Trauma and Addiction Final Flashcards
Theories of Addiction (5)
The moral model (A disorder of choice)
Biological theory
Psychological theory
Sociological theory
Biopsychosocial model/Public health model
3 aspects of the moral model
Personal Choice
Values
Responsibility
Explains addiction as a consequence of personal choice
Places full responsibility on the users
Addictive behavior is influenced by preexisting values. Thus society should attempt to instill values that are incompatible with addiction and substance abusing behaviors
The moral model
Addiction counselors may carry internalized biases that reflect moral model attitudes and should work to increase their awareness so that they do not influence their work with clients.
Whereas public sensitivity to the struggles of addicted people has increased, many challenges and barriers continue to prevent some from accessing needed treatment
Stigma
Biological theories talk about…
Certain biological traits (inherited or acquired) may increase the likelihood of eventual drug abuse or addiction, particularly in the presence of other external influences
- Biological traits (inherited/acquired)
- A Brain Disease Model of Addiction
- Self-medicating (Biological/Psychological)
- The factors of gender, race, and age
Biological Theories
Biological Traits
Inherited
-Reward deficiency syndrome
-Genetic factor
Acquired (Neuroadaptation)
-Frequent and chronic use
Addiction is a brain disease
There is convincing evidence that drugs of abuse act directly on brain mechanisms responsible for reward and punishment
Drugs are usurping brain circuits and motivational priorities
Addiction changes brain circuits
-Reward/saliency
-Motivational/drive
-Memory/learning
-Inhibitory/control
all is explained under the…
Addiction is a brain disease
Four circuits that are involved in addiction
-Reward: Located in the nucleus accubens (NAc) and the ventral pallidum
-Motivation/Drive: Located in the orbitofrontal cortex (OFC)
-Memory and Learning: Located in the amygdala and the hippocampus
-Control: Located in the prefrontal cortex and the anterior cingulate gyrus (CG)
-Tolerance
-Withdrawal
-Blackout
-Craving/Urge
-Impulsivity
-Compulsivity
-Habit
Are explained by the
Addiction is a brain disease
Gender factor
Women have a higher BAC than men when a comparable amount of alcohol is consumed:
-Women weigh less than men
-Women have more fat and less water in their bodies
-Women metabolize less alcohol in their stomach and esophagus
In women, the liver is more prone to the toxic effects of chronic alcohol use than in men (Liver injury progresses more rapidly over a shorter period of time and with less alcohol consumed and/or alcoholic liver cirrhosis is more likely to develop and more likely to cause death.)
It is an explanation related to…
Gender factor
Race factor
The chemical breakdown of alcohol
Alcohol Dehydrogenase (ADH) to Aldehyde dehydrogenase (ALDH)
Alcohol —– Acetaldehyde —– Acetate
Age factor
Older people have a higher BAC than younger people when a comparable amount of alcohol is consumed.
-Older people metabolize alcohol more slowly than younger people. (also “increased brain susceptibility to the depressant effects” of alcohol and “decreased percentages of body water.”
-Alcohol-drug interaction effect
Gene-Environment Interactions
-Genetic effects on behavior occur because they affect an individual’s susceptibility to adverse environments
-Adverse environments, such as negative or inadequate parenting, may create a risk, depending on genetic susceptibility factors
Psychological Theories
- Social Learning Theory
- Co-occurring Disorders (COD)
- Adverse Childhood Experiences (ACEs)
- Sense of Well-being (love, worth,
relatedness, spirituality, etc.)
Theory that states we learn…
by observing others.
by modeling or imitation of significant others (indirect learning).
by the formation of conditioned responses (e.g., positive or negative reinforcement, punishment)(direct learning).
Social Learning Theory (Bandura)
Co-occurring Disorders (COD)
Although the field has well recognized the existence of the co-occurring disorder of addiction and other mental disorders, knowledge regarding its underling mechanisms and treatment is still very limited.
(a) The two co-occur not necessarily because one causes the other, but because they both share similar risk factors (e.g., trauma, genetic vulnerability, stress)
(b) The two may share similar symptoms and, therefore, are wrongly diagnosed as COD
(c) Addiction is secondary to a psychiatric disorder (self-medication).
(d) Psychopathology or a psychiatric disorder is secondary to addiction (a psychiatric disorder is induced by the pharmacologic or psychological effects of alcohol or drugs).
(e) The “hybrid model”
An initially secondary disorder may later become a primary disorder.
Theories explaining COD
Self-medication (COD):
Biological/Psychological Theories
Self-medicating a preexisting disorder
(physical [pain, sleep disturbance]or
psychological [anxiety, depression, trauma])
Psychopathology or a Psychiatric Disorder is Secondary to Addiction (COD)
A long-term six-time wave study: chronic concurrent use of cigarette, alcohol, and marijuana was related to a greater likelihood of occurrence of Antisocial Personality Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder later in adulthood.
Caspi and colleagues: adolescent-onset cannabis use may trigger adult schizophreniform disorder if the person possesses certain genes.
Personality disorders
Antisocial personality disorder
Borderline personality disorder
The prevalence rate of antisocial personality disorder (ASPD) is about 3-4% in the general population; the rate is approximately 40-50% among the drug treatment study samples.
About 90% of people with a dx of ASPD have coexistent substance use disorders.
That is an explanation of the…
Antisocial Personality Disorder
Among individuals who had nicotine dependence, alcohol dependence, or cannabis use disorder at baseline and who were interviewed again at the 3-year-post baseline, Axis I disorders did not play a strong role regarding persistent substance use disorder (SUD); rather, ASPD, borderline personality disorder (BPD), and schizotypal personality disorder are strongly and consistently associated with persistent SUD (Hasin et al., 2011). (Note: the DSM-5 no longer uses the multiaxial system)
A 10-year prospective study found that ASPD is one major predictor for sustained opiate use and stimulant use (Lauritzen & Nordfjaern, 2018).
That is an explanation of the…
Antisocial Personality Disorder (ASPD)
Since their early formulations, theories explaining mental illness or psychopathology have emphasized the lasting impact of early childhood experience, but it is only recently that systematic scientific research on childhood adversity ad its impact has emerged.
It is an explanation of the theory…
Adverse Childhood Experience Theory (ACEs)
ACEs affect an adult in various areas:
-Addictions
-Other psychiatric disorders
-Chronic physical illnesses
-Low life opportunities
-Intimate partner violence
-Etc.
Adverse childhood experience (ACE) is defined as a child’s experiencing of one or more of the following 10 categories:
Emotional abuse, Emotional neglect
Physical abuse, Physical neglect
Sexual abuse,
Spousal abuse between parents,
Parental divorce or separation,
Household substance abuse,
Mental illness in household,
Criminal household member,
Childhood abuse (physical abuse, emotional abuse, and sexual abuse)
Childhood neglect (physical neglect and emotional neglect)
Household dysfunction (household substance abuse, an incarcerated household member, a mentally ill household member, a battered mother/stepmother, parental divorce or separation)
Other types of interpersonal loss: parental death, being placed in foster care, life-threatening physical illness during childhood, extreme childhood poverty
Are characteristics of
Adverse Childhood Experiences (ACE)
Sun’s theory: Unequal footing to begin with
Unequal footing to begin with: A challenge to the “free will” theory
Generalized only to substance-abusing women of the middle or lower socioeconomic groups.
Fetal alcohol syndrome (FAS)
The turbulent and unstable family situation
Growing up in an environment where grandmother, mother, father, aunts, sibling, and/or cousins all used AOD
Physical and/or sexual abuse or exploitation during childhood
AOD use at an early age caused many to drop out of school before completing 6th or 7th grade
Are characteristics of…
Unequal footing to begin with
Maslow’s needs hierarchy (Safety, love, and worth)
William Glasser’s “Weak” Model
Sun’s ACQS: Quality of Life
Are elements required for a…
Sense of Well-being
William Glasser’s “ Weak” Model
“Not Sufficient Love and Worth?”
Each choice is a pain-reducing step:
The first choice of “the weak”: Giving up
The second choice of “the weak”: The symptoms
The third choice of “the weak”: Negative addiction
The first choice of “the weak”
Giving Up –
They give up because it hurts more to keep trying when the effort always fails.
We quit because the pain of attempting to find happiness and not finding it hurts much more than giving up.
“Impulsive”
“Immediate gratification”
“Low frustration tolerance”
“Avoidance”
“Lack of problem solving skills”
*resilience
*life skills
*long-term goal
The first choice of “the weak”
Giving Up –
The second choice of “the weak”: To become depressed
For him the first choice in dealing with life’s problems—go give up—is no longer satisfactory; the pain has returned and in a further attempt to reduce his suffering he has made one of the common second choices—to become depressed (or to act out, to become psychotic, psychosomatic . . .)
The second choice is less painful than the first choice.
The third choice of “the weak”: Negative addiction
Negative addiction is the third, and in terms of pain, essentially successful choice in the series of choices made by people who are unable to find sufficient love and worth.
Not only is the pain gone but it is replaced by an intense pleasure that the person has never before experienced.
Sociological Theories (3)
- Strain theory
- Subcultural theory
- Social factors/Macro factors (e.g.,
social policies)
Anomie occurs when people are denied opportunities to fulfill needs and achieve cultural goals. (e.g., middle- and low-level traffickers in the inner cities of the U.S.)
(Sociological Theories)
Strain Theory
Crime occurred most often in those subcultures where the values that support breaking the law were more prevalent than the values that support obeying the laws.
(Sociological Theories)
Subculture Theory
Macro Factors
Social change
Social policies
Biopsychosocial Model
-Biopsychosocial model
-Multivariate model
-Public Health model
-The ACQS model (Sun, 2018)
Public Health Model (3)
-The agent
-The host
-The environment
The ACQS Model (Sun, 2018)
-A: the fundamentals of Addiction
-C: Co-occurring disorders
-Q: Quality of life
-S: Social factors
Neurobiological Processes
- Impulsivity (early stages)
- Compulsivity (later stages)
- Habit
- Addiction is a treatable, chronic medical disease
involving complex interactions among brain
circuits, genetics, the environment, and an
individual’s life experiences. - People with addiction use substance or engage in
behaviors that become compulsive and often
continue despite harmful consequences. - Prevention efforts and treatment approaches for
addiction are generally as successful as those for
other chronic diseases.
ASAM’s Definition of Addiction
Occurs when a user discontinues drug
administration and may include several
symptoms of pain and dysphoria, including
vomiting, nausea, diarrhea, headache,
depression, irritability, anxiety, stomach
cramps.
Are symptoms of…
Withdrawal
The need to increase the dosage of a drug to
produce the same effect—the user becomes
increasingly insensitive to the drug’s effects.
Are symptoms of…
Tolerance
- Are typically associated with
consuming excessive amounts of alcohol
that can lead to impaired memory of events
that transpired while intoxicated. - They can occur in anyone who drinks
alcohol, no matter their age or level of
experience with drinking.
Blackouts (Alcohol-Induced)
Blackouts (2 types)
- Brownouts (Grayouts): most common type, fragmentary blackout, characterized by spotty memories of events.
- “En bloc” blackout is complete amnesia.
Blackouts vs. Passing out.
Passing out means
either falling asleep or losing consciousness.
During a blackout, a person is still awake but their brain is not creating new memories. Depending on how much the person drank, it is possible to transition from having a blackout to passing out.
What is the Synergistic Effect?
With respect to drug effects, when a
combination of two or more drugs are
taken, the effects will be multiplicative,
rather than simply additive.
Drug Effects May be Determined by:
- Pharmacological properties
- Age
- Gender
- Race
- Weight
- Set
- Setting
- Etc.
What are Set and Setting?
Certain conditions not directly related to the
drug’s pharmacology or the user’s biology
may also profoundly influence and
determine drug effects.
Characteristics of Set:
The effects of psychedelic drugs are
dependent first and foremost upon set –
personality, preparation, expectation, and
intention of the person having the
experience.
The effects of psychedelic drugs are
dependent first and foremost upon setting –
the physical, social, and cultural environment in which the experience takes
place.
If the surroundings are unfamiliar or hostile,
the user may become fearful,
uncomfortable, or have a “bad trip.”
Are characteristics of”
Setting
Differences between set, setting, and substances:
Marijuana and the hallucinogens are more
affected by the set than heroin,
amphetamines, barbiturates, and PCP.
How much is the Standard Drink (Source: NIAAA)
12 fl oz of regular beer
8-9 fl oz malt liquor
5 fl oz of table wine
1.5 fl oz shot of distilled spirits (gin, rum, tequila, vodka, whiskey, etc.)
Define habit
These conditionings lead to the formation of
habit; the initially voluntary behavior now
becomes a habit which compels the person
to continue the use or the act even in the
absence of pleasure and reward.
How the habit changes in terms of addictions?
“Transition from voluntary drug use to
involuntary drug addiction may be seen as a
transition from prefrontal cortex-dependent
goal-directed to dorsolateral striatum-
dependent habitual action”
The survival mechanism
- Amygdala
- Hypothalamus
- Autonomic Nervous
System
(Sympathetic nervous
system and
parasympathetic
nervous system) - HPA Axis (hypothalamus,
the pituitary gland, and
adrenal glands)
- The sympathetic nervous system:
– is like “a gas pedal in a car”
– is fight-or-flight response
– provides the body with a burst of
energy in response to a perceived
danger - The parasympathetic nervous system:
– is like “a brake in a car”
– fosters the “rest and digest” response
that settles down the body after the
danger has gone
Are part of the…
Autonomic Nervous System
Human beings have 3 essential
psychological needs: autonomy,
competence, and relatedness—which if
filled can result in integrity, well-
being, and continuous psychological
growth.
Are elements of the…
Self Determination Theory:
- An evidence-based treatment
approach - A Relational Component
- A Technical Component
Are part of the…
Motivational Interviewing
Explain OARS
- Open-ended Questions
- Affirming
- Reflective Listening
- Summarizing
OARS are interviewing strategies that facilitate empathy from a clinician to a client, which helps to build an alliance and a sense of relatedness between the client and the clinician.
Accentuates its opening strategies, including
open-ended questions, affirmations, reflections, and summaries (OARS). Among these, affirmations serve to recognize a client’s strengths and positive characteristics.
It is a directive client-centered approach.
Are components of the…
Motivational Interview
Stages of change
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- (Relapse)
- Any client language that supports
movement toward change.
Is considered…
Change Talk
- Any client language that supports the status
quo.
Is considered…
Sustain Talk
Change talk may include two
subcategories: DARN and CAT
Define both:
- The DARN
D: Desire
A: Ability
R: Reason
N: Need - The CAT
C: Commitment
A: Activation
T: Taking steps
- Help the client prepare a plan for change
- Guide him/her to clarify goals for change
- Explore his/her options for
change/treatment - Negotiate a treatment plan/a change plan
- Explore the barriers to change
- Encourage him/her to recruit the support
of significant others - With permission, offer information and
advice.
They are part of the stage…
Preparation/Determination Stage
- Affirm the client’s successful changes
and support him/her in addressing barriers
to change - Continue to engage him/her in treatment
- Encourage small steps toward change
- Assist him/her in identifying and
managing relapse triggers - Reinforce positive changes
- Continue to identify social supports and
offer information/advice, with permission.
They are part of the stage…
Action Stage
- Support the client’s commitment to
change - Affirm his/her ability to change
- Acknowledge his/her positive change
- Assist him/her in practicing coping
strategies - Review his/her progress toward long-term
goals.
They are part of the…
Maintenance Stage
Maintenance/Relapse Stage
Emphasize that relapse/psychological
symptoms should not interrupt or stop the counseling relationship.
SBIRT means
- S: Screening
- BI: Brief Intervention
- RT: Referral to Treatment
- AUDIT (a positive screen: a total score of 8
or more) - S2BI (Screening to Brief Intervention)(for
youth aged 12 – 17 years) - CRAFFT (for adolescents aged 14 – 21
years) - CAGE (a positive screen: two or more “yes”
answers)
Are tools utilized for…
Screening Tools
Types of Therapeutic Communication
- Supportive: communicates acceptance,
concern, interest - Facilitative: promote awareness, problem
solving, growth
- Non-verbal: SOLER
- Verbal: accurate verbal following
- paraphrasing
- reflection of feeling
- summarizing
What type of communications are?
Types of Therapeutic Communication: Supportive
Types of Therapeutic Communication:
Facilitative (5)
- Probing
- Focusing
- Interpreting
- Confrontation
- Self-disclosure
- Is the deliberate use of a question or
statement by the worker to induce the client
to face what the worker thinks the client is
avoiding.
It is known as…
Confrontation
