Moral / Temperance Model*Addiction as Sin or Crime Personal Irresponsibility Disease Model *Genetic...
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Transcript of Moral / Temperance Model*Addiction as Sin or Crime Personal Irresponsibility Disease Model *Genetic...
Moral / Temperance Model * Addiction as Sin or Crime Personal Irresponsibility
Disease Model * Genetic and Biological Factors **12-Step Framework;
Abstinence Education as Treatment
Behavioral and Cognitive- Conditioning and Reinforcement
Behavioral Models * Social Learning and ModelingDrug Expectancies and other Cognitive Factors / RP
Family Models Family DiseaseFamily SystemsBehavioral Marital/Family Tx
Psychological / Psychoanalytic Disordered /Addictive Personalities
Sociocultural Models Cultural Factors
Socioeconomics/ Social Policy
Drug Subcultures
Public Health Model Agent, Host, Environment
Interactions
THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION
MODELS OF ADDICTION: A SUMMARY
Moral / Temperance Model Addiction as Sin or Crime Personal Irresponsibility
Disease Model Genetic and Biological Factors
12-Step Framework; Abstinence, Education as Treatment
Psychological / Psychoanalytic Disordered /Addictive Personalities
Behavioral and Cognitive- Conditioning and Behavioral Models Reinforcement
Social Learning / Modeling
Drug Expectancies and other Cognitive Factors / RP
Family Models Family Disease
Family Systems
Behavioral Marital/Family Therapy
Sociocultural Models Cultural Factors
Socioeconomic Factors
Drug Subcultures
Social Policy (e.g., drug control)
Public Health Model Interactions between
Agent Host Environment
THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION
MODELS OF ADDICTION: A SUMMARY
Psychological / Psychoanalytic Disordered /Addictive Personality
Sociocultural Models Cultural FactorsSocioeconomics/ Social Policy Drug Subcultures
Public Health Model Agent, Host, Environment Interactions
THE BIOPSYCHOSOCIAL MODEL:AN INTEGRATION
MODELS OF ADDICTION: A SUMMARY
MODELS OF ADDICTIONMODELS OF ADDICTION
Assumptions of Disease Model
addiction seen as a “primary” disease process
alcoholics qualitatively different from non alcoholics: can’t drink in moderation
central symptom of addiction is loss of control (e.g., one drink, one drunk)
addiction is chronic and progressive; no cure,can only be arrested with total abstinence (e.g. progression models - Johnson…learning &
seeking the mood swing; harmful dependence; drinking to feel normal)
• Early identification
• Education about diagnosis
• Acceptance of disease and overcoming “denial”
• Abstinence
• 12-steps essential for real recovery
Disease Model - Treatment
12 Steps of Alcoholics Anonymous
1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
12 Steps of AA (con’t)
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends to them all.
9. Made direct amends to such people wherever
possible, except when to do so would injure them or others.
10. Continued to take moral inventory and when we were wrong promptly admitted to it.
12 Steps of AA (con’t)
11. Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to
alcoholics, and to practice these principles in all our affairs.
CRITIQUE OF DISEASE MODELCRITIQUE OF DISEASE MODEL
Strengths
- perception shift: from sin to TX - eases guilt, self-blame
- disease is a good metaphor that fits the experience
- 12-step support and framework works for many (prevalence of meetings; 24-hour support…)
- Other strengths? _______________________
• Adoption study of Goodwin• 18% probands alcoholic vs. 5% controls
• Twin Studies• male vs. female twin pairs
• Metabolic Studies
• P3 Wave Studies
Disease Model - Research Support
CRITIQUE OF DISEASE MODELCRITIQUE OF DISEASE MODEL
Limitations - Assumptions not all data-based
addiction as “primary”
loss of control
chronic / progressive
alcoholics qualitatively different
- Dichotomous thinking dangerous; no middle ground (you’re an alcoholic or not)
- Loss of control and responsibility paradox
- Other flaws? ___________________
SUBSTANCE USE DISORDERSSUBSTANCE USE DISORDERS
GENERAL METHODS OF TREATMENT
Inpatient Detoxification and Rehabilitation
Outpatient Individual, Couple, or Family Counseling
Self-help Groups (Alcoholics Anonymous; NA, CA, OA, GA, Al-Anon etc.)
Residential Facilities & TherapeuticCommunities
Medications
4 sessions in 12 weeks
Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking
Mobilize the person’s own commitment and motivation to change
MET
(Motivational Enhancement Therapy)
12 weekly sessions
Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings
Acceptance of the disease of alcoholism and loss of control over drinking
TSF
(Twelve Step Facilitation)
12 weekly sessions
Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse
Learn skills to achieve and maintain sobriety
CBT
(Cognitive Behavioral Therapy)
FrequencyDescriptionGoal of
TreatmentType of
Treatment
Project MATCH Treatment Conditions – Modalities You Will Learn