2. Objectives
Define
Review models of Addiction
Understand definition of addiction within
common models
Common Symptoms and consequences
Identify important co-occurring disorders
Familiarize yourself: addiction within
special populations
Implications for practice
Case Studies
3. Models of Addiction
Moral/ Temperance Model
◦ Sin or Crime
◦ Personal Flaw/Weakness
◦ Failure in personal responsibility (control)
Disease of Medical
◦ Genetic and Biological Factors
Behavioral and Cog-Bx Models
◦ Conditioning and reinforcement
◦ Social learning and modeling
◦ Drug expectancies cognitive factors
Family
◦ Family disease and systems
◦ Behavioral and marital and family
Harm Reduction
◦ Decrease harm created by addiction, does not necessary eliminate addictive behavior
◦ Ex: Needle exchange programs
Life Process Model
◦ Habit, not Disease
◦ Biological factors that account for medical model are not identified
12-Step Framework
◦ Addiction is result of spiritual malady, surrender and relationship with Higher Power, Service work and mentoring can
help avoid relapse
◦ Contains all models listed above except harm reduction (abstinence based)
◦ Terminology- Alcoholic, Addict
4. Define Addiction
America Heritage Dictionary:
◦ Compulsive physiological and psychological need for
a habit-forming substance: a drug used in the
treatment of heroin addiction.
◦ An instance of this: a person with multiple chemical
addictions.
◦ The condition of being habitually or compulsively
occupied with or involved in something.
◦ An instance of this: had an addiction for fast cars
Medical Model:
◦ DSM, ICD-9 Criteria
◦ the onset and development of addiction are
influenced though genetic predisposition and
environmental factors
◦ Brain Disease- Chronic, progressive and relapsing
with no cure, but treatable
5. Common
Symptoms, Consequences
Clinical signs: Withdrawal and signs of
Physical Identification
intoxication
Identify social predeterminates/risk in
assessment
◦ Resources (are basic needs met? i.e. food, shelter,
clean water, healthcare)
◦ Cultural and racial, ethnic discrimination
◦ Gender and Personal Identity (Female/Male, GLBT)
◦ Age (first use, stage of life)
◦ Community (social stratification)
Corrections Populations
Child Welfare System
Trauma and domestic violence
Mental Health Symptoms (Comorbidity)
Chronic Pain
6. Co-Occurring Disorders
Definition- Presence of mental health and substance use disorder
◦ Adults with mental illness/substance use disorders are twice as likely to
have incomes less than 150% of poverty level as adults without either
disorder
◦ Over 8.9 million persons have co-occurring disorders
Depression and anxiety exist in 20-50% of people with
alcoholism, cocaine and other stimulant disorders
◦ Only 7.4% of individuals receive treatment for both conditions with 55.8%
receiving no treatment at all.
◦ 24% of Medicaid recipients had psychiatric conditions, cardiovascular
disease and central nervous disorders
◦ Women more at risk of anxiety, depression and substance use disorder &
history of trauma
◦ Common Co-Occuring combos:
Psychotic disorders (schizophrenia)
Mood Disorders (bipolar disorder, depression, anxiety)
Trauma (PTSD and DID)
Personality Clusters B & C
(Borderline, Antisocial, Narcissistic, Histrionic, Dependent and Avoidant)
(Kreek, et. Al, 2005, Volkow and
Li, 2005, NSDUH)
7. Addiction and Special
Populations
Age
◦ Adolescent: Runaways, juvenile justice, comorbidity (mental health/learning disabled) children of
alcoholics, GLBT
◦ Adults- adult children of alcoholics
◦ Seniors- higher rate of Rx dependence, grief and suicide
Ethnicity and Race
◦ Aboriginals (First Nations in US)
Higher levels of suicide and grief, poverty
◦ Blacks
Higher rates of FAS despite drinking less that white populations
Higher rate of homicide and criminal justice contact
◦ Hispanic
Mexicans and alcohol
Puerto Ricans and illegal drug use
Climbing Rate of HIV infection related to IV Drug Use
Gender/Sexual identity
◦ Female
Greater resistance from family and friends and more negative consequences associated with
treatment entry (lack of child care, job loss, and family responsibilities)
Higher Rates of sexual abuse/trauma
Medical problems develop much sooner, higher rates of mental health disorders, suicide
◦ Transgendered
High rates of suicidality and depression, health problems and discrimination
-NIDA
8. Special Risk
Contexts/Populations
Occupations
◦ Military (active and veteran)
◦ Law enforcement
◦ Lawyers
◦ Medical professionals (nurse, doctor, psych)
Geographic
◦ Rural vs. inner city
Biological
◦ Pregnancy, IV drug users, Chronic Pain
Psychological
◦ Co-occuring disorders
Social
◦ Homeless, prostitutes, GLBT, Offenders
9. Implications for Practice
Controversy of Medically-Assisted Treatment
Dual Relationships for people in recovery
Transference and counter-transferrence
12-step Recovery
◦ Spiritual, not religious
◦ Legal ramifications
Identification of risk factors
Cultural Competency
◦ (a) Awareness of one's own cultural worldview, (b) Attitude
towards cultural differences, (c) Knowledge of different
cultural practices and worldviews, and (d) Cross-cultural
skills
◦ Developing cultural competence results in an ability to
understand, communicate with, and effectively interact with
people across cultures
What else?
10. Case Study #1- Will
Will is a 40 year-old SWM referred for
assessment by Monroe County Probation
with repeated offenses of DUI. History of
head injury, domestic violence as a child
and family history of alcohol dependence.
Has worked in construction.
Married, divorced, full custody of son (age
2). Unstable work history, familial support.
Assessment and treatment implications
Best course of treatment
11. Case Study #2- Lori
Lori is a 19 y/o SWF self-referred to
treatment for alcohol dependence.
Extensive hx of PI arrests, family history
of cult involvement with religious
focus, child abuse and alcoholism.
Eating disorder has ruined her front
teeth. Looking for sober housing and
support, not willing to address eating
disorder. History of suicide attempt.
Assessment and treatment implications
Best course of treatment
