Aods 150 Final: Chpts 8, 9, 10, 12, 13

Front 1

Chpt 8 Effects of Alcohol Problems on the Family

Fact vs Myth

Back 1

Fact: Among those with alcohol dependence, the female

alcoholic dependent is more likely to get divorced than her male counterpart.

Myth: In the past, trying to account for difference speculated women

marry someone with alcohol dependence has unconscious, neurotic need to be married to weak, inadequate males. The implication was that because of the need to stay married & get psychological strokes.

Front 2

Chpt 8 Effects of Alcohol Problems on the Family

It IS likely due to:

Back 2

~ Economic realities of financial support.

~ Men are less likely to seek outside support.

~ Result: May see little alternative to divorce.

Front 3

Chpt 8 Effects of Alcohol Problems on the Family

Research on The Family

Back 3

Society & researchers focused least on effects on drinking on alcoholic's family.

Enabling: (Co-dependency)

~ User is "saved" from painful the pain consequences of their own

behavior. Behaviors that unwittingly allow continuation of drinking.

~ Pain is a significant motivator in the change process, by removing the pain, the motivation for change is reduced, thereby allowing the

problem continue. PAIN IS THE MOTIVATOR.

Front 4

Family Roles

The Adjuster - Lost Child

Descriptions not in the book.

Back 4

Lost Child: Avoids in instead of taking control, because of chaos, they are able to adjust to many situations.

Strengths: Easy going, not upset by negative situations, ability to follow.

Weaknesses: Fear of making decisions, inability to perceive options, & power, inability to initiate, lack of direction, follow without questioning.

No one ever cared about solutions because no one ever cared about their problems, easy going, easy going, don't get upset, follower.

Front 5

Family Roles

The Placer - People Pleaser

Descriptions not in the book.

Back 5

People Pleaser: Takes care of everyone, does not take care of self.

Strengths: Good listener, gives, warm, nice smile, empathic, sensitive to others.

Weaknesses: Doesn't focus on self, fear of anger, tolerance for

inappropriate behavior, false guilt, inability to receive.

What's everyone happy, little mother will take care of drunk (find liquor -

alcohol for them), makes excuses for people's bad behavior.

Front 6

Family Roles

The Acting Out Child - Scape Goat

Descriptions not in the book.

Back 6

Scape Goat: Difficulty expressing their needs & relating to others, act out, & always in trouble.

Strengths: Creative, close to own feelings, humor, less denial % greater honesty, ability to lead without questioning.

Weaknesses: Inability to follow directions, social problems, inappropriate expression of anger, intrusive.

Sarcastic, Conduct Disorder, Blacksheep, feeling are raw - can see their pain & hurt.

Front 7

Family Roles

Family Clown - Mascot

Descriptions not in the book.

Back 7

Mascot: Engage in distractive behavior, to break tension in family.

Strengths: Sense of humor, flexible, able to relieve stress & pain.

Weaknesses: Attention seeker, distracting, immature, lack of focus, poor decision-making ability.

Heightened sense of mood of family, see tension and try to break it,

accurately access stress, become comedians, often jokes inappropriate, typically the youngest.

Front 8

Chpt 9 - Alcohol Use Disorder Identification

Screening and Evaluation

Lab Testing

Back 8

Laboratory measures:

~ Use blood & urine.

~ Limited utility (valuable result).

~ BAC when alcohol is in system ( now up to 96 hrs/expensive).

~ Lower liver function; id liver disorders - heavy drinkers.

~ Does not prove how much you drink.

Front 9

Chpt 9 - Alcohol Use Disorder Identification

Major Screening Tests

Back 9

~ CAGE (Acronym of 4 questions)

~ CRAFT (Car, Relax, Alone, Forget, Friends, Trouble)

~ TWEAK (Pregnant women)

~ MASK (Michigan Alcoholism Screening Test)

~ DAST (Drug Abuse Screening Test)

~ AUDIT (Alcohol Use Disorder)

~ DALI (Dartmouth Assessment of Lifestyle)

Front 10

Chpt 9 - Alcohol Use Disorder Identification

"TWEAK"

Back 10

Developed for PREGNANT women.

5 questions

Modification of the CAGE.

Acronym: Tolerance, Worry, Eye-opener, Anemia (Black-outs), K/cut down.

REMEMBER THIS ONE

Front 11

Chpt 9 - Alcohol Use Disorder Identification

"AUDIT"

Back 11

World Health OrganizationMost widely recommended.

Goals:

~ Id. High-risk use.

~ Provide instrument for primary care.

~ Valid in different cultures.

10 questions: Drinking patterns, signs of dependence, self-concerns, social consequences.

Structured interview or self-Administration.

Front 12

Chpt 9 - Alcohol Use Disorder Identification

Treatment Outcomes

Back 12

Not related to clinicians demographics, careful with self-disclosure,

~ Therapeutic alliance (empathy).

~ Ability to maintain objectivity.

~ Positive emotional response.

~ Adherence to standardized approach. (evidence approach)

~ Independent style

~ Client's evaluation of clinicians competence.

~ Increased length of stay = better outcome.

Front 13

Chpt 9 - Alcohol Use Disorder Identification

Iatrogenic Effects

Definition

Back 13

Latrogenic Definition: Negative outcomes as a result itself.

Harm caused by the treatment itself.

Frequency: 10% - 15% of those treated are worse off after

treatment.

I.e., Conduct Disorder in group setting can increase addiction &

negative behaviors because of influences from peers' behaviors.

Front 14

Chpt 9 - Alcohol Use Disorder Identification

Treatment Outcomes

Causes: Problematic Client Characteristics

Back 14

~ Co-occurring psychiatric illness (dual-occurring substance use disorders).

~ Being younger, unemployed, socially isolated and/or moving frequently.

~ Friends who support alcohol/drug use.

~ Antagonistic (hostile) relationships within family.

Front 15

Test Chpt 9 - Alcohol Use Disorder Identification

Treatment Outcome: Iatrogenic Effects

Causes: Problematic Program Characteristics

Back 15

~ Informal structure & few routines.

~ Failure to monitor clients status.

~ Confrontental style. (Old school)

~ Absence of empathy

~ Miinimal expectations for client change.

~ Modeling problematic behaviors

Smoking when clients can't "Do as I say, not as I do".

Front 16

Test Chpt 9 - Alcohol Use Disorder Identification

Treatment Outcome: Iatrogenic Effects

DEA - Schedule I

Back 16

~ High level of abuse.

~ No accepted medical use.

~ I.e., Heroin, LSD, marijuana (still illegal federally).

NEED TO KNOW FOR TEST.

Front 17

Test Chpt 9 - Alcohol Use Disorder Identification

DEA - Schedule II

Back 17

~ High potential for abuse.

~ Psychological or physical dependence.

~ Oxycodone, cocaine, methamphetamine, methadone, Adderall.

NEED TO KNOW FOR TEST.

Front 18

Test Chpt 9 - Alcohol Use Disorder Identification

DEA - Schedule III

Back 18

~ Has accepted medical use.

~ Prescriptions are non-refillable.

~ I.e., Methadone, morphine, amphetamines, cocaine, oxycodone.

Other Schedule II narcotics include morphine, opium, and codeine.

NEED TO KNOW FOR TEST.

Front 19

Test Chpt 9 - Alcohol Use Disorder Identification

DEA - Schedule IV

Back 19

~ Low-risk physical dependence.

~ Moderate risk psychological.

~ Established medical use.

~ I.e., Ativan, Halcion, Darvon.

NEED TO KNOW FOR TEST.

Front 20

Test Chpt 9 - Alcohol Use Disorder Identification

DEA - Schedule V

Back 20

~ Low risk of dependence.

~ Established medical use.

~ I.e., Lomotil.

NEED TO KNOW FOR TEST.

Front 21

Chpt 9 - Alcohol Use Disorder Identification

Contemplation: Engaging the Patient

Back 21

~ Ask about person, not alcohol.

~ Motivational Interviewing (MI)

Stages of Change:

~ Pre-contemplation

~ Contemplation

~ Determination

~ Action

~ Maintenance

Front 22

Chpt 9 - Alcohol Use Disorder Identification

The 12 Steps - Field Reports

Back 22

From your field reports:

~ What is the goal of AA's 12 steps? Sobriety

~ What is the goal of NA's 12 steps? Clean

~ What is the goal of HA's 12 steps? Clean

Alternative to 12 Steps: SMART, Rational Recovery, Women for Sobriety.

Front 23

Chpt 10 - Treatment Techniques & Approaches

The Twelve Steps

Know 12 Steps (1 - 4)

Back 23

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.

KNOW FOR TEST

Front 24

Chpt 10 - Treatment Techniques Approaches

The Twelve Steps

Know 12 Steps (9 - 11)

Back 24

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

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.

KNOW FOR TEST

Front 25

Chpt 10 - Treatment Techniques Approaches

The Twelve Steps

Know 12 Steps (12)

Back 25

!2. 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.

KNOW FOR TEST

Front 26

Chpt 10 - Treatment Techniques Approaches

Types of Groups

Back 26

~ Psycho-educational (MOST COMMON)

Organized around lecture, film or presentation by specialist, followed by group discussion.

~ Support Groups (Self-help i.e., AA - Promote self-awareness)

~ Problem-Solving Group (Tackle specific problems or stressful areas in member lives, i.e., discussion or role playing).

~ Activity Group (Art, Yoga, trust walk/focus on "task")

Front 27

Chpt 10 - Treatment Techniques Approaches

Group Process - Clinicans Responsibility

Back 27

~ Focus on feelings.

~ No saving, fixing, rescuing, advice giving...don't stop the process.

~ Word on eliminating instructions.

~ Therapeutic style

~ Know the rules.

Front 28

Chpt 10 - Treatment Techniques & Approaches

Relapse Prevention

Client Goals of Treatment

Back 28

~ Want to be able to drink problem free.

Front 29

Chpt 10 - Treatment Techniques & Approache

Relapse Prevention

Counselors focus on relaspe preventioncoping skills development.

Back 29

Common elements:

~ Uses an array of behavior techniques.

~ Id high-risk situations.

~ Learn effective coping mechanisms to deal with negative emotional states.

~ Views relapse as a process, not an event.

~ Sees need to attend to cues and cravings.

~ Addresses social pressures.

Front 30

Chpt 10 - Treatment Techniques & Approaches

Relapse Prevention

Counselor Self-Disclosure

Back 30

~ Can it in very limited cases be helpful, but can it also be damaging. Gloden rule: does it benefit the client?

Connie, not a fan.

Front 31

Chpt 12 - Other Psychiatric Conditions

Conditions

Back 31

Substance use disorders are within themselves

psychiatric conditions.

Alcohol or other substance use problems often mimic psychiatric

conditions.

Front 32

Chpt 12 - Other Psychiatric Conditions

Self Harm - Evaluation & Prevention

Back 32

~ Suicide & substance use go together. especially alcohol.

~ Approximately 40% of all completed suicides are alcohol related.

~ The suicide rate for alcoholics is 50 times that of the general population.

"Black Box" warning on antidepressants warns about suicide risk.

relation to alcohol, worsen depression, Contribute to suicide attempts.

Effort to self-medicate the manic symptoms.

Front 33

Chpt 12 - Other Psychiatric Conditions

How Should Counselors address Suicide?

Back 33

~ All clients should be screened for suicide, especially any person that is depressed.

~ Talking about suicide doesn't cause suicide. It is a relief.

~ Use the word suicide, don't talk around it.

~ Don't moralize.

~ Don't react with shock or horror.

Sitting there not actively killing themselves.

Front 34

Chpt 12 - Other Psychiatric Conditions

Anxiety Disorders

Back 34

Anxiety does not cause a disturbance in mood, thought or judgment.

HOWEVER:

~ Anxiety up?

~ I.Q. down.

~ Perspective distorts.

Heart population.

Anxiety Disorders: Can't find this information in book.

Front 35

Chpt 13 - Drugs of Abuse Other Than Alcohol

Pharmacological Concepts

How Delivered to the Brain

Back 35

Route of administration:

~ Proper absorption & effective & efficient delivery of a drug is ensured by its route of administration.

Solubility: Fat & Water:

~ Marijuana can be detected on drug screen up to 30 days in chronic users, frequently longer (45 days or more) due to it being fat soluble.

Lets us know how we can detect.

Front 36

Chpt 13 - Drugs of Abuse Other Than Alcohol

Nicotine Use Patterns

Back 36

Current smokers:

~ 25% of U.S. population.

~ Additional 5% use other nicotine products.

~ Virtually no difference by gender. Anymore

Initiation of use:

~ Increases marketable between age 12 & 16.

~ At age 21, 40% are smokers.

Front 37

Chpt 13 - Drugs of Abuse Other Than Alcohol

Inhalants

Back 37

~ Can cause permanent brain damage.