Addiction Treatment Medical Paper

Power Point for
Power Point for

Addiction Treatment:
Addiction Treatment:
A Strengths Perspective
A Strengths Perspective
3rd
3rd
Edition
Edition
Katherine van Wormer
Katherine van Wormer
Diane Rae Davis
Diane Rae Davis
Cengage Pu!ishing Compan"
Cengage Pu!ishing Compan"
#$%# cop"right
#$%# cop"right
Part &: &ntroduction
Part &: &ntroduction
Addiction afects us all. Strengths

Addiction afects us all. Strengths
perspectivestrengths of clients and
perspectivestrengths of clients and
strengths of the contemporary
strengths of the contemporary
models:
models:
Harm reduction
Harm reduction
12 Step approach.
12 Step approach.
Rift in feld.
Rift in feld.
oo! in " parts: #io$psycho$social

oo! in " parts: #io$psycho$social
Chapter &
Chapter &

'ature of Addiction
'ature of Addiction
%&amples of addiction$$$smo!er dying

%&amples of addiction$$$smo!er dying
of emphysema' crac! addict
of emphysema' crac! addict
arrested' pregnant mother drin!ing
arrested' pregnant mother drin!ing
heavily' girl hoo!ed on meth she
heavily' girl hoo!ed on meth she
started using to lose (eight
started using to lose (eight
%conomic costhealth' (ar on drugs'

%conomic costhealth' (ar on drugs'
over 1 million in prison for drug
over 1 million in prison for drug
involvement. ig #usiness
involvement. ig #usiness
gam#ling' )hilip *orris' #eer
gam#ling' )hilip *orris' #eer
What is addiction(
What is addiction(

+,atin-
+,atin-
addictus
addictus
$$$attached to something'
$$$attached to something'
positive. .oday alcoholism called a
positive. .oday alcoholism called a
/#rain disease0or #ad ha#it or sin.
/#rain disease0or #ad ha#it or sin.
,eading assumption of the te&t: Addiction
,eading assumption of the te&t: Addiction
is the !ey' not the su#stance or #ehavior
is the !ey' not the su#stance or #ehavior

Addiction defned #y researchers as /a

Addiction defned #y researchers as /a
#ad ha#it'0 /a #rain disease'0
#ad ha#it'0 /a #rain disease'0
/helplessness'0 /a pro#lem of
/helplessness'0 /a pro#lem of
motivation0
motivation0
DSM-5
DSM-5

1hanges to 2S* in ne( edition: no longer 1hanges to 2S* in ne( edition: no longer
dichotomy #et(een a#use and dependence dichotomy #et(een a#use and dependence
Addiction no( the preferred term instead of Addiction no( the preferred term instead of
dependence. dependence.
Addiction no( seen as a continuum. Addiction no( seen as a continuum.
Substance use disorder Substance use disorder re3uires 2 of follo(ing: re3uires 2 of follo(ing:
tolerance tolerance ina#ility to stop ina#ility to stop
(ithdra(al pro#lems (ithdra(al pro#lems e&cessive spending or e&cessive spending or
efort efort
use more than intended use more than intended to o#tain to o#tain
reduced involvement reduced involvement continued use continued use
De)nitions
Addiction*pattern of compu!sive use+
4
,as ph"sica!- ps"cho!ogica!- socia!
aspects+
4
Emphasis on process rather than
outcome+
.am!ing now considered an addiction
in DS/01
Pattern of preoccupation- !ac2 of
contro!- form of escape- chasing one3s
!osses- serious conse4uences+
5o6 %+%
5o6 %+%
A Socia! Wor2 /a7or
A Socia! Wor2 /a7or
Wor2ing in a Casino
Wor2ing in a Casino
5hat is the ethical dilemma here6

5hat is the ethical dilemma here6
Ho( do the managers ensure that

Ho( do the managers ensure that
the gam#lers !eep spending their
the gam#lers !eep spending their
money6
money6
Ho( are the employees controlled

Ho( are the employees controlled
#y the esta#lishment6
#y the esta#lishment6
The Disease Concept
The Disease Concept
7s alcoholism a disease6
7s alcoholism a disease6
Arguments pro:
Arguments pro:
Arguments con:
Arguments con:
8irst- De)ne Disease
8irst- De)ne Disease
2isease 2isease $ as metaphor #y 8elline!: /alcoholism is $ as metaphor #y 8elline!: /alcoholism is

like like a disease0 a disease0
Random House Dictionary, Random House Dictionary, disease is a condition disease is a condition
of the #ody in (hich this is incorrect function. of the #ody in (hich this is incorrect function.
Oxford University Dictionary Oxford University Dictionary9 disease is a#sence 9 disease is a#sence
of ease +in treatment 9 disease as: primary' of ease +in treatment 9 disease as: primary'
progressive' chronic' and possi#ly fatal-. progressive' chronic' and possi#ly fatal-.
7llness 7llness 9 term preferred here' less controversial' 9 term preferred here' less controversial'
less medical. less medical.
est arguments pro disease: est arguments pro disease: alcoholism is a #rain alcoholism is a #rain
disease #ecause the addicted #rain has changed. disease #ecause the addicted #rain has changed.
est arguments against: est arguments against: :ust a ha#it' a #ehavior' :ust a ha#it' a #ehavior'
need to ta!e responsi#ility' people mature out of it. need to ta!e responsi#ility' people mature out of it.
5iops"chosocia!0spiritua!
5iops"chosocia!0spiritua!
/ode!
/ode!
5hy +#io-' (hat +psycho-' (here

5hy +#io-' (hat +psycho-' (here
+social-
+social-
;eed for spiritual healing'

;eed for spiritual healing'
connection (ith Higher )o(er
connection (ith Higher )o(er
7nteractionism and cycle of pain:

7nteractionism and cycle of pain:
pain and sufering
pain and sufering
loss
loss
pain'
pain'
stress and drin!ing
stress and drin!ing
more pain
more pain
<amily as a system in interaction'

<amily as a system in interaction'
roles
roles
Wh" Do We 'eed to Know
Wh" Do We 'eed to Know
aout Addiction(
aout Addiction(
=>? of people #ehind #ars have pro#lems'

=>? of people #ehind #ars have pro#lems'
pervasive in child (elfare system' alcoholism
pervasive in child (elfare system' alcoholism
in the (or!place.
in the (or!place.
@1? of social (or!ers (or!ed (ith clients

@1? of social (or!ers (or!ed (ith clients
(ith su#stance use disorders in the past
(ith su#stance use disorders in the past
year.
year.
Headlines:
Headlines:

$/5hen .anning .urns into an Addiction0
$/5hen .anning .urns into an Addiction0

$/HelpA 7Bm Addicted to <ace#oo!0
$/HelpA 7Bm Addicted to <ace#oo!0
Relevant movies:
Relevant movies:
28 days
28 days
'
'
Trafic, alk t!e
Trafic, alk t!e
"ine
"ine
Ta!e %+% Contrast Traditiona!
Ta!e %+% Contrast Traditiona!
Approach and Strengths
Approach and Strengths
Perspective
Perspective
Traditiona! approach dichotomi9es
Traditiona! approach dichotomi9es
a!coho!ic and non0a!coho!ic
a!coho!ic and non0a!coho!ic
:se of !ae!s*& am an a!coho!ic- addict-
:se of !ae!s*& am an a!coho!ic- addict-
d"sfunctiona! fami!"
d"sfunctiona! fami!"
8ocus on !osses- c!ient in denia!-
8ocus on !osses- c!ient in denia!-
resistant
resistant
Strengths approach*avoids !ae!s-
Strengths approach*avoids !ae!s-
focus on strengths- fami!" as resource
focus on strengths- fami!" as resource
Two Approaches to Treatment
Two Approaches to Treatment
Traditiona! Traditiona!
5io 5io
2ichotomy 2ichotomy
Ps"cho Ps"cho
)ro#lems mandate )ro#lems mandate
one siCe one siCe fts all fts all
Socia! Socia!
7dentify family 7dentify family
dysfunction dysfunction

Strengths0ased Strengths0ased

5io 5io
1ontinuum 1ontinuum
Ps"cho Ps"cho
Strengths$motivation Strengths$motivation

Socia! Socia!
Holistic family as Holistic family as
resource resource

Addiction Recover"
Addiction Recover"
/anagement
/anagement
Strengths0ased treatment
Strengths0ased treatment
approach endorsed " :'
approach endorsed " :'
Case management
Case management
Communit" resources for !ong0
Communit" resources for !ong0
term care
term care
&nterventions re!ate to persona!
&nterventions re!ate to persona!
needs in societ"*menta! hea!th
needs in societ"*menta! hea!th
care- housing
care- housing
Success measured in drin2ing-
Success measured in drin2ing-
using !ess- not tota! astinence
using !ess- not tota! astinence

Strengths Perspective
Strengths Perspective
Rapp and Doscha: Rapp and Doscha:
Si& critical elements: person is not the illness' choice' Si& critical elements: person is not the illness' choice'
hope' purpose' achievement' presence of one !ey person hope' purpose' achievement' presence of one !ey person
to help. to help.
<inding the strengths in divergent modelsharm <inding the strengths in divergent modelsharm
reduction and 12 Step approach reduction and 12 Step approach
2iferent models for diferent fol!s. 2iferent models for diferent fol!s.
Eery negative vie( of disease model: Stanton )eele: Eery negative vie( of disease model: Stanton )eele:
Resistin# $2 Ste% &oercion Resistin# $2 Ste% &oercion
Harm reduction and the strengths perspective /meet Harm reduction and the strengths perspective /meet
the client (here the client is.0 the client (here the client is.0
)olicy issues of reducing harm. )olicy issues of reducing harm.

Empirica! Research
Empirica! Research
)ro:ect *A.1H )ro:ect *A.1H
Directed " '&AAA ; #-$$$ c!ients over < "rs+ Directed " '&AAA ; #-$$$ c!ients over < "rs+
What wor2s( %# step faci!itation- cognitive- motivationa! enhancement What wor2s( %# step faci!itation- cognitive- motivationa! enhancement
therap" =/ET> therap" =/ET>

/ET most e?ective for those with !ow motivation- %# Step with /ET most e?ective for those with !ow motivation- %# Step with
re!igious re!igious
persons+ persons+
Criticism: !ac2 of a contro! group+ /ET- a shorter intervention+ /ode!s Criticism: !ac2 of a contro! group+ /ET- a shorter intervention+ /ode!s
on!" on!"
tested on a!coho!ic c!ients+ tested on a!coho!ic c!ients+
Pro7ect /ATC, con)rms the e?ectiveness of diverse treatments+ 'ew Pro7ect /ATC, con)rms the e?ectiveness of diverse treatments+ 'ew
measure for recover" is improvement- not tota! astinence+ measure for recover" is improvement- not tota! astinence+
EaillantBs Research EaillantBs Research
@$ "ear !ongitudina! stud"*those who recovered had crisis with a!coho! @$ "ear !ongitudina! stud"*those who recovered had crisis with a!coho!
or 7oined AA or entered a sta!e re!ationship or had a re!igious or 7oined AA or entered a sta!e re!ationship or had a re!igious
conversion+ conversion+
Empirica! Research
Empirica! Research
Continued
Continued
Research from 1alifornia: 1F spent saves

Research from 1alifornia: 1F spent saves
@ across states.
@ across states.
Hester and *iller found that these

Hester and *iller found that these
treatment modalities (ere proven to #e
treatment modalities (ere proven to #e
most efective: #rief intervention'
most efective: #rief intervention'
motivational intervie(ing +*7-' use of the
motivational intervie(ing +*7-' use of the
medication naltre&one' social s!ills
medication naltre&one' social s!ills
training' aversion therapy' cognitive
training' aversion therapy' cognitive
therapy' acupuncture. +See chapter =-
therapy' acupuncture. +See chapter =-
Treatment Trends
Treatment Trends
)rescription drug misuse as increasing pro#lemG )rescription drug misuse as increasing pro#lemG
Harm reduction recogniCed as important to save Harm reduction recogniCed as important to save
livesG pu#lic health approachG livesG pu#lic health approachG
elief that punitive la(s cause harmG elief that punitive la(s cause harmG
*a:ority of Americans favor treatment over :ailG *a:ority of Americans favor treatment over :ailG
2e$emphasis on incarceration' reentry 2e$emphasis on incarceration' reentry

programmingG programmingG
2rug courts' mental health courtsG 2rug courts' mental health courtsG
Attention to co$occurring disorders and e&tensive Attention to co$occurring disorders and e&tensive
use of prescri#ed medications to reduce cravingG use of prescri#ed medications to reduce cravingG
Restorative 8ustice Restorative 8ustice' ' victim$ofender programming victim$ofender programming

to promote healing. )%AS% Academy. to promote healing. )%AS% Academy.
Chapter #
Chapter #
,istorica! Perspectives
,istorica! Perspectives
Ear!" ,istor"
Ear!" ,istor"
Alcohol #ac! to H>>> 1 7ran

Alcohol #ac! to H>>> 1 7ran
In!no(n to (orldBs indigenous people

In!no(n to (orldBs indigenous people
Joran $$$ condemned (ine. Alcohol from

Joran $$$ condemned (ine. Alcohol from
Ara#ic al$!uhul.
Ara#ic al$!uhul.
Ara#ian dr. discovered evaporated distilled

Ara#ian dr. discovered evaporated distilled
spirits. .echnology e&ceeded its grasp
spirits. .echnology e&ceeded its grasp
1H@H $$$ distilling used9gin. ooCe from

1H@H $$$ distilling used9gin. ooCe from
2utch
2utch
busen
busen
.
.
Dreat devastation from %ngland' 1@>>$

Dreat devastation from %ngland' 1@>>$
1@H>.
1@H>.
7nfant mortality' crime

7nfant mortality' crime
'orth America
'orth America
*ore #eer than (ater on

*ore #eer than (ater on
*ayKo(er.
*ayKo(er.
Slaves for#idden to drin! e&cept

Slaves for#idden to drin! e&cept
on special occasions' taught
on special occasions' taught
#ingeing.
#ingeing.
)uritan traditions.
)uritan traditions.
1=
1=
th th
9 Lua!ers and *ethodists
9 Lua!ers and *ethodists
disapproved of hard li3uor.
disapproved of hard li3uor.
*ale drin!ing cult 1@2H$1=2H

*ale drin!ing cult 1@2H$1=2H
notorious.
notorious.
Temperance movement
Temperance movement
%<#10%A%A
%<#10%A%A
: Against hard li3uor.
: Against hard li3uor.
.emperance (oman for (omenBs

.emperance (oman for (omenBs
sufrage and #an on distilled
sufrage and #an on distilled
#everages.
#everages.
Ear!" %A$$s
Ear!" %A$$s
1ocaine in 1o!e
1ocaine in 1o!e
.o#acco outla(ed for #rief period.

.o#acco outla(ed for #rief period.
1M1N Harrison Act $$$ restricted

1M1N Harrison Act $$$ restricted
opioids +associated (ith 1hinese
opioids +associated (ith 1hinese
people- cocaine must no( #e
people- cocaine must no( #e
prescri#ed.
prescri#ed.
*ari:uana +associated (ith

*ari:uana +associated (ith
*e&icans- State la(s in south(est
*e&icans- State la(s in south(est
criminaliCed.
criminaliCed.
Teetotaler
Teetotaler
. Ototal a#stinence'
. Ototal a#stinence'
from 7reland.
from 7reland.
:+S+ Prohiition %A#$0
:+S+ Prohiition %A#$0
%A33
%A33
DlamoriCed crime. *afaP

DlamoriCed crime. *afaP
Holly(oodP5ash. 21 lin!. Homicide
Holly(oodP5ash. 21 lin!. Homicide
rates increased.
rates increased.
Dreat 2epression created need for

Dreat 2epression created need for
:o#s.
:o#s.
Diancana'
Diancana'
Double &ross
Double &ross
/odern War on Drugs
/odern War on Drugs
Bohnson*war on povert"
Bohnson*war on povert"
'i6on tthrough the 5ushes*war
'i6on tthrough the 5ushes*war
on drugs
on drugs
%AC$s heroin horror stories
%AC$s heroin horror stories
%A<$s- crac2 cocaine
%A<$s- crac2 cocaine
#$$$s- meth
#$$$s- meth
Attac2s directed toward poor-
Attac2s directed toward poor-
minorities+
minorities+

,istor" of .am!ing in
,istor" of .am!ing in
:+S+
:+S+
Dotteries American Revo!ution Dotteries American Revo!ution
5anned after Civi! War and during Prohiition+ 5anned after Civi! War and during Prohiition+
%A3%*casino gam!ing !ega! in 'evada %A3%*casino gam!ing !ega! in 'evada
%AC$s*!otteries for state revenue %AC$s*!otteries for state revenue
%AE#*)rst gam!ing treatment center at FA- %AE#*)rst gam!ing treatment center at FA-
'ew Gor2 'ew Gor2
%A<E*Supreme Court anned state regu!ation %A<E*Supreme Court anned state regu!ation
of tria! casinos of tria! casinos
/ississippi River casinos /ississippi River casinos
&nternet gam!ing popu!ar toda" &nternet gam!ing popu!ar toda"
Themes of 8irst ,a!f of
Themes of 8irst ,a!f of
Chapter
Chapter
2angers of potent alcohol' role of

2angers of potent alcohol' role of
ethnic pre:udice in shaping drug
ethnic pre:udice in shaping drug
legislation' unintended
legislation' unintended
conse3uences of prohi#ition.
conse3uences of prohi#ition.
%&ample of happy 7talian family

%&ample of happy 7talian family
en:oying (ine (ith their meals.
en:oying (ine (ith their meals.
*odern 5ar on 2rugs' t(o$thirds

*odern 5ar on 2rugs' t(o$thirds
of money for la( enforcement.
of money for la( enforcement.
,istor" of Addiction Treatment

,istor" of Addiction Treatment
5illiam 5hite'
5illiam 5hite'
Slayin# t!e Dra#on(
Slayin# t!e Dra#on(

*istreatment of persons (ith mentally
*istreatment of persons (ith mentally
illness and alcoholics in asylums.
illness and alcoholics in asylums.
)ettin# *etter
)ettin# *etter
#y ;an Ro#ertson tells of
#y ;an Ro#ertson tells of
ill 5. and 2r. o#. R&ford Droups. ig
ill 5. and 2r. o#. R&ford Droups. ig
oo!. 2 million mem#ers in AA (orld(ide
oo!. 2 million mem#ers in AA (orld(ide
today.
today.
8elline! +
8elline! +
T!e Disease &once%t
T!e Disease &once%t
' 1MS>- 9 H
' 1MS>- 9 H
types of alcoholism #ased on (orld travels:
types of alcoholism #ased on (orld travels:
Alpha' eta' Damma ' 2elta' %psilon.

Alpha' eta' Damma ' 2elta' %psilon.
Treatment ,istor"
Treatment ,istor"
continued
continued
1MHS A*A declared alcoholism an

1MHS A*A declared alcoholism an
illness' 1MSS' a disease.
illness' 1MSS' a disease.
Harold Hughes 9founded ;7AAA.

Harold Hughes 9founded ;7AAA.
HaCelden adapted 12 Step approach.

HaCelden adapted 12 Step approach.

o& 2:1/.reatment in ;or(ay0

o& 2:1/.reatment in ;or(ay0
universal health care for support.
universal health care for support.
)eele and <ingarette: addiction as

)eele and <ingarette: addiction as
#ad ha#its not disease.
#ad ha#its not disease.
,istor" of ,arm Reduction
,istor" of ,arm Reduction
A72S in ;etherlands spa(ned ne(

A72S in ;etherlands spa(ned ne(
approach' to reduce the harm.
approach' to reduce the harm.
ritain' 1MS>s and later.

ritain' 1MS>s and later.
Heroin prescri#ed. ;eedle

Heroin prescri#ed. ;eedle
e&changes$I.S.
e&changes$I.S.
Alan *arlatt' died in 2>11' pioneer in

Alan *arlatt' died in 2>11' pioneer in
spread of harm reduction approach to
spread of harm reduction approach to
I.S.' researcher at I. of 5ashington.
I.S.' researcher at I. of 5ashington.
Part &&
Part &&

5&HDH.G
5&HDH.G
Chapter 3
Chapter 3
Sustance /isuse- Dependence-
and the 5od"
and the 5od"
Part &&
Part &&

5&HDH.G
5&HDH.G
Chapter 3
Chapter 3
and the 5od"
and the 5od"
Recent Trends
Recent Trends
2evelopment of )%. scans' f*R7
2evelopment of )%. scans' f*R7

functional magnetic resonance
functional magnetic resonance
imaging
imaging

1raving research
1raving research

;e( facts on #rain damage
;e( facts on #rain damage
Depressants
Depressants
A!coho!
A!coho!
<igure ".1alcohol involvement:
<igure ".1alcohol involvement:
N@? of homicidesG "N? of
N@? of homicidesG "N? of
dro(ningsG N2? of fre in:uriesG
dro(ningsG N2? of fre in:uriesG
N@? of young male car crashesG
N@? of young male car crashesG
H>? date rapeG 1S? child a#use
H>? date rapeG 1S? child a#use
+doesnBt count neglect-G 2"? of
+doesnBt count neglect-G 2"? of
suicide.
suicide.
7nternational studies sho( high
7nternational studies sho( high
correlation
correlation
(ith partner violence.
(ith partner violence.
1ollege student deaths per year 9
1ollege student deaths per year 9
1'=2H +;7AAA' 2>1>-
1'=2H +;7AAA' 2>1>-
8ather /artin*
8ather /artin*
Chalk
Chalk
Talks
Talks
Bocose drun2- amorose- e!!icose-
!achr"mose drun2s
Hur additions: somnos drun2-
=s!eep"> c!amorose- =!oud>-
scientose =2now it a!!>
.!oa! Drin2ing Patterns
.!oa! Drin2ing Patterns
%uropeans consume si& times as much

%uropeans consume si& times as much
alcohol as southeast Asians
alcohol as southeast Asians
*oldova' the 1Cech Repu#lic' drin!

*oldova' the 1Cech Repu#lic' drin!
around 1= liters per capita each year.
around 1= liters per capita each year.
%astern %uropeanshard li3uor

%astern %uropeanshard li3uor
ritish and 7rish#eer

ritish and 7rish#eer
<rench and 7talians(ine

<rench and 7talians(ine
High ratesindigenous populations

High ratesindigenous populations
;orthern S(eden and ;orthern 1anada
;orthern S(eden and ;orthern 1anada
A!coho! continued
A!coho! continued
Health efects of moderate drin!ers

Health efects of moderate drin!ers
heart #enefts' lo(er death rates than
heart #enefts' lo(er death rates than
teetotalers.
teetotalers.
@$1>? of drin!ers get addicted. Signs:

@$1>? of drin!ers get addicted. Signs:
tolerance' (ithdra(al +tremors' nauseaG
tolerance' (ithdra(al +tremors' nauseaG
H? have 2.s-' heavy nicotine' cafeine use
H? have 2.s-' heavy nicotine' cafeine use
.olerance reversal
.olerance reversal
.N .A.1. may #e comatose.

.N .A.1. may #e comatose.
lac!outs: common at ." A1' case in

lac!outs: common at ." A1' case in
Tom
Tom
Sa+yer
Sa+yer
Real court cases

Real court cases
'arcotics
'arcotics
Rpiatesfrom opium poppyTnarcotics'

Rpiatesfrom opium poppyTnarcotics'
heroin no( can #e smo!ed or snorted.
heroin no( can #e smo!ed or snorted.
High tolerance so need greater

High tolerance so need greater
3uantities for high.
3uantities for high.
7nhalantshousehold products'
7nhalantshousehold products'
hufing' #rain damage' coma
hufing' #rain damage' coma
*isuse of pain medication increasing

*isuse of pain medication increasing
today
today
R&y1ontin
R&y1ontin
Stimu!ants
Stimu!ants
1ocaine$crac! and po(der' in urine = hrs.' 1ocaine$crac! and po(der' in urine = hrs.'
smo!ed for faster high. High lasts only 1H$2> smo!ed for faster high. High lasts only 1H$2>
minutes. minutes.
rain #loc!s reupta!e of dopamineT Addicted rain #loc!s reupta!e of dopamineT Addicted
rats dieT heart attac!. rats dieT heart attac!.
Amphetamines and methsynthetic unli!e Amphetamines and methsynthetic unli!e

cocainesuppresses appetite. Ised #y ;aCis. cocainesuppresses appetite. Ised #y ;aCis.
N$1S hour high. N$1S hour high.
,et!land ,et!land #y ;ic! Reding a#out Rel(ein' 7o(a. #y ;ic! Reding a#out Rel(ein' 7o(a.
)o(der can #e snorted' in:ected. Stay a(a!e )o(der can #e snorted' in:ected. Stay a(a!e
for long durationsT for long durationsT
-n!edonia -n!edonia$$$ina#ility to feel pleasure (ith $$$ina#ility to feel pleasure (ith

drug$induced #rain in:ury. drug$induced #rain in:ury.
'icotine
'icotine
1an #oth stimulate and rela&. =>$MH? of

1an #oth stimulate and rela&. =>$MH? of
alcoholics smo!e' reduces alcohol efects.
alcoholics smo!e' reduces alcohol efects.
Rver half of persons (ith schiCophrenia
Rver half of persons (ith schiCophrenia
smo!e.
smo!e.
;icotine decreases A1 levels.

;icotine decreases A1 levels.
American #usinessmanBs story from 1hina.

American #usinessmanBs story from 1hina.
*alachy *c1ourt smo!ed for ad and got

*alachy *c1ourt smo!ed for ad and got
hoo!ed.
hoo!ed.
o& ".1 /.o 2ie for a 1igarette0

o& ".1 /.o 2ie for a 1igarette0
1ase of che(ing to#accosnuf.

1ase of che(ing to#accosnuf.
,a!!ucinogens
,a!!ucinogens

)lants' ,S2' synthetic' Kash#ac!s' )1)

)lants' ,S2' synthetic' Kash#ac!s' )1)
%cstasy and roofesheightens sensory

%cstasy and roofesheightens sensory
e&perienceTraves..
e&perienceTraves..
1anBt get #ac! to original high due to

1anBt get #ac! to original high due to
#rain changes.
#rain changes.
1>? in high school have used %cstasy.

1>? in high school have used %cstasy.
2ance Safe 9 harm reduction strategies.

2ance Safe 9 harm reduction strategies.
Roofes: sleeping pill in %urope.

Roofes: sleeping pill in %urope.
What &s Ecstas"(
What &s Ecstas"(
%cstasy is a drug that

%cstasy is a drug that
has some
has some
hallucinogenic
hallucinogenic
properties and is
properties and is
structurally related
structurally related
to amphetamines. 7ts
to amphetamines. 7ts
short form chemical
short form chemical
name is *2*A +"'N$
name is *2*A +"'N$
methylenedio&ymeth
methylenedio&ymeth
am$phetamine-.
am$phetamine-.
Sp!it
Short Term E?ects of
Short Term E?ects of
Ecstas"
Ecstas"
<eeling of confdence
<eeling of confdence
Sense of arousal
Sense of arousal
7ncreased heart rate

7ncreased heart rate
2ry and sore mouthPthroat

2ry and sore mouthPthroat
.ension' High ody .emperature

.ension' High ody .emperature
*uscle t(itching
*uscle t(itching
2epression U 1onfusion
2epression U 1onfusion
Hther S"nthetic
Hther S"nthetic
Sustances
Sustances
Spice
Spice
5ath sa!ts*increase in
5ath sa!ts*increase in
ER visits associated
ER visits associated
with this drug+
with this drug+
,ard to detect+
,ard to detect+
Cannais
Cannais

*ari:uana
*ari:uana
.H1' the psychoactive ingredient'

.H1' the psychoactive ingredient'
lo(ers #lood glucose' increases
lo(ers #lood glucose' increases
appetite' Stored in fat cells' long
appetite' Stored in fat cells' long
term use possi#ly associated (ith
term use possi#ly associated (ith
apathy.
apathy.
%arlier reports of lung cancer after

%arlier reports of lung cancer after
long$term use (ere not validated.
long$term use (ere not validated.
Costs to .et ,igh

Costs to .et ,igh
Estimates Di?er " Region
Estimates Di?er " Region
Vnot in te&tW
Vnot in te&tW
1rac!: FH$1> 3uic! f& only lasts "> min.

1rac!: FH$1> 3uic! f& only lasts "> min.
Heroin: F1>>$2>> day$$F2> day can #y

Heroin: F1>>$2>> day$$F2> day can #y
maintenance dose in:ect a couple of times
maintenance dose in:ect a couple of times
%cstasy: F2H may ta!e H or so pills.

%cstasy: F2H may ta!e H or so pills.
*eth: F2H long$lasting high' popular in gay

*eth: F2H long$lasting high' popular in gay
party scene in Seattle' factory (or!ers in
party scene in Seattle' factory (or!ers in
7o(a
7o(a
*ari:uana: F2H or higher' depends on 3uality

*ari:uana: F2H or higher' depends on 3uality
/etao!ism
/etao!ism
,iver: organ that meta#oliCes alcohol'

,iver: organ that meta#oliCes alcohol'
alcohol circulates in the #loodstream
alcohol circulates in the #loodstream
until meta#oliCed.
until meta#oliCed.
*en have special enCymes that help.

*en have special enCymes that help.
)eople meta#oliCe X oC. per hour O

)eople meta#oliCe X oC. per hour O
small glass of (ine.
small glass of (ine.
Rne 2rin! Y Rne #ottle of #eer +12 oC.-

Rne 2rin! Y Rne #ottle of #eer +12 oC.-
Y Rne glass of (ine +S oC.-

Y Rne glass of (ine +S oC.-
Y Rne /single0 drin! +1Y oC. of li3uor-

Y Rne /single0 drin! +1Y oC. of li3uor-
/etao!ism continued
/etao!ism continued
Brain Regions and Their Functions
Brain Regions and Their Functions

Ecstas" and the 5rain
Ecstas" and the 5rain
The 5rain and Addiction
The 5rain and Addiction
;eurotransmitters afect emotions and memory ;eurotransmitters afect emotions and memory
'eurotransmitters A?ect
'eurotransmitters A?ect
Emotions and /emor"
Emotions and /emor"
2opaminereupta!e afected #y cocaine'

2opaminereupta!e afected #y cocaine'
(hich #loc!s dopamine synapse
(hich #loc!s dopamine synapse
2epletion follo(ing cocaine use. ;icotine

2epletion follo(ing cocaine use. ;icotine
afects dopamine too.
afects dopamine too.
)ar!insonBs (hen too little. 2opamine$

)ar!insonBs (hen too little. 2opamine$
#oosting drugs for )ar!insonBs associated
#oosting drugs for )ar!insonBs associated
(ith mania and gam#ling #ehavior.
(ith mania and gam#ling #ehavior.
%&cess of dopamine associated (ith

%&cess of dopamine associated (ith
schiCophrenia.
schiCophrenia.
Serotonin: inKuenced #y alcohol' involved in

Serotonin: inKuenced #y alcohol' involved in
sleep. 2ecreased levels lin!ed to
sleep. 2ecreased levels lin!ed to
depression' an&iety' impulsiveness suicide.
depression' an&iety' impulsiveness suicide.
Dep!etion 8o!!owing
Dep!etion 8o!!owing
Cocaine :se+
Cocaine :se+
The right scan is ta2en from someone who is on cocaine+ The The right scan is ta2en from someone who is on cocaine+ The
!oss of red areas in the right scan compared to the !eft !oss of red areas in the right scan compared to the !eft
=norma!> scan indicates that the rain is using !ess g!ucose =norma!> scan indicates that the rain is using !ess g!ucose
and therefore is !ess active+ This reduction in activit" resu!ts in and therefore is !ess active+ This reduction in activit" resu!ts in
disruption of man" rain functions+ disruption of man" rain functions+

/emor" and Craving
/emor" and Craving
Addict never gets original high

Addict never gets original high
#rain has changed. Addiction is a
#rain has changed. Addiction is a
#rain disease.
#rain disease.
1ues can trigger memoryTpicture

1ues can trigger memoryTpicture
of alcoholic #everages activates
of alcoholic #everages activates
certain areas of the #rain.
certain areas of the #rain.
)roCac reduces craving #y

)roCac reduces craving #y
regulating serotonin levels.
regulating serotonin levels.

Cocaine in the Brain
Cocaine in the Brain
S!ides are from the 'ationa! &nstitute on Drug Ause ='&DA>
=www+nida+nih+gov>

.am!ing and the 5rain
.am!ing and the 5rain
Persons with gam!ing
Persons with gam!ing
disorders ma" have anorma!
disorders ma" have anorma!
!eve!s of dopamine
!eve!s of dopamine
and serotonin+
and serotonin+
Dac2 of contro! ma" resu!t+
Dac2 of contro! ma" resu!t+
,ighs enhanced when rewards
,ighs enhanced when rewards
uncertain+
uncertain+
'ear misses especia!!"
'ear misses especia!!"
thri!!ing+
thri!!ing+
The Ro!e of .enes
The Ro!e of .enes
Stud" of menta! hospita!s- prisons- 1$I who used Stud" of menta! hospita!s- prisons- 1$I who used
chemica! sustances had menta! disorders+ chemica! sustances had menta! disorders+
C!oninger*Sweden++#1A ma!e adoptees with C!oninger*Sweden++#1A ma!e adoptees with

a!coho!ic fathers a!coho!ic fathers
T"pe % T"pe %: !ate onset++E1I of a!coho!ics- re!ates to : !ate onset++E1I of a!coho!ics- re!ates to
harm avoidance- an6iet"- gui!t harm avoidance- an6iet"- gui!t
T"pe # T"pe #: ris2 ta2er- =starts aout age %%> ma!e- : ris2 ta2er- =starts aout age %%> ma!e-
h"peractive- antisocia!- hereditar" h"peractive- antisocia!- hereditar"
Hndansetron: wor2s on serotonin- !itt!e e?ect on Hndansetron: wor2s on serotonin- !itt!e e?ect on
t"pe % t"pe %
Twins Twins: @$0C$I concurrence of a!coho!ism+ : @$0C$I concurrence of a!coho!ism+

Separated at irth mon2e"s dran2 more under Separated at irth mon2e"s dran2 more under
stress- peop!e with !ow dopamine !i2e stimu!ants stress- peop!e with !ow dopamine !i2e stimu!ants
Peop!e with AD,D ris2 for drug ause+ Peop!e with AD,D ris2 for drug ause+
/edica! Conse4uences
5ernic!e Jorsa!of: 5ernic!e Jorsa!of:
1ases reported of 2r. Rliver Sachs 1ases reported of 2r. Rliver Sachs
)eripheral neuropathy related to lac! of Eitamin )eripheral neuropathy related to lac! of Eitamin
1onfa#ulationT.2r. SachsA(a!enings 1onfa#ulationT.2r. SachsA(a!enings
continued
continued
Diver damageJremoves to6ins
Diver damageJremoves to6ins
from !ood- i!e circu!ates in !ood
from !ood- i!e circu!ates in !ood
stream
stream
Ge!!ow s2in tone- cirrhosis-
Ge!!ow s2in tone- cirrhosis-
immune s"stem rea2down+
immune s"stem rea2down+
,eart ; nicotine- cocaine
,eart ; nicotine- cocaine
8eta! a!coho! s"ndrome+ See
8eta! a!coho! s"ndrome+ See
photograph in te6t+ Short nose-
photograph in te6t+ Short nose-
indistinct groove etween nose
indistinct groove etween nose
and mouth- thin upper !ip- sma!!
and mouth- thin upper !ip- sma!!
head and e"es- !earning pro!ems+
head and e"es- !earning pro!ems+
Ro!e of sperm shou!d e
Ro!e of sperm shou!d e
considered as we!! as mother3s
considered as we!! as mother3s
ro!e+
ro!e+
&nterventions Re!ated to
&nterventions Re!ated to
5io!og"
5io!og"
Schic! Shadel' Seattle treatment

Schic! Shadel' Seattle treatment
center
center
1onditioning or aversion therapy

1onditioning or aversion therapy
favorite drin! plus emetine to induce
favorite drin! plus emetine to induce
vomiting.
vomiting.
Ise of truth serum on alternate days.

Ise of truth serum on alternate days.

Changing 5rain
Changing 5rain
Chemistr"
Chemistr"
*rain "ock
*rain "ock
+Sch(artC- cognitive
+Sch(artC- cognitive
treatment for R12 to /re(ire the #rain0
treatment for R12 to /re(ire the #rain0
Rndansetrondecreases craving
Rndansetrondecreases craving
Zy#an
Zy#an
and smo!ingG 1hanti& helps person
and smo!ingG 1hanti& helps person
produce more dopamine.
produce more dopamine.
;icotine gumG patch.

;icotine gumG patch.
;altre&one' approved 1MMH' not a narcotic

;altre&one' approved 1MMH' not a narcotic
unli!e methadone.
unli!e methadone.
loc!s receptors for getting high.

loc!s receptors for getting high.
S"nthetic Prescription
S"nthetic Prescription
Drugs
Drugs
*ethadone +synthetic form of heroin-G *ethadone +synthetic form of heroin-G
*ethadone maintenance *ethadone maintenance
Heroin maintenance in ritain' S(itCerland' Heroin maintenance in ritain' S(itCerland'

Eancouver. Eancouver.
uprenorphine can #e prescri#ed #y D)s' uprenorphine can #e prescri#ed #y D)s'

reduces li!elihood of overdose reduces li!elihood of overdose
%ating disorders and dopamine %ating disorders and dopamine
ulimicsrelated to depression ulimicsrelated to depression
Anore&iaan&iety Anore&iaan&iety
,uvo&' )roCac' and )a&il decrease #inges. ,uvo&' )roCac' and )a&il decrease #inges.
,o!istic Treatments
,o!istic Treatments
Her#al remedies
Her#al remedies
St. 8ohnBs (ort

St. 8ohnBs (ort
Hypnosis
Hypnosis
Acupuncture from 1hina

Acupuncture from 1hina
*assage therapy
*assage therapy
)hysical e&ercise to reduce tension

)hysical e&ercise to reduce tension
Chapter @
Chapter @
Dender and Se&ual
Dender and Se&ual
Rrientation
Rrientation
2iferences
2iferences
.ender &ssues
.ender &ssues
4
Recent trends*voices of women and ga"s and Recent trends*voices of women and ga"s and
!esians are increasing!" heard regarding !esians are increasing!" heard regarding
treatment- research+ treatment- research+
4
Some emphasis on gender0sensitive treatment+ Some emphasis on gender0sensitive treatment+
4
C!ass and cu!tura! di?erences in drug use+ C!ass and cu!tura! di?erences in drug use+
4
/a!eLfema!e ratios di?er in drin2ing 4uantit" /a!eLfema!e ratios di?er in drin2ing 4uantit"
ratios from %3:%# in &ta!" to #<:%% in Canada- ratios from %3:%# in &ta!" to #<:%% in Canada-
@C:1 in /e6ico- and %1:3 in Russia+ @C:1 in /e6ico- and %1:3 in Russia+
4
&n American high schoo!s- sustance use rates &n American high schoo!s- sustance use rates
aout the same+ aout the same+
4
Adu!t men- twice the rate of women for Adu!t men- twice the rate of women for
mari7uana and cocaine use and gam!ing- meth mari7uana and cocaine use and gam!ing- meth
and tran4ui!i9ers aout the same+ and tran4ui!i9ers aout the same+
4
/ore eating disorders in women /ore eating disorders in women
.ender Di?erences
.ender Di?erences
4
Shame factor for women in treatment+ Shame factor for women in treatment+
4
Women in treatment more !i2e!" than men to have Women in treatment more !i2e!" than men to have
a sustance0dependent partner+ a sustance0dependent partner+
4
Treatment !ess accessi!e for mothers than fathers Treatment !ess accessi!e for mothers than fathers
due to chi!d care responsii!ities+ due to chi!d care responsii!ities+
4
/an" women !ose custod" of chi!dren over /an" women !ose custod" of chi!dren over
sustance misuse+ sustance misuse+
4
Astinence demands unrea!istic+ Astinence demands unrea!istic+
4
Dac2 of treatment avai!ai!it" for pregnant women+ Dac2 of treatment avai!ai!it" for pregnant women+
4
.ood resu!ts with recover" coaches and fami!" .ood resu!ts with recover" coaches and fami!"
courts+ courts+
.ender Di?erences
.ender Di?erences
continued
continued
*eth addiction rates high among (omen. *eth addiction rates high among (omen.
Rne study sho(ed that =>? of female meth addicts (ere Rne study sho(ed that =>? of female meth addicts (ere
victims of domestic violence. victims of domestic violence.
Eiolence$$$" of N intimate partner murders are of (omen. Eiolence$$$" of N intimate partner murders are of (omen.
5omen alcoholics $$$N@? in treatment molested as 5omen alcoholics $$$N@? in treatment molested as
children in study of N@2 (omen +2o(ns-. .reatment children in study of N@2 (omen +2o(ns-. .reatment
needs to focus on ).S2 issues. needs to focus on ).S2 issues.
5omen smo!e to control (eight' males to relieve 5omen smo!e to control (eight' males to relieve
#oredom. #oredom.
%scape gam#lers +(omen-. 5omen start gam#ling later %scape gam#lers +(omen-. 5omen start gam#ling later
in life than men do. in life than men do.
5io!ogica! Di?erences
5io!ogica! Di?erences
Women get into6icated 4uic2er than men+
Women have a higher morta!it" rate with heav"
drin2ing+
Dives are shortened " %1 "ears on average with
a!coho!ism*heart and !iver damage+
Women3s Treatment
Women3s Treatment
'eeds
'eeds
1. Address #arriers to treatment that many (omen 1. Address #arriers to treatment that many (omen
e&perience' such as lac! of transportation' child care' e&perience' such as lac! of transportation' child care'
and treatment availa#ility. and treatment availa#ility.
2. 1hanging program goals and processes to 2. 1hanging program goals and processes to
accommodate (omenBs needs for more support' less accommodate (omenBs needs for more support' less
confrontation' :o# s!ill training' and parenting s!ills. confrontation' :o# s!ill training' and parenting s!ills.
". %m#racing an empo(erment model of change. ". %m#racing an empo(erment model of change.
N. <emale counselors (ho can attend to shame and N. <emale counselors (ho can attend to shame and
stigma issues. stigma issues.
H. ;eed to cele#rate any signifcant decrease in H. ;eed to cele#rate any signifcant decrease in
su#stance use. su#stance use.
Se6ua! Hrientation
Se6ua! Hrientation

4
,eterose6ism and homophoia: :+S+ studies of ,eterose6ism and homophoia: :+S+ studies of
schoo!s shows suicide is %@ times the schoo!s shows suicide is %@ times the
heterose6ua! rates+ heterose6ua! rates+
4
Desians*!owest rate of A&DS of an" group- ut Desians*!owest rate of A&DS of an" group- ut
dou!e the drug use of other women- 11I smo2e dou!e the drug use of other women- 11I smo2e
at some point in their !ivesM #<I are oese+ at some point in their !ivesM #<I are oese+
4
Reasons for high drin2ing rate*ga" ar- fewer Reasons for high drin2ing rate*ga" ar- fewer
are mothersJ+.LD AA+ are mothersJ+.LD AA+
4
.a" ma!es*high ris2 of se6ua! ause in 7ai! ce!!s+ .a" ma!es*high ris2 of se6ua! ause in 7ai! ce!!s+
4
Re!igious fundamenta!ism corre!ated with Re!igious fundamenta!ism corre!ated with
suicideJa!coho! pro!ems persist across !ife suicideJa!coho! pro!ems persist across !ife
span+ span+
4
TransgenderJ+See Do3s and Don3tsJta!e TransgenderJ+See Do3s and Don3tsJta!e
%%+# %%+#
4
Resources: Pride &nstitute and P8DA. Resources: Pride &nstitute and P8DA.
Chapter 1
Chapter 1
.am!ing- Eating
.am!ing- Eating
Disorders- Shopping- and
Disorders- Shopping- and
Hther 5ehaviora!
Hther 5ehaviora!
Addictions
Addictions
.am!ing Addiction
.am!ing Addiction
4
Dam#ling' has #ecome socially accepta#le
Dam#ling' has #ecome socially accepta#le
4
1riteria of pathological gam#ling$$$
1riteria of pathological gam#ling$$$
preoccupation' increasing amounts' etc.
preoccupation' increasing amounts' etc.
"$@? of gam#lers have pro#lems' suicide
"$@? of gam#lers have pro#lems' suicide
high in gam#lers
high in gam#lers
4
1ost to economy is FHN #illion
1ost to economy is FHN #illion
#an!ruptcies' lost (or! time' crime' etc.
#an!ruptcies' lost (or! time' crime' etc.
Eery high among ;ative Americansover
Eery high among ;ative Americansover
1N? have gam#ling pro#lems
1N? have gam#ling pro#lems
4
Research sho(s counties (ith gam#ling
Research sho(s counties (ith gam#ling
casinos have higher crime rates and
casinos have higher crime rates and
#an!ruptcies than others
#an!ruptcies than others
.am!ing
.am!ing
continued
continued
4
Pro!ems among the e!der!"
Pro!ems among the e!der!"
4
&nternet gam!ing is the fastest growing
&nternet gam!ing is the fastest growing
form+
form+
4
#0@I in .am!ers Anon"mous =.A> are
#0@I in .am!ers Anon"mous =.A> are
women+ 5ut man" he!p!ine ca!!s+
women+ 5ut man" he!p!ine ca!!s+
4
Women gam!e to escapeM men for action+
Women gam!e to escapeM men for action+
4
Associated with other pro!ems
Associated with other pro!ems
4
5o6 1+% ReNections of a /a!e Compu!sive
5o6 1+% ReNections of a /a!e Compu!sive
.am!er+ .eographica! re!ocation he!ped
.am!er+ .eographica! re!ocation he!ped
him rea2 his hait+
him rea2 his hait+
Ouestions for Screening
Ouestions for Screening
4
,ave "ou ever orrowed mone" in order
,ave "ou ever orrowed mone" in order
to gam!e or cover !ost mone"(
to gam!e or cover !ost mone"(
4
,ave "ou ever thought "ou might have
,ave "ou ever thought "ou might have
a gam!ing pro!em or een to!d that
a gam!ing pro!em or een to!d that
"ou might(
"ou might(
4
,ave "ou ever een untruthfu! aout
,ave "ou ever een untruthfu! aout
the e6tent of "our gam!ing or hidden
the e6tent of "our gam!ing or hidden
it from others(
it from others(
4
,ave "ou ever tried to stop or cut ac2
,ave "ou ever tried to stop or cut ac2
on how much or how often "ou gam!e(
on how much or how often "ou gam!e(
Treatment &ssues
Treatment &ssues
4
Treatment: cognitive wor2 and
Treatment: cognitive wor2 and
motivationa! therap"
motivationa! therap"
4
&rrationa! thin2ing aout winning:
&rrationa! thin2ing aout winning:
4
P
P
& put so much mone" in this
& put so much mone" in this
machine-
machine-
&3m ound to win+Q
&3m ound to win+Q
4
,igh pro)!e winners
,igh pro)!e winners
4
Duc2" machine and dates
Duc2" machine and dates
4
States3 spending on treatment00R3C
States3 spending on treatment00R3C
mi!!ion is sma!! compared to R#$
mi!!ion is sma!! compared to R#$
i!!ion in ta6 revenues from gam!ing
i!!ion in ta6 revenues from gam!ing
Eating Disorders
Eating Disorders
4
.he only one in this chapter related to a
.he only one in this chapter related to a
su#stance 9 food addiction. All others' for
su#stance 9 food addiction. All others' for
e&ample' 7nternet addiction are #ehavioralT
e&ample' 7nternet addiction are #ehavioralT
often clients in treatment for another disorder
often clients in treatment for another disorder
4
Headline: /%ating disorders start in #rain0
Headline: /%ating disorders start in #rain0
4
M>? of anore&ia and #ulimia is found in
M>? of anore&ia and #ulimia is found in
females.
females.
4
egins in adolescence
egins in adolescence
4
.H? of girls and (omen are anore&ic' 1$"?
.H? of girls and (omen are anore&ic' 1$"?
#ulimic.
#ulimic.
Anore6ia
Anore6ia
4
,ess than =M? of normal #ody (eight
,ess than =M? of normal #ody (eight
and fne #ody hair.
and fne #ody hair.
4
1>? mortality rate' often #y suicide'
1>? mortality rate' often #y suicide'
correlated (ith perfectionism'
correlated (ith perfectionism'
ritualism' high an&iety
ritualism' high an&iety
4
Related to o#sessive compulsive
Related to o#sessive compulsive
disorder +R12-:
disorder +R12-:
4
o#sessive$$recurrent and persistent
o#sessive$$recurrent and persistent
thoughtsG
thoughtsG
4
compulsionsritualistic practices.
compulsionsritualistic practices.
5u!imia
5u!imia
4
Day men at ris!.
Day men at ris!.
4
ulimia (ith alcohol misuse$$">$@>?.
ulimia (ith alcohol misuse$$">$@>?.
4
"H? of #ulimics e&perienced childhood
"H? of #ulimics e&perienced childhood
se&ual a#use and use food as a drug.
se&ual a#use and use food as a drug.
4
,ittle information on compulsive
,ittle information on compulsive
overeating.
overeating.
4
;e( studies sho( lac! of dopamine
;e( studies sho( lac! of dopamine
receptors in the #rains of mor#idly o#ese.
receptors in the #rains of mor#idly o#ese.
4
Some after gastric #ypass surgery turn to
Some after gastric #ypass surgery turn to
heavy drin!ing.
heavy drin!ing.
&nterventions
&nterventions
4
Study in the ritish medical :ournal'
Study in the ritish medical :ournal'

"ancet
"ancet
fndings from t(in studies
fndings from t(in studies
sho(ed that a strong craving for s(eets
sho(ed that a strong craving for s(eets
predicted alcohol a#use pro#lems'
predicted alcohol a#use pro#lems'
perhaps caused #y a lac! of dopamine.
perhaps caused #y a lac! of dopamine.
4
ulimiacognitive treatmentsG avoid
ulimiacognitive treatmentsG avoid
strict dieting
strict dieting
4
Anore&ia)roCac is efective in
Anore&ia)roCac is efective in
reducing compulsive #ehavior #ut only
reducing compulsive #ehavior #ut only
(hen (eight has #een gained.
(hen (eight has #een gained.
4
*enmuscle dysmorphia'
*enmuscle dysmorphia'
antidepressants may help here too.
antidepressants may help here too.
Treatment
Treatment
4
Rvereaters anonymous +RA- for
Rvereaters anonymous +RA- for
compulsive eatingG
compulsive eatingG
4
Droup treatment.. teach moderation
Droup treatment.. teach moderation
1.
1.
4
.heme of
.heme of
neuroplasticity
neuroplasticity
#rain neurons
#rain neurons
can form ne( connectionsG /#rain loc!0
can form ne( connectionsG /#rain loc!0
can #e corrected +Sch(artC-
can #e corrected +Sch(artC-
4
o& H.2 compares t(o treatment
o& H.2 compares t(o treatment
programsG the second one in Jansas
programsG the second one in Jansas
1ity included trauma (or!
1ity included trauma (or!
Shopping or Spending
Shopping or Spending
Addiction
Addiction
)ro#lems in a#out 2$=? of people

)ro#lems in a#out 2$=? of people
.ypical "1 yr.old female (ho has

.ypical "1 yr.old female (ho has
overspent for 1" years.
overspent for 1" years.
DS,./
DS,./
lists !leptomaniaG
lists !leptomaniaG
*edications: ,uvo&
*edications: ,uvo&
2e#tors Anonymous groups

2e#tors Anonymous groups
springing up
springing up
C"er Addiction
C"er Addiction
&au#!t in t!e 0et1

&au#!t in t!e 0et1
7nternet addicts:
7nternet addicts:
preoccupied' e&cessive amounts of time
preoccupied' e&cessive amounts of time
involved in chat rooms' playing gamesG
involved in chat rooms' playing gamesG
8eopardiCed relationships.
8eopardiCed relationships.
<antasy (orldfctitious names' ofice

<antasy (orldfctitious names' ofice
pro#lems
pro#lems
Self$eficacy for empo(erment

Self$eficacy for empo(erment
Jorean government training

Jorean government training
psychiatrists to help treat
psychiatrists to help treat
8RA/ES
8RA/ES
4
F
F
eed#ac! 9 assessment of use
eed#ac! 9 assessment of use
4
R
R
esponsi#ility 9 choice is theirs
esponsi#ility 9 choice is theirs
4
A
A
dvice 9 set goals together
dvice 9 set goals together
4
M
M
enus 9 of self$directed change
enus 9 of self$directed change
options +e&.$ monitor computer use-
options +e&.$ monitor computer use-
4
E
E
mpathy
mpathy
4
S
S
elf$eficacy
elf$eficacy
,arm Reductions Strategies:
,arm Reductions Strategies:

0
0
Det a timer
Det a timer

$1ut mailing lists
$1ut mailing lists

$;o detours
$;o detours
Se6 Addiction
Se6 Addiction
4
Ris! ta!er
Ris! ta!er
4
1ognitive therapy recommended.
1ognitive therapy recommended.
4
)rone to lyingone .E #roadcast
)rone to lyingone .E #roadcast
loo!ed at )resident 1lintonBs
loo!ed at )resident 1lintonBs
#ac!ground and his se&ual ris! ta!ing:
#ac!ground and his se&ual ris! ta!ing:
others disagree.
others disagree.
4
1ase of .iger 5oods.
1ase of .iger 5oods.
4
Self$help group$$Se& Addicts
Self$help group$$Se& Addicts
Anonymous.
Anonymous.
Cognitive Therap"
Cognitive Therap"
4
2istortions especially (ith these
2istortions especially (ith these
addictions and anore&ia. .endency
addictions and anore&ia. .endency
to(ards e&treme #ehavior.
to(ards e&treme #ehavior.
4
Slogans of AA +/easy does it0-
Slogans of AA +/easy does it0-
4
Rational recovery' *%.' R%. more
Rational recovery' *%.' R%. more
adversarial' focus on current #eliefs
adversarial' focus on current #eliefs
Cognitive Therap"
Cognitive Therap"
continued
continued
4
.each clients to avoid #lac! and (hite .each clients to avoid #lac! and (hite
thin!ing. thin!ing.
4
As! a#out times (hen client successfully As! a#out times (hen client successfully
handled a pro#lem. handled a pro#lem.
4
Ise regular assessment for disease of Ise regular assessment for disease of
addiction. addiction.
4
<eeling (or! <eeling (or!
4
)ositive reinforcement and reframing )ositive reinforcement and reframing
4
Stress management$$$ modify thin!ing' Stress management$$$ modify thin!ing'
e&ercises for group (or!: art (or! can reveal e&ercises for group (or!: art (or! can reveal
underlying feelings. underlying feelings.
Therap"
Therap"
4
)ositive reframing and self tal!T.
)ositive reframing and self tal!T.
1ognitive therapy can #e directed to(ard
1ognitive therapy can #e directed to(ard
the past as (ell as the present.
the past as (ell as the present.
4
<eeling (or!anger management. Anger
<eeling (or!anger management. Anger
as a cover. Avoid all$or$nothing thin!ing.
as a cover. Avoid all$or$nothing thin!ing.
4
Stress management$$$$ drin! mil!' use self
Stress management$$$$ drin! mil!' use self
tal!' get e&ercise.
tal!' get e&ercise.
4
Droup e&ercises for feeling (or!: art'
Droup e&ercises for feeling (or!: art'
faces' grief and loss' 3uiC cards' dreams'
faces' grief and loss' 3uiC cards' dreams'
assertiveness.
assertiveness.
Part &&
Part &&
Ps"cho!og" Hf Addiction
Ps"cho!og" Hf Addiction
Chapter C
Chapter C

Addiction across the !ife span
Addiction across the !ife span
Eri2 Eri2son3s Stages
Eri2 Eri2son3s Stages
irth to old age irth to old age
Stage 1: .rust vs. *istrust Stage 1: .rust vs. *istrust
Stage 2: Autonomy vs. Shame and 2ou#t Stage 2: Autonomy vs. Shame and 2ou#t
Stage ": 7nitiative vs. Duilt Stage ": 7nitiative vs. Duilt
Stage N: 7ndustry vs. 7nferiority Stage N: 7ndustry vs. 7nferiority
Stage H: 7dentity vs. Role 1onfusion 12$1@ years Stage H: 7dentity vs. Role 1onfusion 12$1@ years
old old
Stage S: 7ntimacy vs. 7solation Stage S: 7ntimacy vs. 7solation
Stage @: Denerativity vs. Stagnation Stage @: Denerativity vs. Stagnation
Stage =: %go 7ntegrity vs. 2espair Stage =: %go 7ntegrity vs. 2espair
*ust resolve each crisis #efore going to ne&t *ust resolve each crisis #efore going to ne&t
stage stage
1arol DilliganBs criticism. 1arol DilliganBs criticism.
Adolescent rain
Adolescent rain
4
)refrontal corte& matures until
)refrontal corte& matures until
mid$2>s
mid$2>s
4
%vidence of #rain immaturity
%vidence of #rain immaturity
during the teen years comes from
during the teen years comes from
*R7 scans of the adolescent #rain
*R7 scans of the adolescent #rain
Teenage Drin2ing :se
Teenage Drin2ing :se

4
7dentity vs role confusion
7dentity vs role confusion
4
Alcohol is the drug of choice #y
Alcohol is the drug of choice #y
American teens aged 12$1@
American teens aged 12$1@

4
,ess smo!ing #y teens in the IS
,ess smo!ing #y teens in the IS
than previously
than previously
Argentina
Argentina
4
1S year old e&change student found:
1S year old e&change student found:
4
;o drin!ing age
;o drin!ing age
4
5ine or #eer (ith supper
5ine or #eer (ith supper
4
2rin!ing to #e social not to get drun!
2rin!ing to #e social not to get drun!
4
5hat the I.S. can learn from
5hat the I.S. can learn from
Argentina
Argentina
4
<ocus on moderation and adult
<ocus on moderation and adult
supervision
supervision

Parents in Prison
Parents in Prison
Doss of parent p!us stigma to chi!d+
Three times the odds that chi!dren wi!! engage in antisocia!
or de!in4uent ehavior =vio!ence or drug ause>+
'egative outcomes as chi!dren and adu!ts =schoo! fai!ure and
unemp!o"ment>+
Twice the odds of deve!oping serious menta! hea!th
pro!ems+
A?ects E and S times more !ac2 chi!dren+
European vs+ :+S+ Gouth
European vs+ :+S+ Gouth
Alcohol use more prevalent in %urope

Alcohol use more prevalent in %urope
e&cept in *editerranean countries. 7reland
e&cept in *editerranean countries. 7reland
vs. 7taly. 2riving allo(ed at age 1=.
vs. 7taly. 2riving allo(ed at age 1=.
22? %uropeans smo!e vs. 1N? Americans

22? %uropeans smo!e vs. 1N? Americans
at ages 1H$1S.
at ages 1H$1S.
)eele argues in
)eele argues in
-ddiction 2roof 3our &!ild
-ddiction 2roof 3our &!ild
for *editerranean moderate drin!ing
for *editerranean moderate drin!ing
pattern in the home.
pattern in the home.
7llicit drug use in %urope half that of I.S.

7llicit drug use in %urope half that of I.S.
SA*HSA Household survey
SA*HSA Household survey
reported
reported
4
1igarette use 11.S? (ith 12 to 1@ year olds +2>1>- 1igarette use 11.S? (ith 12 to 1@ year olds +2>1>-
4
inge drin!ing #y 1@? of youths aged 1S and 1@ inge drin!ing #y 1@? of youths aged 1S and 1@
Age 21around half are #inge drin!ers. Heavy

drin!ers tend to have high drug$using rates as (ell. drug$using rates as (ell.
Rates of past month alcohol use for ages 12$2> (ere: past month alcohol use for ages 12$2> (ere:
1S.1? among AsiansG 2>.N? among #lac!sG 1S.1? among AsiansG 2>.N? among #lac!sG
22? among American 7ndians or Alas!a ;ativesG 22? among American 7ndians or Alas!a ;ativesG
2H.1? among HispanicsG 2H.1? among HispanicsG
2@.H? among those reporting t(o or more racesG 2@.H? among those reporting t(o or more racesG
and ">.N? among (hites. and ">.N? among (hites.

SA/,SA S:RFEG
SA/,SA S:RFEG
continued
continued
1=$2H: 21.2 ? illicit drug use during

1=$2H: 21.2 ? illicit drug use during
past month' around half of all youths
past month' around half of all youths
used alcohol.
used alcohol.
Racial #rea!do(n for drugs not

Racial #rea!do(n for drugs not
given for youth in 2>>M #ut previous
given for youth in 2>>M #ut previous
surveys sho( higher rates for #lac!
surveys sho( higher rates for #lac!
than (hite !ids' American 7ndians
than (hite !ids' American 7ndians
the highest.
the highest.
2>1> School and %R
2>1> School and %R
Surveys
Surveys
Use of alcohol, the most dangerous drugcar crashes, Use of alcohol, the most dangerous drugcar crashes,
drownings, etc., one-third of high school seniors get drunk drownings, etc., one-third of high school seniors get drunk
once a month or more; (same in Canada) once a month or more; (same in Canada)
Almost all current smokers also drank alcohol Almost all current smokers also drank alcohol
School sure!s show African American and "atino seniors School sure!s show African American and "atino seniors
hae rates of illicit drug use lower than that of whites; the hae rates of illicit drug use lower than that of whites; the
reerse is true among # reerse is true among #
th th
graders. graders.
$% isits among !outh mostl! for alcohol oerdoses (&'(). $% isits among !outh mostl! for alcohol oerdoses (&'().
%ise in use of )ainkilling drugs shown in high rate of $% %ise in use of )ainkilling drugs shown in high rate of $%
isits among !outh.*+!Contin a ma,or )ro-lem. isits among !outh.*+!Contin a ma,or )ro-lem.
5usiness Ang!e
5usiness Ang!e
Rivera ,ive: F1> #illion alcohol consumed #y Rivera ,ive: F1> #illion alcohol consumed #y
under 21 under 21
4 4eer and li3uor companies most (ell funded eer and li3uor companies most (ell funded
lo##ies of people in 1ongress. lo##ies of people in 1ongress.
=>? of adult smo!ers start as children so #ig =>? of adult smo!ers start as children so #ig
incentive to mar!et to !ids. incentive to mar!et to !ids.
%&tensive mar!eting of casinos. %&tensive mar!eting of casinos.
S"9=2? of teenagers +12$ to 1@$year$olds- S"9=2? of teenagers +12$ to 1@$year$olds-

gam#le each year' N9@? of teens e&hi#it serious gam#le each year' N9@? of teens e&hi#it serious
patterns of disordered gam#ling. patterns of disordered gam#ling.
Societ"3s &nNuences
Societ"3s &nNuences
4
.o#acco companies targeting !idsG
.o#acco companies targeting !idsG
4ield and
4ield and
Stream
Stream
ads for
ads for
smo!eless to#acco
smo!eless to#acco
4
1hildren learn gam#ling on the
1hildren learn gam#ling on the
7nternetG
7nternetG
4
Eideo po!er' slot machines' and the
Eideo po!er' slot machines' and the
lottery
lottery
4
Strenuous e&ercise programs
Strenuous e&ercise programs
reduce smo!ing. Smo!ing may #e
reduce smo!ing. Smo!ing may #e
considered a gate(ay drug.
considered a gate(ay drug.
Ris2s for Sustance
Ris2s for Sustance
/isuse
/isuse
A2H2' trauma in early childhood' poor

A2H2' trauma in early childhood' poor
role models.
role models.
Se&ual a#use leads to sense of shame.

Se&ual a#use leads to sense of shame.
.rauma changes #rain chemistry and

.rauma changes #rain chemistry and
reduces later a#ility to cope (ith stress.
reduces later a#ility to cope (ith stress.
7nKuence of high stress and drin!ing'

7nKuence of high stress and drin!ing'
found in :uvenile mouse studies.
found in :uvenile mouse studies.
Hther Ris2 8actors
Hther Ris2 8actors
4
.ur#ulent teen$father relationship
.ur#ulent teen$father relationship
4
1hild a#use and other trauma
1hild a#use and other trauma
4
Jids (ho start smo!ing early
Jids (ho start smo!ing early
4
Smo!ing can #e considered a gate(ay
Smo!ing can #e considered a gate(ay
drugG as many girls as #oys smo!ing' lo(
drugG as many girls as #oys smo!ing' lo(
rate among African American girls.
rate among African American girls.
4
*edia$generated (eight o#session' a
*edia$generated (eight o#session' a
ma:or pro#lem among girls of %uropean
ma:or pro#lem among girls of %uropean
American ethnicity.
American ethnicity.
4
R#session leads to ma:or pro#lems (ith
R#session leads to ma:or pro#lems (ith
eating' such as anore&ia and #ulimia.
eating' such as anore&ia and #ulimia.
)redictions from
)redictions from
Scandinavia:
Scandinavia:
4
4
High ris!: girls (ho cry easily (hen teased
High ris!: girls (ho cry easily (hen teased
are an&ious and shy.
are an&ious and shy.
4
4
*ale aggression at age = predicted
*ale aggression at age = predicted
alcoholism 1= to 2> years later.
alcoholism 1= to 2> years later.
%valuations at ages 1> and 2@ sho(ed:
%valuations at ages 1> and 2@ sho(ed:
9
9
High novelty see!ing
High novelty see!ing
9
9
,o( harm avoidance +dare devil #ehavior-
,o( harm avoidance +dare devil #ehavior-
oth traits predicted early$onset alcoholism.
oth traits predicted early$onset alcoholism.
<or #oth se&es' poor school success
<or #oth se&es' poor school success
predicted later drin!ing pro#lems
predicted later drin!ing pro#lems
Chi!d Ause continued
Chi!d Ause continued
4
4
Dirls (ho are se&ually a#used are
Dirls (ho are se&ually a#used are
three times more li!ely than other girls
three times more li!ely than other girls
to develop drin!ing pro#lems later
to develop drin!ing pro#lems later
4
4
oys (ho (ere se&ually a#used more
oys (ho (ere se&ually a#used more
li!ely to #e diagnosed (ith conduct
li!ely to #e diagnosed (ith conduct
disorder' dysthymia +mild depression-'
disorder' dysthymia +mild depression-'
and A2H2
and A2H2
4
4
A#used girls are more li!ely to #e
A#used girls are more li!ely to #e
diagnosed (ith post$traumatic stress
diagnosed (ith post$traumatic stress
disorder and ma:or depression.
disorder and ma:or depression.
Ris!s for Dirls
Ris!s for Dirls
4
2aughters of alcoholics at
2aughters of alcoholics at
increased ris! for alcoholism.
increased ris! for alcoholism.
4
.eenage girls (ho are heavy
.eenage girls (ho are heavy
drin!ers are:
drin!ers are:
4
fve times more li!ely to engage in
fve times more li!ely to engage in
se&ual intercourse.
se&ual intercourse.
4
a third less li!ely to use condoms
a third less li!ely to use condoms
4
more li!ely to practice unsafe se&.
more li!ely to practice unsafe se&.
Ris2s for 5o"s:
Ris2s for 5o"s:
4
4
Study of priest a#use victims sho(ed
Study of priest a#use victims sho(ed
high heavy alcohol use rate.
high heavy alcohol use rate.
iggest threat to life and health for

iggest threat to life and health for
adolescent #oys is alcohol$related
adolescent #oys is alcohol$related
accidents
accidents
4
4
*ale counterpart to anore&ia in
*ale counterpart to anore&ia in
females is muscle dysmorphia.
females is muscle dysmorphia.
4
4
2ysmorphia a diagnosis in 2S*.
2ysmorphia a diagnosis in 2S*.
/ore Ris2s for 5o"s
/ore Ris2s for 5o"s
4
R#sessive #ody #uilding ma:or
R#sessive #ody #uilding ma:or
pro#lem for young males
pro#lem for young males
4
Revealed in popularity of ana#olic
Revealed in popularity of ana#olic
steroids
steroids
4
Steroids used #y 2.@ ? of male
Steroids used #y 2.@ ? of male
high school seniors.
high school seniors.
4
Health haCards: stunted gro(th'
Health haCards: stunted gro(th'
acne' and
acne' and

shrin!ing testicles.
shrin!ing testicles.
Co!!ege Students
Co!!ege Students

4 1ase of college pledge in 1olorado (ho died of
overdoseG police not called out of fear of under$21
drin!ing la(s. ,a( passed 1M=N.
History of la(1M=>s to cur# drin!ing$and$driving History of la(1M=>s to cur# drin!ing$and$driving

deaths' r deaths' role of *A22 and ;7AAA.
SA*HSA 2>1> survey of past month S"."? S"."?

college students (ere current drin!ers' N2.1? (ere college students (ere current drin!ers' N2.1? (ere
#inge drin!ers +dran! N$H drin!s at a time-' and #inge drin!ers +dran! N$H drin!s at a time-' and
1H.S? (ere heavy drin!ers +#inge dran! H or more 1H.S? (ere heavy drin!ers +#inge dran! H or more
times-. times-.
Ris! of age 21 #irthday cele#rations.
Ameth"st &nitiative
Ameth"st &nitiative
Rver 12> college presidents signed statement to Rver 12> college presidents signed statement to
consider revising under$21 drin!ing la(. consider revising under$21 drin!ing la(.
*A22 notes lives saved from 1M=2 to 1MM=. S1? *A22 notes lives saved from 1M=2 to 1MM=. S1?
fe(er fatal crashes under age 21 and a HS? fe(er fatal crashes under age 21 and a HS?
decrease among 21$to 2N$year$olds. decrease among 21$to 2N$year$olds.
*ay have #een result of stricter drin!ing la(s *ay have #een result of stricter drin!ing la(s
that (ere passed in many states starting in 1M=N. that (ere passed in many states starting in 1M=N.
;e( seat #elt regulations' stricter drin!ing ;e( seat #elt regulations' stricter drin!ing
and and
driving la(s. ;ote reduction in over age 21. driving la(s. ;ote reduction in over age 21.
5inge Drin2ing: Co!!ege
5inge Drin2ing: Co!!ege
4
4
I.S. government imposed nation(ide
I.S. government imposed nation(ide
minimum drin!ing age of 21 in the 1M=>s'
minimum drin!ing age of 21 in the 1M=>s'
the attempt to curtail drun!en driving #y
the attempt to curtail drun!en driving #y
youth.
youth.
4
4
<e(er drin! today' #ut those (ho do
<e(er drin! today' #ut those (ho do
drin! more.
drin! more.
4/
4/
)arty till you pu!eA0 signs (ere posted
)arty till you pu!eA0 signs (ere posted
on one university campus.
on one university campus.
/odern 8orm of Prohiition

/odern 8orm of Prohiition
4
4
1ritics argue students are driven
1ritics argue students are driven
to partying underground and a(ay
to partying underground and a(ay
from faculty supervision.
from faculty supervision.
4
4
;e( campaigns for moderate
;e( campaigns for moderate
drin!ing encouraged #y Iniversity
drin!ing encouraged #y Iniversity
of 5ashington +Alan *arlatt-
of 5ashington +Alan *arlatt-
research.
research.
4
4
Social norms campaign (ith
Social norms campaign (ith
messages of moderation (ere
messages of moderation (ere
unsuccessful.
unsuccessful.
'eed for ,arm Reduction
'eed for ,arm Reduction
4
1ollege ne(spaper slo( to restrict
1ollege ne(spaper slo( to restrict
enticing #eer ads.
enticing #eer ads.
4
*ost #inge drin!ers mature out of (ild
*ost #inge drin!ers mature out of (ild
drin!ing days of early adulthood. ut over
drin!ing days of early adulthood. ut over
1'=>> college students die each year from
1'=>> college students die each year from
alcohol$related in:uries. Rape and unsafe
alcohol$related in:uries. Rape and unsafe
se&.
se&.
4
1igarettes$$a#stinence pro#a#ly (or!s
1igarettes$$a#stinence pro#a#ly (or!s
#etter than moderation here.
#etter than moderation here.
4
.(o paths to drug use #y youths: striving
.(o paths to drug use #y youths: striving
to #e cool' using drugs to escape
to #e cool' using drugs to escape
4
*essages a#out long$term damage are apt
*essages a#out long$term damage are apt
to have little impact.
to have little impact.
,arm Reduction
,arm Reduction
4
;eed for drug courts$$important for family
;eed for drug courts$$important for family
preservation and closely supervised treatment
preservation and closely supervised treatment
4
<or#id /happy hours'0 free drin!s on 21
<or#id /happy hours'0 free drin!s on 21
st st

#irthdays at #ars.
#irthdays at #ars.
4
,o(er drin!ing age la(sG discourage drin!ing
,o(er drin!ing age la(sG discourage drin!ing
hard li3uor
hard li3uor
4
%ncourage adult supervision (ith !ids (ho
%ncourage adult supervision (ith !ids (ho
are drin!ing. %ncourage moderate drin!ing as
are drin!ing. %ncourage moderate drin!ing as
(ith meals.
(ith meals.
4
Serve food (ith alcoholic #everages.
Serve food (ith alcoholic #everages.
/otivationa! Princip!es
/otivationa! Princip!es
from Socia! Ps"cho!og"
from Socia! Ps"cho!og"
<rom %lliot Aronson'
<rom %lliot Aronson' The Social Animal The Social Animal
4
7f you state a position' you (ill #e (edded to it.
7f you state a position' you (ill #e (edded to it.
4
A small commitment to ta!e action goes a long
A small commitment to ta!e action goes a long
(ay.
(ay.
4
)eople (ith high self esteem can easier resist
)eople (ith high self esteem can easier resist
temptation.
temptation.
4
5or!ing to(ard a goal might pay of eventually.
5or!ing to(ard a goal might pay of eventually.
4
1hange of attitude might help.
1hange of attitude might help.
4
)eople desire to reduce dissonance.
)eople desire to reduce dissonance.
/i!!er and Ro!!nic2: /& Strategies

/i!!er and Ro!!nic2: /& Strategies
.raps to avoid:
.raps to avoid:
9)remature focus' such as on clientBs
9)remature focus' such as on clientBs

addictive #ehavior
addictive #ehavior
9
9
1onfrontational round #et(een
1onfrontational round #et(een
therapist
therapist

and client over denial
and client over denial
9
9
,a#eling trap$$forcing the individual to
,a#eling trap$$forcing the individual to

accept a la#el alcoholic or addict
accept a la#el alcoholic or addict
9
9
laming trap' fallacy that is especially
laming trap' fallacy that is especially

pronounced in couplesB counseling
pronounced in couplesB counseling
Primar" Prevention
Primar" Prevention
1hild a#use' early$prevention

1hild a#use' early$prevention
education and treatment programs
education and treatment programs
Smo!ing education to !eep youths

Smo!ing education to !eep youths
from ever starting to smo!e
from ever starting to smo!e
Health and s!ill education at schools

Health and s!ill education at schools
Reducing ads promoting addictive

Reducing ads promoting addictive
#ehavior
#ehavior
Advocacy for the hiring of more

Advocacy for the hiring of more
school counselors and social (or!ers
school counselors and social (or!ers
Stage0Speci)c /otivationa!
Stage0Speci)c /otivationa!
Statements:
Statements:
Stage of 1hange: )recontemplation
Stage of 1hange: )recontemplation
9
9
Doals are to esta#lish rapport
Doals are to esta#lish rapport
9
9
1ounselor reinforces
1ounselor reinforces
discrepancies
discrepancies

Adolescent comment: /*y parents
Adolescent comment: /*y parents
canBt tell me (hat to doG 7 still use
canBt tell me (hat to doG 7 still use
and 7 donBt see the harm in it$ do
and 7 donBt see the harm in it$ do
you60
you60
/otivationa! Enhancement
/otivationa! Enhancement
continued:
continued:
Stage of change:
Stage of change:
1ontemplation
1ontemplation
4
As!: Ho( (as life #etter #efore drug
As!: Ho( (as life #etter #efore drug
use6
use6
4
%mphasiCe choices
%mphasiCe choices
4
.ypical 3uestions are:
.ypical 3uestions are:
$5hat do you get out of drin!ing6
$5hat do you get out of drin!ing6
$5hatBs the do(n side6
$5hatBs the do(n side6
Resistance:
Resistance:
7nevita#le
7nevita#le
*iller advises roll (ith it /roll (ith

*iller advises roll (ith it /roll (ith
resistance0
resistance0
Ise reKective summariCing

Ise reKective summariCing
Contemp!ation Stage
Contemp!ation Stage
continued:
continued:

4
4
4
.ypical adolescent comment:
.ypical adolescent comment:
4
7Bm on top of the (orld (hen 7Bm
7Bm on top of the (orld (hen 7Bm
high' #ut then (hen 7 come do(n'
high' #ut then (hen 7 come do(n'
7Bm really do(n. 7t (as #etter #efore
7Bm really do(n. 7t (as #etter #efore
7 got started on these things.
7 got started on these things.
Preparation Stage:
Preparation Stage:

4
Setting the date
Setting the date
4
5hat do you thin! (ill (or! for you6
5hat do you thin! (ill (or! for you6
4
Adolescent comments' /7Bm feeling
Adolescent comments' /7Bm feeling
good a#out setting a date to 3uit'
good a#out setting a date to 3uit'
#ut (ho !no(s60
#ut (ho !no(s60
Action Stage:
Action Stage:
Adolescent comment: /Staying clean may
Adolescent comment: /Staying clean may
#e healthy' #ut it sure ma!es for a dull
#e healthy' #ut it sure ma!es for a dull
life. *ay#e 7Bll chec! out one of those
life. *ay#e 7Bll chec! out one of those
groups.0
groups.0
/
/
.herapist: /5hy donBt you loo! at (hat
.herapist: /5hy donBt you loo! at (hat
others
others
have done in this situation60
have done in this situation60

Help locate an appropriate group.
Help locate an appropriate group.
/aintenance Stage:
/aintenance Stage:
Adolescent comment:
Adolescent comment:
/
/
7tBs #een a fe( monthsG 7Bm not there yet
7tBs #een a fe( monthsG 7Bm not there yet
#ut 7Bm hanging out (ith some ne(
#ut 7Bm hanging out (ith some ne(
friends...0
friends...0
.ender Speci)c Approach for
.ender Speci)c Approach for
.ir!s
.ir!s
4
%3uality does not mean sameness.
%3uality does not mean sameness.
4
)rograms for girls do #etter (hen
)rograms for girls do #etter (hen
they focus on relationships.
they focus on relationships.
4
5aterloo'7o(a $$group home$$
5aterloo'7o(a $$group home$$
Lua!erdale specialiCes in care of
Lua!erdale specialiCes in care of
teenage girls.
teenage girls.
4
,earning of life s!ills
,earning of life s!ills
4
Daining competency as in art
Daining competency as in art
Pro!ems in /idd!e
Pro!ems in /idd!e
Adu!thood
Adu!thood
Relapse pro#lems.
Relapse pro#lems.
7mpact of #a#y #oom generation

7mpact of #a#y #oom generation
illicit drug use dou#led 2>>2$2>>@ in
illicit drug use dou#led 2>>2$2>>@ in
over H> age group.
over H> age group.
S.S? use illicit drugs over age 2SG

S.S? use illicit drugs over age 2SG
most is mari:uana.
most is mari:uana.
1>.=? of pregnant (omen drin!G 1

1>.=? of pregnant (omen drin!G 1
in S smo!e.
in S smo!e.
Ris2 to Comat Feterans
Ris2 to Comat Feterans
*ost pro#lems of EA clients (ith su#stance

*ost pro#lems of EA clients (ith su#stance
use and ).S2 in younger age group' #ut
use and ).S2 in younger age group' #ut
11? are older.
11? are older.
.rauma is common. ).S2 among female

.rauma is common. ).S2 among female
veterans (ho (ere se&ually victimiCed
veterans (ho (ere se&ually victimiCed
+1H? (ere victimiCed-.
+1H? (ere victimiCed-.
;eed for treatmentG more is #eing done

;eed for treatmentG more is #eing done
today.
today.
;eed to control mar!eting of alcohol and

;eed to control mar!eting of alcohol and
cigarettes to soldiers
cigarettes to soldiers
.
.
Sustance
Sustance
Ause among
Ause among
H!der Adu!ts
H!der Adu!ts
4
1"? of I.S. population over age SH.
1"? of I.S. population over age SH.
4
*ore men (ith alcohol pro#lems
*ore men (ith alcohol pro#lems
4
Rlder adults consume 2>$2H? of all
Rlder adults consume 2>$2H? of all
prescription medications
prescription medications
4
.(o types of alcoholism: early and
.(o types of alcoholism: early and
late onset
late onset
4
%arly onset$ $ more severe levels of
%arly onset$ $ more severe levels of
depression and an&iety
depression and an&iety
8acts aout Date Dife
8acts aout Date Dife
Sustance :se
Sustance :se
4
Rlder adults consume less alcohol
Rlder adults consume less alcohol
than the young.
than the young.
4
H.2? over age H> used an illicit
H.2? over age H> used an illicit
drug in the past yearG M.1? smo!e.
drug in the past yearG M.1? smo!e.
4
.rend to(ard nursing homes for
.rend to(ard nursing homes for
short$term alcoholism
short$term alcoholism
reha#ilitation
reha#ilitation
4
*any male e&$alcoholics reside in
*any male e&$alcoholics reside in
nursing homes.
nursing homes.
Drin2ing Patterns
Drin2ing Patterns
Rlder adults tend to:

Rlder adults tend to:
drin! smaller amounts at one time'

drin! smaller amounts at one time'
misuse drugs prescri#ed #y doctors'
misuse drugs prescri#ed #y doctors'
e&perience a hidden alcohol pro#lem.
e&perience a hidden alcohol pro#lem.
drin! in connection (ith a num#er of

drin! in connection (ith a num#er of
late$life stresses' including
late$life stresses' including
#ereavement and loss of occupational
#ereavement and loss of occupational
roles.
roles.
SA/,SA #$%$ Treatment
SA/,SA #$%$ Treatment
Report
Report
1 of = persons over age H> sought help

1 of = persons over age H> sought help
for su#stance use in 2>>=.
for su#stance use in 2>>=.
.heir share of treatment admissions

.heir share of treatment admissions
dou#led
dou#led
#et(een 1MM2 and 2>>=.

#et(een 1MM2 and 2>>=.
)rimary su#stance use pro#lems (ere

)rimary su#stance use pro#lems (ere
(ith alcohol' heroin' cocaine.
(ith alcohol' heroin' cocaine.
*any late onset drug users had

*any late onset drug users had
pro#lems (ith prescription medications.
pro#lems (ith prescription medications.
/ore 8acts
/ore 8acts

4
*any early onset sufer from
*any early onset sufer from
Jorsa!ofBs syndrome and other
Jorsa!ofBs syndrome and other
alcohol$related neurological
alcohol$related neurological
pro#lems.
pro#lems.
4
*edical complications:
*edical complications:
4
Hip fracture' suicide' #rain damage
Hip fracture' suicide' #rain damage
4
,ate onsetTmore (omen here'
,ate onsetTmore (omen here'
close family ties
close family ties
Counse!ing H!der C!ients
Counse!ing H!der C!ients
4
257 and efect on self image
257 and efect on self image
4
Age segregated vs. mi&ed ages in
Age segregated vs. mi&ed ages in
treatment
treatment
4
Duidelines for (or! in groups (ith
Duidelines for (or! in groups (ith
elderly:
elderly:
4
$Avoid strong language' re#uild
$Avoid strong language' re#uild
support systems
support systems
4
$Jeep pace slo(
$Jeep pace slo(
Re!apse Prevention:
Re!apse Prevention:
4
.each older clients to learn the (arning signs .each older clients to learn the (arning signs
and high ris! eventsG and high ris! eventsG
4
Revie( feelings that led to relapse so they can #e Revie( feelings that led to relapse so they can #e
avoided +for e&ample' depression-G HA,. avoided +for e&ample' depression-G HA,.
4
<ocus on critical thin!ing s!ills. <ocus on critical thin!ing s!ills.
4
Help clients rene( their commitment to so#rietyG Help clients rene( their commitment to so#rietyG
4
<ind efective coping stylesG <ind efective coping stylesG
4
uild support systemsG uild support systemsG
4
Remem#er that non$confrontational approach is Remem#er that non$confrontational approach is
#est. #est.
Counse!or Pitfa!!s: =5eechem>
Counse!or Pitfa!!s: =5eechem>
4
Anticipate feelings of guilt and
Anticipate feelings of guilt and
shame in older clients in trou#le
shame in older clients in trou#le
(ith the la(G
(ith the la(G
4
Ageism
Ageism
4
1ountertransference
1ountertransference
4
2enial in assessment
2enial in assessment
4
Sympathy not empathy
Sympathy not empathy
Doss and grief in fami!" memers
Doss and grief in fami!" memers
of addicted persons:
of addicted persons:
.ypes of Duilt
.ypes of Duilt
Survivor guilt
Survivor guilt
Helplessness
Helplessness
Am#ivalence
Am#ivalence
Spiritual healingsense of
Spiritual healingsense of
meaning' connectedness
meaning' connectedness
Strength from 12 Steps

Strength from 12 Steps
Spiritua! ,ea!ing
Spiritua! ,ea!ing
.oday' social (or! education stresses
.oday' social (or! education stresses
importance of helping clients fnd spiritual
importance of helping clients fnd spiritual
meaning.
meaning.
Rlder adults often change their outloo! as
Rlder adults often change their outloo! as
they loo! #ac! on their lives. See! for the
they loo! #ac! on their lives. See! for the
meaning of life.
meaning of life.
Higher )o(er as nature in ;or(ay' ;ative
Higher )o(er as nature in ;or(ay' ;ative
American traditions.
American traditions.
Search for forgiveness and rene(al.
Search for forgiveness and rene(al.
12 Steps as guide to self !no(ledge
12 Steps as guide to self !no(ledge
Chapter E: Screening and
Chapter E: Screening and
Assessment
Assessment
1hapter focus on strengths perspective.

1hapter focus on strengths perspective.
Advantages of doing assessment: get

Advantages of doing assessment: get
information' match to counselor' get
information' match to counselor' get
insurance reim#ursement for diagnosis.
insurance reim#ursement for diagnosis.
2isadvantages: may set up false

2isadvantages: may set up false
e&pectations for specialiCed treatment'
e&pectations for specialiCed treatment'
delays actual treatment' may #e
delays actual treatment' may #e
inappropriate for many minority groups.
inappropriate for many minority groups.
Screening &nstruments
Screening &nstruments
1onsist of :ust a fe( 3uestions to

1onsist of :ust a fe( 3uestions to
determine nature of help needed.
determine nature of help needed.
7nformal 3uestions li!e' /2o you

7nformal 3uestions li!e' /2o you
sometimes drin!60
sometimes drin!60
%fective one$3uestion screen for

%fective one$3uestion screen for
(omen: /Ho( many times in the
(omen: /Ho( many times in the
past year have you had four or more
past year have you had four or more
drin!s in a day60
drin!s in a day60
CA.E
CA.E
1 Have you ever felt you ought to cut do(n on 1 Have you ever felt you ought to cut do(n on
your drin!ing or drug your drin!ing or drug
use6 use6
A Have people annoyed you #y criticiCing your A Have people annoyed you #y criticiCing your
drin!ing or drug use6 drin!ing or drug use6
D Have you ever felt #ad or guilty a#out your D Have you ever felt #ad or guilty a#out your
drin!ing or drug use6 drin!ing or drug use6
% Have you ever had a drin! or used drugs frst % Have you ever had a drin! or used drugs frst
thin! in the morning thin! in the morning
to steady your nerves or get rid of a hangover6 to steady your nerves or get rid of a hangover6
TWEAK
TWEAK
.olerance
.olerance
5orried
5orried
%ye Rpeners
%ye Rpeners
Amnesia
Amnesia
Jut do(n
Jut do(n

5or!s (ell (ith mi&ed
5or!s (ell (ith mi&ed
ethnic populations
ethnic populations
A:D&T
A:D&T
Recommended #y 5HR for glo#al use.

Recommended #y 5HR for glo#al use.
.he AI27. includes 1> items that

.he AI27. includes 1> items that
cover amount and fre3uency of
cover amount and fre3uency of
drin!ing' alcohol dependence
drin!ing' alcohol dependence
symptoms' personal pro#lems' and
symptoms' personal pro#lems' and
social pro#lems
social pro#lems
/
/
Have you or someone else #een
Have you or someone else #een
in:ured #ecause of your drin!ing60
in:ured #ecause of your drin!ing60
A:D&T continued
A:D&T continued
Scoring discriminates #et(een diferent

Scoring discriminates #et(een diferent
levels of ris!haCardous' harmful' and
levels of ris!haCardous' harmful' and
possi#le dependence.
possi#le dependence.
A prevention tool to assess future ris!s.

A prevention tool to assess future ris!s.
1an #e given to the client as a

1an #e given to the client as a
3uestionnaire
3uestionnaire
to fll out' or it can #e used as intervie(

to fll out' or it can #e used as intervie(
3uestions.
3uestions.
Availa#le for free on the 7nternet.

Availa#le for free on the 7nternet.
Assessment Too!s
Assessment Too!s
+1SA.- +2>>H- defnes assessment as

+1SA.- +2>>H- defnes assessment as
the /process for defning the nature
the /process for defning the nature
of the pro#lem and developing
of the pro#lem and developing
specifc treatment recommendations
specifc treatment recommendations
for addressing the pro#lem.0
for addressing the pro#lem.0
1an give a deeper picture of

1an give a deeper picture of
motivation to change.
motivation to change.
1an #e #eginning of relationship.

1an #e #eginning of relationship.
.am!ing Assessment
.am!ing Assessment
Dam#lers Anonymous has 2> 3uestions to Dam#lers Anonymous has 2> 3uestions to
determine if someone has a pro#lem. %&amples: determine if someone has a pro#lem. %&amples:
2id you ever lose time from (or! or school due 2id you ever lose time from (or! or school due
to gam#ling6 to gam#ling6
Has gam#ling ever made your home life Has gam#ling ever made your home life
unhappy6 unhappy6
2id gam#ling afect your reputation6 2id gam#ling afect your reputation6
Have you ever felt remorse after gam#ling6 Have you ever felt remorse after gam#ling6
2id you ever gam#le to get money (ith (hich to 2id you ever gam#le to get money (ith (hich to
pay de#ts or other(ise solve fnancial pay de#ts or other(ise solve fnancial
dificulties6 dificulties6
DR&'C
DR&'C
.he 2rin!er 7nventory of 1onse3uences +2rinc- .he 2rin!er 7nventory of 1onse3uences +2rinc-
originally designed for )ro:ect *A.1H originally designed for )ro:ect *A.1H
A H>$item 3uestionnaire that covers physical' A H>$item 3uestionnaire that covers physical'
social' intrapersonal' impulse control' and social' intrapersonal' impulse control' and
interpersonal pro#lem areas. Rf proven interpersonal pro#lem areas. Rf proven
relia#ility' validity. relia#ility' validity.
7ncludes positive 3uestions such as +/Ho( often 7ncludes positive 3uestions such as +/Ho( often
has drin!ing helped me to rela&60-' and has drin!ing helped me to rela&60-' and
negatives: /Ho( often has my a#ility to #e a good negatives: /Ho( often has my a#ility to #e a good
parent #een harmed #y my drin!ing0. parent #een harmed #y my drin!ing0.
The SASS&
The SASS&
.he Su#stance A#use Screening 7nventory .he Su#stance A#use Screening 7nventory
+SASS7- +*iller U ,aCo(s!i' 1MMM- +SASS7- +*iller U ,aCo(s!i' 1MMM-
A diferent approach to assessment instruments A diferent approach to assessment instruments

does not as! directly a#out su#stance misuse does not as! directly a#out su#stance misuse
on one side of the form. on one side of the form.
1onsists of true$false items. such as /7 am often 1onsists of true$false items. such as /7 am often
resentful'0 and /7 li!e to o#ey the la(.0 resentful'0 and /7 li!e to o#ey the la(.0
Assessing Deve!s of Care
Assessing Deve!s of Care
%arly 7ntervention
%arly 7ntervention
Rutpatient .reatment
Rutpatient .reatment
7ntensive RutpatientP)artial
7ntensive RutpatientP)artial
HospitaliCation .reatment
HospitaliCation .reatment
ResidentialP7npatient .reatment
ResidentialP7npatient .reatment
*edically *anaged 7ntensive 7npatient

*edically *anaged 7ntensive 7npatient
.reatment.
.reatment.
%ach level of care includes several layers

%ach level of care includes several layers
of intensity.
of intensity.
ASSESS/E'T H8 PERSH'S
ASSESS/E'T H8 PERSH'S
W&T, CH0HCC:RR&'.
W&T, CH0HCC:RR&'.
D&SHRDERS =CHD>
D&SHRDERS =CHD>
A #asic program from the 1SA.

A #asic program from the 1SA.
provides treatment for one disorder'
provides treatment for one disorder'
#ut screens for the other disorderG
#ut screens for the other disorderG
An intermediate level focuses

An intermediate level focuses
primarily on one disorder #ut also
primarily on one disorder #ut also
addresses some specifc needs of the
addresses some specifc needs of the
other.
other.
Advanced level provides services for

Advanced level provides services for
#oth disorders.
#oth disorders.
.uide!ines for
.uide!ines for
Assessment of CHD
Assessment of CHD
e familiar (ith latest 2S* and criteria

e familiar (ith latest 2S* and criteria
for diagnosis.
for diagnosis.
Jeep up to date on the relevant

Jeep up to date on the relevant
psychiatric medications.
psychiatric medications.
Harm reduction therapists recommend

Harm reduction therapists recommend
only contacting family mem#ers and
only contacting family mem#ers and
others if clients so (ish and (ith the
others if clients so (ish and (ith the
client present.
client present.
Jno( the community resources.

Jno( the community resources.
Assessment of H!der
Assessment of H!der
C!ients
C!ients
Ris! factors for gam#ling pro#lems are:

Ris! factors for gam#ling pro#lems are:
the presence of current posttraumatic
the presence of current posttraumatic
stress disorder symptoms' minority race
stress disorder symptoms' minority race
or ethnicity' and #eing a Eeterans Afairs
or ethnicity' and #eing a Eeterans Afairs
+EA- patient.
+EA- patient.
.herefore include 3uestions a#out

.herefore include 3uestions a#out
gam#ling.
gam#ling.

1AD% and *AS.Deriatric version are
1AD% and *AS.Deriatric version are
validated for use (ith older adults.
validated for use (ith older adults.
ASSESS/E'T 8HR
ASSESS/E'T 8HR
STRE'.T,S
STRE'.T,S
Eie( clients as in charge of their o(n goals.

Eie( clients as in charge of their o(n goals.
.a!e into account social factors as (ell as

.a!e into account social factors as (ell as
individual factors for a comprehensive vie(
individual factors for a comprehensive vie(
of the situation.
of the situation.
*ove the assessment to(ard strengths' #oth

*ove the assessment to(ard strengths' #oth
intrapersonal +motivation' emotional
intrapersonal +motivation' emotional
strengths and a#ility to thin! clearly- and
strengths and a#ility to thin! clearly- and
interpersonal +family
interpersonal +family
net(or!s' etc.
net(or!s' etc.
Avoid identifying the person (ith a la#el.

Avoid identifying the person (ith a la#el.
Strengths Assessment
Strengths Assessment
continued
continued
Jey ingredients:
Jey ingredients:
%mpathy.
%mpathy.
)rovide hope.
)rovide hope.
ReKective listening.
ReKective listening.
End of Chapters %0E
End of Chapters %0E
Assessment
Assessment
;eed for assessment forms to #e

;eed for assessment forms to #e
sensitive to genderPcultural diferences
sensitive to genderPcultural diferences
,anguage diferences' e.g.' the (ord

,anguage diferences' e.g.' the (ord
cravin#
cravin#
hard to translate
hard to translate
1AD% and .5%AJ (or! (ell (ith

1AD% and .5%AJ (or! (ell (ith
(omen
(omen
CA.E
CA.E
Have you tried 1utting do(n6

Have you tried 1utting do(n6
Have people Annoyed you6

Have people Annoyed you6
Have you felt Duilty a#out your

Have you felt Duilty a#out your
A.R2 use6
A.R2 use6
Have you ever used A.R2 as an %ye

Have you ever used A.R2 as an %ye
opener6
opener6
Hther Screening 8orms
Hther Screening 8orms
AI27. developed #y 5HR for alcohol

AI27. developed #y 5HR for alcohol
use
use
;7AAAH> item instrument' 7nventory

;7AAAH> item instrument' 7nventory
of 2rug Ise 1onse3uences' in pu#lic
of 2rug Ise 1onse3uences' in pu#lic
domain
domain
5HR designated areas of harm caused

5HR designated areas of harm caused
#y drin!physical' emotional' health'
#y drin!physical' emotional' health'
family' fnances' etc.
family' fnances' etc.
Chapter <
Chapter <
Strengths0 and Evidence0
Strengths0 and Evidence0
5ased ,e!ping Strategies
5ased ,e!ping Strategies
Dennis Sa!eee"
Dennis Sa!eee"
8ocus on possii!ities- choices*providing 8ocus on possii!ities- choices*providing

treatment options+ treatment options+
Resi!ience- hea!ing- and who!eness+ Resi!ience- hea!ing- and who!eness+
Contrast with pro!em0so!ving approach+ Contrast with pro!em0so!ving approach+

Dennis Sa!eee"
Dennis Sa!eee"
8ocus on possii!ities- choices*providing 8ocus on possii!ities- choices*providing

treatment options+ treatment options+
Resi!ience- hea!ing- and who!eness+ Resi!ience- hea!ing- and who!eness+
Contrast with pro!em0so!ving approach+ Contrast with pro!em0so!ving approach+
Strengths--ased )ractice defined -! Salee-e! as .a ersatile Strengths--ased )ractice defined -! Salee-e! as .a ersatile
)ractice a))roach, rel!ing heail! on ingenuit! and creatiit!./ )ractice a))roach, rel!ing heail! on ingenuit! and creatiit!./
&ssue of Se!f0
&ssue of Se!f0
Determination
Determination
Ho( do (e honor clientBs self$determination
Ho( do (e honor clientBs self$determination
(hen the client is harming himself$herself
(hen the client is harming himself$herself
(ith su#stance misuse6
(ith su#stance misuse6
1.Right of choice should #e e&tended to all
1.Right of choice should #e e&tended to all
social classesG as it is people in poverty have
social classesG as it is people in poverty have
far less choice than those at high income
far less choice than those at high income
levels.
levels.
2. 7mportance of providing options.
2. 7mportance of providing options.
A#stinence$#ased models do not.
A#stinence$#ased models do not.
". Attend to readiness of client to change.
". Attend to readiness of client to change.
8irst of 8our /ode!s of Strengths0
8irst of 8our /ode!s of Strengths0
5ased Approaches
5ased Approaches
1.
1.
Harm reduction
Harm reduction
: pu#lic health model'
: pu#lic health model'
prevention' outreach.
prevention' outreach.

A#stinence not precondition to treatmentG
A#stinence not precondition to treatmentG
recovery can #e measured through degree of
recovery can #e measured through degree of
improvement.
improvement.

Stages of 1hange *odel: )rochas!a and
Stages of 1hange *odel: )rochas!a and
2i1lemente
2i1lemente

)recontemplation
)recontemplation

1ontemplation
1ontemplation

)reparation
)reparation

Action
Action

*aintenance
*aintenance

Relapse
Relapse
,arm Reduction
,arm Reduction
Strategies
Strategies
)ractitioners are advised to focus on harms

)ractitioners are advised to focus on harms
other than su#stance use' such as
other than su#stance use' such as
unemployment' poverty' need for housing.
unemployment' poverty' need for housing.
Dam#ling pro#lems can #e prevented #y

Dam#ling pro#lems can #e prevented #y
removing gam#ling machines from
removing gam#ling machines from
shopping centers' strip malls' clu#s' and
shopping centers' strip malls' clu#s' and
hotels.
hotels.
Rther support services' such as mental

Rther support services' such as mental
health and fnancial counseling should #e
health and fnancial counseling should #e
readily availa#le.
readily availa#le.
#
#
.
.
/otivationa! &nterviewing
/otivationa! &nterviewing
=/&>000Wi!!iam /i!!er
=/&>000Wi!!iam /i!!er
2efned as a /client$centered' directive

2efned as a /client$centered' directive
method for enhancing intrinsic motivation

method for enhancing intrinsic motivation
to change #y e&ploring and resolving
to change #y e&ploring and resolving
am#ivalence.0
am#ivalence.0
;eed to as! the right 3uestionsG /.ell me

;eed to as! the right 3uestionsG /.ell me
a#out a period (hen you (ere doing
a#out a period (hen you (ere doing
(ell60
(ell60
Smo!ing: on a scale of 1$1> to give up

Smo!ing: on a scale of 1$1> to give up
smo!ing' (here are you no(6
smo!ing' (here are you no(6
/& continued
/& continued
Steps to enhance motivation:
Steps to enhance motivation:
%&press empathy
%&press empathy
2evelop discrepancy
2evelop discrepancy
Avoid argumentation
Avoid argumentation
Roll (ith resistance
Roll (ith resistance
Support self$eficacy
Support self$eficacy
As!ing open$ended 3uestions helps
As!ing open$ended 3uestions helps
clients evo!e the decision to change.
clients evo!e the decision to change.
3+ So!ution focused therap"
3+ So!ution focused therap"
<inding solution to pro#lem vie(ed as
<inding solution to pro#lem vie(ed as
more important than fnding the
more important than fnding the
cause. Strategies:
cause. Strategies:
*iracle 3uestion
*iracle 3uestion
.he personal narrative

.he personal narrative
Scaling 3uestions
Scaling 3uestions
1oping 3uestions
1oping 3uestions
@+ CognitiveL5ehaviora!
@+ CognitiveL5ehaviora!
Therap" =C5T>
Therap" =C5T>
Attri#uted to Aaron ec!Bs (or! (ith depression. Attri#uted to Aaron ec!Bs (or! (ith depression.
Al#ert %llis challenged clientsB faulty #elief Al#ert %llis challenged clientsB faulty #elief
systems. systems.
1urrently more focus on promoting positive 1urrently more focus on promoting positive
thoughts rather than focus on the negative. thoughts rather than focus on the negative.
Studies consistently sho( 1. as the most Studies consistently sho( 1. as the most
empirically empirically
supported form of group therapy for supported form of group therapy for
addictions addictions
Teaching aout
Teaching aout
Distortions
Distortions
Dam#ling e&ample: conditioning used #y casino Dam#ling e&ample: conditioning used #y casino
o(ners to get players to spend moreuse of #ells' o(ners to get players to spend moreuse of #ells'
positive reinforcement. positive reinforcement.
Dam#lers often have distorted #eliefs a#out luc!y Dam#lers often have distorted #eliefs a#out luc!y
days and machines and so forth. days and machines and so forth.
S!ills training can help clients avoid succum#ing to S!ills training can help clients avoid succum#ing to
triggers that promote gam#ling. triggers that promote gam#ling.
Role plays and reinforcement of #ehaviors to resist Role plays and reinforcement of #ehaviors to resist
temptation are efective strategies. temptation are efective strategies.
C5T for Re!apse
C5T for Re!apse
Prevention
Prevention
7nterpersonal coping s!ills help

7nterpersonal coping s!ills help
clients deal (ith high$ris! relapse
clients deal (ith high$ris! relapse
situations and to develop social
situations and to develop social
support for their recovery.
support for their recovery.
.eaching of refusal s!ills.

.eaching of refusal s!ills.
7ntrapersonal coping s!ills focus on

7ntrapersonal coping s!ills focus on
learning ho( to cope (ith oneBs o(n
learning ho( to cope (ith oneBs o(n
internal triggers' such as anger'
internal triggers' such as anger'
stress' and negative moods.
stress' and negative moods.
.roup Therap"
.roup Therap"
*ost popular form of delivering

*ost popular form of delivering
su#stance a#use treatment.
su#stance a#use treatment.
1ost efective' good source for

1ost efective' good source for
feed#ac!.
feed#ac!.
Rf proven efectiveness in teaching

Rf proven efectiveness in teaching
s!ills' helping people to learn from
s!ills' helping people to learn from
others' getting feed#ac!.
others' getting feed#ac!.
Ear!" Stages of .roup
Ear!" Stages of .roup
Therap"
Therap"
<irst stepto esta#lish trust' #uild faith in

<irst stepto esta#lish trust' #uild faith in
the counselor and group mem#ers.
the counselor and group mem#ers.
2iscuss rules of agency and group norms.

2iscuss rules of agency and group norms.
<or e&ample' confdentiality(hat is said in

<or e&ample' confdentiality(hat is said in
the group stays in the group.
the group stays in the group.
*otivational intervie(ing groups for college

*otivational intervie(ing groups for college
students sho(n to #e helpful in reducing
students sho(n to #e helpful in reducing
drin!ing pro#lems.
drin!ing pro#lems.
%&ample of drop$in group for homeless

%&ample of drop$in group for homeless
people.
people.
Traditiona! Treatment and
Traditiona! Treatment and
Strengths05ased Approaches
Strengths05ased Approaches
2eto&opportunity to introduce
2eto&opportunity to introduce
patient to choices.
patient to choices.
Rutpatientprimarily group
Rutpatientprimarily group
counseling.
counseling.
7npatient and half(ay houses.

7npatient and half(ay houses.
Aftercare once a month' may #e

Aftercare once a month' may #e
12 Step group or religious activity.
12 Step group or religious activity.
Chapter A
Chapter A
Su#stance *isuse 5ith A 1o$
Su#stance *isuse 5ith A 1o$
Rccurring
Rccurring
2isorder
2isorder
Rr 2isa#ility
Rr 2isa#ility
1o$Rccurring 2isorders
1o$Rccurring 2isorders
2ou#le (hammysu#stance dependence and mental 2ou#le (hammysu#stance dependence and mental
disorder. ipolarfeeling high can imitate drug use. disorder. ipolarfeeling high can imitate drug use.
*ental Health )arity and Addiction %3uity Act of *ental Health )arity and Addiction %3uity Act of
2>>= ended discrimination against consumers of 2>>= ended discrimination against consumers of
mental health and su#stance a#use treatment mental health and su#stance a#use treatment
services in insurance coverage. services in insurance coverage.
.he num#ers of people (ith serious mental disorders .he num#ers of people (ith serious mental disorders
(ho misuse su#stances and (ho smo!e is dou#le the (ho misuse su#stances and (ho smo!e is dou#le the
rate of those (ithout mental health disorders. rate of those (ithout mental health disorders.
Around half of people in treatment for su#stance use Around half of people in treatment for su#stance use
disorder have a serious mental disorder. disorder have a serious mental disorder.
'eed for &ntegrated
'eed for &ntegrated
Treatment
Treatment
4
7ntegrated Approachfts (ith harm
7ntegrated Approachfts (ith harm
reduction
reduction
4
A#out a third of addiction treatment
A#out a third of addiction treatment
programs no( include treatment for
programs no( include treatment for
psychiatric disorders.
psychiatric disorders.
4
Rnly =.H? ofer integrated programming
Rnly =.H? ofer integrated programming
+2>>S-
+2>>S-
4
An&iety disorder diagnosed in N>? of
An&iety disorder diagnosed in N>? of
persons (ith drug dependencyG may #e
persons (ith drug dependencyG may #e
efect of stimulant drugs.
efect of stimulant drugs.
Co0Hccurring Disorders
Co0Hccurring Disorders
continued
continued
4
Addiction counselors often e&plain
Addiction counselors often e&plain
psychosis as drug induced.
psychosis as drug induced.
4
*ental health professionals tend to
*ental health professionals tend to
see alcohol use as self medication.
see alcohol use as self medication.
4
.ruth is #othPand' not eitherPor.
.ruth is #othPand' not eitherPor.
4
1oe&isting disorders: an&iety'
1oe&isting disorders: an&iety'
compulsive gam#ling' eating and
compulsive gam#ling' eating and
mood disorders.
mood disorders.
Disorders that Hften Co0
Disorders that Hften Co0
e6ist with
e6ist with
Sustance Ause:
Sustance Ause:
4
An6iet"
An6iet"
4
Compu!sive gam!ing
Compu!sive gam!ing
4
/ood disorders
/ood disorders
4
Eating disorders
Eating disorders
4
Persona!it" disorders
Persona!it" disorders
4
Ps"chosis
Ps"chosis
Persona!it" Disorders:
Persona!it" Disorders:
4
5order!ine persona!it"
5order!ine persona!it"
4
Anti0socia! persona!it"
Anti0socia! persona!it"
4
These diagnoses often ased on
These diagnoses often ased on
cu!tura! iases
cu!tura! iases
4
&ntegrated treatment needed
&ntegrated treatment needed
4
'eed to o?er etter housing- can
'eed to o?er etter housing- can
re!" on funding " Supp!ementa!
re!" on funding " Supp!ementa!
Securit" &nsurance =SS&>
Securit" &nsurance =SS&>
PTSD
PTSD
4
Diagnosis came in %A<$ in response to
Diagnosis came in %A<$ in response to
Fietnam war veterans and feminist
Fietnam war veterans and feminist
movement on eha!f of rape victims
movement on eha!f of rape victims
4
Aout #1I e6posed to severe trauma
Aout #1I e6posed to severe trauma
wi!! deve!op sustance re!ated pro!ems
wi!! deve!op sustance re!ated pro!ems
4
,igh rate of re!apse among women in
,igh rate of re!apse among women in
sustance ause treatment with PTSD
sustance ause treatment with PTSD
upon re!ease
upon re!ease
4
,igh an6iet" a pro!em
,igh an6iet" a pro!em
4
Trauma from natura! disasters such as
Trauma from natura! disasters such as
,urricane Katrina
,urricane Katrina
PTSD after Comat
PTSD after Comat
4
At !east % in C veterans of war in
At !east % in C veterans of war in
&ra4 has PTSD
&ra4 has PTSD
4
8!ashac2s common
8!ashac2s common
4
&mmediate intervention with SSR&s
&mmediate intervention with SSR&s
recommended to o?set formation
recommended to o?set formation
of !oc2ed memories
of !oc2ed memories
4
Women see2ing he!p for rape
Women see2ing he!p for rape
trauma- someimes from attac2s "
trauma- someimes from attac2s "
fe!!ow so!diers
fe!!ow so!diers
5ipo!ar Disorder
5ipo!ar Disorder
4
/ost common!" diagnosed of the
/ost common!" diagnosed of the
menta! disorders for those with
menta! disorders for those with
co0occurring disorders+
co0occurring disorders+
4
8rom mania to depression
8rom mania to depression
4
A$I with this disorder have
A$I with this disorder have
sustance0re!ated pro!ems in a
sustance0re!ated pro!ems in a
prison samp!e
prison samp!e
Schi9ophrenia
Schi9ophrenia
4
Aout %I deve!op schi9ophrenia
Aout %I deve!op schi9ophrenia
4
De!usions- ha!!ucinations- apath" and
De!usions- ha!!ucinations- apath" and
!oss of p!easure- pro!ems
!oss of p!easure- pro!ems
concentrating
concentrating
4
Bohn 'ash- A 5eautifu! /ind
Bohn 'ash- A 5eautifu! /ind
4
@<I have sustance0re!ated pro!ems-
@<I have sustance0re!ated pro!ems-
a variet" of sustances used
a variet" of sustances used
4
P
P
'o wrong doorQ to treatment
'o wrong doorQ to treatment
4
Prone to home!essnessM ,ousing 8irst
Prone to home!essnessM ,ousing 8irst
programs
programs
&ntegrated Treatment
&ntegrated Treatment
Princip!es SA/S,A
Princip!es SA/S,A
7ntegrated treatment specialists are trained to 7ntegrated treatment specialists are trained to
treat #oth su#stance use disorders and serious treat #oth su#stance use disorders and serious
mental illnesses. mental illnesses.
1o$occurring disorders are treated in a stage$ 1o$occurring disorders are treated in a stage$
(ise fashion (ith diferent services provided at (ise fashion (ith diferent services provided at
diferent stages. diferent stages.
*otivational interventions are used to treat *otivational interventions are used to treat
consumers in all stages' #ut especially in the consumers in all stages' #ut especially in the
/persuasion0 stage. /persuasion0 stage.
&ntegrated Princip!es
&ntegrated Princip!es
continued
continued
Su#stance a#use counseling' using a

Su#stance a#use counseling' using a
cognitive$#ehavioral approach for the
cognitive$#ehavioral approach for the
active treatment and relapse
active treatment and relapse
prevention stages.
prevention stages.
*ultiple formats for services are

*ultiple formats for services are
availa#le' including individual' group'
availa#le' including individual' group'
self$help' and family.
self$help' and family.
*edication services are integrated and

*edication services are integrated and
coordinated (ith psychosocial services.
coordinated (ith psychosocial services.
Assertive Communit"
Assertive Communit"
Treatment =ACT>
Treatment =ACT>
Unlike integrated treatment, here the counselors go to

Unlike integrated treatment, here the counselors go to
the client and are aaila-le around the clock. *nl!
the client and are aaila-le around the clock. *nl!
for the most seere mental illness. 0rinci)les1
for the most seere mental illness. 0rinci)les1
2eam a))roach1 AC2 team mem-ers interdisci)linar!

2eam a))roach1 AC2 team mem-ers interdisci)linar!
and act as a whole to ensure -asic needs are met.
and act as a whole to ensure -asic needs are met.
Small caseload1 2eams of 3'435 sere 3''

Small caseload1 2eams of 3'435 sere 3''
consumers.
consumers.
2ime unlimited serices. 6o indiidual caseloads

2ime unlimited serices. 6o indiidual caseloads
.
.
,ousing 8irst
,ousing 8irst
Supportive model for chronically mentally

Supportive model for chronically mentally
ill (ith su#stance use pro#lems. 7n
ill (ith su#stance use pro#lems. 7n
contrast to housing programs re3uiring
contrast to housing programs re3uiring
total a#stinence.
total a#stinence.
7ntensive case management provided.

7ntensive case management provided.
1lient choices are respected.
1lient choices are respected.
/
/
5et0 houses.
5et0 houses.
1ost efective for communities;e( [or!

1ost efective for communities;e( [or!
1ity' Seattle' San <rancisco' )ortland' RR.
1ity' Seattle' San <rancisco' )ortland' RR.
Ph"sica! and Cognitive
Ph"sica! and Cognitive
Disai!ities
Disai!ities
%AA$ Americans with Disai!ities Act for
%AA$ Americans with Disai!ities Act for
fu!! participation in services
fu!! participation in services
Persons with head in7uries at high ris2
Persons with head in7uries at high ris2
for sustance misuseM man" were
for sustance misuseM man" were
into6icated when in7ured
into6icated when in7ured
,igh among wounded war veterans*
,igh among wounded war veterans*
Traumatic rain in7ur" from war in &ra4
Traumatic rain in7ur" from war in &ra4
5arriers to treatment*few programs
5arriers to treatment*few programs
with e6pertise to meet the need+
with e6pertise to meet the need+
Part &F
Part &F
Socia! Aspects of Addictions
Socia! Aspects of Addictions
Chapter %$
Chapter %$
8ami!" Ris2s and Resi!ience
8ami!" Ris2s and Resi!ience
4
Addiction is a fami!" diseaseJpain and stigma+ Addiction is a fami!" diseaseJpain and stigma+
4
5o6 %$+% 5o6 %$+% Des Moines Register Des Moines Register PChi!dren of PChi!dren of
AddictsQ*meth !as- fami!" )ghts- and chi!d AddictsQ*meth !as- fami!" )ghts- and chi!d
neg!ect in &owa neg!ect in &owa
4
C!assic 8ami!" Structure: C!assic 8ami!" Structure:
4
Addict as s"mptom of carrier+ Addict as s"mptom of carrier+
4
8au!t" communication in fami!" Tanore6ia 8au!t" communication in fami!" Tanore6ia
4
Confusion of cause and e?ect Confusion of cause and e?ect
4
8ami!" therap" )e!d- !itt!e attention to 8ami!" therap" )e!d- !itt!e attention to
addiction pro!ems e6cept as s"mptoms addiction pro!ems e6cept as s"mptoms
4
Ditt!e attention to cu!tura! diversit" as we!!+ See Ditt!e attention to cu!tura! diversit" as we!!+ See
/c.o!dric2 et a!3s /c.o!dric2 et a!3s Ethnicity and Family Therapy Ethnicity and Family Therapy
=#$$1> =#$$1>
,istor" of 8ami!" Treatment
,istor" of 8ami!" Treatment
4
Dac2 of insurance prevents
Dac2 of insurance prevents
emphasis on fami!" treatment
emphasis on fami!" treatment
4
Firginia Satir: studied fami!"
Firginia Satir: studied fami!"
adaptation to person3s i!!ness+
adaptation to person3s i!!ness+
4
C!audia 5!ac2
C!audia 5!ac2
4
P
P
&t wi!! never happen to meQ
&t wi!! never happen to meQ
4
Don3t ta!2- trust- fee!*co0
Don3t ta!2- trust- fee!*co0
a!coho!ic- codependent+
a!coho!ic- codependent+
4
A!0Anon*%A1$s
A!0Anon*%A1$s
Wegscheider3s Ro!e Theor"
Wegscheider3s Ro!e Theor"
4
Codependent person- chief ena!er*
Codependent person- chief ena!er*
terms too2 on negative connotations
terms too2 on negative connotations
!ater+
!ater+
4
This te6t uses the more positive term-
This te6t uses the more positive term-
amily manager
amily manager
instead of chief ena!er+
instead of chief ena!er+
4
Wegscheider3s terms for fami!" ro!es:
Wegscheider3s terms for fami!" ro!es:
hero- scapegoat- !ost chi!d- mascot
hero- scapegoat- !ost chi!d- mascot
4
/e!od" 5eattie:
/e!od" 5eattie:
Codependency !o More
Codependency !o More

popu!ari9ed the term+ We suggest
popu!ari9ed the term+ We suggest
survivor instead of codependent- a term
survivor instead of codependent- a term
that has ta2en on a !ife of its own+
that has ta2en on a !ife of its own+
8igure A+% 8ami!" 8orms
8igure A+% 8ami!" 8orms
Enmeshed amily
Enmeshed amily
: Spouses are
: Spouses are
estranged: one chi!d here is
estranged: one chi!d here is
enmeshed with father- one with
enmeshed with father- one with
mother
mother
7
C
8
C
&so!ated fami!":
&so!ated fami!":
,ac! of cohesion and social
,ac! of cohesion and social
support. %ach mem#er is
support. %ach mem#er is
protected #y (all of defenses.
protected #y (all of defenses.
C
7
8
C
,ea!th" fami!":
,ea!th" fami!":
A!! are touching- ut their
A!! are touching- ut their
oundaries are not
oundaries are not
over!apping+
over!apping+
C
8
7
C
Stages of Change and
Stages of Change and
8ami!":
8ami!":
4
%+
%+
"recontemplation
"recontemplation
: Counse!ors
: Counse!ors
descrie fami!" communication
descrie fami!" communication
patterns+
patterns+
4
#+
#+
Contemplation
Contemplation
: fami!" concerns ;
: fami!" concerns ;
!oo2 for so!utions+ /a!e partners ma"
!oo2 for so!utions+ /a!e partners ma"
e hard to engage+
e hard to engage+
4
3+
3+
"reparation
"reparation
: 5rea2ing point00
: 5rea2ing point00
forma! intervention =see o6ed reading
forma! intervention =see o6ed reading
" Carro!! Schute"> 8ami!" memers
" Carro!! Schute"> 8ami!" memers
ma2e a !ist of fee!ing responses to
ma2e a !ist of fee!ing responses to
addict3s actions+
addict3s actions+
Stages continued
Stages continued
4
@+
@+
Action#
Action#
4
Rehearsa! and treatment of fami!"
Rehearsa! and treatment of fami!"
without
without
4
addicted memer+
addicted memer+
4
Therapist feedac2*E6amp!e of therapist Therapist feedac2*E6amp!e of therapist
response to fami!" argument: P& note that as response to fami!" argument: P& note that as
"ou- Steve said that 7ust then- "ou =2id> fe!! out "ou- Steve said that 7ust then- "ou =2id> fe!! out
of chair+Q Purpose to revea! how the fami!" ro!es of chair+Q Purpose to revea! how the fami!" ro!es
operate in a s"stem+ operate in a s"stem+
4
1+
1+

Maintenance
Maintenance
:
:
4
8ocus on process not content Pwhat
8ocus on process not content Pwhat
to do ifJ+Q Transition with soriet"+
to do ifJ+Q Transition with soriet"+
Cu!tura! Considerations
Cu!tura! Considerations
/c.o!dric2 et a!3s oo2 on di?erent
/c.o!dric2 et a!3s oo2 on di?erent
ethnicities+ Descries wor2 with:
ethnicities+ Descries wor2 with:
4
African American fami!ies*reciprocit" a
African American fami!ies*reciprocit" a
strength here
strength here
4
Datino fami!ies*avoid a usiness!i2e
Datino fami!ies*avoid a usiness!i2e
approach
approach
4
Asian and Asian American fami!ies*
Asian and Asian American fami!ies*
engage most powerfu! person in the fami!"
engage most powerfu! person in the fami!"
4
Appa!achian fami!ies*engage the women
Appa!achian fami!ies*engage the women
who wi!! teach hea!th care practices
who wi!! teach hea!th care practices
Situations of Domestic
Situations of Domestic
Fio!ence
Fio!ence
1onnection of su#stance use and violence.
1onnection of su#stance use and violence.
attering intervention programs.
attering intervention programs.
*otivational intervie(ing as #ridge
*otivational intervie(ing as #ridge
#et(een (omenBs domestic violence
#et(een (omenBs domestic violence
services and su#stance a#use treatment.
services and su#stance a#use treatment.
.eaching (omen safety plans for harm
.eaching (omen safety plans for harm
reduction.
reduction.
Ris! of serious violence and death.
Ris! of serious violence and death.
Ru!es of 8ighting 8air
Ru!es of 8ighting 8air
4
Attac2 ehavior- not person
Attac2 ehavior- not person
4
Keep issues of managea!e si9e-
Keep issues of managea!e si9e-
don3t !ae!-
don3t !ae!-
4
Don3t use negative !ae!s+
Don3t use negative !ae!s+
4
Don3t rehash the past+
Don3t rehash the past+
Three R3s /ode!
Three R3s /ode!

4
Rename
Rename
: 'o !ae!s- shopping
: 'o !ae!s- shopping
addiction as i!!ness- not foo!ish
addiction as i!!ness- not foo!ish
spending+
spending+
4
Rerame
Rerame
: he!p c!ient see things
: he!p c!ient see things
happen for a reason
happen for a reason
4
Reclaim
Reclaim
: hea!ing- we0ness- fami!"
: hea!ing- we0ness- fami!"
circ!es to ma2e decisions =from
circ!es to ma2e decisions =from
'ative Americans>
'ative Americans>
4
Kath" and Ed: Case Stud"
Kath" and Ed: Case Stud"
E6ercises Re!ated to 8ami!"

E6ercises Re!ated to 8ami!"
Wor2
Wor2
%+ %+
Drawing fami!" maps- circ!es
Drawing fami!" maps- circ!es
#+ #+
Re!apse prevention p!an+
Re!apse prevention p!an+
3+ 3+
Fiewing e6cerpt from a movie or
Fiewing e6cerpt from a movie or
videotape+
videotape+
Chapter %%
Chapter %%
*utual$Help Droups
*utual$Help Droups
/utua! Aid .roups
/utua! Aid .roups
4
1onfusion12 Step facilitated
1onfusion12 Step facilitated
treatment and 12 Step self help groups
treatment and 12 Step self help groups
+far more tolerant and non$:udgmental-.
+far more tolerant and non$:udgmental-.

4
AA 9 spiritually #ased fello(ship is free
AA 9 spiritually #ased fello(ship is free
4
Eoluntary treatment: consistent (ith
Eoluntary treatment: consistent (ith
harm reduction.
harm reduction.
4
7nvoluntary treatment for those (ho
7nvoluntary treatment for those (ho
failed at moderation.
failed at moderation.
Twe!ve Steps
Twe!ve Steps
)resented in o&
)resented in o& 33.3. 7irst fie1 33.3. 7irst fie1
3. 9e admitted we were )owerless oer alcoholthat our 3. 9e admitted we were )owerless oer alcoholthat our
lies had -ecome unmanagea-le. lies had -ecome unmanagea-le.
5. Came to -eliee that a 0ower greater than ourseles could 5. Came to -eliee that a 0ower greater than ourseles could
restore us to sanit!. restore us to sanit!.
:. 8ade a decision to turn our will and our lies oer to the :. 8ade a decision to turn our will and our lies oer to the
care of ;od as we understood <im. care of ;od as we understood <im.
=. 8ade a searching and fearless moral inentor! of ourseles. =. 8ade a searching and fearless moral inentor! of ourseles.
>. Admitted to ;od, to ourseles and to another human -eing >. Admitted to ;od, to ourseles and to another human -eing
the e+act nature of our wrongs. the e+act nature of our wrongs.
A!coho!ics Anon"mous
A!coho!ics Anon"mous
=AA>
=AA>
4
.reater invo!vement in AA found to
.reater invo!vement in AA found to
e?ective+
e?ective+
4
:se of narrativesJstories of
:se of narrativesJstories of
power!essness over the addiction- !ives
power!essness over the addiction- !ives
out of contro!J
out of contro!J
4
8eminist o7ections to %# Steps
8eminist o7ections to %# Steps
4
/etaphor of disease*menta!- ph"sica!-
/etaphor of disease*menta!- ph"sica!-
and spiritua!- metaphor of power!essness
and spiritua!- metaphor of power!essness
4
/eans of e6panding treatment++ words in
/eans of e6panding treatment++ words in
5ig 5oo2JHne da" at a timeJ,igher
5ig 5oo2JHne da" at a timeJ,igher
Power+
Power+
Hther Se!f0,e!p .roups
Hther Se!f0,e!p .roups
;Amem-ers tend to -e older and hae high rate of

;Amem-ers tend to -e older and hae high rate of
a-stinence after attending for 5 months.
a-stinence after attending for 5 months.
Addresses financial as well as s)iritual )ro-lems.

Addresses financial as well as s)iritual )ro-lems.
6Amultilingual meetings.
6Amultilingual meetings.
9omen for So-riet!3: Ste)s.

9omen for So-riet!3: Ste)s.
S8A%2 %ecoer!----cognitie a))roach.

S8A%2 %ecoer!----cognitie a))roach.
8oderation 8anagementstarts at :' da!s of
8oderation 8anagementstarts at :' da!s of
a-stinence, a harm reduction strateg!
a-stinence, a harm reduction strateg!
?Some sa! 35 Ste)s should -e moderni@ed. See one

?Some sa! 35 Ste)s should -e moderni@ed. See one
attem)tA Ste)s at www.katherineanwormer.comB
attem)tA Ste)s at www.katherineanwormer.comB
Recover" Communit"
Recover" Communit"
Centers
Centers
A ne( development in some states'
A ne( development in some states'
follo( recovery management philosophy.
follo( recovery management philosophy.
)rovides services such as telephone
)rovides services such as telephone
support +usually #y a volunteer in
support +usually #y a volunteer in
recovery-' family support groups'
recovery-' family support groups'
housing assistance' recovery group
housing assistance' recovery group
meetings' social events' and recovery
meetings' social events' and recovery
coaching.
coaching.
Chapter %#
Chapter %#
Racia!- Ethnic- Cu!ture
Racia!- Ethnic- Cu!ture
and C!ass &ssues
and C!ass &ssues
/inorit" .roup
/inorit" .roup
/emership
/emership
4
;eed to !no( social political conte&t
;eed to !no( social political conte&t
of #eing minority.
of #eing minority.
4
.reatment must ta!e into account
.reatment must ta!e into account
ethnoculture norms.
ethnoculture norms.
.he 1ouncil on Social 5or! %ducation

.he 1ouncil on Social 5or! %ducation
+1S5%- lists the a#ility to /engage
+1S5%- lists the a#ility to /engage
diversity and diference in practice0
diversity and diference in practice0
as one of the ten core competencies.
as one of the ten core competencies.
5e need to !no( something a#out

5e need to !no( something a#out
norms of particular groups to
norms of particular groups to
enhance treatment.
enhance treatment.
Socia! C!ass
Socia! C!ass
7mportance of class#ell hoo!s$
7mportance of class#ell hoo!s$
1lass afects adolescents access to
1lass afects adolescents access to
drugs.
drugs.
2rug use afected #y unemployment
2rug use afected #y unemployment
and lo( income status.
and lo( income status.
Rften as acculturation increases' so
Rften as acculturation increases' so
does su#stance misuse
does su#stance misuse
Asian AmericansLPaci)c
Asian AmericansLPaci)c
&s!anders
&s!anders
4
Dow rate of sustance misuse*7ust over Dow rate of sustance misuse*7ust over
3I+ 3I+
4
Bapanese Americans drin2 much more Bapanese Americans drin2 much more
than Chinese Americans+ than Chinese Americans+
4
Success often is re!ated to their !eve! of Success often is re!ated to their !eve! of
education at home and urani9ation+ education at home and urani9ation+
4
Camodians 0 war trauma+ Camodians 0 war trauma+
Asians and ,awaiians
Asians and ,awaiians
4
Asian Americans 0 highest income of a!! Asian Americans 0 highest income of a!!
ethnicities- )!ia! piet"+ ethnicities- )!ia! piet"+
4
Emotiona! sharing ma" !ead to !oss of face+ Emotiona! sharing ma" !ead to !oss of face+
4
&mmigration- a ma7or stress+ &mmigration- a ma7or stress+
4
8or 'ative ,awaiians fema!e e!ders provide 8or 'ative ,awaiians fema!e e!ders provide
cu!tura!!" ased treatment+ cu!tura!!" ased treatment+
4
Pi!ot program in &ndia uses "oga and Pi!ot program in &ndia uses "oga and
meditation to reduce stress+ meditation to reduce stress+
American &ndians and
American &ndians and
A!as2an 'atives
A!as2an 'atives
4
Historical trauma Historical traumaracism and children (ere once racism and children (ere once
sent to #oarding schools to destroy culture. sent to #oarding schools to destroy culture.
4
;ative Americans are less than .M? of IS ;ative Americans are less than .M? of IS
population. Almost half report they are of mi&ed population. Almost half report they are of mi&ed
race. race.
4
High rate of su#stance a#use or dependence: 1H.H?. High rate of su#stance a#use or dependence: 1H.H?.
illicit drug use1=."?' #inge drin!ing22.2?' illicit drug use1=."?' #inge drin!ing22.2?'
cigarette useN1.=?. High fatal accident rate' <AS. cigarette useN1.=?. High fatal accident rate' <AS.
4
High poverty' alcohol a#use' youth inhalant use. High poverty' alcohol a#use' youth inhalant use.
4
Ise of *edicine 5heel for holistic' spiritual Ise of *edicine 5heel for holistic' spiritual
frame(or!' tal!ing circles. +o& 12.2- frame(or!' tal!ing circles. +o& 12.2-
4
Red Road to So#riety. Red Road to So#riety.
Datinos
Datinos
4
%CI of popu!ation =Ca!ifornia: %L3 of popu!ation> %CI of popu!ation =Ca!ifornia: %L3 of popu!ation>
4
1<I of ,ispanics in the :+S+ are /e6icans+ 1<I of ,ispanics in the :+S+ are /e6icans+
4
Sustance ause or dependence for ,ispanics Sustance ause or dependence for ,ispanics
%$+#I+ &ncrease in treatment admissions for meth %$+#I+ &ncrease in treatment admissions for meth
use+ use+
4
Treatment needs for a!coho! misuse among Treatment needs for a!coho! misuse among
/e6ican Americans =A+#I> and Puerto Ricans /e6ican Americans =A+#I> and Puerto Ricans
=C+%I>+ =C+%I>+
4
&n :+S+ #%+%I of Datinos smo2e+ Dess among &n :+S+ #%+%I of Datinos smo2e+ Dess among
women ut increasing+ women ut increasing+
4
,igh rate of gam!ing pro!ems+ ,&FLA&DS a ,igh rate of gam!ing pro!ems+ ,&FLA&DS a
ma7or pro!em+ ma7or pro!em+
4
,igh rate of povert"M few have hea!th insurance+ ,igh rate of povert"M few have hea!th insurance+
4
.roup has the highest high schoo! drop0out rate- .roup has the highest high schoo! drop0out rate-
Puerto Ricans- the highest povert" rate+ Puerto Ricans- the highest povert" rate+
Treatment &ssues for
Treatment &ssues for
Datinos
Datinos
4
/a!eLfema!e ro!e di?erentiation+ /a!eLfema!e ro!e di?erentiation+
4
Wor2 with fami!" shou!d support fami!" Wor2 with fami!" shou!d support fami!"
strengths+ strengths+
4
'eed for Spanish0spea2ing counse!ors+ 'eed for Spanish0spea2ing counse!ors+
:nderstand that with second generation- women :nderstand that with second generation- women
have more addiction pro!ems+ have more addiction pro!ems+
4
Case management services needed to get c!ients Case management services needed to get c!ients
into .ED programs where needed and 7o into .ED programs where needed and 7o
training programs+ training programs+
African Americans
African Americans
4
Are 7ust over %#I of popu!ation+ Are 7ust over %#I of popu!ation+
4
Sustance ause and addiction rate is <+<I+ Sustance ause and addiction rate is <+<I+
#@I report inge drin2ing+ &!!icit drug ause #@I report inge drin2ing+ &!!icit drug ause
A+CI+ Aout #@I of treatment popu!ation ut A+CI+ Aout #@I of treatment popu!ation ut
drug use is not much more than that of drug use is not much more than that of
genera! popu!ation+ genera! popu!ation+
4
&n prison are @@I of inmates sentenced for &n prison are @@I of inmates sentenced for
i!!icit drug invo!vement+ i!!icit drug invo!vement+
4
Hf those who gam!e- high addiction rate+ Hf those who gam!e- high addiction rate+
4
@1I of a!! new ,&F cases are African @1I of a!! new ,&F cases are African
American+ American+
African Americans
African Americans
continued
continued
4
,igher socia! c!ass and church attendance are ,igher socia! c!ass and church attendance are
protective factors+ protective factors+
4
H!der African American women* over <1I astain+ H!der African American women* over <1I astain+
4
Twice as man" are in povert" as whites+ ,igher Twice as man" are in povert" as whites+ ,igher
socia! c!ass a protective factor+ socia! c!ass a protective factor+
4
A!most ha!f of advertising udget targets !ac2s+ A!most ha!f of advertising udget targets !ac2s+
4
Recover" re!ates to spiritua!it" and fami!" support+ Recover" re!ates to spiritua!it" and fami!" support+
4
David .oodson 4uote: P dea!s with cu!tura! pain+Q David .oodson 4uote: P dea!s with cu!tura! pain+Q
,arm reduction techni4ues recommended+ ,arm reduction techni4ues recommended+
4
Treatment arriers*paper wor2 for /edicaid- Treatment arriers*paper wor2 for /edicaid-
waiting period- wanting to concea! pro!em- waiting period- wanting to concea! pro!em-
waiting period+ waiting period+
Wor2 with Soma!is
Wor2 with Soma!is
4
.rauma from (ar and refugee
.rauma from (ar and refugee
e&periences.
e&periences.
4
;eed for translation services.
;eed for translation services.
4
Dam#ling may #e a pro#lem among
Dam#ling may #e a pro#lem among
the young immigrants although
the young immigrants although
for#idden in the culture.
for#idden in the culture.
4
7mmigrants (ill see! spiritual
7mmigrants (ill see! spiritual
counseling at the mos3ue.
counseling at the mos3ue.
Chapter %3
Chapter %3
)u#lic )olicy
)u#lic )olicy
Po!ic" &ssues
Po!ic" &ssues
4
Rnly 11? of those (ho need
Rnly 11? of those (ho need
treatment get it' #ut may not (ant it.
treatment get it' #ut may not (ant it.
4
5ar on 2rugs is not harm reduction'
5ar on 2rugs is not harm reduction'
#ut harm ma&imiCation
#ut harm ma&imiCation
4
SS7 +Supplemental Security 7ncome-
SS7 +Supplemental Security 7ncome-
for alcoholPdrugs disa#ilities has #een
for alcoholPdrugs disa#ilities has #een
discontinued
discontinued
4
*anaged care' reduced inpatient
*anaged care' reduced inpatient
coverage' reductions in *edicare
coverage' reductions in *edicare
reim#ursement
reim#ursement
Promising Deve!opments
Promising Deve!opments
2rug courts' mental health courts.
2rug courts' mental health courts.
altimore uni3uely has a huge num#er
altimore uni3uely has a huge num#er
of treatment slots availa#le.
of treatment slots availa#le.
Reduction in drug overdose deaths in
Reduction in drug overdose deaths in
5ashington 21 than!s to more
5ashington 21 than!s to more
treatment funding.
treatment funding.
We!fare Reform
We!fare Reform
4
<ederal government denies #enefts to needy
<ederal government denies #enefts to needy
people (ith alcohol and drug pro#lems.
people (ith alcohol and drug pro#lems.
4
.A;< drug testing in some states.
.A;< drug testing in some states.
4
Removal of coverage for su#stance related
Removal of coverage for su#stance related
disa#ilities such as alcoholism from SS7
disa#ilities such as alcoholism from SS7
+Supplemental Security 7ncome-' loss of
+Supplemental Security 7ncome-' loss of
*edicaid eligi#ility through this program for
*edicaid eligi#ility through this program for
treatment.
treatment.
4
Dovernment encourages drug testing for
Dovernment encourages drug testing for
(elfare recipientsG ne( la(s in states no(
(elfare recipientsG ne( la(s in states no(
doing this.
doing this.
/anaged Care
/anaged Care
Restrictions on care are familiar to all
Restrictions on care are familiar to all
treatment providers.
treatment providers.
1ost containment and accounta#ility
1ost containment and accounta#ility
are stressed.
are stressed.
<ocus on #rief' outpatient visits.
<ocus on #rief' outpatient visits.
1uts in mental health care #y the
1uts in mental health care #y the
states.
states.
8edera! Con)dentia!it"
8edera! Con)dentia!it"
Daws
Daws
/ /1onfdentiality of Alcohol and 2rug A#use 1onfdentiality of Alcohol and 2rug A#use
)atient Records0 +2>11- apply to all agencies that )atient Records0 +2>11- apply to all agencies that
provide su#stance a#use treatment or prevention. provide su#stance a#use treatment or prevention.
.he rules are far more stringent than for any .he rules are far more stringent than for any
other category of treatment. other category of treatment.
;o disclosure of content that (ould #e harmful to ;o disclosure of content that (ould #e harmful to
the patient (ith or (ithout the patientBs signed the patient (ith or (ithout the patientBs signed
consent. consent.
.his is true even (ith a court su#poena. .his is true even (ith a court su#poena.
.his la( is protect clients (ho see! treatment .his la( is protect clients (ho see! treatment
from facts a#out their prior drug use or dealing. from facts a#out their prior drug use or dealing.
Hther Dega! /atters
Hther Dega! /atters
4
.reatment options to AASupreme 1ourt ruling .reatment options to AASupreme 1ourt ruling
related to separation of church and state. related to separation of church and state.
4
5ar on 2rugsfailed policy' most agree in 5ar on 2rugsfailed policy' most agree in
survey: in:ustice' racial oppression' huge survey: in:ustice' racial oppression' huge
e&pense. e&pense.
4
*edia hype a#out drug crime' mandatory *edia hype a#out drug crime' mandatory
minimum sentencing. minimum sentencing.
4
*ost inmates in federal prison are minorities. *ost inmates in federal prison are minorities.
4
*others of crac! #a#ies given punitive *others of crac! #a#ies given punitive
treatment. treatment.
Ethica! /atters
Ethica! /atters
8ental health )rofessionals hae their codes of ethics as
8ental health )rofessionals hae their codes of ethics as
do su-stance a-use counselors that reCuire1
do su-stance a-use counselors that reCuire1
6ondiscrimination of clients on the -asis of race, color,

6ondiscrimination of clients on the -asis of race, color,
gender, se+ual orientation, age, disa-ilit!,
gender, se+ual orientation, age, disa-ilit!,
Continuing )rofessional and educational growth;

Continuing )rofessional and educational growth;
6ot e+)loiting clients se+uall! or financiall!;

6ot e+)loiting clients se+uall! or financiall!;
%e)orting )rofessional misconduct of colleagues, such

%e)orting )rofessional misconduct of colleagues, such
as iolations of client confidentialit!.
as iolations of client confidentialit!.
Aoid dual relationshi)s.

Aoid dual relationshi)s.
War on Drugs
War on Drugs
Rver N>'>>> !illed in *e&ican (ar on
Rver N>'>>> !illed in *e&ican (ar on
drugs(ar of cartels.
drugs(ar of cartels.
Dlo#al 1ommission on 2rug )olicy +2>11-
Dlo#al 1ommission on 2rug )olicy +2>11-
led #y former presidents from ,atin
led #y former presidents from ,atin
America called for end to drug (ars.
America called for end to drug (ars.
;eed to rethin! Cero tolerance policies.
;eed to rethin! Cero tolerance policies.
.(o$thirds of Americans agreeG a slight
.(o$thirds of Americans agreeG a slight
ma:ority of Americans favor legaliCation
ma:ority of Americans favor legaliCation
of mari:uana.
of mari:uana.
/andator" Sentencing
/andator" Sentencing
4
5omen have the fastest gro(ing prison
5omen have the fastest gro(ing prison
population rate' especially in federal prisons.
population rate' especially in federal prisons.
4
1M=S' federal mandatory minimum
1M=S' federal mandatory minimum
sentencing la(s enacted.
sentencing la(s enacted.
4
Hysteria over /crac! #a#ies0harm to fetus
Hysteria over /crac! #a#ies0harm to fetus
actually (as from the alcohol used.
actually (as from the alcohol used.
4
IS Supreme 1ourt in 2>>@ ruled the la(s
IS Supreme 1ourt in 2>>@ ruled the la(s
should serve as guidelines only.
should serve as guidelines only.
4
2rug conspiracy la(s cause (omen to #e
2rug conspiracy la(s cause (omen to #e
arrested as their partners turn them in as a
arrested as their partners turn them in as a
part of their plea #argaining agreements to
part of their plea #argaining agreements to
get their sentences reduced.
get their sentences reduced.
The 'ew Bim Crow
The 'ew Bim Crow
*ichelle Ale&ander +2>1>-:
*ichelle Ale&ander +2>1>-:
T!e 0e+
T!e 0e+
5im &ro+' ,ass 6ncarceration in t!e
5im &ro+' ,ass 6ncarceration in t!e
-#e of &olor.*lindness
-#e of &olor.*lindness
1 in M young #lac! men #ehind #ars.
1 in M young #lac! men #ehind #ars.
*any children (ithout fathers or #oth
*any children (ithout fathers or #oth
parents.
parents.
Civi! Asset 8orfeitures
Civi! Asset 8orfeitures
4
)olice seiCe property +cars' houses-
)olice seiCe property +cars' houses-
related to crimes committed #ased on
related to crimes committed #ased on
/a mere preponderance of evidence.0
/a mere preponderance of evidence.0
4
Rregon re3uires a conviction frst.
Rregon re3uires a conviction frst.
4
)artners of drug dealers often pay the
)artners of drug dealers often pay the
price.
price.
4
7nformants a(arded part of the value
7nformants a(arded part of the value
of the goods seiCed.
of the goods seiCed.
,arm Reduction Strategies
,arm Reduction Strategies

4
;eedle e&change serves only 1H? of drug
;eedle e&change serves only 1H? of drug
in:ectors.
in:ectors.
4
*ethadone and #uprenorphine maintenance
*ethadone and #uprenorphine maintenance
4
Heroin prescri#ed to addicts in some
Heroin prescri#ed to addicts in some
%uropean countries
%uropean countries
4
2rug courts: a promising strategy' cost
2rug courts: a promising strategy' cost
efective for communities
efective for communities
4
.his te&t argues not legaliCation #ut for
.his te&t argues not legaliCation #ut for
middle of the road policies
middle of the road policies
decriminaliCationto reduce harm.
decriminaliCationto reduce harm.
Recommendations
Recommendations
Concerning .am!ing
Concerning .am!ing
Restrict all gam#ling to those (ho are at least

Restrict all gam#ling to those (ho are at least
21
21

years of age
years of age
Remove slot machines from neigh#orhood

Remove slot machines from neigh#orhood

stores' #anning #etting on collegiate and
stores' #anning #etting on collegiate and
amateur
amateur

athletic events.
athletic events.
an aggressive advertising that targets

an aggressive advertising that targets
impoverished neigh#orhoods and youth'
impoverished neigh#orhoods and youth'
)rohi#it credit card machines in casinos.

)rohi#it credit card machines in casinos.
The End
The End
Addiction .reatment: A
Addiction .reatment: A
Strengths )erspective' "rd
Strengths )erspective' "rd
ed.
ed.

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Addiction Treatment Medical Paper

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Power Point for

Power Point for

Addiction afects us all. Strengths

oo! in " parts: #io$psycho$social

%&amples of addiction$$$smo!er dying

%conomic costhealth' (ar on drugs'

Addiction defned #y researchers as /a

5hat is the ethical dilemma here6

Ho( do the managers ensure that

Ho( are the employees controlled

2isease 2isease $ as metaphor #y 8elline!: /alcoholism is $ as metaphor #y 8elline!: /alcoholism is

5hy +#io-' (hat +psycho-' (here

;eed for spiritual healing'

7nteractionism and cycle of pain:

<amily as a system in interaction'

=>? of people #ehind #ars have pro#lems'

@1? of social (or!ers (or!ed (ith clients

)olicy issues of reducing harm. )olicy issues of reducing harm.

Research from 1alifornia: 1F spent saves

Hester and *iller found that these

2e$emphasis on incarceration' reentry 2e$emphasis on incarceration' reentry

Restorative 8ustice Restorative 8ustice' ' victim$ofender programming victim$ofender programming

Alcohol #ac! to H>>> 1 7ran

In!no(n to (orldBs indigenous people

Joran $$$ condemned (ine. Alcohol from

Ara#ian dr. discovered evaporated distilled

1H@H $$$ distilling used9gin. ooCe from

Dreat devastation from %ngland' 1@>>$

7nfant mortality' crime

*ore #eer than (ater on

Slaves for#idden to drin! e&cept

*ale drin!ing cult 1@2H$1=2H

.emperance (oman for (omenBs

.o#acco outla(ed for #rief period.

1M1N Harrison Act $$$ restricted

*ari:uana +associated (ith

DlamoriCed crime. *afaP

Dreat 2epression created need for

2angers of potent alcohol' role of

%&ample of happy 7talian family

*odern 5ar on 2rugs' t(o$thirds

,istor" of Addiction Treatment

Alpha' eta' Damma ' 2elta' %psilon.

1MHS A*A declared alcoholism an

Harold Hughes 9founded ;7AAA.

HaCelden adapted 12 Step approach.

o& 2:1/.reatment in ;or(ay0

)eele and <ingarette: addiction as

A72S in ;etherlands spa(ned ne(

ritain' 1MS>s and later.

Heroin prescri#ed. ;eedle

Alan *arlatt' died in 2>11' pioneer in

%uropeans consume si& times as much

*oldova' the 1Cech Repu#lic' drin!

%astern %uropeanshard li3uor

ritish and 7rish#eer

<rench and 7talians(ine

High ratesindigenous populations

Health efects of moderate drin!ers

@$1>? of drin!ers get addicted. Signs:

.N .A.1. may #e comatose.

lac!outs: common at ." A1' case in

Real court cases

Rpiatesfrom opium poppyTnarcotics'

alachy c1ourt smo!ed for ad and got

C!oningerSweden++#1A ma!e adoptees with C!oningerSweden++#1A ma!e adoptees with

ethadone +synthetic form of heroin-G ethadone +synthetic form of heroin-G

ethadone maintenance ethadone maintenance