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1、Power Point for Addiction Treatment:A Strengths Perspective 3rd EditionKatherine van Wormer Diane Rae DavisCengage Publishing Company2012 copyright,Part I:Introduction,Addiction affects us all.Strengths perspectivestrengths of clients and strengths of the contemporary models:Harm reduction 12 Step a
2、pproach.Rift in field.Book in 3 parts:bio-psycho-social,Chapter I Nature of Addiction,Examples of addiction-smoker dying of emphysema,crack addict arrested,pregnant mother drinking heavily,girl hooked on meth she started using to lose weightEconomic costhealth,war on drugs,over 1 million in prison f
3、or drug involvement.Big businessgambling,Philip Morris,beer,What is addiction?,(Latin)addictus-attached to something,positive.Today alcoholism called a“brain disease”or bad habit or sin.Leading assumption of the text:Addiction is the key,not the substance or behavior Addiction defined by researchers
4、 as“a bad habit,”“a brain disease,”“helplessness,”“a problem of motivation”,DSM-5,Changes to DSM in new edition:no longer dichotomy between abuse and dependenceAddiction now the preferred term instead of dependence.Addiction now seen as a continuum.Substance use disorder requires 2 of following:tole
5、ranceinability to stop withdrawal problems excessive spending or effort use more than intended to obtain reduced involvement continued use,DefinitionsAddictionpattern of compulsive use.Has physical,psychological,social aspects.Emphasis on process rather than outcome.Gambling now considered an addict
6、ion in DSM-5Pattern of preoccupation,lack of control,form of escape,chasing ones losses,serious consequences.,Box 1.1 A Social Work Major Working in a Casino,What is the ethical dilemma here?How do the managers ensure that the gamblers keep spending their money?How are the employees controlled by th
7、e establishment?,The Disease Concept,Is alcoholism a disease?Arguments pro:Arguments con:,First,Define Disease,Disease-as metaphor by Jellinek:“alcoholism is like a disease”Random House Dictionary,disease is a condition of the body in which this is incorrect function.Oxford University Dictionary dis
8、ease is absence of ease(in treatment disease as:primary,progressive,chronic,and possibly fatal).Illness term preferred here,less controversial,less medical.Best arguments pro disease:alcoholism is a brain disease because the addicted brain has changed.Best arguments against:just a habit,a behavior,n
9、eed to take responsibility,people mature out of it.,Biopsychosocial-spiritual Model,Why(bio),what(psycho),where(social)Need for spiritual healing,connection with Higher PowerInteractionism and cycle of pain:pain and suffering loss pain,stress and drinking more painFamily as a system in interaction,r
10、oles,Why Do We Need to Know about Addiction?,80%of people behind bars have problems,pervasive in child welfare system,alcoholism in the workplace.71%of social workers worked with clients with substance use disorders in the past year.Headlines:-“When Tanning Turns into an Addiction”-“Help!Im Addicted
11、 to Facebook”Relevant movies:28 days,Traffic,Walk the Line,Table 1.1 Contrast Traditional Approach and Strengths PerspectiveTraditional approach dichotomizes alcoholic and non-alcoholicUse of labelsI am an alcoholic,addict,dysfunctional familyFocus on losses,client in denial,resistantStrengths appro
12、achavoids labels,focus on strengths,family as resource,Two Approaches to Treatment,Traditional Bio Dichotomy PsychoProblems mandateone size fits all SocialIdentify family dysfunction,Strengths-based Bio Continuum Psycho Strengths-motivation Social Holistic family as resource,Addiction Recovery Manag
13、ement Strengths-based treatment approach endorsed by UNCase managementCommunity resources for long-term careInterventions relate to personal needs in societymental health care,housingSuccess measured in drinking,using less,not total abstinence,Strengths Perspective Rapp and Goscha:Six critical eleme
14、nts:person is not the illness,choice,hope,purpose,achievement,presence of one key person to help.Finding the strengths in divergent modelsharm reduction and 12 Step approachDifferent models for different folks.Very negative view of disease model:Stanton Peele:Resisting 12 Step CoercionHarm reduction
15、 and the strengths perspective“meet the client where the client is.”Policy issues of reducing harm.,Empirical Research,Project MATCH Directed by NIAAA 2,000 clients over 8 yrs.What works?12 step facilitation,cognitive,motivational enhancement therapy(MET)MET most effective for those with low motivat
16、ion,12 Step with religiouspersons.Criticism:lack of a control group.MET,a shorter intervention.Models onlytested on alcoholic clients.Project MATCH confirms the effectiveness of diverse treatments.New measure for recovery is improvement,not total abstinence.Vaillants Research40 year longitudinal stu
17、dythose who recovered had crisis with alcohol or joined AA or entered a stable relationship or had a religious conversion.,Empirical Research Continued,Research from California:1$spent saves 7 across states.Hester and Miller found that these treatment modalities were proven to be most effective:brie
18、f intervention,motivational interviewing(MI),use of the medication naltrexone,social skills training,aversion therapy,cognitive therapy,acupuncture.(See chapter 8),Treatment Trends,Prescription drug misuse as increasing problem;Harm reduction recognized as important to save lives;public health appro
19、ach;Belief that punitive laws cause harm;Majority of Americans favor treatment over jail;De-emphasis on incarceration,reentry programming;Drug courts,mental health courts;Attention to co-occurring disorders and extensive use of prescribed medications to reduce craving;Restorative Justice:victim-offe
20、nder programming to promote healing.PEASE Academy.,Chapter 2,Historical Perspectives,Early History,Alcohol back to 5000 BC IranUnknown to worlds indigenous peopleKoran-condemned wine.Alcohol from Arabic al-kuhul.Arabian dr.discovered evaporated distilled spirits.Technology exceeded its grasp1575-dis
21、tilling usedgin.Booze from Dutch busen.Great devastation from England,1700-1750.Infant mortality,crime,North America,More beer than water on Mayflower.Slaves forbidden to drink except on special occasions,taught bingeing.Puritan traditions.18th Quakers and Methodists disapproved of hard liquor.Male
22、drinking cult 1725-1825 notorious.,Temperance movement,1825-1919:Against hard liquor.Temperance woman for womens suffrage and ban on distilled beverages.,Early 1900s,Cocaine in CokeTobacco outlawed for brief period.1914 Harrison Act-restricted opioids(associated with Chinese people)cocaine must now
23、be prescribed.Marijuana(associated with Mexicans)State laws in southwest criminalized.Teetotaler T=total abstinence,from Ireland.,U.S.Prohibition 1920-1933,Glamorized crime.Mafia/Hollywood/Wash.DC link.Homicide rates increased.Great Depression created need for jobs.Giancana,Double Cross,Modern War o
24、n DrugsJohnsonwar on povertyNixon tthrough the Busheswar on drugs1960s heroin horror stories1980s,crack cocaine2000s,methAttacks directed toward poor,minorities.,History of Gambling in U.S.Lotteries American RevolutionBanned after Civil War and during Prohibition.1931casino gambling legal in Nevada1
25、960slotteries for state revenue1972first gambling treatment center at VA,New York1987Supreme Court banned state regulation of tribal casinosMississippi River casinosInternet gambling popular today,Themes of First Half of Chapter,Dangers of potent alcohol,role of ethnic prejudice in shaping drug legi
26、slation,unintended consequences of prohibition.Example of happy Italian family enjoying wine with their meals.Modern War on Drugs,two-thirds of money for law enforcement.,History of Addiction Treatment,William White,Slaying the Dragon.Mistreatment of persons with mentally illness and alcoholics in a
27、sylums.Getting Better by Nan Robertson tells of Bill W.and Dr.Bob.Oxford Groups.Big Book.2 million members in AA worldwide today.Jellinek(The Disease Concept,1960)5 types of alcoholism based on world travels:Alpha,Beta,Gamma,Delta,Epsilon.,Treatment History continued,1956 AMA declared alcoholism an
28、illness,1966,a disease.Harold Hughes founded NIAAA.Hazelden adapted 12 Step approach.Box 2:1“Treatment in Norway”universal health care for support.Peele and Fingarette:addiction as bad habits not disease.,History of Harm Reduction,AIDS in Netherlands spawned new approach,to reduce the harm.Britain,1
29、960s and later.Heroin prescribed.Needle exchanges-U.S.Alan Marlatt,died in 2011,pioneer in spread of harm reduction approach to U.S.,researcher at U.of Washington.,Part II BIOLOGY,Chapter 3Substance Misuse,Dependence,and the Body,Part II BIOLOGY,Chapter 3Substance Misuse,Dependence,and the Body,Rece
30、nt Trends,Development of PET scans,fMRI functional magnetic resonance imaging Craving research New facts on brain damage,DepressantsAlcohol,Figure 3.1alcohol involvement:47%of homicides;34%of drownings;42%of fire injuries;47%of young male car crashes;50%date rape;16%child abuse(doesnt count neglect)
31、;23%of suicide.International studies show high correlationwith partner violence.College student deaths per year 1,825(NIAAA,2010),Father MartinChalk Talks,Jocose drunk,amorose,bellicose,lachrymose drunksOur additions:somnos drunk,(sleepy)clamorose,(loud),scientose(know it all),Global Drinking Patter
32、ns,Europeans consume six times as much alcohol as southeast AsiansMoldova,the Czech Republic,drink around 18 liters per capita each year.Eastern Europeanshard liquorBritish and IrishbeerFrench and ItalianswineHigh ratesindigenous populations Northern Sweden and Northern Canada,Alcohol continued,Heal
33、th effects of moderate drinkersheart benefits,lower death rates than teetotalers.7-10%of drinkers get addicted.Signs:tolerance,withdrawal(tremors,nausea;5%have DTs),heavy nicotine,caffeine useTolerance reversal.4 B.A.C.may be comatose.Blackouts:common at.3 BAC,case in Tom SawyerReal court cases,Narc
34、otics,Opiatesfrom opium poppynarcotics,heroin now can be smoked or snorted.High tolerance so need greater quantities for high.Inhalantshousehold products,huffing,brain damage,comaMisuse of pain medication increasing todayOxyContin,Stimulants,Cocaine-crack and powder,in urine 8 hrs.,smoked for faster
35、 high.High lasts only 15-20 minutes.Brain blocks reuptake of dopamine Addicted rats die heart attack.Amphetamines and methsynthetic unlike cocainesuppresses appetite.Used by Nazis.4-16 hour high.Methland by Nick Reding about Oelwein,Iowa.Powder can be snorted,injected.Stay awake for long durationsAn
36、hedonia-inability to feel pleasure with drug-induced brain injury.,Nicotine,Can both stimulate and relax.80-95%of alcoholics smoke,reduces alcohol effects.Over half of persons with schizophrenia smoke.Nicotine decreases BAC levels.American businessmans story from China.Malachy McCourt smoked for ad
37、and got hooked.Box 3.1“To Die for a Cigarette”Case of chewing tobaccosnuff.,Hallucinogens,Plants,LSD,synthetic,flashbacks,PCPEcstasy and roofiesheightens sensory experienceraves.Cant get back to original high due to brain changes.10%in high school have used Ecstasy.Dance Safe harm reduction strategi
38、es.Roofies:sleeping pill in Europe.,What Is Ecstasy?,Ecstasy is a drug that has some hallucinogenic properties and is structurally related to amphetamines.Its short form chemical name is MDMA(3,4-methylenedioxymetham-phetamine).,Split,Short Term Effects of Ecstasy,Feeling of confidenceSense of arous
39、alIncreased heart rateDry and sore mouth/throatTension,High Body TemperatureMuscle twitchingDepression&Confusion,Other Synthetic SubstancesSpiceBath saltsincrease in ER visits associated with this drug.Hard to detect.,Cannabis,Marijuana THC,the psychoactive ingredient,lowers blood glucose,increases
40、appetite,Stored in fat cells,long term use possibly associated with apathy.Earlier reports of lung cancer after long-term use were not validated.,Costs to Get HighEstimates Differ by Region,not in textCrack:$5-10 quick fix only lasts 30 min.Heroin:$100-200 day-$20 day can by maintenance dose inject
41、a couple of timesEcstasy:$25 may take 5 or so pills.Meth:$25 long-lasting high,popular in gay party scene in Seattle,factory workers in IowaMarijuana:$25 or higher,depends on quality,Metabolism,Liver:organ that metabolizes alcohol,alcohol circulates in the bloodstream until metabolized.Men have spec
42、ial enzymes that help.People metabolize oz.per hour=small glass of wine.One Drink One bottle of beer(12 oz.)One glass of wine(6 oz.)One“single”drink(1 oz.of liquor),Metabolism continued,Brain Regions and Their Functions,Ecstasy and the Brain,The Brain and Addiction,Neurotransmitters affect emotions
43、and memory,Neurotransmitters Affect Emotions and Memory,Dopaminereuptake affected by cocaine,which blocks dopamine synapseDepletion following cocaine use.Nicotine affects dopamine too.Parkinsons when too little.Dopamine-boosting drugs for Parkinsons associated with mania and gambling behavior.Excess
44、 of dopamine associated with schizophrenia.Serotonin:influenced by alcohol,involved in sleep.Decreased levels linked to depression,anxiety,impulsiveness suicide.,Depletion Following Cocaine Use.The right scan is taken from someone who is on cocaine.The loss of red areas in the right scan compared to
45、 the left(normal)scan indicates that the brain is using less glucose and therefore is less active.This reduction in activity results in disruption of many brain functions.,Memory and Craving,Addict never gets original highbrain has changed.Addiction is a brain disease.Cues can trigger memorypicture
46、of alcoholic beverages activates certain areas of the brain.Prozac reduces craving by regulating serotonin levels.,Cocaine in the Brain,Slides are from the National Institute on Drug Abuse(NIDA)(www.nida.nih.gov),Gambling and the BrainPersons with gambling disorders may have abnormal levels of dopam
47、ineand serotonin.Lack of control may result.Highs enhanced when rewards uncertain.Near misses especially thrilling.,The Role of Genes,Study of mental hospitals,prisons,50%who used chemical substances had mental disorders.CloningerSweden.259 male adoptees with alcoholic fathers Type 1:late onset.75%o
48、f alcoholics,relates to harm avoidance,anxiety,guilt Type 2:risk taker,(starts about age 11)male,hyperactive,antisocial,hereditaryOndansetron:works on serotonin,little effect on type 1Twins:40-60%concurrence of alcoholism.Separated at birth monkeys drank more under stress,people with low dopamine li
49、ke stimulantsPeople with ADHD risk for drug abuse.,Medical Consequences,Wernicke Korsakoff:Cases reported of Dr.Oliver SachsPeripheral neuropathy related to lack of Vitamin BConfabulation.Dr.SachsAwakenings,Medical Consequences continuedLiver damageremoves toxins from blood,bile circulates in blood
50、streamYellow skin tone,cirrhosis,immune system breakdown.Heart nicotine,cocaineFetal alcohol syndrome.See photograph in text.Short nose,indistinct groove between nose and mouth,thin upper lip,small head and eyes,learning problems.Role of sperm should be considered as well as mothers role.,Interventi
