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Moral Model (Definition of Addiction) - ✔✔- Dates to the 1850's. - Defines an addicted client as weak in character. Think "moral failure". - Based on the idea that individuals have free choice and are responsible for their behaviors. Think "morals that are aligned with God" and this approach has influenced public policy and the American judicial system. Self-medication
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Moral Model (Definition of Addiction) - ✔✔- Dates to the 1850's.
Self-medication Model (Definition of Addiction) - ✔✔- Originated in the 1960's among psychoanalysts.
-Self-medication hypothesis should be considered parallel with other approaches and not in competition with them.
Medical/Disease Model (Definition of Addiction) - ✔✔- First proposed in 1810 by Dr. Benjamin Rush
Spirituality Model (Definition of Addiction) - ✔✔- Assumes that addictive disorder stem from a lack of spirituality, that is, being disconnected from a "Higher Power" ("the source of light, truth, love, and wellness").
Impulse-Control Disorder (Definition of Addiction) - ✔✔- relatively new definition.
Reward Deficiency and Neuro-physiological Adaption (Definition of Addiction) - ✔✔- Assumes that chemical imbalance is manifested as one or more behavioral disorders called the "reward deficiency syndrome".
Genetic Model (Definition of Addiction) - ✔✔- Research over past 20 years indicated genetic predisposition in some individuals to substances of abuse.
Biopsychosocial Model (Definition of Addiction) - ✔✔- Developed in 1980's.
Public Health Model (Definition of Addiction) - ✔✔- Institute of Medicine (1989) defines addiction from a public health perspective, identifying 3 etiologic factors:
Characteristics of Addiction - ✔✔All addictions have generally 3 characteristics. Called the 3 C's - Compulsive use, loss of Control, & Continued use despite adverse consequences. Client doesn't have to exhibit all 3 but will happen problem with at least one.
-Tolerance and withdrawal.
Compulsive use - ✔✔Has 3 elements:
Loss of Control - ✔✔Individuals suffering from addictions cannot predict or determine how much of the drug they will use or when they will use it. Once starting difficulty with stopping.
Continued use despite adverse consequences - ✔✔- Addictive bx's have negative consequences, however, the pleasure/relief of substance/bx may outweigh the problems and a client may continue to use.
Tolerance - ✔✔- When the drug is continually used, the body adapts to - and begins to tolerate - the drugs pharmacological effects. Thus, user needs more and more to get same pleasurable effect.
-2 types of tolerance:
Withdrawal - ✔✔When drug use is stopped, user suffers from unpleasant effects that are usually the opposite of those induced by the chemical. May be life threatening for some.
Brain & Psychoactive Drugs (enlightening) quote - ✔✔"The behavior of addicts is strongly influenced by the maladaptive learning that takes place as addiction develops. As a result, recovering from drug addiction does not mean returning to a condition like the one that existed before drug abuse began. Instead, addicts must grow into a new level of personal awareness, with new patterns of behaviors."
Brain & Addictive Behaviors - ✔✔- The term addiction (including neuroadaptation - i.e. biological processes of tolerance & withdrawals) also applies to behaviors such as pathological gambling, forms of sexual excess, pornography, eating excesses, overwork, compulsive buying, and other compulsive excesses.
DSM IV-TR Substance abuse disorders - ✔✔A maladaptive use of chemical substances leading to clinically significant outcomes or distress ("recurrent legal problems &/or failure to perform at work, school, home, or physically hazardous behaviors, such as driving when impaired.
DSM IV-TR Substance dependence disorders - ✔✔Loss of control over how much a substance is used once begun, manifested by seven symptoms; tolerance; withdrawal, using more than was intended;
unsuccessful efforts to control use; a great deal of time spent obtaining and using the substance; and continued use despite knowing that it causes problems.
DSM IV-TR Substance induced disorders - ✔✔Manifesting the same symptoms as depression &/or mental health disorder, which symptoms, the direct result of using the substance, will cease shortly after discontinuing the substance.
Compulsive Gambling - ✔✔- Is listed in the DSM IV-TR as an "impulse control disorder" and is grouped with pyromania, kleptomania, intermittent explosive disorder and trichotillomania. However, it is now placed in the DSM V in the "Addiction & Related Disorders" category.
Addictive Interaction Disorder - ✔✔The 11 ways in which using and addictions impact one another.
Cross tolerance - ✔✔A simultaneous increase in addictive behavior in two or more addictions or a transfer of a high level of addictive activity to a new addiction with little or no developmental sequence.
Withdrawal mediation - ✔✔One addiction moderates, provides relief from, or prevents physical withdrawal symptoms from another.
Replacement - ✔✔One addiction replaces another with a majority of the emotional and behavioral features of the first.
Alternating addiction cycles - ✔✔Addictions cycle back and forth in a patterned systemic way.
Escalation (Drug-use Stage) - ✔✔A time of increasing preoccupation with substances and more frequent socializing with other users. Intoxication is thought of as normal and fun - a healthy form of recreation. Variety of substances used is increased and users typically have little concern about drugs impact on health/future.
Maintenance (Drug-use Stage) - ✔✔No longer recreational, more of a necessity. As tolerance increase, time is spent using to just "feel normal" and manage personal feelings with substances. Using becomes primary focus and housing, food, work, relationships, and other necessities are ignored or abandoned.
Discontinuation & Relapse (Drug-use Stage) - ✔✔4. Discontinuation & Relapse: The stage of seeking help to stop using - sometimes forced (ex: incarceration), "hitting rock bottom", family pressues, OD's, and/or the revelation that the substances are not the solution but rather the problem. Some do it on their own others with significant treatment. Relapse is also a part of this stage as addiction is a chronic condition.
Recovery (Drug-use Stage) - ✔✔Varies to each individual. For most, it is the cessation of all psychoactive substances with the recognition that substances were problem not solution. Grieving process of "losing" the drug lifestyle. Increase in healthier activities and networks. Can regain physical health but must grow emotionally as using stunted emotional process. Developmentally behind due to drug use as primary coping mechanism.
3 Stages of Recovery: (1) Early Stage Recovery - ✔✔- Spanning first 6 months of sobriety, the risk of relapse is highest during this time. Mental clarity is impaired and so is physical health. Clients are beginning to develop new non-chemical ways of dealing with daily stressors. Building of social support networks. Can also experience the accompanying mood swings and depression that can derail treatment.
3 Stages of Recovery: (2) Middle Stage of Recovery - ✔✔- 2nd 6 months of sobriety. Individuals struggle with the physical, social, and psychological adjustments of sobriety. Many emotions including grieving process (mourning loss of BF/good times enjoyed using drugs). Individuals begin to re-establish their ability to feel and to deal with their emotions without using drugs.
3 Stages of Recovery: (3) Late Stage Recovery - ✔✔- Begins after roughly a year of sobriety. Individuals begin to gain confidence in new support systems and the psychosocial and (spiritual, emotional, etc) tools they have learned in treatment/recovery groups. Increased stability and continuous work reconnecting and reforming healthy relationships and activities.
Levels of Drug Use - ✔✔Drug conditions, not stages. Individuals do not necessarily move predictably from one condition to another and may swing from one extreme to another.
Levels of Drug Use (1) Abstainers - ✔✔- Roughly 1/3rd of all Americans abstain from using substances, some conscious (e.g. religious reasons) or other reasons due to horrible experiences from a using lifestyle (e.g. AA participants, 12-step participants).
Levels of Drug Use (2) Social Users - ✔✔- Constitutes majority of people. Limit their intake of substances to social gathering where using is peripheral rather than the main purpose or attraction. Substances are seen simply as ways to enhance the pleasure of the gathering wile accomplishing other social goals. Ingestion intermittently, go long periods of time without it, quit at any time (*in control). No to little preoccupation with drugs or getting high.
-("Loves" drug). Blame is not on substances for spiraling decline and consider substance solution, not problem. Continue to use despite deterioration in order to feel normal/survive.
Trans-Theoretical Model or Stages of (behavioral) Change - ✔✔Believes client comes in with different levels of motivation and the clients motivation significantly influences behavioral change. So, counselor should match motivation level with an effective tx plan. Use Stages of Change model to assess client's motivation level and create appropriate tx.
Stage of Change 1 - Precontemplation - ✔✔- Clients do not perceive their actions as problematic.
Stage of Change 2 - Contemplation - ✔✔- Greater awareness of risks of present behaviors but still struggle with ambivalence.
Stage of Change 3 - Preparation - ✔✔- Clients agree there is a problem but are not yet 100% committed to the recovery process. Ambivalence is no longer an insurmountable barrier to change.
Stage of Change 4 - Action - ✔✔- Clients are motivated to improve their lived by following a clearly defined action plan with goals leading to desired outcomes.
Stage of Change 5 - Maintenance & Relapse Prevention - ✔✔- Clients have taken action and are now learning the necessary skills to avoid relapse. The longer the client stays on course, the less chance of relapse.
Institute of Medicine Prevention Classification - ✔✔- Based on operational classification of disease prevention with three parts - prevention, treatment, and maintenance.
Institute of Medicine Prevention Classification - Universal - ✔✔- Focusing on large populations (national, local community, school, or neighborhood) with efforts seeking to prevent or delay illicit drug use.
EX: Creating a prevention program for all students at a given school/school district.
Institute of Medicine Prevention Classification - Selective - ✔✔- Focus is on specific populations known to be at great risk for substance abuse
Institute of Medicine Prevention Classification - Indicated - ✔✔- Interventions directed at those who have already experimented with drugs or who exhibit other risk-related bxs.
Prevention Principles - ✔✔Typically focus on 3 elements:
Prevention Principle Risk Factors - Community - ✔✔Access to drugs and firearms, community laws, and norms favorable toward drug use, crime, media portrayals of violence, transition & mobility, low neighborhood attachment and community disorganization, "extreme" economic deprivation.
Prevention Principle Risk Factors - Family - ✔✔Family history of problem behaviors, family management problems, family conflict, favorable parental attitude, involvement in problem bx's.
Prevention Principle Risk Factors - School - ✔✔Early & persistent antisocial behavior, academic failure beginning in late elementary school, and lack of commitment to school.
Prevention Principle Risk Factors - Individual/peer - ✔✔Alientation, rebelliousness, friends who engage in the problem behavior, favorable attitude toward the problem behavior, early initiation.
Prevention Principles Research - ✔✔This should include (among others):
Observable warning signs of relapse - ✔✔- Being in the presence of drugs or alcohol, drug or alcohol users, or places where chemicals are used or bought. (*Hmmm...)
Marlatt & Gordon's Relapse Prevention Model - ✔✔- Rooted in social learning theory and cognitive psychology. 1978-2000.
Marlatt & Gordon's RP Model - ✔✔- Helps client:
Gorski's CENAPS Relapse Model - ✔✔- Grounded in CBT pschology, involves 6 stages:
Gorski's relapse model stage 1 - ✔✔Transition: The individual recognizes problems but tries to surmount them by controlling his or her substance use.
Gorski's relapse model stage 2 - ✔✔Stabilization: The individual decides to refrain from substance use completely and recuperates over an extended length of time (6-18 months)
Gorski's relapse model stage 3 - ✔✔Early recovery: The individual becomes comfortable with being abstinent.
Gorski's relapse model stage 4 - ✔✔Middle recovery: The individual repairs past damage caused by his or her substance use and develops a balanced lifestyle.
Gorski's relapse model stage 5 - ✔✔Late recovery: Individual overcomes barriers to healthy living that stem from childhood experiences.
Gorski's relapse model stage 6 - ✔✔Maintenance: Individual recognizes a need for continued growth and for balanced living.