1. Chemical Dependency:
The Crisis of Addiction
Chapter Eleven

2. Background
 Long history of attempting to treat substance
abuse.
 Whole economies have been founded on drug
use.
 Alcohol and tobacco in the United States
 Volstead Act and ratification of the 18th Amendment
 21st Amendment
 Economic gains and burdens
 Prevalence
 Controlled use
 Is this a reality for an abuser or an addict?

3. Sociocultural Determinants of
Substance Abuse
 Set vs. setting
 Alcohol and drugs have culturally specific:
 Rules
 Sanctions
 Prohibitions
 Admonitions
 Permissions
 Although there are cultural implications, do not
stereotype!

4. Alcohol:
Number One Abused Substance
 Duration
 Legality
 Widespread use
 Indirect financial costs
 Psychological costs
 Physical costs
 Links to crime
 Implication in accidents
 Suicide
 Alcohol IS a drug
 Interpersonal relationships
 Polyuse
 Embroilment in controversy

5. Models of Addiction
 Behavioral Learning Model
 Biopsychosocial Models
 Cognitive Models
 Disease Model
 Final Common Pathway
 Gateway Model
 Genetic Predisposition Model
 Lifestyle Model
 Moral Model
 Parental Influence Model

6. Models of Addiction Cont.
 Peer-Cluster Model
 Personality Model
 Prescriptive Model
 Problem Behavior Model
 Psychoanalytic Model
 Psychosocial Model
 Sanctioned-Use Model
 Sociocultural Models
 Stress-Coping Model

7. Definitions of Commonly Used Terms
 Abuse
 Chronic, recurrent misuse of chemicals.
 One or more of the following occur in a maladaptive pattern during a 12
month period:
 Failure to fulfill major role obligations (work, school, or family)
 Physical impairment that creates a hazard
 Recurrent legal or social problems
 Addiction
 Physical reactions include the development of tolerance and withdrawal.
 Psychologically, it is the compulsion to use drugs regardless of the
negative consequences.
 Progressive, potentially fatal, and marked by preoccupation with chemical
use.
 Addictive behavior
 Preferred by many in the field because it focuses on behavior.
 Is used to describe a broad spectrum of problematic compulsions.
 Alcoholism
 Addiction to alcohol.

8. Definitions of Commonly Used Terms
 Chemical dependent
 Addiction to drugs.
 Codependent
 Reciprocal dependency of the addict in need of care and a
caretaker’s need to control the addict’s behavior.
 Dependence
 Cognitive, behavioral, and physiological symptoms indicating that
the individual continues to use the substance despite significant
chemical-related problems.
 Drug
 Psychoactive substance that has a direct and significant impact on
the processes of the mind with respect to thinking, feeling, and
acting.
 Enabler
 A person who allows the addict to continue the addiction rather
than suffering the full extent of the substance-related
consequences.

9. Definitions of Commonly Used Terms
 Habituation
 Degree to which one is accustomed to taking a certain drug.
 Misuse
 Use of a substance with some adverse physical, psychological,
social, or legal consequence.
 Relapse/Slip
 Use of a substance after a period of abstinence.
 Tolerance
 When more of a substance is needed to achieve the same effect.
 Use
 The intake of a chemical substance with the intent of altering one’s
state of consciousness.
 Withdrawal
 Physical and psychological symptoms as a result of the reduction
or cessation of a drug.

10. Defense Mechanisms
 Denial
 Displacement
 Fantasy
 Projection
 Rationalization
 Intellectualization
 Minimizing
 Reaction formation
 Regression
 Repression

11. Enabling and Codependency
 Suppression
 Dissociation
 Repression
 Escape to therapy
 Intellectualization
 Displacement
 Reaction formation
 Passive aggression
 Hypochondriasis

12. Children in Alcoholic Families
 Personality Roles
 The Scapegoat
 The Hero
 The Lost Child
 The Family Mascot
 Family Rules in Alcoholic Families
 Do not talk/do not have problems
 Do not trust
 Do not feel
 Do not behave differently
 Do not blame chemical dependency
 Do behave as I want
 Do be better and more responsible
 Do not have fun

13. Adult Children of Alcoholics (ACOA)
 Facts
 Addiction has a genetic component
 Addictive behavior can be learned
 ACOA’s tend to marry addicts
 Emotional issues
 Trust
 Dependency
 Control
 Guilt
 Identification and expression of feelings
 Effects of childhood roles
 Adaptive roles from childhood follow them into adulthood

14. Treatment Approaches
 Alcoholics Anonymous (AA)
 Cognitive-Behavioral Therapy (CBT)
 Inpatient Treatment: The Minnesota Model
 Outpatient Programs
 Contingency Management (CM)
 Community Reinforcement Approach
(CRA)
 Reinforcement-Based Treatment (RBT)
 Inpatient vs. Outpatient
 Contemporary Model

15. Intervention Strategies
 Motivation and Stages of Change
 Precontemplation
 Contemplation
 Determination/Preparation
 Action
 Maintenance
 Termination
 Motivational Interviewing

16. Assessment
 Personality Inventories
 Direct Measures
 Parsimony
 Computer-Administered Direct Measures
 The Problem Is . . .
 Motivation to Change
 Intake Assessment
 Assessment of Spirituality
 Triage Assessment
 Diagnostic Intake

17. Detoxification
 Can be a serious medical process
 Addict may be given small, controlled amount of
the addicted substance to reduce severe
symptoms
 Common symptoms
 Delirium Tremens (DTs)
 Somatic complaints
 Excessive sleep
 Mood swings
 Detoxification without treatment is nearly always
futile.

18. Principles of Treatment
 Treatment Techniques
 Treatment Goals
 Treatment Protocol
 Individual Therapy
 The Treatment Group
 Learning Relationship Skills
 Accepting Responsibility
 Getting Past Denial
 Confrontation

19. Principles of Treatment
 Limit Testing
 Treatment Secrets
 Disrupting Irrational Mental Sets
 Overcoming Environmental Cues That Lead to
Drinking
 Treating the Family
 Family Therapy Session
 Therapy for the Children
 Aftercare and Relapse Prevention
 Cognitive-Behavioral Boosters
 Pharmacology
 Euphoria
 AA's Role in Aftercare