Foundations of Addictions Counseling, 1 st Edition © 2009 Pearson Education, Inc. All rights reserved. Chapter 1 History and Etiological Models of Addiction.

Foundations of Addictions Counseling, 1st Edition

© 2009 Pearson Education, Inc.All rights reserved.

Chapter 1History and Etiological Models of Addiction

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History and Models of Addiction

A specialized field in counseling The addiction counseling field

evolved like psychology, social work

Early Practice Limited education, supervision,

ethics, and research

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Prevention in the United States

Historical approaches to prevention Alcohol’s central role in the colonies Temperance as moderation

Original goal was moderation Temperance as abstinence

Women’s Christian Temperance Movement Volstead Act and Prohibition (1920)

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U.S. Drug Laws Until 1903 cocaine was used in

soda drinks (“Coca Cola”) Pure Food and Drug Act, 1906

(labeling) The Harrison Act, 1914 (taxation of

opium and coca products) Controlled Substance Act, 1970

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Laws and Agencies

National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1971

National Institute on Drug Abuse (NIDA), 1974

The Anti-Drug Abuse Prevention Act of 1986 created the United States Office for Substance Abuse Prevention (OSAP) Later became CSAP (part of SAMHSA)

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Models for Explaining the Etiology of Addiction

The Moral Model

Psychological Models

Family Models

The Disease Model Biological Models Sociocultural

Models Multicausal

Models

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The Moral Model

Personal Choice Religious Beliefs

Sinfulness

Legal System Punishment

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Psychological Models

Cognitive-behavioral models Motivations Reinforcement (positive & negative)

Learning models Learned response

Use decreases anxiety, stress, etc. Aversion to withdrawal Physical dependence

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Biological Models

Genetic Models Statistical associations

Genetic factors

Neurobiological Models Brain chemistry

Limbic system

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Multicausal Models No single model adequately explains

addiction Syndrome model

Multiple and interacting antecedents Integral Model

Concepts from integrative medicine and transpersonal psychology

Public Health Model Agent, Host, Environment

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Useful Web Sites www.ncadi.samhsa.gov www.drugabuse.gov www.niaaa.nih.gov

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Chapter 2Substance and Process Addictions

Laura Veach and Emeline P. Hollander

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Neurobiology and Physiology Addiction

Neurobiology Brain research

Reward pathway

http://teens.drugabuse.gov/mom/tg_brainimages_fig6.html

Reward Circuit

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Reward Pathway

Ventral tegmental area NA Prefrontal Cortex

Source: http://www.drugabuse.gov/pubs/teaching/Teaching3/Teaching2.html

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Nerve Cells and Neurotransmission Neurons

100 billion nerve cells in the brain

Neurotransmitters Chemical

messengers Dopamine Neuroreceptors

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Cocaine Interfering with NeuronsWhen cocaine enters the brain, it blocks the dopamine transporter from pumping dopamine back into the transmitting neuron, flooding the synapse with dopamine. This intensifies and prolongs the stimulation of receiving neurons in the brain's pleasure circuits, causing a cocaine "high." http://teens.drugabuse.gov/mom/tg_effects.php# (http://teens.drugabuse.gov/mom/tg_brainimages_fig7.html)

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Positron emission tomography (PET) scan

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Physiological Factors

Tolerance Neuroadaptation Metabolic tolerance Pharmacodynamic tolerance

Withdrawal

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Substances of Addiction Depressants Stimulants Cannabinoids Hallucinogens Opioids

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Depressants Alcohol Sedative/Hypnotics

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Alcohol Ethanol

Proof 7% alcohol/ethanol = 14 proof 151-proof rum = ___ % ethanol?

Mood altering effects within 20 minutes Metabolized by the liver as a toxin

Intoxicated Blood alcohol concentration (BAC)

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Sedative/Hypnotics Sedative/Hypnotic drugs (CNS)

Also depress the CNS Benzodiazepines (aka “tranquilizers”)

Valium (diazepam), Xanax (alprazolam) High risk for abuse and addiction Women at risk

Barbiturates (Tuinal, Nembutal) Lethal potential

Non-barbiturates (Quaaludes)

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Stimulants Tobacco

Nicotine Ephedrine Amphetamines Ritalin Cocaine

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Ephedrine, Amphetamines, Amphetamine-like Medications

Ephedrine Legal ban in 2004 (side effects)

Amphetamines (“Speed”) Methamphetamine

Oral, snorted, smoked, injected Amphetamine-like medications Ritalin (for ADHD)

Side effects: weight loss, insomnia, hypertension, anemia

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Cocaine

Epidemics in late 1800’s, early 1900’s Use has declined since 1990’s

“Crack” cocaine Smokeable, concentrated form of cocaine Physical Dependence

(tolerance/withdrawal) Strong potential for abuse

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Cannabinoids Marijuana

Unique properties Tolerance Withdrawal Dependence Negative physical effects

Reduced lung capacity Lowered testosterone levels Racing pulse Decreased muscle strength

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Hallucinogens and Other Psychedelics

Lysergic acid derivatives (LSD) Phencyclidine (PCP) MDMA (Ectasy)

The most popular psychedelic of the 1990’s

Perception-altering properties

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Opioids

Parent of all narcotic drugs Opium

Morphine Heroin

Intravenous injection HIV Infection risks

OxyContin

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Process Addictions Ingestive addiction

Chemical dependence Process addictions

Addiction to a behavior, process, or action

Still debated Examples

Gambling, sexual addiction, work, shopping, food

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Sexual Addiction Varying definitions Sexaholics Anonymous (SA)

“Addicted to lust”, loss of control Isolation, Guilt, Depression, Emptiness

Sex Addicts Anonymous (SAA) Progressive path to increasingly

dangerous behaviors No DSM criteria for sexual addiction

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Gambling Addiction

Pathological gambling Impulse Control Disorder in DSM

Warning signs Secretiveness Extravagant expenditures Increased debt and worry over

finances Increased alcohol, drug consumption

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Work Addiction “Workaholism”

Little data available on prevalence Socially accepted, encouraged,

rewarded Self-esteem problems, inability to relax,

out of control, frenetic, unsatisfied unless doing something

Less productive than non-workaholics Perfectionistic, inefficient More research needed

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Compulsive Buying Shopaholism Consistent, repetitive purchasing

in response to stress Overspending, Indebtedness,

Bankruptcy Treatment

Teaching how to resist social forces (media, easy credit)

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Food Addiction and Disordered Eating

Eating Disorders, including: Anorexia

Compulsive self-starvation Bulimia

Compulsive cycle – eating and purging Binge Eating Disorder (no purging)

Overeaters Anonymous 10% of sufferers are male

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Useful Web Sites Alcoholics Anonymous

www.alcoholics-anonymous.org Al-Anon and Alateen

www.al-anon.org Narcotics Anonymous

www.na.org Overeaters Anonymous

www.oa.org