Drug/alcohol Counseling Midterm

Front 1

Substance Abuse (DSM; can lead to dependence/addiction)

Back 1

maladaptive pattern leading to clinically significant distress

1 or more in 12 months:
-failure in role obligations (work/home/school)
-use in physically hazardous situations
-recurrent legal problems
-use despite continuous social problems exacerbated by use

Front 2

Substance Dependence (DSM; abuse leads to this)

Back 2

maladaptive pattern leading to clinically significant distress

3 or more in 12 months:
-using more or for longer than intended
-tolerance (need more)
-withdrawal (physical symptoms) or using to avoid withdrawal
-unsuccessful cutdown efforts
-great deal of time to obtain, use, or recover
-give up/reduce activites
-continued use despite physical/psychological problems

Front 3

Addiction

Back 3

continued use despite negative consequences.

(biopsychosocial phenomenon; can involve financial/school/medical/legal/work/psychological/relationship/physical problems)

Front 4

deleria tremens

Back 4

shaking; severe alcohol withdrawal (Joe had it in the movie)

Front 5

Days of Wine and Roses characters

Back 5

Joe (PR)
Kirsten (secretary)
Debbie (daughter)
Mr. Arnesen (Kirsten's father; landscaper/greenhouse)
Jim Hungerford (AA sponsor)

Front 6

Days of Wine and Roses plot

Back 6

Joe meets Kirsten who doesn't like him, he drinks and she is a teetotaller; they go out. She loves chocolate so he gives her Brandy Alexanders. Social drinking. Married; kid, become alcoholics. Joe loses job. Joe sees himself as a bum, they sober up. Work at Mr. Arnesen's. Relapse--Joe smashes greenhouse looking for hidden bottle. Deleria tremens, hospital. AA for Joe. Joe finds Kirsten, they drink, Joe breaks into bar. Relapse and hospital Kirsten goes to pick up people at bars while drunk. Arnesen blames Joe. Joe takes Donna, Kirsten visits but will not admit she is an alcoholic. "Threesome--you me and booze" on a boat on a sea of booze, boat sank, drowning--Kirsten can grab on but Joe will not let go to drown with her. Kirsten says everything "looks dirty" w/out and walks towards bar.

Front 7

Case Study

Back 7

Jean (addictions counselor) - mom was a drinker, once drove to RI to get Ellen help (ellen drunk and suicidal), could not really help, likes motiviational interviewing (client defines in own words)
Ellen (alcoholic friend) - mom drank, "keep it in the family", did not attend college, works for bank, divorced, 2 kids, once suicidal, drove with kids while drinking, physical symptoms, did not like AA, kids getting depressed and anxious, called Jean upset

Front 8

Proof

Back 8

divide it in half to get percentage of alcohol in the bottle

Front 9

neuroplasticity/brain plasticity

Back 9

ability for brain to repair, replace, and retrain its neural circuitry.
brain can change and adapt and grow
addiction highjacks the brain and changes its structure

Front 10

Etiological models

Back 10

(theories of explaining causes of addiction)
-Disease/Medical model
-CBT model
-Genetic model
-Moral model
-Psychodynamic Model
-Family Systems model
-Sociocultural model
-Biopsychosocial model

Front 11

Medical Model

Back 11

it is a disease (primary disease, not secondary)
GOAL IS ABSTINENCE. addictive disease is CHRONIC and INCURABLE
Abstinence = cure
DSM follows this. Insurance covers.
removes moral stigma
George Washington era - Benjamin Rush
Jellinek surveyed, but did not survey women

Front 12

CBT model/learning model

Back 12

motivation and reinforcement.
Ellis, Skinner
use = escape from boredom, craving variety--reinforced
challenge irrational thoughts, work cognitively
supported by insurance
addiction possibly similar to OCD
LEARNING MODEL - use decreases uncomfortable psychological states (anxiety/stress) which positively reinforces use; aversion for withdrawal symptoms continues it. Bandura - unlearn

Front 13

Genetic model/neurobiological model

Back 13

-statistical info shows genetic factors association.
-heritability, monozygotic twins share relationship over dizygotic, or with bio parents over adoptive
-Human Genome project, NIH, Dept of Energy
-possible metabolic or enzyme reactions
-pharmocogenomics - tailor drug treatment to body chemistry
-possible diagnostic tests for addiction
limbic area of the brain - dopamine - key in addiction

Front 14

Moral model

Back 14

no biology - if you use there is something morally wrong with you. emphasizes punishment.
personal choices--bad choices--lead to addiction
religious groups advocate it.
choose not to use it
sinfulness is part of human nature

Front 15

Psychodynamic model/personality theory model

Back 15

"self-medication", ego deficiencies, disturbed object relations
Freud, Adler, Jung
childhood events cause one to develop addiction issues. E.g. oral fixation and smokers.
not a lot of evidence
negative correlations with issues likeinadequate parenting, attachment, masturbation, homosexuality
PERSONALITY THEORY MODEL - certain personality traits predispose individual to drug use (dependent, immature, impulsive, emotional, low frustration, etc) - but anyone can be addicted.

Front 16

Family models

Back 16

Treat in the context of families--circular causality. Families can help or hinder addicts (enable or help them get better). Families like to maintain homeostasis so may actually do things to encourage the behavior to continue
also possible family disease - all need treatment
healthy family structure requires clear boundaries and flexible roles.

Front 17

Sociocultural model

Back 17

look at person in cultural context/norms
aim for moderation.
cultures are different. e.g. US it is taboo, Italy, they grow up with it but culture discourages being drunk, France it is not okay to deny when offered a drink
(Good, Levin, Bales?)
Bales - supracultural - attitudes: 1) abstinence 2) ritual use 3) convivial social drinking 4) utilitarian drinking for personal reasons [most alcoholism]
also requires alternatives for drinking
subculture important too (SES, gender, ethnicity, family background, etc.)

Front 18

Biopsychosocial model

Back 18

Multicausal
Biology (disease/genetics), psychological, cultural norms and life events
many aspects
Engle proposed it in 1977
syndrome model?

Front 19

Opiates

Back 19

naturally derived from from poppies

Front 20

opiods

Back 20

synthetic

Front 21

neurons

Back 21

contain dendrites, nucleus, axon, axon terminals. send and receive signals between synapses/synaptic clefts.
when signal is sent, neurotransmitters are released by vesicles into the synapatic cleft and activate receptors on other neurons. then reuptake occurs. drugs affects receptors and/or transporters (which do reuptake) - e.g. cocaine inhibits reuptake so more dopamine remains loose in the system for longer, stimulating the 2nd neuron

Front 22

dopamine

Back 22

brain chemical linked to pleasure, reward and motivation. affects motor function. drugs enhance this (and serotonin) pathway. dopamine receptor in the brain affects addiction

Front 23

serotonin

Back 23

brain chemical linked to learning, memory, sleee, and mood. drugs enhance this pathway. affects cognition.

Front 24

cravings

Back 24

areas of the brain light up (especailly with PET scan) when individual is presented with drug stimuli. anterior cingulate (impulse control) and *amygdala* (emotional response) light up

Front 25

side effects of drug addiction on the brain

Back 25

-impaired ability to feel pleasure
-often affects memory, cognition, motor skills
-*limbic system, esp. prefrontal cortex impaired (area controls self-monitoring, social thinking, abstract thought, moral behavior) [meetings help moral and social]
-brain is physically damaged and it is less capable of unlearning things
-interrupts neurogenesis (new brain cell creation)

Front 26

Alcohol - Early beliefs (colonial days)

Back 26

high regard, healthy, preventative and curative capabilities (not intoxicant).
"temperance movement" - moderation. clergy - alcohol could "corrupt"
Benjamin Rush - alcoholism = "disease"
"Washington Total Abstinence Society" 1840

Front 27

Alcohol - early 1900s

Back 27

Volstead Act - prohibition in 1920
"speakeasies" appeared
religious groups - prevention
Response to immigration - "lower class" people's drinking patterns
Opium banned in late 1800s due to Chinese immigrants associated with it; Marijuana legal until 1930 with Mexican immigrants. LSD legal until associated with counterculture
Pure Drug and Food Act passed in 1906
Harrison Act in 1914

Front 28

Pure Drug and Food Act

Back 28

passed in 1906 to control addiction by requiring labels on drugs contained in products (including opium, morphine, heroin)

Front 29

Harrison Act of 1914

Back 29

taxation of opium and coca products
registration and record keeping

Front 30

1970 Controlled Substance Act

Back 30

drugs classified according to medical use, potential for abuse, possibility of dependence

Front 31

late 1900s government organizations

Back 31

NIAAA (National Institute on Alcohol Abuse and Alcoholism); NIDA (National Institute on Drug Abuse) = 1970s. Later transferred to NIH
OSAP (US Office for Substance Abuse Prevention) = 1980s - consolidated prevention initiatives under ADAMA (Alcohol, Drug Abuse, and Mental Health Administration). Later changed to CSAP (Center for Substance Abuse Prevention)
Part of SAMSHA (Substance Abuse and Mental Health Administration)--reauthorized in 2000

Front 32

Anti-Drug Abuse Prevention Act of 1986

Back 32

created OSAP (US Office for Substance Abuse Prevention) - consolidated prevention initiatives under ADAMA (Alcohol, Drug Abuse, and Mental Health Administration)
20% of $ for prevention, 80% for treatment programs
Later changed to CSAP (Center for Substance Abuse Prevention)
Part of SAMSHA (Substance Abuse and Mental Health Administration).

Front 33

some laws influencing prevention

Back 33

minimum age, penalize retailrs, dry option allowed, taxation on substances, control distribution, liability laws
federal policy more concerned with preventing recreational use than helping habitual users. focuses on casual, middle-class drug use

Front 34

GABA and glutamate

Back 34

neurotransmitters affected by alcohol . so learning and memory are impaired

Front 35

anterior cingulated cortext (ACC) and orbitofrontal cortext (OFC)

Back 35

impaired by drug use. OCD tendencies?

Front 36

depressants

Back 36

DOWNER.
alcohol and sedatives/hypnotics. depress central nervous system.

-alcohol (ethyl alcohol). depressant to central nervous system, nothing can break it down faster.
-baribituates [injected/swallowed] (barbs, reds, yellow jackets; 1950s-1960s 2nd to ETOH)
-benzodiazepines [injected/swallowed] (candy, downers, sleeping pills, tranks. DATE RAPE DRUG = flunitrazepam [swallowed/snorted] (rohypnol/roofies)
-GHB [swallowed] (liquid ecstasy, G)
-methaqualone [injected/swallowed] (quad, ludes)

reduced anxiety, lowered inhibitions, slowed pulse and breathing, lowered blood pressure, poor concentration
barbs and benzos - sedation, drowsiness
flunitrazepam - memory loss (roofies)
GHB - drowsiness, nausea, possibly death
quad - euphoria/depression, coma

Front 37

stimulants

Back 37

UPPER
-amphetamine [injected/swallowed/smoked/snorted] (speed, uppers)
-cocaine [injected/smoked/snorted] (coke, crack = smokeable and concentrated, snow, blow)
-MDMA [swallowed] (ecstasy, X, XTC, Molly)
-methamphetamine [injected/swallowed/smoked/snorted] (crank, crystal, meth, speed)
- methlphenidate (FOR ADHD; like Ritalin) [injected/swallowed/snorted]
-nicotine [smoked, or snuff form] (cigarettes, cigars, smokeless tobacco, snuff, spit tobacco, chew). usually addicted to other substances too.

increased heart rate, blood pressure, metabolism, exhilaration, energy, mental alertness

coke - increased temp, sexual desire
amphetamine - rapid breathing
MDMA - hallucinogenic, empathic feelings
meth - aggression, violence, psychotic behavior
nicotine - cancer, lung disease, adverse pregnancy outcomes, etc.

Front 38

cannaboids

Back 38

DOWNER

-hashish [swallowed/smoked] (hemp)
-marijuana [swallowed/smoked] (pot, blunt, dope, grass, weed). most commonly abused illegal drug, legal in some areas.

euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination
see things more vividly, can cause paranoia if you have a bad trip. relaxed--things slow down

cannabis staiva = plant.
THC is chemical in it that makes it potent.

Front 39

hallucinogens

Back 39

HALLUCINOGEN
-LSD [swallowed, absorbed through mouth] (acid)
-mescaline [swallowed, smoked] (peyote)
-psilocybin [swallowed] (mushroom, shrooms)

altered states of perception and feeling, nausea, FLASHBACKS

possible nervousness, paranoia, mental disorders, sleeplessness, increased heart rate

Front 40

opiods and morphine derivaties

Back 40

DOWNER
-codeine (Robitussin A-C, Tylenol, pancakes and syrup)
-fentanyl and fentanly analogs (Apache, China girl)
-heroin (dope, smack) [injected]
-morphine (Roxanol)
-opium (laudanum)
-oxycodone HCL (OxyContin)
-hydrocodone bitartrate acetaminophen (Vicodin)
-Krokodil (injectable opiod)

pain relief, euphoria, drowsiness/nausea
codeine is less strong than morphine as an analgesic
heroin = staggering gate
gangrene/flesh falls off with Krokodil

withdrawal from opiates is terrible. people might suicide

Front 41

Dissociative Anesthetics
Other Compounds

Back 41

Dissociate Anesthetics
-ketamine (special K, Vitamin K)
-PCP (angel dust)
increased heart rate, delirium, depression, panic

Other compounds
-anabolic steroids (roids): cancer, shrunken testicles, aggression, masculine characteristics in females
-dextromtorphan (DXM). in some cold/cough meds (Robotripping)
-inhalants (solvents like paint thinner or gasoline or glue; gases like butane or propane; nitrites. street name = whippets): stimluation, loss of inhibition, nausea, wheezing, uncoordinated, death, slurred speech

Front 42

alcohol effects on females and certain minorities

Back 42

Asians usually do not have enzyme acetaldehyde to break down ETOH and will flush, sweat, feel ill (alcoholism rate is low)

women show more severe consequences.
"telescoping" response to alcohol. faster progression into dependency
metabolism is different. lower body mass with more fat content, alcohol "hangs out" with fat cells and lingers longer. get drunk faster.

Front 43

speedball

Back 43

mix of cocaine (upper) and heroin (downer). body is confused!!!!!!!

Front 44

one size fits all model

Back 44

not true.
most studies done on white males who are middle aged

Front 45

BAC

Back 45

blood alcohol concentration. measured by breathalyzer or blood sample. usually best within 12 hours

Front 46

alcohol issues

Back 46

alcohol counseling can be effective
accidents, especially with motor vehicles
college students have highest binge drinking rates

Front 47

methadone

Back 47

used to treat heroin--like heroin but less strong, helps with harm-reduction

Front 48

Process addictions

Back 48

-addiction to behavior, process, or action.
-sex, gambling, working, compulsive buying, food
-often replaced by another addiction

sex addiction: internet. progressive downward path. CBT
gambling - impulse control disorder in DSM
workaholism--can lead to heart attack/stroke from stress, so much work little leisure or social activity, yet society and organization reinforces behavior with promotions and money
compulsive buying - fill the void. $ problems
food - eating disorders may share traits with addiction. Overeater's Anonymous is a 12-step program

Front 49

ethics

Back 49

don't practice outside your competency, issues with minors (e.g. confidentiality), get supervision, boundary violation issues e.g. gifts or physical contact, multicultural issues, counselors in recovery need to watch out for dual relationships and make sure they are functioning and able to counsel (e.g. you should have 3-5 years of abstinence before working as an addictions counselor), counter-transference, self disclosure, counselors who have never used and their values re: addiction, self-care, research-based practice (CBT, motivational interviewing, 12-steps, etc.), credentials, certification (e.g. MAC through NBCC), insurance issues

Front 50

Transtheoretical Model of Behavior Change (TTM)

Back 50

a) stages of change (precontemplation, contemplation, preparation, action, maintenance, RELAPSE)
b) process of change (cognitive, behavioral, affective activities)
c) self-efficacy (self belief in ability to make change)
d) decisional balance (advantages and disadvantages of change

Front 51

stages of change

Back 51

Pre-contemplation "I don't have a problem. can stop whenever"
Contemplation "Maybe I have a problem. i'll consider it"
Preparation "I have a problem, but don't know what to do. need to look at options" [Ellen in case study here?]
Action "I have a problem, I know what to do about it, I'm going to do it" [provide support and resources]
Maintenance "I beat my problem, i'm doing well" [help find internal rewards]
Relapse "I blew it" [self-explanatory, identify triggers and reasses barriers/supports/coping skills. relapse is common in recovery process]

Front 52

addicted families

Back 52

low intimacy
isolated
poor communication, problem-solving
low cohesion
illogical and inconsistent rules
addiction upsets homeostasis initially but then family works around and includes addiction to remain balanced
children roles: hero (responsible/successful), scapegoat (blamed), lost child/adjuster (no attention), mascot (funny)
rules: use is more important thing in family, addict is not responsible and drug is not cause of problems, maintain status quo at all times/don't upset routine. don't talk, don't trust, don't feel
stages: denial, home treatment, chaos, control *may repeat*
if one parent can provide stability, better outcome for kids

Front 53

addicted couples

Back 53

link between violence and sexual functioning in couples

couple issues can cause drinking or use, but this can also cause issues with the couple.
THIRD POINT IN THE TRIANGLE

enabling and codependence

Front 54

diathesis stress model

Back 54

overcoming stressful situations can lead to more resiliency, but sometimes too much is too overwhelming. shapes but is also dependent on personality--ideal balance of stress and coping skills?

Front 55

children of alcoholics

Back 55

more impulsivity, conduct disorders, alexithymia, depression, anxiety
poor cognition, attentional deficits,
lower academic achivement
more external locus of control
elevated risk of alcoholism

Front 56

treating families

Back 56

assess environment, system, and individual.
family must create safety from external threats and family of origin (be nonblaming and noncontrolling, be consistent and predictable)
have each family member tell story of the trauma. can also have them write letters to each other
restablize family.

Front 57

disabilities and addictions

Back 57

high rate of co-occurring disorders amoung SSI beneficiaries (substance abuse and mental health issue)
higher rate of substance abuse for PWD
hard to access treatment for PWD
low employment
more isolated, more stigma
society does not believe PWD are addicted sometimes or believe they can't learn how or are sick/fragile/helpless

risk factors: psychological, social, health and medical, economic, employment

tx should be inclusive! should also help with ADLs and network building and life skills

Front 58

psychoactive drugs

Back 58

cross blood-brain barrier and create behavioral changes (judgment, movement, vision, etc.)

Front 59

drugs

Back 59

chemicals or substances that effect change in the body