognitive-Behavioral Therapy (CBT)
(Stinking-thinking)
Inpatient Treatment: The Minnesota
Model (28 days)
Outpatient Programs (1-2 times per
week, with much criticism)
Contingency Management (CM)
(reward/reinforcement based)


Intervention
Strategies
• Motivation and Stages of Change
• Precontemplation (using but seen as a problem)
• Contemplation (using but thinking about it)
• Determination/Preparation (quit in the future)

• Action (taking active steps/treatment)
• Maintenance - about 6 months (behavior

change with continued work)
• Termination - about 5 years (cognitive and
emotional changes, support system in place)


Assessment
• Personality Inventories
• Direct Measures
• Parsimony (simple questions)
• Computer-Administered Direct Measures
• The Problem Is . . . (double what ever the person
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self reports)
Motivation to Change (instruments)
Intake Assessment
Assessment of Spirituality
Triage Assessment (seek collateral info. and
assume deception)
Diagnostic Intake (formal clinical assessment)


Detoxification

• Can be a serious medical process
• Addict may be given small, controlled amount

of the addicted substance to reduce severe
symptoms
• Common symptoms
• Delirium Tremens (DTs)
• Somatic complaints
• Excessive sleep
• Mood swings

• Detoxification without treatment is nearly

always futile.


Principles of
Treatment
• Treatment Techniques (solution-focused, 12 step,

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cognitive behavioral, reinforcement based, rationalemotive behavioral)

Treatment Goals (actions)
Treatment Protocol (schedule in activities)
Individual Therapy
The Treatment Group
Learning Relationship Skills
Accepting Responsibility ("what part did you play")
Getting Past Denial (1. presence and magnitude, 2.
life problems)
Confrontation (potent, but dangerous)


Principles of Treatment
Cont.
• Overcoming Environmental Cues That Lead

to Drinking (playmates and playgrounds)
• Treating the Family
• Family Therapy Session
• Therapy for the Children

• Aftercare and Relapse Prevention
• Cognitive-Behavioral Boosters (statements,

messages)
• Pharmacology

• Euphoria (over kill)
• AA's Role in Aftercare