FIVE QUESTIONS:

1. What is addiction?

2. How do addicts differ from others?

3. What thinking causes addiction?

4. What cultures cause addiction?

5. Is addiction decreasing/increasing?

MODELSOF

ADDICTION

Disease Model of Addiction

Inbred/biological

Loss of control

Lifelong/permanent

Inevitable progression

Requires medical/spiritual treatment

Neurochemical Model

Addiction operates through dopamine

Drugs elevate dopamine pleasure

Neuroadaptation dependence

Requires treatment chemical blocks

Leshner: “It's a myth that millions of people get better by themselves.”

ADDICTION IS…

Understanding brain chemistry, not building up

willpower, is the key to preventing adolescent alcohol

and other drug addiction.

Source:

Nora Volkow, director, National Institute of Drug Abuse (NIDA).

Cognitive-Behavioral Model

Alter thinking action

Present oriented

Skills oriented

- internal/cognitive

- external/practical

Coping/problem solving

- applied to substance abuse

- dysfunctional thinking cycle

THE CONCEPT OF

ADDICTION

Which drugs are addictive?

Problems with the

Addiction Concept

ILLICIT cocaine marijuana

LEGAL nicotine caffeine antidepressants

hospital patients

the clinical bias

Vietnam

Are Addictive Drugs

Always Addictive

What Happened in Vietnam?

Of all those addicted…

60% used narcotics stateside

12% re-addicted any time

6% addicted after three years

What is Addiction?

Source:Stanton Peele, Diseasing of America,

San Francisco: Jossey-Bass.

Vietnam

vs.

Home Environments

Fear and privation

-Control

-Positive options

-Social support

-Values of moderation

Addictive Criteria

Absorbing

Predictable

Sense of control / value

Illusory

Deepening / worsening

Gambling Example

Absorbing activity

“Predictable”

Sense of value and control

Growing penalties

ADDICTION IS…

an absorbing activity that provides essential emotional

rewards otherwise not available to one that entails

growing life detriments.

Source:Stanton Peele, The Meaning of Addiction,

San Francisco: Jossey-Bass.

Sources of Addiction

Stressed environments

Lack of satisfaction

Lack of moderating influences

Lack of coping skills

Lack of self-efficacy

HOW CAN LOVE BE

ADDICTIVE?

Causes of Relapse

Two factors predicted relapse

following treatment:

“lack of coping skills and belief in

the disease model of alcoholism.”

Source:Miller, W.R., Westerberg, V.S., Harris, R.J., et al. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-171.

NATURAL RECOVERY &THE PROCESS OF CHANGE

Lifetime, Past Month, Ages 12+: Percentages, 2002

Illicit Drug Use

Lifetime Last Month Last Month/Lifetime

Cocaine 15 1 7

Crack 3 .3 9

Heroin 2 .1 6

Source: SAMHSA (2003, Table 1.1B)

Addiction and Age

Age16-1718-2526-2930-3435-3940-4445-4950-5455-5960-6465+

% Abuse/Dep172215121198734

1

NESARC

2001-2002 National Epidemiologic

Survey on Alcohol and Related

Conditions (NESARC) :

43,093 in-person interviews

4422 DSM-IV alcohol dependent

Source:Dawson, D.A., Grant, B.F., Stinson, F.S., & Chou, P.S., et al. (2005). Recovery from DSM-IV

alcohol dependence: United States, 2001-2002. Addiction, 100, 281-292.

NESARC Past-Year ImprovementAmong Alcoholics

(columns percentaged)

Treated UntreatedPast Year Status (n=1,205) (n=3,217)

Dependent 28 24

Abstinent 35 12

Drinking w/o dependence 36 64 Source: Dawson et al. (2005)

Summarizing NESARC

Most alcoholics untreated

Treated alcoholics do no better

Most alcoholics cut back drinking

What were these people thinking?

Implications for treatment/policy

HARM REDUCTION THERAPY

What is harm

reduction?

Principles of Harm Reduction

Consequences of behavior

Non-abstinence outcomes

Client-centered

Low threshold / low commitment

Pragmatic

Marlatt, A. (1996). Harm reduction: Come as you are. Addictive Behavior, 21, 779-788.

Is harm reduction

accepted?

Why not?

SCIENTIFIC RESEARCH ON ALCOHOLISM

EFFECTIVE THERAPIES

Effective Alcoholism Treatments CES *

Severity

Brief interventions 390 2.47

Motivational enhancement 189 2.72

GABA (Acamprosate) 116 3.80

Community reinforcement 110 3.43

Self-help manual 110 2.59

*Cumulative Evidence ScoreSource: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon.

Ineffective Alcoholism Treatments CES*

Severity

Twelve-step facilitation -82 3.67

Alcoholics Anonymous -94 3.14

Confrontational counseling -183 3.00

General alcoholism counseling -284 3.22

Education (tapes, lectures) -443 2.44

* Cumulative evidence scoreSource: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon. (3rd Ed.).

Boston: Allyn and Bacon.

HOW DO PEOPLE REALLY CHANGE?

BI/MI – What Is Common?

Minimal time in therapy

You must change

True to your values

Self-efficacy

Harm reduction

Patient Resources + Outcomes Treatment or No

Stable marriage

Social/community stability

Higher socioeconomic functioning

Higher intellectual functioning

Employment - Job skills

Motivation to change

Ability to cope with stress

A Different View of Addiction

People change the more resources they have

They are helped by summoning the resources they possess

Treatment assists by helping them gather resources

Treatment not essential

Assessing Resources:

Intimacy and supportive relations

Work skills and accomplishments

Activities and interests

Coping with your world

Coping with yourself

Beating previous addictions

Stages of Change:How People Really Do It

Believe that the addictive involvement violates more important values.

Want to quit/ and believe you can.

Develop alternative rewards that are more meaningful than addiction.

Find/develop resources in life to maintain rewards.

Stages of Change:How People Really Do It

(continued)

Rely on friends, family, and groups to help support the change in behavior.

Avoid situations and ways of thinking that provoke relapse.

Eventually develop a new self-image, a view of oneself as a former addict.

Develop higher goals than addiction.

ARE ALL SOCIETIES EQUAL? ALCOHOL

Alcohol and ModerationIreland vs. Italy

Ireland 2 48 Italy 42 11

% of men whoDrink every day Binge 1+/week

Source: European Comparative Alcohol Study

Norstöm, T. (Ed.). (2002). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm: SW: National Institute of Public Health, pp. 196-205.

Drunken 15-16 year olds

Country % Drunk 10+/year

Denmark 39Finland 29U.K. 28Ireland 27Iceland 19

+ + +Greece 4Malta 4Portugal 4France 3Italy 2

Source: Plant, M., & Miller, P. (2001). Young people and

alcohol. Alcohol & Alcoholism, 36, 513-515.

Non-Temperance Recipe

Regular consumption

With meals

Across gender, age groups

Drinking + / drunkenness -

Model for Moderation

Drinking is regular, accepted

Bad drinking, good drinking taught

Bad behavior not excused by drinking

PROTECTING AMERICAN YOUTH

Monitoring the Future 2004Drinking by U.S. H.S. Seniors

Behavior

Drank in last year 71%

Drunk in last year 52%

Drunk in last month 33%

Attitudes

Disapprove of 1 or 2 drinks/daily 76%

Disapprove 5+ drinks weekends 66%

Source: Johnston, L.D.. National Results on Adolescent Drug Use: Overview of Key Findings, 2004. Bethesda,

MD: National Institute on Drug Use, 2005.

What are kids most likely to be addicted to?

Are children not sufficiently protected?

Heavily protected

Echo boomers are the most watched-over

generation in history. Most have never

ridden a bike without a helmet, ridden in a

car without a seat belt, or eaten in a

cafeteria that serves peanut butter.

Source: 60 Minutes, “The Echo Boomers”

Not independent

“Sometimes, they don't know what to do if

they're just left outside and you say, ‘Well,

just do something by yourself for a while’

They'll look around stunned.”

Source: 60 Minutes, “The Echo Boomers”

Not independent

"Parents feel as if they're holding onto a piece of

Baccarat crystal or something that could

somehow shatter at any point. They have a sense

their kids are fragile. Parents therefore are

protecting them, inflating their egos, massaging

them, fighting their battles for them."

Source: 60 Minutes, “The Echo Boomers”

Immediate gratification

“Everything has to be immediate, like a video game.

And they have a lot of trouble doing things in a

stepwise fashion, delaying gratification.”

Source: 60 Minutes, “The Echo Boomers”