addiction treatment medical paper

8/11/2019 Addiction Treatment Medical Paper

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Addiction Treatment:Addiction Treatment:

A Strengths PerspectiveA Strengths Perspective

3rd3rdEditionEdition

Katherine van WormerKatherine van WormerDiane Rae DavisDiane Rae Davis

Cengage Pu!ishing Compan"Cengage Pu!ishing Compan"

#$%# cop"right#$%# cop"right


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Part &: &ntroductionPart &: &ntroduction

Addiction afects us all. StrengthsAddiction afects us all. Strengths

perspectivestrengths o clients andperspectivestrengths o clients and

strengths o the contemporarystrengths o the contemporary

models:models: Harm reductionHarm reduction

12 Step approach.12 Step approach.

Rit in eld.Rit in eld.

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


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Chapter &Chapter &'ature of Addiction'ature of Addiction

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

o emphysema' crac! addicto emphysema' crac! addict

arrested' pregnant mother drin!ingarrested' pregnant mother drin!ing

heavily' girl hoo!ed on meth sheheavily' girl hoo!ed on meth shestarted using to lose (eightstarted using to lose (eight

%conomic costhealth' (ar on drugs'%conomic costhealth' (ar on drugs'

over 1 million in prison or drugover 1 million in prison or druginvolvement. ig #usinessinvolvement. ig #usiness

gam#ling' )hilip *orris' #eergam#ling' )hilip *orris' #eer


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What is addiction(What is addiction(

+,atin-+,atin- addictusaddictus$$$attached to something'$$$attached to something'

positive. oday alcoholism called apositive. oday alcoholism called a

/#rain disease0or #ad ha#it or sin./#rain disease0or #ad ha#it or sin.

,eading assumption o the te&t: Addiction,eading assumption o the te&t: Addictionis the !ey' not the su#stance or #ehavioris the !ey' not the su#stance or #ehavior

Addiction dened #y researchers as /aAddiction dened #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 o/helplessness'0 /a pro#lem o

motivation0motivation0


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De)nitions

Addiction*pattern of compu!sive use+

4,as ph"sica!- ps"cho!ogica!- socia!

aspects+4Emphasis on process rather thanoutcome+

.am!ing now considered an addictionin DS/01Pattern of preoccupation- !ac2 ofcontro!- form of escape- chasing ones

!osses- serious conse4uences+


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5o6 %+%5o6 %+%

A Socia! Wor2 /a7orA Socia! Wor2 /a7or

Wor2ing in a CasinoWor2ing in a Casino 5hat is the ethical dilemma here65hat is the ethical dilemma here6

Ho( do the managers ensure thatHo( do the managers ensure thatthe gam#lers !eep spending theirthe gam#lers !eep spending their

money6money6

Ho( are the employees controlledHo( are the employees controlled#y the esta#lishment6#y the esta#lishment6


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The Disease ConceptThe Disease Concept

7s alcoholism a disease67s alcoholism a disease6Arguments pro:Arguments pro:

Arguments con:Arguments con:


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8irst- De)ne Disease8irst- De)ne Disease

iseaseisease$ as metaphor #y 8elline!: /alcoholism is$ as metaphor #y 8elline!: /alcoholism islikelikea disease0a disease0

Random House Dictionary,Random House Dictionary,disease is a conditiondisease is a conditiono the #ody in (hich this is incorrect unction.o the #ody in (hich this is incorrect unction.

Oxford University DictionaryOxford University Dictionary9 disease is a#sence9 disease is a#senceo ease +in treatment 9 disease as: primary'o ease +in treatment 9 disease as: primary'progressive' chronic' and possi#ly atal-.progressive' chronic' and possi#ly atal-.

7llness7llness9 term preerred here' less controversial'9 term preerred here' less controversial'less medical.less medical.

est arguments pro disease:est arguments pro disease:alcoholism is a #rainalcoholism is a #raindisease #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 o it.need to ta!e responsi#ility' people mature out o it.


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5iops"chosocia!0spiritua!5iops"chosocia!0spiritua!

/ode!/ode! 5hy +#io-' (hat +psycho-' (here5hy +#io-' (hat +psycho-' (here

+social-+social-

;eed or spiritual healing';eed or spiritual healing'

connection (ith Higher )o(erconnection (ith Higher )o(er 7nteractionism and cycle o pain:7nteractionism and cycle o pain:

pain and suferingpain and sufering lossloss pain'pain'

stress and drin!ingstress and drin!ing more painmore pain


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Wh" Do We 'eed to KnowWh" Do We 'eed to Know

aout Addiction(aout Addiction( =>? o people #ehind #ars have pro#lems'=>? o people #ehind #ars have pro#lems'

pervasive in child (elare system' alcoholismpervasive in child (elare system' alcoholismin the (or!place.in the (or!place.

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

Headlines:Headlines:

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

$/Help 7Bm Addicted to


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Ta!e %+% Contrast Traditiona!Ta!e %+% Contrast Traditiona!

Approach and StrengthsApproach and Strengths


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Two Approaches to TreatmentTwo Approaches to Treatment

Traditiona!Traditiona!

5io5io

ichotomyichotomy

Ps"choPs"cho

)ro#lems mandate)ro#lems mandateone siCeone siCe ts allts all

Socia!Socia!7dentiy amily7dentiy amily

dysunctiondysunction

Strengths0asedStrengths0ased

5io5io ontinuumontinuum

Ps"choPs"cho

Strengths$motivationStrengths$motivation

Socia!Socia! Holistic amily asHolistic amily as

resourceresource


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Addiction Recover"Addiction Recover"/anagement/anagement

Strengths0ased treatmentStrengths0ased treatment


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Strengths PerspectiveStrengths 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 o one !ey personhope' purpose' achievement' presence o one !ey personto help.to help.


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Empirica! ResearchEmpirica! Research

)roect *AH)roect *AHDirected " '&AAA ; #-$$$ c!ients over < "rs+Directed " '&AAA ; #-$$$ c!ients over < "rs+

What wor2s( %# step faci!itation- cognitive- motivationa! enhancementWhat wor2s( %# step faci!itation- cognitive- motivationa! enhancementtherap" =/ET>therap" =/ET>

/ET most e?ective for those with !ow motivation- %# Step with/ET most e?ective for those with !ow motivation- %# Step withre!igiousre!igious

persons+persons+

Criticism: !ac2 of a contro! group+ /ET- a shorter intervention+ /ode!sCriticism: !ac2 of a contro! group+ /ET- a shorter intervention+ /ode!son!"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+ 'ewPro7ect /ATC, con)rms the e?ectiveness of diverse treatments+ 'ewmeasure for recover" is improvement- not tota! astinence+measure for recover" is improvement- not tota! astinence+

EaillantBs ResearchEaillantBs 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!igiousor 7oined AA or entered a sta!e re!ationship or had a re!igiousconversion+conversion+


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Empirica! ResearchEmpirica! Research

ContinuedContinued Research rom aliornia: 1F spent savesResearch rom aliornia: 1F spent saves

@ across states.@ across states.

Hester and *iller ound that theseHester and *iller ound that thesetreatment modalities (ere proven to #etreatment modalities (ere proven to #e

most efective: #rie intervention'most efective: #rie intervention'

motivational intervie(ing +*7-' use o themotivational intervie(ing +*7-' use o the

medication naltre&one' social s!illsmedication naltre&one' social s!ills

training' aversion therapy' cognitivetraining' aversion therapy' cognitive

therapy' acupuncture. +See chapter =-therapy' acupuncture. +See chapter =-


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Treatment TrendsTreatment Trends

)rescription drug misuse as increasing pro#lemG)rescription drug misuse as increasing pro#lemG Harm reduction recogniCed as important to saveHarm reduction recogniCed as important to save

livesG pu#lic health approachGlivesG pu#lic health approachG elie that punitive la(s cause harmGelie that punitive la(s cause harmG *aority o Americans avor treatment over ailG*aority o Americans avor treatment over ailG e$emphasis on incarceration' reentrye$emphasis on incarceration' reentry

programmingGprogrammingG rug courts' mental health courtsGrug courts' mental health courtsG

Attention to co$occurring disorders and e&tensiveAttention to co$occurring disorders and e&tensiveuse o prescri#ed medications to reduce cravingGuse o prescri#ed medications to reduce cravingG

Restorative 8usticeRestorative 8ustice''victim$ofender programmingvictim$ofender programmingto promote healing. )%AS% Academy.to promote healing. )%AS% Academy.


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Chapter #Chapter #

,istorica! Perspectives,istorica! Perspectives

E ! ,i tE , t


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Ear!" ,istor"Ear " , stor"

Alcohol #ac! to >>> 7ranAlcohol #ac! to >>> 7ran

In!no(n to (orldBs indigenous peopleIn!no(n to (orldBs indigenous people

Joran $$$ condemned (ine. Alcohol romJoran $$$ condemned (ine. Alcohol rom

Ara#ic al$!uhul.Ara#ic al$!uhul.

Ara#ian dr. discovered evaporated distilledAra#ian dr. discovered evaporated distilledspirits. echnology e&ceeded its graspspirits. echnology e&ceeded its grasp

1@ $$$ distilling used9gin. ooCe rom1@ $$$ distilling used9gin. ooCe rom

utchutch busenbusen..

Dreat devastation rom %ngland' 1@>>$Dreat devastation rom %ngland' 1@>>$1@>.1@>.

7nant mortality' crime7nant mortality' crime


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'orth America'orth America

*ore #eer than (ater on*ore #eer than (ater on

*ayKo(er.*ayKo(er.

Slaves or#idden to drin! e&ceptSlaves or#idden to drin! e&cept

on special occasions' taughton special occasions' taught

#ingeing.#ingeing.

)uritan traditions.)uritan traditions.

1=1=thth9 Lua!ers and *ethodists9 Lua!ers and *ethodists

disapproved o hard li3uor.disapproved o hard li3uor.

*ale drin!in cult 1@2$1=2*ale drin!in cult 1@2$1=2


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Temperance movementTemperance movement

%


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Ear!" %$$sEar!" %$$s

ocaine in o!eocaine in o!e

o#acco outla(ed or #rie period.o#acco outla(ed or #rie period.

1M1N Harrison Act $$$ restricted1M1N Harrison Act $$$ restricted

opioids +associated (ith hineseopioids +associated (ith hinese

people- cocaine must no( #epeople- cocaine must no( #e

prescri#ed.prescri#ed.

*ariuana +associated (ith*ariuana +associated (ith*e&icans- State la(s in south(est*e&icans- State la(s in south(est

criminaliCed.criminaliCed.

TeetotalerTeetotaler Ototal a#stinence' Ototal a#stinence'


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+S+ Prohiition %#$0+S+ Prohiition %#$0

%33%33

DlamoriCed crime. *aaPDlamoriCed crime. *aaP

Holly(oodP5ash. lin!. HomicideHolly(oodP5ash. lin!. Homicide

rates increased.rates increased.

Dreat epression created need orDreat epression created need or

o#s.o#s.

Diancana'Diancana'Double &rossDouble &ross


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/odern War on Drugs/odern War on Drugs


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,istor" of .am!ing in,istor" of .am!ing in

+S++S+


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Themes of 8irst ,a!f ofThemes of 8irst ,a!f of

ChapterChapter

angers o potent alcohol' role oangers o potent alcohol' role o

ethnic preudice in shaping drugethnic preudice in shaping drug

legislation' unintendedlegislation' unintendedconse3uences o prohi#ition.conse3uences o prohi#ition.

%&ample o happy 7talian amily%&ample o happy 7talian amily

enoying (ine (ith their meals.enoying (ine (ith their meals. *odern 5ar on rugs' t(o$thirds*odern 5ar on rugs' t(o$thirds

o money or la( enorcement.o money or la( enorcement.


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,istor" of Addiction Treatment,istor" of Addiction Treatment

5illiam 5hite'5illiam 5hite' Slayin# t!e Dra#on(Slayin# t!e Dra#on(*istreatment o persons (ith mentally*istreatment o persons (ith mentallyillness and alcoholics in asylums.illness and alcoholics in asylums.

)ettin# *etter)ettin# *etter #y ;an Ro#ertson tells o#y ;an Ro#ertson tells oill 5. and r. o#. &ord Droups. igill 5. and r. o#. &ord Droups. igoo!. 2 million mem#ers in AA (orld(ideoo!. 2 million mem#ers in AA (orld(idetoday.today.

8elline! +8elline! +T!e Disease &once%tT!e Disease &once%t' 1M>- 9 ' 1M>- 9 types o alcoholism #ased on (orld travels:types o alcoholism #ased on (orld travels:

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


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Treatment ,istor"Treatment ,istor"

continuedcontinued 1M A*A declared alcoholism an1M A*A declared alcoholism an

illness' 1M' a disease.illness' 1M' a disease. Harold Hughes 9ounded ;7AAA.Harold Hughes 9ounded ;7AAA. HaCelden adapted 12 Step approach.HaCelden adapted 12 Step approach.

o& 2:1/reatment in ;or(ay0o& 2:1/reatment in ;or(ay0

universal health care or support.universal health care or support. )eele and


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,istor" of ,arm Reduction,istor" of ,arm Reduction

A7S in ;etherlands spa(ned ne(A7S in ;etherlands spa(ned ne(

approach' to reduce the harm.approach' to reduce the harm.

ritain' 1M>s and later.ritain' 1M>s and later.

Heroin prescri#ed. ;eedleHeroin prescri#ed. ;eedle

e&changes$I.S.e&changes$I.S.

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

spread o harm reduction approach tospread o harm reduction approach toI.S.' researcher at I. o 5ashington.I.S.' researcher at I. o 5ashington.


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Part &&Part &&5&HH.G5&HH.G

Chapter 3Chapter 3

Sustance /isuse- Dependence-Sustance /isuse- Dependence-

and the 5od"and the 5od"


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Part &&Part &&5&HH.G5&HH.G

Chapter 3Chapter 3

Sustance /isuse- Dependence-Sustance /isuse- Dependence-

and the 5od"and the 5od"


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Recent TrendsRecent Trends

evelopment o )% scans' *R7evelopment o )% scans' *R7

unctional magnetic resonanceunctional magnetic resonance

imagingimaging

raving researchraving research

;e( acts on #rain damage;e( acts on #rain damage


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DepressantsDepressantsA!coho!A!coho!

? date rapeG 1? child a#use>? date rapeG 1? child a#use+doesnBt count neglect-G 2"? o+doesnBt count neglect-G 2"? osuicide.suicide.

7nternational studies sho( high7nternational studies sho( high

correlationcorrelation(ith partner violence.(ith partner violence.

ollege student deaths per year 9ollege student deaths per year 91'=2 +;7AAA' 2>1>-1'=2 +;7AAA' 2>1>-


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8ather /artin*8ather /artin*ChalkChalk

TalksTalksBocose drun2- amorose- e!!icose-!achr"mose drun2s

Hur additions: somnos drun2-=s!eep"> c!amorose- =!oud>-scientose =2now it a!!>


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.!oa! Drin2ing Patterns.!oa! Drin2ing Patterns

%uropeans consume si& times as much%uropeans consume si& times as much

alcohol as southeast Asiansalcohol as southeast Asians

*oldova' the Cech Repu#lic' drin!*oldova' the Cech 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#eerritish and 7rish#eer


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A!coho! continuedA!coho! continued

Health efects o moderate drin!ersHealth efects o moderate drin!ersheart #enets' lo(er death rates thanheart #enets' lo(er death rates thanteetotalers.teetotalers.

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

tolerance' (ithdra(al +tremors' nauseaGtolerance' (ithdra(al +tremors' nauseaG? have s-' heavy nicotine' cafeine use? have s-' heavy nicotine' cafeine use

olerance reversalolerance reversal .N .A.. may #e comatose..N .A.. may #e comatose. lac!outs: common at ." A' case inlac!outs: common at ." A' case in TomTom

Sa+yerSa+yer Real court casesReal court cases


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'arcotics'arcotics

piatesrom opium poppyTnarcotics'piatesrom opium poppyTnarcotics'heroin no( can #e smo!ed or snorted.heroin no( can #e smo!ed or snorted.

High tolerance so need greaterHigh tolerance so need greater

3uantities or high.3uantities or high. 7nhalantshousehold products'7nhalantshousehold products'

hufing' #rain damage' comahufing' #rain damage' coma

*isuse o pain medication increasing*isuse o pain medication increasingtodaytoday

&yontin&yontin


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Stimu!antsStimu!ants

ocaine$crac! and po(der' in urine = hrs.'ocaine$crac! and po(der' in urine = hrs.'smo!ed or aster high. High lasts only 1$2>smo!ed or aster high. High lasts only 1$2>minutes.minutes.

rain #loc!s reupta!e o dopamineT Addictedrain #loc!s reupta!e o dopamineT Addicted

rats dieT heart attac!.rats dieT heart attac!. Amphetamines and methsynthetic unli!eAmphetamines and methsynthetic unli!e

cocainesuppresses appetite. Ised #y ;aCis.cocainesuppresses appetite. Ised #y ;aCis.N$1 hour high.N$1 hour high.

et!landet!land#y ;ic! Reding a#out el(ein' 7o(a.#y ;ic! Reding a#out el(ein' 7o(a. )o(der can #e snorted' inected. Stay a(a!e)o(der can #e snorted' inected. Stay a(a!eor long durationsTor long durationsT

-n!edonia-n!edonia$$$ina#ility to eel pleasure (ith$$$ina#ility to eel pleasure (ithdrug$induced #rain inury.drug$induced #rain inury.


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'icotine'icotine

an #oth stimulate and rela&. =>$M? oan #oth stimulate and rela&. =>$M? oalcoholics smo!e' reduces alcohol efects.alcoholics smo!e' reduces alcohol efects.ver hal o persons (ith schiCophreniaver hal o persons (ith schiCophreniasmo!e.smo!e.

;icotine decreases A levels.;icotine decreases A levels. American #usinessmanBs story rom hina.American #usinessmanBs story rom hina. *alachy *court smo!ed or ad and got*alachy *court smo!ed or ad and got

hoo!ed.hoo!ed. o& ".1 /o ie or a igarette0o& ".1 /o ie or a igarette0 ase o che(ing to#accosnuf.ase o che(ing to#accosnuf.


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,a!!ucinogens,a!!ucinogens

)lants' ,S' synthetic' Kash#ac!s' )))lants' ,S' synthetic' Kash#ac!s' )) %cstasy and rooesheightens sensory%cstasy and rooesheightens sensory

e&perienceTraves..e&perienceTraves..

anBt get #ac! to original high due toanBt 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.

ance Sae 9 harm reduction strategies.ance Sae 9 harm reduction strategies. Rooes: sleeping pill in %urope.Rooes: sleeping pill in %urope.


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What &s Ecstas"(What &s Ecstas"( %cstasy is a drug that%cstasy is a drug that

has somehas some

hallucinogenichallucinogenic

properties and isproperties and is

structurally relatedstructurally relatedto amphetamines. 7tsto amphetamines. 7ts

short orm chemicalshort orm chemical

name is **A +"'N$name is **A +"'N$

methylenedio&ymethmethylenedio&ymeth

am$phetamine-.am$phetamine-.Sp!it


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Short Term E?ects ofShort Term E?ects of

Ecstas"Ecstas"


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Hther S"ntheticHther S"nthetic

SustancesSustances


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CannaisCannais

*ariuana*ariuana H' the psychoactive ingredient'H' the psychoactive ingredient'

lo(ers #lood glucose' increaseslo(ers #lood glucose' increases

appetite' Stored in at cells' longappetite' Stored in at cells' longterm use possi#ly associated (ithterm use possi#ly associated (ithapathy.apathy.

%arlier reports o lung cancer ater%arlier reports o lung cancer aterlong$term use (ere not validated.long$term use (ere not validated.

Costs to .et ,ighCosts to .et ,igh


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Costs to .et ,ighCosts to .et ,igh

Estimates Di?er " RegionEstimates Di?er " Region

Vnot in te&tWVnot in te&tW

rac!: F$1> 3uic! & only lasts "> min.rac!: F$1> 3uic! & only lasts "> min.

Heroin: F1>>$2>> day$$F2> day can #yHeroin: F1>>$2>> day$$F2> day can #y

maintenance dose inect a couple o timesmaintenance dose inect a couple o times %cstasy: F2 may ta!e or so pills.%cstasy: F2 may ta!e or so pills.

*eth: F2 long$lasting high' popular in gay*eth: F2 long$lasting high' popular in gay

party scene in Seattle' actory (or!ers inparty scene in Seattle' actory (or!ers in

7o(a7o(a *ariuana: F2 or higher' depends on 3uality*ariuana: F2 or higher' depends on 3uality


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/etao!ism/etao!ism

,iver: organ that meta#oliCes alcohol',iver: organ that meta#oliCes alcohol'alcohol circulates in the #loodstreamalcohol circulates in the #loodstreamuntil 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 Osmall glass o (ine.small glass o (ine.

ne rin! Y ne #ottle o #eer +12 oC.-ne rin! Y ne #ottle o #eer +12 oC.-

Y ne glass o (ine + oC.-Y ne glass o (ine + oC.- Y ne /single0 drin! +1Y oC. o li3uor-Y ne /single0 drin! +1Y oC. o li3uor-


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/etao!ism continued/etao!ism continued


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Brain Regions and Their FunctionsBrain Regions and Their Functions


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Ecstas" and the 5rainEcstas" and the 5rain


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The 5rain and AddictionThe 5rain and Addiction

;eurotransmitters afect emotions and memory;eurotransmitters afect emotions and memory

'eurotransmitters A?ect'eurotransmitters A?ect


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'eurotransmitters A?ect'eurotransmitters A?ect

Emotions and /emor"Emotions and /emor"

opaminereupta!e afected #y cocaine'opaminereupta!e afected #y cocaine'(hich #loc!s dopamine synapse(hich #loc!s dopamine synapse

epletion ollo(ing cocaine use. ;icotineepletion ollo(ing cocaine use. ;icotine

afects dopamine too.afects dopamine too.

)ar!insonBs (hen too little. opamine$)ar!insonBs (hen too little. opamine$#oosting drugs or )ar!insonBs associated#oosting drugs or )ar!insonBs associated

(ith mania and gam#ling #ehavior.(ith mania and gam#ling #ehavior.

%&cess o dopamine associated (ith%&cess o dopamine associated (ith

schiCophrenia.schiCophrenia. Serotonin: inKuenced #y alcohol' involved inSerotonin: inKuenced #y alcohol' involved in

sleep. ecreased levels lin!ed tosleep. ecreased levels lin!ed to

depression' an&iety' impulsiveness suicide.depression' an&iety' impulsiveness suicide.


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Dep!etion 8o!!owingDep!etion 8o!!owing

Cocaine se+Cocaine se+

The right scan is ta2en from someone who is on cocaine+ TheThe 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 inand therefore is !ess active+ This reduction in activit" resu!ts in

disruption of man" rain functions+disruption of man" rain functions+


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/emor" and Craving/emor" and Craving

Addict never gets original highAddict never gets original high

#rain has changed. Addiction is a#rain has changed. Addiction is a

#rain disease.#rain disease. ues can trigger memoryTpictureues can trigger memoryTpicture

o alcoholic #everages activateso alcoholic #everages activates

certain areas o the #rain.certain areas o the #rain. )roCac reduces craving #y)roCac reduces craving #y

regulating serotonin levels.regulating serotonin levels.


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Cocaine in the BrainCocaine in the Brain

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


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Th R ! f .Th R ! f .


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The Ro!e of .enesThe Ro!e of .enes

Stud" of menta! hospita!s- prisons- 1$I who usedStud" of menta! hospita!s- prisons- 1$I who usedchemica! sustances had menta! disorders+chemica! sustances had menta! disorders+

C!oninger*Sweden++#1 ma!e adoptees withC!oninger*Sweden++#1 ma!e adoptees witha!coho!ic fathersa!coho!ic fathers

T"pe %T"pe %: !ate onset++1I of a!coho!ics- re!ates to: !ate onset++1I of a!coho!ics- re!ates to

harm avoidance- an6iet"- gui!tharm 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 onHndansetron: wor2s on serotonin- !itt!e e?ect ont"pe %t"pe %

TwinsTwins: @$0$I concurrence of a!coho!ism+: @$0$I concurrence of a!coho!ism+Separated at irth mon2e"s dran2 more underSeparated at irth mon2e"s dran2 more understress- peop!e with !ow dopamine !i2e stimu!antsstress- 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+

/ di ! C/ di ! C


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/edica! Conse4uences/edica! Conse4uences

5ernic!e Jorsa!of:5ernic!e Jorsa!of:

ases reported o r. liver Sachsases reported o r. liver Sachs

)eripheral neuropathy related to lac! o Eitamin )eripheral neuropathy related to lac! o Eitamin

ona#ulationT.r. SachsA(a!eningsona#ulationT.r. SachsA(a!enings


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/edica! Conse4uences/edica! Conse4uencescontinuedcontinued

&nterventions Re!ated to&nterventions Re!ated to


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&nterventions Re!ated to&nterventions Re!ated to5io!og"5io!og"

Schic! Shadel' Seattle treatmentSchic! Shadel' Seattle treatment

centercenter

onditioning or aversion therapyonditioning or aversion therapy

avorite drin! plus emetine to induceavorite drin! plus emetine to induce

vomiting.vomiting.

Ise o truth serum on alternate days.Ise o truth serum on alternate days.

Changing 5rainChanging 5rain


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Changing 5rainChanging 5rain

Chemistr"Chemistr" *rain "ock*rain "ock+Sch(artC- cognitive+Sch(artC- cognitive

treatment or to /re(ire the #rain0treatment or to /re(ire the #rain0 ndansetrondecreases cravingndansetrondecreases craving

Zy#anZy#anand smo!ingG hanti& helps personand smo!ingG hanti& helps personproduce more dopamine.produce more dopamine. ;icotine gumG patch.;icotine gumG patch. ;altre&one' approved 1MM' not a narcotic;altre&one' approved 1MM' not a narcotic

unli!e methadone.unli!e methadone. loc!s receptors or getting high.loc!s receptors or getting high.


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63/232

,o!istic Treatments,o!istic Treatments

Her#al remediesHer#al remedies

St. 8ohnBs (ortSt. 8ohnBs (ort

HypnosisHypnosis

Acupuncture rom hinaAcupuncture rom hina

*assage therapy*assage therapy )hysical e&ercise to reduce tension)hysical e&ercise to reduce tension

Ch @


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Chapter @Chapter @

Dender and Se&ualDender and Se&ual

rientationrientation

iferencesiferences

. d &. d &


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.ender &ssues.ender &ssues

4 Recent trends*voices of women and ga"s andRecent trends*voices of women and ga"s and!esians are increasing!" heard regarding!esians are increasing!" heard regardingtreatment- 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 #


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.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 haveWomen in treatment more !i2e!" than men to havea sustance0dependent partner+a sustance0dependent partner+

4 Treatment !ess accessi!e for mothers than fathersTreatment !ess accessi!e for mothers than fathersdue 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 oversustance misuse+sustance misuse+

4 Astinence demands unrea!istic+Astinence demands unrea!istic+

4 ac2 of treatment avai!ai!it" for pregnant women+ac2 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+



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continuedcontinued *eth addiction rates high among (omen.*eth addiction rates high among (omen. ne study sho(ed that =>? o emale meth addicts (erene study sho(ed that =>? o emale meth addicts (ere

victims o domestic violence.victims o domestic violence.

Eiolence$$$" o N intimate partner murders are o (omen.Eiolence$$$" o N intimate partner murders are o (omen.

5omen alcoholics $$$N@? in treatment molested as5omen alcoholics $$$N@? in treatment molested aschildren in study o N@2 (omen +o(ns-. reatmentchildren in study o N@2 (omen +o(ns-. reatment

needs to ocus on )S issues.needs to ocus on )S issues.

5omen smo!e to control (eight' males to relieve5omen 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 lie than men do.in lie than men do.


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5io!ogica! Di?erences5io!ogica! Di?erences

Women get into6icated 4uic2er than men+Women have a higher morta!it" rate with heav"drin2ing+

ives are shortened " %1 "ears on average witha!coho!ism*heart and !iver damage+

Womens TreatmentWomens Treatment


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Women s TreatmentWomen s Treatment

'eeds'eeds 1. Address #arriers to treatment that many (omen1. Address #arriers to treatment that many (omen

e&perience' such as lac! o transportation' child care'e&perience' such as lac! o transportation' child care'

and treatment availa#ility.and treatment availa#ility.

2. hanging program goals and processes to2. hanging program goals and processes to

accommodate (omenBs needs or more support' lessaccommodate (omenBs needs or more support' less

conrontation' o# s!ill training' and parenting s!ills.conrontation' o# s!ill training' and parenting s!ills.

". %m#racing an empo(erment model o change.". %m#racing an empo(erment model o change.

N.


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. !i Addi i. !i Addi ti


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.am!ing Addiction.am!ing Addiction

4 Dam#ling' has #ecome socially accepta#leDam#ling' has #ecome socially accepta#le4 riteria o pathological gam#ling$$$riteria o pathological gam#ling$$$

preoccupation' increasing amounts' etc.preoccupation' increasing amounts' etc."$@? o gam#lers have pro#lems' suicide"$@? o gam#lers have pro#lems' suicide

high in gam#lershigh in gam#lers4 ost to economy is FN #illionost to economy is FN #illion#an!ruptcies' lost (or! time' crime' etc.#an!ruptcies' lost (or! time' crime' etc.Eery high among ;ative AmericansoverEery high among ;ative Americansover1N? have gam#ling pro#lems1N? have gam#ling pro#lems

4 Research sho(s counties (ith gam#lingResearch sho(s counties (ith gam#lingcasinos have higher crime rates andcasinos have higher crime rates and#an!ruptcies than others#an!ruptcies than others


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.am!ing.am!ingcontinuedcontinued

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> arewomen+ 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!emsAssociated with other pro!ems

4 5o6 1+% ReNections of a /a!e Compu!sive5o6 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+


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Ouestions for ScreeningOuestions for Screening

4 ,ave "ou ever orrowed mone" in order,ave "ou ever orrowed mone" in orderto 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 thata 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 hiddenthe 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(


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Treatment &ssuesTreatment &ssues

4 Treatment: cognitive wor2 andTreatment: cognitive wor2 and

motivationa! therap"motivationa! therap"

4 &rrationa! thin2ing aout winning:&rrationa! thin2ing aout winning:

4 & put so much mone" in this& put so much mone" in thismachine-machine- &m ound to win+Q&m ound to win+Q

4 ,igh pro)!e winners,igh pro)!e winners

4 uc2" machine and datesuc2" machine and dates4 States spending on treatment003States spending on treatment003

mi!!ion is sma!! compared to #$mi!!ion is sma!! compared to #$

i!!ion in ta6 revenues from gam!ingi!!ion in ta6 revenues from gam!ing


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Eating DisordersEating Disorders

4 he only one in this chapter related to ahe only one in this chapter related to asu#stance 9 ood addiction. All others' orsu#stance 9 ood addiction. All others' or

e&ample' 7nternet addiction are #ehavioralTe&ample' 7nternet addiction are #ehavioralT

oten clients in treatment or another disorderoten clients in treatment or another disorder

4 Headline: /%ating disorders start in #rain0Headline: /%ating disorders start in #rain0

4 M>? o anore&ia and #ulimia is ound inM>? o anore&ia and #ulimia is ound in

emales.emales.

4 egins in adolescenceegins in adolescence4 .? o girls and (omen are anore&ic' 1$"?.? o girls and (omen are anore&ic' 1$"?

#ulimic.#ulimic.


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Anore6iaAnore6ia

4 ,ess than =M? o normal #ody (eight,ess than =M? o normal #ody (eightand ne #ody hair.and ne #ody hair.

4 1>? mortality rate' oten #y suicide'1>? mortality rate' oten #y suicide'

correlated (ith perectionism'correlated (ith perectionism'ritualism' high an&ietyritualism' high an&iety4 Related to o#sessive compulsiveRelated to o#sessive compulsive

disorder +-:disorder +-:4 o#sessive$$recurrent and persistento#sessive$$recurrent and persistent

thoughtsGthoughtsG4 compulsionsritualistic practices.compulsionsritualistic practices.


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5u!imia5u!imia

4 Day men at ris!.Day men at ris!.4 ulimia (ith alcohol misuse$$">$@>?.ulimia (ith alcohol misuse$$">$@>?.4 "? o #ulimics e&perienced childhood"? o #ulimics e&perienced childhood

se&ual a#use and use ood as a drug.se&ual a#use and use ood as a drug.4 ,ittle inormation on compulsive,ittle inormation on compulsive

overeating.overeating.4 ;e( studies sho( lac! o dopamine;e( studies sho( lac! o dopamine

receptors in the #rains o mor#idly o#ese.receptors in the #rains o mor#idly o#ese.4 Some ater gastric #ypass surgery turn toSome ater gastric #ypass surgery turn to

heavy drin!ing.heavy drin!ing.


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&nterventions&nterventions

4 Study in the ritish medical ournal'Study in the ritish medical ournal'"ancet"ancetndings rom t(in studiesndings rom t(in studiessho(ed that a strong craving or s(eetssho(ed that a strong craving or s(eetspredicted alcohol a#use pro#lems'predicted alcohol a#use pro#lems'perhaps caused #y a lac! o dopamine.perhaps caused #y a lac! o dopamine.

4 ulimiacognitive treatmentsG avoidulimiacognitive treatmentsG avoidstrict dietingstrict dieting

4 Anore&ia)roCac is efective inAnore&ia)roCac is efective in

reducing compulsive #ehavior #ut onlyreducing 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.

T


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TreatmentTreatment

4 vereaters anonymous +A- orvereaters anonymous +A- orcompulsive eatingGcompulsive eatingG

4 Droup treatment.. teach moderationDroup treatment.. teach moderation

4 heme oheme o neuroplasticityneuroplasticity#rain neurons#rain neuronscan orm ne( connectionsG /#rain loc!0can orm ne( connectionsG /#rain loc!0can #e corrected +Sch(artC-can #e corrected +Sch(artC-

4 o& .2 compares t(o treatmento& .2 compares t(o treatmentprogramsG the second one in JansasprogramsG the second one in Jansasity included trauma (or!ity included trauma (or!

Shopping or SpendingShopping or Spending


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Shopping or SpendingShopping or Spending

AddictionAddiction )ro#lems in a#out 2$=? o people)ro#lems in a#out 2$=? o people ypical "1 yr.old emale (ho hasypical "1 yr.old emale (ho has

overspent or 1" years.overspent or 1" years.

DS./DS./lists !leptomaniaGlists !leptomaniaG

*edications: ,uvo&*edications: ,uvo&

e#tors Anonymous groupse#tors Anonymous groupsspringing upspringing up

C Addi iC Addi i


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C"er AddictionC"er Addiction

&au#!t in t!e 0et1&au#!t in t!e 0et17nternet addicts:7nternet addicts:preoccupied' e&cessive amounts o timepreoccupied' e&cessive amounts o timeinvolved in chat rooms' playing gamesGinvolved in chat rooms' playing gamesG

8eopardiCed relationships.8eopardiCed relationships.


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8RA/ES8RA/ES

4 FFeed#ac! 9 assessment o useeed#ac! 9 assessment o use

4 RResponsi#ility 9 choice is theirsesponsi#ility 9 choice is theirs

4 AAdvice 9 set goals togetherdvice 9 set goals together

4 MMenus 9 o sel$directed changeenus 9 o sel$directed change

options +e&.$ monitor computer use-options +e&.$ monitor computer use-

4

EEmpathympathy4 SSel$eficacyel$eficacy


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,arm Reductions Strategies:,arm Reductions Strategies:

00Det a timerDet a timer

$ut mailing lists$ut mailing lists $;o detours$;o detours

S Addi iS Addi ti


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Se6 AddictionSe6 Addiction

4 Ris! ta!erRis! ta!er4 ognitive therapy recommended.ognitive therapy recommended.

4 )rone to lyingone E #roadcast)rone to lyingone E #roadcast

loo!ed at )resident lintonBsloo!ed at )resident lintonBs#ac!ground and his se&ual ris! ta!ing:#ac!ground and his se&ual ris! ta!ing:

others disagree.others disagree.

4 ase o iger 5oods.ase o iger 5oods.4 Sel$help group$$Se& AddictsSel$help group$$Se& Addicts

Anonymous.Anonymous.

C i i ThC iti Th


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Cognitive Therap"Cognitive Therap"

4 istortions especially (ith theseistortions especially (ith theseaddictions and anore&ia. endencyaddictions and anore&ia. endency

to(ards e&treme #ehavior.to(ards e&treme #ehavior.

4 Slogans o AA +/easy does it0-Slogans o AA +/easy does it0-4 Rational recovery' *%' R% moreRational recovery' *%' R% more

adversarial' ocus on current #eliesadversarial' ocus on current #elies



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continuedcontinued4 each clients to avoid #lac! and (hiteeach clients to avoid #lac! and (hite

thin!ing.thin!ing.

4 As! a#out times (hen client successullyAs! a#out times (hen client successully

handled a pro#lem.handled a pro#lem.

4 Ise regular assessment or disease oIse regular assessment or disease o

addiction.addiction.

4


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Therap"Therap"

4 )ositive reraming and sel tal!T.)ositive reraming and sel tal!T.ognitive therapy can #e directed to(ardognitive therapy can #e directed to(ard

the past as (ell as the present.the past as (ell as the present.

4


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Part &&Part &&

Ps"cho!og" Hf AddictionPs"cho!og" Hf Addiction

Chapter Chapter

Addiction across the !ife spanAddiction across the !ife span


90/232

Adolescent rainAdolescent rain


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do esce t a

4 )rerontal corte& matures until)rerontal corte& matures untilmid$2>smid$2>s

4 %vidence o #rain immaturity%vidence o #rain immaturity

during the teen years comes romduring the teen years comes rom*R7 scans o the adolescent #rain*R7 scans o the adolescent #rain

Teenage Drin2ing seTeenage Drin2ing se


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g gg g

4 7dentity vs role conusion7dentity vs role conusion

4 Alcohol is the drug o choice #yAlcohol is the drug o choice #yAmerican 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 ISthan previouslythan previously

A tiArgentina


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ArgentinaArgentina

4 1 year old e&change student ound:1 year old e&change student ound:4 ;o drin!ing age;o drin!ing age

4 5ine or #eer (ith supper5ine or #eer (ith supper

4 rin!ing to #e social not to get drun!rin!ing to #e social not to get drun!

4 5hat the I.S. can learn rom5hat the I.S. can learn rom

ArgentinaArgentina

4


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Parents in PrisonParents in Prisonoss 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 andunemp!o"ment>+Twice the odds of deve!oping serious menta! hea!thpro!ems+

A?ects and times more !ac2 chi!dren+

E ropean s S Go thEuropean vs S Gouth


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European vs+ +S+ GouthEuropean vs+ +S+ Gouth

Alcohol use more prevalent in %uropeAlcohol use more prevalent in %uropee&cept in *editerranean countries. 7relande&cept in *editerranean countries. 7reland

vs. 7taly. riving allo(ed at age 1=.vs. 7taly. riving allo(ed at age 1=.

22? %uropeans smo!e vs. 1N? Americans22? %uropeans smo!e vs. 1N? Americansat ages 1$1.at ages 1$1.

)eele argues in)eele argues in-ddiction roof 3our &!ild-ddiction roof 3our &!ild

or *editerranean moderate drin!ingor *editerranean moderate drin!ing

pattern in the home.pattern in the home. 7llicit drug use in %urope hal that o I.S.7llicit drug use in %urope hal that o I.S.


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2>1> Sc oo an %Rc oo anSurveysSurveys


98/232

SurveysSurveys

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 drunkdrownings, etc., one-third of high school seniors get drunkonce a month or more; (same in Canada)once a month or more; (same in Canada)

Almost all current smokers also drank alcoholAlmost all current smokers also drank alcohol School sure!s show African American and "atino seniorsSchool sure!s show African American and "atino seniors

hae rates of illicit drug use lower than that of whites; thehae rates of illicit drug use lower than that of whites; thereerse is true among #reerse is true among # ththgraders.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 maor rolem.isits among !outh.*+!Contin a maor rolem.

5usiness Ang!e5usiness Ang!e


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5usiness Ang!e5usiness Ang!e

Rivera ,ive: F1> #illion alcohol consumed #yRivera ,ive: F1> #illion alcohol consumed #yunder 21under 21

44 eer and li3uor companies most (ell undedeer and li3uor companies most (ell undedlo##ies o people in ongress.lo##ies o people in ongress.

=>? o adult smo!ers start as children so #ig=>? o adult smo!ers start as children so #igincentive to mar!et to !ids.incentive to mar!et to !ids.

%&tensive mar!eting o casinos.%&tensive mar!eting o casinos.

"9=2? o teenagers +12$ to 1@$year$olds-"9=2? o teenagers +12$ to 1@$year$olds-

gam#le each year' N9@? o teens e&hi#it seriousgam#le each year' N9@? o teens e&hi#it seriouspatterns o disordered gam#ling.patterns o disordered gam#ling.

Societ"s &nNuencesSociet"s &nNuences


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Societ"s &nNuencesSociet" s &nNuences

4 o#acco companies targeting !idsGo#acco companies targeting !idsG

4ield and4ield andStreamStreamads orads or

smo!eless to#accosmo!eless to#acco

4 hildren learn gam#ling on thehildren learn gam#ling on the

7nternetG7nternetG

4 Eideo po!er' slot machines' and theEideo po!er' slot machines' and the

lotterylottery4 Strenuous e&ercise programsStrenuous e&ercise programs

reduce smo!ing. Smo!ing may #ereduce smo!ing. Smo!ing may #e

considered a gate(ay drug.considered a gate(ay drug.

Ris2s for SustanceRis2s for Sustance


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/isuse/isuseAH' trauma in early childhood' poorAH' trauma in early childhood' poor

role models.role models.

Se&ual a#use leads to sense o shame.Se&ual a#use leads to sense o shame.

rauma changes #rain chemistry andrauma changes #rain chemistry andreduces later a#ility to cope (ith stress.reduces later a#ility to cope (ith stress.

7nKuence o high stress and drin!ing'7nKuence o high stress and drin!ing'

ound in uvenile mouse studies.ound in uvenile mouse studies.

Hther Ris2 8actorsHther Ris2 8actors


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Hther Ris2 8actorsHther Ris2 8actors

4 ur#ulent teen$ather relationshipur#ulent teen$ather relationship4 hild a#use and other traumahild a#use and other trauma4 Jids (ho start smo!ing earlyJids (ho start smo!ing early4 Smo!ing can #e considered a gate(aySmo!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 Arican American girls.rate among Arican American girls.

4 *edia$generated (eight o#session' a*edia$generated (eight o#session' amaor pro#lem among girls o %uropeanmaor pro#lem among girls o %uropean

American ethnicity.American ethnicity.4 #session leads to maor pro#lems (ith#session leads to maor pro#lems (ith

eating' such as anore&ia and #ulimia.eating' such as anore&ia and #ulimia.

)re ictions romre ct ons romScandinavia:Scandinavia:


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Scandinavia:Scandinavia:

44 High ris!: girls (ho cry easily (hen teasedHigh ris!: girls (ho cry easily (hen teasedare an&ious and shy.are an&ious and shy.

44 *ale aggression at age = predicted*ale aggression at age = predictedalcoholism 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:

99 High novelty see!ingHigh novelty see!ing

99 ,o( harm avoidance +dare devil #ehavior-,o( harm avoidance +dare devil #ehavior-

oth traits predicted early$onset alcoholism.oth traits predicted early$onset alcoholism.


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Ris!s or DirlsRis!s or Dirls


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4 aughters o alcoholics ataughters o alcoholics atincreased ris! or alcoholism.increased ris! or alcoholism.

4 eenage girls (ho are heavyeenage girls (ho are heavy

drin!ers are:drin!ers are:4 ve times more li!ely to engage inve times more li!ely to engage in

se&ual intercourse.se&ual intercourse.

4 a third less li!ely to use condomsa third less li!ely to use condoms4 more li!ely to practice unsae se&.more li!ely to practice unsae se&.

Ris2s for 5o"s:Ris2s for 5o"s:


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Ris2s for 5o"s:Ris2s for 5o"s:

44 Study o priest a#use victims sho(edStudy o priest a#use victims sho(edhigh heavy alcohol use rate.high heavy alcohol use rate.

iggest threat to lie and health origgest threat to lie and health or

adolescent #oys is alcohol$relatedadolescent #oys is alcohol$relatedaccidentsaccidents

44 *ale counterpart to anore&ia in*ale counterpart to anore&ia in

emales is muscle dysmorphia.emales is muscle dysmorphia.44 ysmorphia a diagnosis in S*.ysmorphia a diagnosis in S*.

/ore Ris2s for 5o"s/ore Ris2s for 5o"s


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/ore Ris2s for 5o"s/ore Ris2s for 5o"s

4 #sessive #ody #uilding maor#sessive #ody #uilding maor

pro#lem or young malespro#lem or young males

4 Revealed in popularity o ana#olicRevealed in popularity o ana#olicsteroidssteroids

4 Steroids used #y 2.@ ? o maleSteroids used #y 2.@ ? o male

high school seniors.high school seniors.4 Health haCards: stunted gro(th'Health haCards: stunted gro(th'

acne' andacne' and

shrin!ing testiclesshrin!ing testicles

Co!!ege StudentsCo!!ege Students


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Co!!ege StudentsCo!!ege Students

4 ase o college pledge in olorado (ho died ooverdoseG police not called out o ear o under$21drin!ing la(s. ,a( passed 1M=N.

History o la(1M=>s to cur# drin!ing$and$drivingHistory o la(1M=>s to cur# drin!ing$and$drivingdeaths' rdeaths' role o *A and ;7AAA.

SA*HSA 2>1> survey o past month"."?"."?college students (ere current drin!ers' N2.1? (erecollege students (ere current drin!ers' N2.1? (ere

#inge drin!ers +dran! N$ drin!s at a time-' and#inge drin!ers +dran! N$ drin!s at a time-' and

1.? (ere heavy drin!ers +#inge dran! or more1.? (ere heavy drin!ers +#inge dran! or more

times-.times-.

Ris! o age 21 #irthday cele#rations.

Ameth"st &nitiativeAmeth"st &nitiative


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Ameth"st &nitiativeAmeth"st &nitiative

ver 12> college presidents signed statement tover 12> college presidents signed statement toconsider revising under$21 drin!ing la(.consider revising under$21 drin!ing la(.

*A notes lives saved rom 1M=2 to 1MM=. 1?*A notes lives saved rom 1M=2 to 1MM=. 1?

e(er atal crashes under age 21 and a ?e(er atal crashes under age 21 and a ?

decrease among 21$to 2N$year$olds.decrease among 21$to 2N$year$olds. *ay have #een result o stricter drin!ing la(s*ay have #een result o 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!ingandanddriving la(s. ;ote reduction in over age 21.driving la(s. ;ote reduction in over age 21.

5inge Drin2ing: Co!!ege5inge Drin2ing: Co!!ege


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5inge Drin2ing: Co!!ege5inge Drin2ing: Co!!ege

44 I.S. government imposed nation(ideI.S. government imposed nation(ideminimum drin!ing age o 21 in the 1M=>s'minimum drin!ing age o 21 in the 1M=>s'

the attempt to curtail drun!en driving #ythe attempt to curtail drun!en driving #y

youth.youth.

44


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/odern 8orm of Prohiition/odern 8orm of Prohiition

44 ritics argue students are drivenritics argue students are driven

to partying underground and a(ayto partying underground and a(ay

rom aculty supervision.rom aculty supervision.

44 ;e( campaigns or moderate;e( campaigns or moderate

drin!ing encouraged #y Iniversitydrin!ing encouraged #y Iniversity

o 5ashington +Alan *arlatt-o 5ashington +Alan *arlatt-

research.research.44 Social norms campaign (ithSocial norms campaign (ith

messages o moderation (eremessages o moderation (ere

unsuccessulunsuccessul

'eed for ,arm Reduction'eed for ,arm Reduction


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'eed for ,arm Reduction'eed for ,arm Reduction

4 ollege ne(spaper slo( to restrictollege ne(spaper slo( to restrictenticing #eer ads.enticing #eer ads.

4 *ost #inge drin!ers mature out o (ild*ost #inge drin!ers mature out o (ilddrin!ing days o early adulthood. ut overdrin!ing days o early adulthood. ut over

1'=>> college students die each year rom1'=>> college students die each year romalcohol$related inuries. Rape and unsaealcohol$related inuries. Rape and unsaese&.se&.

4 igarettes$$a#stinence pro#a#ly (or!sigarettes$$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 escapeto #e cool' using drugs to escape4 *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


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4 ;eed or drug courts$$important or amily;eed or drug courts$$important or amilypreservation and closely supervised treatmentpreservation and closely supervised treatment

4


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from Socia! Ps"cho!og"from Socia! Ps"cho!og"


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/i!!er and Ro!!nic2: /& Strategies/i!!er and Ro!!nic2: /& Strategies

raps to avoid:raps to avoid:9 )remature ocus' such as on clientBs9 )remature ocus' such as on clientBs

addictive #ehavioraddictive #ehavior

99 onrontational round #et(eenonrontational round #et(eentherapisttherapist

and client over denialand client over denial

99 ,a#eling trap$$orcing the individual to,a#eling trap$$orcing the individual to

accept a la#el alcoholic or addictaccept a la#el alcoholic or addict 99 laming trap' allacy that is especiallylaming trap' allacy that is especially

pronounced in couplesB counselingpronounced in couplesB counseling

Primar" PreventionPrimar" Prevention


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Primar" PreventionPrimar" Prevention

hild a#use' early$preventionhild a#use' early$preventioneducation and treatment programseducation and treatment programs

Smo!ing education to !eep youthsSmo!ing education to !eep youths

rom ever starting to smo!erom ever starting to smo!e Health and s!ill education at schoolsHealth and s!ill education at schools Reducing ads promoting addictiveReducing ads promoting addictive

#ehavior#ehaviorAdvocacy or the hiring o moreAdvocacy or the hiring o more

school counselors and social (or!ersschool counselors and social (or!ers


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/otivationa! Enhancement/otivationa! Enhancementcontinued:continued:


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continued:continued:

Stage o change:Stage o change: ontemplationontemplation4 As!: Ho( (as lie #etter #eore drugAs!: Ho( (as lie #etter #eore drug

use6use6

4 %mphasiCe choices%mphasiCe choices4 ypical 3uestions are:ypical 3uestions are:

$5hat do you get out o drin!ing6$5hat do you get out o drin!ing6

$5hatBs the do(n side6$5hatBs the do(n side6


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Preparation Stage:Preparation Stage:


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Preparation Stage:Preparation Stage:

4 Setting the dateSetting the date

4 5hat do you thin! (ill (or! or you65hat do you thin! (ill (or! or you6

4 Adolescent comments' /7Bm eelingAdolescent comments' /7Bm eeling

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:


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Action Stage:Action Stage:

Adolescent comment: /Staying clean mayAdolescent comment: /Staying clean may#e healthy' #ut it sure ma!es or a dull#e healthy' #ut it sure ma!es or a dull

lie. *ay#e 7Bll chec! out one o thoselie. *ay#e 7Bll chec! out one o those

groups.0groups.0

//herapist: /5hy donBt you loo! at (hatherapist: /5hy donBt you loo! at (hat

othersothers have done in this situation60have done in this situation60

Help locate an appropriate group.Help locate an appropriate group.

/aintenance Stage:/aintenance Stage:


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/aintenance Stage:/aintenance Stage:

Adolescent comment:Adolescent comment://7tBs #een a e( monthsG 7Bm not there yet7tBs #een a e( monthsG 7Bm not there yet

#ut 7Bm hanging out (ith some ne(#ut 7Bm hanging out (ith some ne(

riends...0riends...0

.ender Speci)c Approach for.ender Speci)c Approach for


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.ender Speci)c Approach for.ender Speci)c Approach for

.ir!s.ir!s4 %3uality does not mean sameness.%3uality does not mean sameness.4 )rograms or girls do #etter (hen)rograms or girls do #etter (hen

they ocus on relationships.they ocus on relationships.

4 5aterloo'7o(a $$group home$$5aterloo'7o(a $$group home$$

Lua!erdale specialiCes in care oLua!erdale specialiCes in care o

teenage girls.teenage girls.4 ,earning o lie s!ills,earning o lie s!ills

4 Daining competency as in artDaining competency as in art

Pro!ems in /idd!ePro!ems in /idd!e

Ad !th dAd !th d


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Adu!thoodAdu!thood Relapse pro#lems.Relapse pro#lems. 7mpact o #a#y #oom generation7mpact o #a#y #oom generation

illicit drug use dou#led 2>>2$2>>@ inillicit drug use dou#led 2>>2$2>>@ in

over > age group.over > age group. .? use illicit drugs over age 2G.? use illicit drugs over age 2G

most is mariuana.most is mariuana.

1>.=? o pregnant (omen drin!G 11>.=? o pregnant (omen drin!G 1in smo!e.in smo!e.

Ris2 to Comat FeteransRis2 to Comat Feterans


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Ris2 to Comat Feteranss to Co at ete a s

*ost pro#lems o EA clients (ith su#stance*ost pro#lems o EA clients (ith su#stanceuse and )S in younger age group' #utuse and )S in younger age group' #ut

11? are older.11? are older.

rauma is common. )S among emalerauma is common. )S among emale

veterans (ho (ere se&ually victimiCedveterans (ho (ere se&ually victimiCed

+1? (ere victimiCed-.+1? (ere victimiCed-.

;eed or treatmentG more is #eing done;eed or treatmentG more is #eing done

today.today. ;eed to control mar!eting o alcohol and;eed to control mar!eting o alcohol and

cigarettes to soldierscigarettes to soldiers..

SustanceSustanceAuse amongAuse amongH!der Adu!tsH!der Adu!ts


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H!der Adu!tsH!der Adu!ts

4 1"? o I.S. population over age .1"? o I.S. population over age .4 *ore men (ith alcohol pro#lems*ore men (ith alcohol pro#lems

4 lder adults consume 2>$2? o alllder adults consume 2>$2? o all

prescription medicationsprescription medications4 (o types o alcoholism: early and(o types o alcoholism: early and

late onsetlate onset

4 %arly onset$ $ more severe levels o%arly onset$ $ more severe levels o

depression and an&ietydepression and an&iety


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129/232

SA/,SA #$%$ TreatmentSA/,SA #$%$ Treatment

R tReport


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ReportReport

1 o = persons over age > sought help1 o = persons over age > sought helpor su#stance use in 2>>=.or su#stance use in 2>>=.

heir share o treatment admissionsheir share o treatment admissions

dou#leddou#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


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4 *any early onset sufer rom*any early onset sufer rom

Jorsa!ofBs syndrome and otherJorsa!ofBs syndrome and other

alcohol$related neurologicalalcohol$related neurological

pro#lems.pro#lems.

4 *edical complications:*edical complications:4 Hip racture' suicide' #rain damageHip racture' suicide' #rain damage

4 ,ate onsetTmore (omen here',ate onsetTmore (omen here'

close amily tiesclose amily ties

Counse!ing H!der C!ientsCounse!ing H!der C!ients


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gg

4 57 and efect on sel image57 and efect on sel image4 Age segregated vs. mi&ed ages inAge segregated vs. mi&ed ages in

treatmenttreatment

4 Duidelines or (or! in groups (ithDuidelines or (or! in groups (ithelderly:elderly:

4 $Avoid strong language' re#uild$Avoid strong language' re#uild

support systemssupport systems4 $Jeep pace slo($Jeep pace slo(

Re!apse Prevention:Re!apse Prevention:


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pp

4 each older clients to learn the (arning signseach older clients to learn the (arning signsand high ris! eventsGand high ris! eventsG

4 Revie( eelings that led to relapse so they can #eRevie( eelings that led to relapse so they can #e

avoided +or e&ample' depression-G HA,avoided +or e&ample' depression-G HA,

4


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4 Anticipate eelings o guilt andAnticipate eelings o guilt andshame in older clients in trou#leshame in older clients in trou#le

(ith the la(G(ith the la(G

4 AgeismAgeism4 ountertranserenceountertranserence

4 enial in assessmentenial in assessment

4 Sympathy not empathySympathy not empathy

oss and grief in fami!" memersoss and grief in fami!" memers

of addicted persons:of addicted persons:


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of addicted persons:of addicted persons:

ypes o Duiltypes o Duilt Survivor guiltSurvivor guilt

HelplessnessHelplessness

Am#ivalenceAm#ivalence Spiritual healingsense oSpiritual healingsense o

meaning' connectednessmeaning' connectedness

Strength rom 12 StepsStrength rom 12 Steps

Spiritua! ,ea!ingSpiritua! ,ea!ing


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p gp g

oday' social (or! education stressesoday' social (or! education stressesimportance o helping clients nd spiritualimportance o helping clients nd spiritual

meaning.meaning.

lder adults oten change their outloo! aslder adults oten change their outloo! as

they loo! #ac! on their lives. See! or thethey loo! #ac! on their lives. See! or themeaning o lie.meaning o lie.

Higher )o(er as nature in ;or(ay' ;ativeHigher )o(er as nature in ;or(ay' ;ative

American traditions.American traditions.

Search or orgiveness and rene(al.Search or orgiveness and rene(al.

12 Steps as guide to sel !no(ledge12 Steps as guide to sel !no(ledge

Chapter : Screening andChapter : Screening and

AssessmentAssessment


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hapter ocus on strengths perspective.hapter ocus on strengths perspective.Advantages o doing assessment: getAdvantages o doing assessment: get

inormation' match to counselor' getinormation' match to counselor' get

insurance reim#ursement or diagnosis.insurance reim#ursement or diagnosis. isadvantages: may set up alseisadvantages: may set up alse

e&pectations or specialiCed treatment'e&pectations or specialiCed treatment'

delays actual treatment' may #edelays actual treatment' may #e

inappropriate or many minority groups.inappropriate or many minority groups.

Screening &nstrumentsScreening &nstruments


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gg

onsist o ust a e( 3uestions toonsist o ust a e( 3uestions todetermine nature o help needed.determine nature o help needed.

7normal 3uestions li!e' /o you7normal 3uestions li!e' /o you

sometimes drin!60sometimes drin!60 %fective one$3uestion screen or%fective one$3uestion screen or

(omen: /Ho( many times in the(omen: /Ho( many times in the

past year have you had our or morepast year have you had our or moredrin!s in a day60drin!s in a day60

CA.ECA.E


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Have you ever elt you ought to cut do(n on Have you ever elt you ought to cut do(n onyour drin!ing or drugyour drin!ing or drug

use6use6

A Have people annoyed you #y criticiCing yourA Have people annoyed you #y criticiCing your

drin!ing or drug use6drin!ing or drug use6 D Have you ever elt #ad or guilty a#out yourD Have you ever elt #ad or guilty a#out your

drin!ing or drug use6drin!ing or drug use6

% Have you ever had a drin! or used drugs rst% Have you ever had a drin! or used drugs rst

thin! in the morningthin! in the morning to steady your nerves or get rid o a hangover6to steady your nerves or get rid o a hangover6

TWEAKTWEAK


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oleranceolerance 5orried5orried

%ye peners%ye peners

AmnesiaAmnesia

Jut do(nJut do(n

5or!s (ell (ith mi&ed5or!s (ell (ith mi&edethnic populationsethnic populations

AD&TAD&T


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Recommended #y 5H or glo#al use.Recommended #y 5H or glo#al use. he AI7 includes 1> items thathe AI7 includes 1> items that

cover amount and re3uency ocover amount and re3uency o

drin!ing' alcohol dependencedrin!ing' alcohol dependencesymptoms' personal pro#lems' andsymptoms' personal pro#lems' and

social pro#lemssocial pro#lems

//Have you or someone else #eenHave you or someone else #eeninured #ecause o your drin!ing60inured #ecause o your drin!ing60

AD&T continuedAD&T continued


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Scoring discriminates #et(een diferentScoring discriminates #et(een diferentlevels o ris!haCardous' harmul' andlevels o ris!haCardous' harmul' and

possi#le dependence.possi#le dependence.

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

3uestionnaire3uestionnaire

to ll out' or it can #e used as intervie(to ll out' or it can #e used as intervie(

3uestions.3uestions.

Availa#le or ree on the 7nternet.Availa#le or ree on the 7nternet.

Assessment Too!sAssessment Too!s


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+SA- +2>>- denes assessment as+SA- +2>>- denes assessment asthe /process or dening the naturethe /process or dening the nature

o the pro#lem and developingo the pro#lem and developing

specic treatment recommendationsspecic treatment recommendationsor addressing the pro#lem.0or addressing the pro#lem.0

an give a deeper picture oan give a deeper picture o

motivation to change.motivation to change. an #e #eginning o relationship.an #e #eginning o relationship.

.am!ing Assessment.am!ing Assessment


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Dam#lers Anonymous has 2> 3uestions toDam#lers Anonymous has 2> 3uestions todetermine i someone has a pro#lem. %&amples:determine i someone has a pro#lem. %&amples:

id you ever lose time rom (or! or school dueid you ever lose time rom (or! or school due

to gam#ling6to gam#ling6

Has gam#ling ever made your home lieHas gam#ling ever made your home lieunhappy6unhappy6

id gam#ling afect your reputation6id gam#ling afect your reputation6

Have you ever elt remorse ater gam#ling6Have you ever elt remorse ater gam#ling6

id you ever gam#le to get money (ith (hich toid you ever gam#le to get money (ith (hich topay de#ts or other(ise solve nancialpay de#ts or other(ise solve nancial

dificulties6dificulties6


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The SASS&The SASS&


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he Su#stance A#use Screening 7nventoryhe 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 instrumentsA diferent approach to assessment instruments

does not as! directly a#out su#stance misusedoes not as! directly a#out su#stance misuse

on one side o the orm.on one side o the orm. onsists o true$alse items. such as /7 am otenonsists o true$alse items. such as /7 am oten

resentul'0 and /7 li!e to o#ey the la(.0resentul'0 and /7 li!e to o#ey the la(.0

Assessing eve!s of CareAssessing eve!s of Care


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%arly 7ntervention%arly 7ntervention utpatient reatmentutpatient reatment

7ntensive utpatientP)artial7ntensive utpatientP)artial

HospitaliCation reatmentHospitaliCation reatment ResidentialP7npatient reatmentResidentialP7npatient reatment

*edically *anaged 7ntensive 7npatient*edically *anaged 7ntensive 7npatient

reatment.reatment.

%ach level o care includes several layers%ach level o care includes several layers

o intensity.o intensity.

ASSESS/E'T H8 PERSH'SASSESS/E'T H8 PERSH'S

W&T, CH0HCCRR&'.W&T, CH0HCCRR&'.


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W&T, CH HCCRR&'.W&T, CH HCCRR&'.

D&SHRDERS =CHD>D&SHRDERS =CHD>A #asic program rom the SAA #asic program rom the SAprovides treatment or one disorder'provides treatment or one disorder'

#ut screens or the other disorderG#ut screens or the other disorderG

An intermediate level ocusesAn intermediate level ocusesprimarily on one disorder #ut alsoprimarily on one disorder #ut also

addresses some specic needs o theaddresses some specic needs o the

other.other.

Advanced level provides services orAdvanced level provides services or

#oth disorders.#oth disorders.

.uide!ines for.uide!ines for

Assessment of CHDAssessment of CHD


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Assessment of CHDAssessment of CHD e amiliar (ith latest S* and criteriae amiliar (ith latest S* and criteria

or diagnosis.or diagnosis.

Jeep up to date on the relevantJeep up to date on the relevant

psychiatric medications.psychiatric medications.

Harm reduction therapists recommendHarm reduction therapists recommend

only contacting amily mem#ers andonly contacting amily mem#ers and

others i clients so (ish and (ith theothers i clients so (ish and (ith the

client present.client present. Jno( the community resources.Jno( the community resources.

Assessment of H!derAssessment of H!der

C!ientsC!ients


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C!ientsC!ients Ris! actors or gam#ling pro#lems are:Ris! actors or gam#ling pro#lems are:the presence o current posttraumaticthe presence o current posttraumatic

stress disorder symptoms' minority racestress disorder symptoms' minority race

or ethnicity' and #eing a Eeterans Afairsor ethnicity' and #eing a Eeterans Afairs+EA- patient.+EA- patient.

hereore include 3uestions a#outhereore include 3uestions a#out

gam#ling.gam#ling.

AD% and *ASDeriatric version areAD% and *ASDeriatric version arevalidated or use (ith older adults.validated or use (ith older adults.

ASSESS/E'T 8HRASSESS/E'T 8HR

STRE'.T,SSTRE'.T,S


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STRE'.T,SSTRE'.T,S Eie( clients as in charge o their o(n goals.Eie( clients as in charge o their o(n goals. a!e into account social actors as (ell asa!e into account social actors as (ell as

individual actors or a comprehensive vie(individual actors or a comprehensive vie(

o the situation.o the situation.

*ove the assessment to(ard strengths' #oth*ove the assessment to(ard strengths' #othintrapersonal +motivation' emotionalintrapersonal +motivation' emotional

strengths and a#ility to thin! clearly- andstrengths and a#ility to thin! clearly- and

interpersonal +amilyinterpersonal +amily

net(or!s' etc.net(or!s' etc.

Avoid identiying the person (ith a la#el.Avoid identiying the person (ith a la#el.

Strengths AssessmentStrengths Assessment

continuedcontinued


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continuedcontinued

Jey ingredients:Jey ingredients: %mpathy.%mpathy.

)rovide hope.)rovide hope. ReKective listening.ReKective listening.

End of Chapters %0End of Chapters %0


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154/232

;eed or assessment orms to #e;eed or assessment orms to #esensitive to genderPcultural diferencessensitive to genderPcultural diferences

,anguage diferences' e.g.' the (ord,anguage diferences' e.g.' the (ordcravin#cravin# hard to translatehard to translate

AD% and 5%AJ (or! (ell (ithAD% and 5%AJ (or! (ell (ith(omen(omen

CA.ECA.E


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Have you tried utting do(n6Have you tried utting do(n6 Have people Annoyed you6Have people Annoyed you6

Have you elt Duilty a#out yourHave you elt Duilty a#out your

A use6A use6 Have you ever used A as an %yeHave you ever used A as an %ye

opener6opener6

Hther Screening 8ormsHther Screening 8orms


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AI7 developed #y 5H or alcoholAI7 developed #y 5H or alcoholuseuse

;7AAA> item instrument' 7nventory;7AAA> item instrument' 7nventoryo rug Ise onse3uences' in pu#lico rug Ise onse3uences' in pu#licdomaindomain

5H designated areas o harm caused5H designated areas o harm caused#y drin!physical' emotional' health'#y drin!physical' emotional' health'amily' nances' etc.amily' nances' etc.

Chapter


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Strengths0 and Evidence0Strengths0 and Evidence05ased ,e!ping Strategies5ased ,e!ping Strategies

Dennis Sa!eee"Dennis Sa!eee"


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8ocus on possii!ities- choices*providing8ocus on possii!ities- choices*providingtreatment 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"


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8ocus on possii!ities- choices*providing8ocus 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 ! Saleee! as a ersatileStrengths-ased ractice defined ! Saleee! as a ersatile

ractice aroach, rel!ing heail! on ingenuit! and creatiit!./ractice aroach, rel!ing heail! on ingenuit! and creatiit!./

&ssue of Se!f0&ssue of Se!f0DeterminationDetermination


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DeterminationDetermination

Ho( do (e honor clientBs sel$determinationHo( do (e honor clientBs sel$determination(hen the client is harming himsel$hersel(hen the client is harming himsel$hersel

(ith su#stance misuse6(ith su#stance misuse6

1.Right o choice should #e e&tended to all1.Right o choice should #e e&tended to all

social classesG as it is people in poverty havesocial classesG as it is people in poverty havear less choice than those at high incomear less choice than those at high income

levels.levels.

2. 7mportance o providing options.2. 7mportance o providing options.

A#stinence$#ased models do not.A#stinence$#ased models do not.

". Attend to readiness o client to change.". Attend to readiness o client to change.

8irst of 8our /ode!s of Strengths08irst of 8our /ode!s of Strengths05ased Approaches5ased Approaches


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1.1.Harm reductionHarm reduction: pu#lic health model': pu#lic health model'prevention' outreach.prevention' outreach.

A#stinence not precondition to treatmentGA#stinence not precondition to treatmentGrecovery can #e measured through degree orecovery can #e measured through degree oimprovement.improvement.

Stages o hange *odel: )rochas!a andStages o hange *odel: )rochas!a andilementeilemente

)recontemplation)recontemplation

ontemplationontemplation

)reparation)reparation

ActionAction

*aintenance*aintenance

RelapseRelapse

,arm Reduction,arm ReductionStrategiesStrategies


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StrategiesStrategies

)ractitioners are advised to ocus on harms)ractitioners are advised to ocus on harmsother than su#stance use' such asother than su#stance use' such as

unemployment' poverty' need or housing.unemployment' poverty' need or housing.

Dam#ling pro#lems can #e prevented #yDam#ling pro#lems can #e prevented #y

removing gam#ling machines romremoving gam#ling machines romshopping centers' strip malls' clu#s' andshopping centers' strip malls' clu#s' and

hotels.hotels.

ther support services' such as mentalther support services' such as mentalhealth and nancial counseling should #ehealth and nancial counseling should #e

readily availa#le.readily availa#le.

##.. /otivationa! &nterviewing/otivationa! &nterviewing=/&>000Wi!!iam /i!!er=/&>000Wi!!iam /i!!er


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ened as a /client$centered' directiveened as a /client$centered' directive method or enhancing intrinsic motivationmethod or enhancing intrinsic motivation

to change #y e&ploring and resolvingto change #y e&ploring and resolving

am#ivalence.0am#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 doinga#out a period (hen you (ere doing

(ell60(ell60

Smo!ing: on a scale o 1$1> to give upSmo!ing: on a scale o 1$1> to give upsmo!ing' (here are you no(6smo!ing' (here are you no(6

/& continued/& continued


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Steps to enhance motivation:Steps to enhance motivation:%&press empathy%&press empathy

evelop discrepancyevelop discrepancy

Avoid argumentationAvoid argumentationRoll (ith resistanceRoll (ith resistance

Support sel$eficacySupport sel$eficacy

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