Addictions Flashcards
Definition of addiction (Miller)
-Addiction occurs when it increasingly dominates a person’s life and, as a result, harms or detracts from other aspects of life
-Something done regularly, repeatedly, and habitually
-Something done with compulsion, and is thus beyond voluntary control
-Presents potential or actual adverse consequences
Definition of Addiction (Lewis)
-Disease model: addiction as brain disease (strongly biological)
-Personal choice: addiction as a problem with the decision-making (strongly cognitive)
-Self-medication: addiction as a result of attempts to manage distressing symptoms (strongly developmental)
5 Etiologies of Addiction
- Personal Responsibility Models
- Agent Models
- Dispositional Models
- Social Learning Models
- Sociocultural Models
Personal responsibility models
-Regarded as some extent as a failure of self-control, a violation of moral, ethical, or religious standards
-TTreated or prevented through legislation, education, repentance, punishment, and social sanctions
-Addiction as a choice – assumes that substance use is a voluntary, chosen behavior, and that the person could have done otherwise
-Substance use is regarded as a choice for which one is responsible
Agent Models
-Places primary emphasis on the strong effects of the agent (the drug) itself – anyone who is exposed to the drug is at risk because of its addicted and destructive properties
-The drug itself is to blame, so remove it from society
Dispositional Models
-Place the primary cause of addiction within the person
-Addiction attributed at least partially to physical conditions of the addict, though not to a lack of fortitude or willpower
-Treatment through humane (often medicalized) routes, not punishment
-Addiction as a (physical) disease
-Typically construe the cause as a physical condition that is beyond the individual’s willful control
-Among these is a disease model that regards people with addiction to be different from others and incapable of controlling their own use
-Emphasized changes that occur in the brain with chronic use and that compromise self-control
Social Learning Models
-Emphasizes the role of experience in shaping addiction
-Addiction arises due to the basic learning principles such as classical and operant conditioning, and social learning
-Treatment through behavior modification and manipulations of experience
Sociocultural Model
-Emphasizes the influence of societal and cultural factors
-Addiction attributed at least partially to social and cultural factors, such as price/availability of alcohol or socioeconomic disparities
-Treatment through alcohol/drug policy
-Ease of availability and price of alcohol, tobacco, and other drugs clearly affect the level of use in a community
-Social environments with high levels of use tend to increase consumption
Public Health Perspective
-Integrates components from each of the other 5 models: interactive and interdisciplinary
-Groups causal factors into three categories: those involving the agent, the host (personal characteristics of an individual), and the environment
-Takes all important factors into account and considers their interactions with each other
-Psychoactive drugs mimic or influence neurotransmitters, like the release of dopamine and can make substances highly reinforcing
-Drugs can be preferred over natural rewards because of the rapid and intense pleasure
General Diagnostic criteria for SUDs
-Criteria 1-4: Impaired control over substance use
-Criteria 5-7: Social impairment
-Criteria 8-9: Risky use of substance
-Criteria 10-11: Pharmacological criteria
Stages of Change
-Precontemplation: individuals are not especially aware of their problems and have no plans to change their behavior in the foreseeable future
-Contemplation: individuals are aware of their problems but have no yet made a serious commitment to do anything about them
-Preparation: individuals have begun to make small changes in their problematic behaviors with the intention of making more complete changes within 1 month
-Action: successful (more complete) change has occurred for short time periods
-Notable changes of
behavior
-Maintenance: goal is to maintain the behavioral and attitudinal changes
-Clients maintain their
current level of
substance use
Rogers conditions
-Accurate empathy
-Interpersonal warmth or unconditional positive regard
-Personal honesty or genuiness
Empathy and importance in treating addiction
-Ability to listen to your client and accurately reflect back to them the essence and meaning of what they have said which is called active listening
-Ensures correctly understanding what your client means
-Communicates respect, understanding, and acceptance
-Helps clients clarify their own internal processes
-Low level of empathy in addiction treatment can be toxic so clients whose counselors show low level of skill in accurate empathy have particularly poor outcomes relative to clients with high-empathy counselors
-Low levels of the critical skills described by Carl rogers were 2-4x more likely to be drinking across 2 years of follow up, relative to high-skill counselors’ clients
Engagement and benefits for the treatment of SUDs
-Defer urge to gather information (temper the intake process)
-Four treatment processes:
>Engaging: forming a working relationship
>Focusing: negotiating goals of treatment
>Evoking: eliciting the client’s own motivation for change
>Planning: choosing and implementing strategies for change
-Ongoing process of foraging and maintaining a working relationship
>Person-center approach
>Empathetic understanding (accurate reflecting, not relating to yourself)
>Unconditional positive regard (interpersonal warmth)
>Genuineness (personal honesty)
>Traits: kindness, comfort, empathy, avoid confrontation, patience
-Strong engagement:
>Decreases resistance and dropout rates
>Increases adherence
>Improves outcome
>Evidence of large variance based on counselor to whom client is assigned
Reflective listening
-Skillful reflective listening considers what the person has not quite spoken but reflecting to them the underlying meaning
>At times, what they haven’t directly stated, but what they mean
>Statement, not a question
>At time, reflecting in an anticipative way
-You know your reflection was accurate if client keeps on talking, keeps exploring, tells you more
-Positive signs: if it is accurate, the client is likely to say “yes” and will continue to elaborate (even if a little defensive)
