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59 Cards in this Set
- Front
- Back
Substance Abuse (DSM; can lead to dependence/addiction)
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maladaptive pattern leading to clinically significant distress
1 or more in 12 months: -failure in role obligations (work/home/school) -use in physically hazardous situations -recurrent legal problems -use despite continuous social problems exacerbated by use |
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Substance Dependence (DSM; abuse leads to this)
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maladaptive pattern leading to clinically significant distress
3 or more in 12 months: -using more or for longer than intended -tolerance (need more) -withdrawal (physical symptoms) or using to avoid withdrawal -unsuccessful cutdown efforts -great deal of time to obtain, use, or recover -give up/reduce activites -continued use despite physical/psychological problems |
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Addiction
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continued use despite negative consequences.
(biopsychosocial phenomenon; can involve financial/school/medical/legal/work/psychological/relationship/physical problems) |
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deleria tremens
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shaking; severe alcohol withdrawal (Joe had it in the movie)
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Days of Wine and Roses characters
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Joe (PR)
Kirsten (secretary) Debbie (daughter) Mr. Arnesen (Kirsten's father; landscaper/greenhouse) Jim Hungerford (AA sponsor) |
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Days of Wine and Roses plot
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Joe meets Kirsten who doesn't like him, he drinks and she is a teetotaller; they go out. She loves chocolate so he gives her Brandy Alexanders. Social drinking. Married; kid, become alcoholics. Joe loses job. Joe sees himself as a bum, they sober up. Work at Mr. Arnesen's. Relapse--Joe smashes greenhouse looking for hidden bottle. Deleria tremens, hospital. AA for Joe. Joe finds Kirsten, they drink, Joe breaks into bar. Relapse and hospital Kirsten goes to pick up people at bars while drunk. Arnesen blames Joe. Joe takes Donna, Kirsten visits but will not admit she is an alcoholic. "Threesome--you me and booze" on a boat on a sea of booze, boat sank, drowning--Kirsten can grab on but Joe will not let go to drown with her. Kirsten says everything "looks dirty" w/out and walks towards bar.
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Case Study
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Jean (addictions counselor) - mom was a drinker, once drove to RI to get Ellen help (ellen drunk and suicidal), could not really help, likes motiviational interviewing (client defines in own words)
Ellen (alcoholic friend) - mom drank, "keep it in the family", did not attend college, works for bank, divorced, 2 kids, once suicidal, drove with kids while drinking, physical symptoms, did not like AA, kids getting depressed and anxious, called Jean upset |
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Proof
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divide it in half to get percentage of alcohol in the bottle
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neuroplasticity/brain plasticity
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ability for brain to repair, replace, and retrain its neural circuitry.
brain can change and adapt and grow addiction highjacks the brain and changes its structure |
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Etiological models
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(theories of explaining causes of addiction)
-Disease/Medical model -CBT model -Genetic model -Moral model -Psychodynamic Model -Family Systems model -Sociocultural model -Biopsychosocial model |
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Medical Model
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it is a disease (primary disease, not secondary)
GOAL IS ABSTINENCE. addictive disease is CHRONIC and INCURABLE Abstinence = cure DSM follows this. Insurance covers. removes moral stigma George Washington era - Benjamin Rush Jellinek surveyed, but did not survey women |
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CBT model/learning model
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motivation and reinforcement.
Ellis, Skinner use = escape from boredom, craving variety--reinforced challenge irrational thoughts, work cognitively supported by insurance addiction possibly similar to OCD LEARNING MODEL - use decreases uncomfortable psychological states (anxiety/stress) which positively reinforces use; aversion for withdrawal symptoms continues it. Bandura - unlearn |
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Genetic model/neurobiological model
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-statistical info shows genetic factors association.
-heritability, monozygotic twins share relationship over dizygotic, or with bio parents over adoptive -Human Genome project, NIH, Dept of Energy -possible metabolic or enzyme reactions -pharmocogenomics - tailor drug treatment to body chemistry -possible diagnostic tests for addiction limbic area of the brain - dopamine - key in addiction |
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Moral model
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no biology - if you use there is something morally wrong with you. emphasizes punishment.
personal choices--bad choices--lead to addiction religious groups advocate it. choose not to use it sinfulness is part of human nature |
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Psychodynamic model/personality theory model
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"self-medication", ego deficiencies, disturbed object relations
Freud, Adler, Jung childhood events cause one to develop addiction issues. E.g. oral fixation and smokers. not a lot of evidence negative correlations with issues likeinadequate parenting, attachment, masturbation, homosexuality PERSONALITY THEORY MODEL - certain personality traits predispose individual to drug use (dependent, immature, impulsive, emotional, low frustration, etc) - but anyone can be addicted. |
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Family models
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Treat in the context of families--circular causality. Families can help or hinder addicts (enable or help them get better). Families like to maintain homeostasis so may actually do things to encourage the behavior to continue
also possible family disease - all need treatment healthy family structure requires clear boundaries and flexible roles. |
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Sociocultural model
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look at person in cultural context/norms
aim for moderation. cultures are different. e.g. US it is taboo, Italy, they grow up with it but culture discourages being drunk, France it is not okay to deny when offered a drink (Good, Levin, Bales?) Bales - supracultural - attitudes: 1) abstinence 2) ritual use 3) convivial social drinking 4) utilitarian drinking for personal reasons [most alcoholism] also requires alternatives for drinking subculture important too (SES, gender, ethnicity, family background, etc.) |
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Biopsychosocial model
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Multicausal
Biology (disease/genetics), psychological, cultural norms and life events many aspects Engle proposed it in 1977 syndrome model? |
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Opiates
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naturally derived from from poppies
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opiods
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synthetic
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neurons
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contain dendrites, nucleus, axon, axon terminals. send and receive signals between synapses/synaptic clefts.
when signal is sent, neurotransmitters are released by vesicles into the synapatic cleft and activate receptors on other neurons. then reuptake occurs. drugs affects receptors and/or transporters (which do reuptake) - e.g. cocaine inhibits reuptake so more dopamine remains loose in the system for longer, stimulating the 2nd neuron |
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dopamine
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brain chemical linked to pleasure, reward and motivation. affects motor function. drugs enhance this (and serotonin) pathway. dopamine receptor in the brain affects addiction
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serotonin
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brain chemical linked to learning, memory, sleee, and mood. drugs enhance this pathway. affects cognition.
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cravings
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areas of the brain light up (especailly with PET scan) when individual is presented with drug stimuli. anterior cingulate (impulse control) and *amygdala* (emotional response) light up
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side effects of drug addiction on the brain
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-impaired ability to feel pleasure
-often affects memory, cognition, motor skills -*limbic system, esp. prefrontal cortex impaired (area controls self-monitoring, social thinking, abstract thought, moral behavior) [meetings help moral and social] -brain is physically damaged and it is less capable of unlearning things -interrupts neurogenesis (new brain cell creation) |
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Alcohol - Early beliefs (colonial days)
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high regard, healthy, preventative and curative capabilities (not intoxicant).
"temperance movement" - moderation. clergy - alcohol could "corrupt" Benjamin Rush - alcoholism = "disease" "Washington Total Abstinence Society" 1840 |
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Alcohol - early 1900s
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Volstead Act - prohibition in 1920
"speakeasies" appeared religious groups - prevention Response to immigration - "lower class" people's drinking patterns Opium banned in late 1800s due to Chinese immigrants associated with it; Marijuana legal until 1930 with Mexican immigrants. LSD legal until associated with counterculture Pure Drug and Food Act passed in 1906 Harrison Act in 1914 |
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Pure Drug and Food Act
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passed in 1906 to control addiction by requiring labels on drugs contained in products (including opium, morphine, heroin)
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Harrison Act of 1914
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taxation of opium and coca products
registration and record keeping |
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1970 Controlled Substance Act
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drugs classified according to medical use, potential for abuse, possibility of dependence
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late 1900s government organizations
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NIAAA (National Institute on Alcohol Abuse and Alcoholism); NIDA (National Institute on Drug Abuse) = 1970s. Later transferred to NIH
OSAP (US Office for Substance Abuse Prevention) = 1980s - consolidated prevention initiatives under ADAMA (Alcohol, Drug Abuse, and Mental Health Administration). Later changed to CSAP (Center for Substance Abuse Prevention) Part of SAMSHA (Substance Abuse and Mental Health Administration)--reauthorized in 2000 |
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Anti-Drug Abuse Prevention Act of 1986
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created OSAP (US Office for Substance Abuse Prevention) - consolidated prevention initiatives under ADAMA (Alcohol, Drug Abuse, and Mental Health Administration)
20% of $ for prevention, 80% for treatment programs Later changed to CSAP (Center for Substance Abuse Prevention) Part of SAMSHA (Substance Abuse and Mental Health Administration). |
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some laws influencing prevention
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minimum age, penalize retailrs, dry option allowed, taxation on substances, control distribution, liability laws
federal policy more concerned with preventing recreational use than helping habitual users. focuses on casual, middle-class drug use |
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GABA and glutamate
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neurotransmitters affected by alcohol . so learning and memory are impaired
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anterior cingulated cortext (ACC) and orbitofrontal cortext (OFC)
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impaired by drug use. OCD tendencies?
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depressants
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DOWNER.
alcohol and sedatives/hypnotics. depress central nervous system. -alcohol (ethyl alcohol). depressant to central nervous system, nothing can break it down faster. -baribituates [injected/swallowed] (barbs, reds, yellow jackets; 1950s-1960s 2nd to ETOH) -benzodiazepines [injected/swallowed] (candy, downers, sleeping pills, tranks. DATE RAPE DRUG = flunitrazepam [swallowed/snorted] (rohypnol/roofies) -GHB [swallowed] (liquid ecstasy, G) -methaqualone [injected/swallowed] (quad, ludes) reduced anxiety, lowered inhibitions, slowed pulse and breathing, lowered blood pressure, poor concentration barbs and benzos - sedation, drowsiness flunitrazepam - memory loss (roofies) GHB - drowsiness, nausea, possibly death quad - euphoria/depression, coma |
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stimulants
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UPPER
-amphetamine [injected/swallowed/smoked/snorted] (speed, uppers) -cocaine [injected/smoked/snorted] (coke, crack = smokeable and concentrated, snow, blow) -MDMA [swallowed] (ecstasy, X, XTC, Molly) -methamphetamine [injected/swallowed/smoked/snorted] (crank, crystal, meth, speed) - methlphenidate (FOR ADHD; like Ritalin) [injected/swallowed/snorted] -nicotine [smoked, or snuff form] (cigarettes, cigars, smokeless tobacco, snuff, spit tobacco, chew). usually addicted to other substances too. increased heart rate, blood pressure, metabolism, exhilaration, energy, mental alertness coke - increased temp, sexual desire amphetamine - rapid breathing MDMA - hallucinogenic, empathic feelings meth - aggression, violence, psychotic behavior nicotine - cancer, lung disease, adverse pregnancy outcomes, etc. |
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cannaboids
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DOWNER
-hashish [swallowed/smoked] (hemp) -marijuana [swallowed/smoked] (pot, blunt, dope, grass, weed). most commonly abused illegal drug, legal in some areas. euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination see things more vividly, can cause paranoia if you have a bad trip. relaxed--things slow down cannabis staiva = plant. THC is chemical in it that makes it potent. |
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hallucinogens
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HALLUCINOGEN
-LSD [swallowed, absorbed through mouth] (acid) -mescaline [swallowed, smoked] (peyote) -psilocybin [swallowed] (mushroom, shrooms) altered states of perception and feeling, nausea, FLASHBACKS possible nervousness, paranoia, mental disorders, sleeplessness, increased heart rate |
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opiods and morphine derivaties
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DOWNER
-codeine (Robitussin A-C, Tylenol, pancakes and syrup) -fentanyl and fentanly analogs (Apache, China girl) -heroin (dope, smack) [injected] -morphine (Roxanol) -opium (laudanum) -oxycodone HCL (OxyContin) -hydrocodone bitartrate acetaminophen (Vicodin) -Krokodil (injectable opiod) pain relief, euphoria, drowsiness/nausea codeine is less strong than morphine as an analgesic heroin = staggering gate gangrene/flesh falls off with Krokodil withdrawal from opiates is terrible. people might suicide |
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Dissociative Anesthetics
Other Compounds |
Dissociate Anesthetics
-ketamine (special K, Vitamin K) -PCP (angel dust) increased heart rate, delirium, depression, panic Other compounds -anabolic steroids (roids): cancer, shrunken testicles, aggression, masculine characteristics in females -dextromtorphan (DXM). in some cold/cough meds (Robotripping) -inhalants (solvents like paint thinner or gasoline or glue; gases like butane or propane; nitrites. street name = whippets): stimluation, loss of inhibition, nausea, wheezing, uncoordinated, death, slurred speech |
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alcohol effects on females and certain minorities
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Asians usually do not have enzyme acetaldehyde to break down ETOH and will flush, sweat, feel ill (alcoholism rate is low)
women show more severe consequences. "telescoping" response to alcohol. faster progression into dependency metabolism is different. lower body mass with more fat content, alcohol "hangs out" with fat cells and lingers longer. get drunk faster. |
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speedball
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mix of cocaine (upper) and heroin (downer). body is confused!!!!!!!
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one size fits all model
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not true.
most studies done on white males who are middle aged |
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BAC
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blood alcohol concentration. measured by breathalyzer or blood sample. usually best within 12 hours
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alcohol issues
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alcohol counseling can be effective
accidents, especially with motor vehicles college students have highest binge drinking rates |
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methadone
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used to treat heroin--like heroin but less strong, helps with harm-reduction
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Process addictions
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-addiction to behavior, process, or action.
-sex, gambling, working, compulsive buying, food -often replaced by another addiction sex addiction: internet. progressive downward path. CBT gambling - impulse control disorder in DSM workaholism--can lead to heart attack/stroke from stress, so much work little leisure or social activity, yet society and organization reinforces behavior with promotions and money compulsive buying - fill the void. $ problems food - eating disorders may share traits with addiction. Overeater's Anonymous is a 12-step program |
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ethics
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don't practice outside your competency, issues with minors (e.g. confidentiality), get supervision, boundary violation issues e.g. gifts or physical contact, multicultural issues, counselors in recovery need to watch out for dual relationships and make sure they are functioning and able to counsel (e.g. you should have 3-5 years of abstinence before working as an addictions counselor), counter-transference, self disclosure, counselors who have never used and their values re: addiction, self-care, research-based practice (CBT, motivational interviewing, 12-steps, etc.), credentials, certification (e.g. MAC through NBCC), insurance issues
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Transtheoretical Model of Behavior Change (TTM)
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a) stages of change (precontemplation, contemplation, preparation, action, maintenance, RELAPSE)
b) process of change (cognitive, behavioral, affective activities) c) self-efficacy (self belief in ability to make change) d) decisional balance (advantages and disadvantages of change |
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stages of change
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Pre-contemplation "I don't have a problem. can stop whenever"
Contemplation "Maybe I have a problem. i'll consider it" Preparation "I have a problem, but don't know what to do. need to look at options" [Ellen in case study here?] Action "I have a problem, I know what to do about it, I'm going to do it" [provide support and resources] Maintenance "I beat my problem, i'm doing well" [help find internal rewards] Relapse "I blew it" [self-explanatory, identify triggers and reasses barriers/supports/coping skills. relapse is common in recovery process] |
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addicted families
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low intimacy
isolated poor communication, problem-solving low cohesion illogical and inconsistent rules addiction upsets homeostasis initially but then family works around and includes addiction to remain balanced children roles: hero (responsible/successful), scapegoat (blamed), lost child/adjuster (no attention), mascot (funny) rules: use is more important thing in family, addict is not responsible and drug is not cause of problems, maintain status quo at all times/don't upset routine. don't talk, don't trust, don't feel stages: denial, home treatment, chaos, control *may repeat* if one parent can provide stability, better outcome for kids |
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addicted couples
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link between violence and sexual functioning in couples
couple issues can cause drinking or use, but this can also cause issues with the couple. THIRD POINT IN THE TRIANGLE enabling and codependence |
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diathesis stress model
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overcoming stressful situations can lead to more resiliency, but sometimes too much is too overwhelming. shapes but is also dependent on personality--ideal balance of stress and coping skills?
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children of alcoholics
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more impulsivity, conduct disorders, alexithymia, depression, anxiety
poor cognition, attentional deficits, lower academic achivement more external locus of control elevated risk of alcoholism |
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treating families
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assess environment, system, and individual.
family must create safety from external threats and family of origin (be nonblaming and noncontrolling, be consistent and predictable) have each family member tell story of the trauma. can also have them write letters to each other restablize family. |
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disabilities and addictions
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high rate of co-occurring disorders amoung SSI beneficiaries (substance abuse and mental health issue)
higher rate of substance abuse for PWD hard to access treatment for PWD low employment more isolated, more stigma society does not believe PWD are addicted sometimes or believe they can't learn how or are sick/fragile/helpless risk factors: psychological, social, health and medical, economic, employment tx should be inclusive! should also help with ADLs and network building and life skills |
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psychoactive drugs
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cross blood-brain barrier and create behavioral changes (judgment, movement, vision, etc.)
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drugs
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chemicals or substances that effect change in the body
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