Causes of addiction and theories of addiction. Deaddiction process and deaddiction centers. Counselling for deaddction

1. 4/11/2024 1
Scope of the Problem - Alcohol
• Alcohol-related deaths approximately
105,000 annually (conservative)
• 50% of deaths from liver diseases.
• 30% of gen. hospital admits
• 50% of murders and their victims
• 30 - 50% --- of all Suicides
• 15%-67% of home injuries, falls,
drowning, fire fatalities and job injuries.
• 25% of fatal car wrecks

2. 4/11/2024 2
Alcohol (continued)
• 105 million Americans age 12 and older
reported current use of alcohol.
• 45 million of these engaged in binge
drinking (5 or more drinks on one
occasion).
• 12.4 million of these were heavy
drinkers (5 or more drinks on one
occasion, 5 or more days in the past 30
days).
National Household Survey, 1999

3. 4/11/2024 3
Scope of the Problem –
Other Addictive Drugs
• 14.8 million Americans current illicit
drug users in 1999
• Conservatively 39,000 deaths in 1995
Unintentional Overdose Pneumonia
HIV Endocarditis
Hepatitis Accidents/Injury
Tuberculosis Suicide/Homicide

4. 4/11/2024 4
Alcoholism (Addiction)
• Defined: A primary, progressive
biochemical, psychosocial, genetically
transmitted disease of relapse who's
hallmarks are denial, loss of control and
unmanageability

5. 4/11/2024 5
Myths of Alcoholism/Addiction
• A behavioral issue
• A moral issue
• An ethical issue
• A symptom of a psychiatric illness
• A choice
• A lack of willpower
• A “bad apple”

6. 4/11/2024 6
A Genetic Disease?
• “Drunken Women Bring Forth Children Like
Themselves” - Aristotle
• “One drunkard begets another” - Plutarch
• Animal Studies
• Human Family Tree Studies
• Twin & Adoption Studies
• Sons of Alcoholics Studies
• COGA – Seg. Of Chrom. 1, 2, 4, 7, 15 & 16
• Yes, a SLAM DUNK

7. 4/11/2024 7
Alcoholism: A Common
Complex Disease

8. 4/11/2024 8
The good news is…
Drug Abuse is a
preventable behavior
and
Drug Addiction is
a treatable disease

9. 4/11/2024 9
Alcohol – How Much is Too Much
• Moderate drinking :
Men: Up to 2 drinks per day
Women: 1 drink per day
Over 65 YO: 1 drink per day
• At-risk drinking:
Men: >14 drinks / wk or > 4/occ.
Women: > 7 drinks / wk or > 3/occ.
-Americans drink 2.58 gallons ETOH/person/yr
-6.5% of drinkers consume 50% of ETOH.
(NIAAA)

10. 4/11/2024 10
How Does The Addicted Patient
Present?
• Monday morning flu Drug Seeking Behav.*
• Hypertension* Injection Site Infec.
• Sinus Tach Anxiety/Panic*
• Depression* Hep. B, C
• Accidents* HIV
• Marital Discord* Sexual Dysfunction
• Ulcer Sleep Disorder
• Abnormal LFTs Asks for Help*
• Suicide Attempts
• Process Addiction* Trauma (DGJO)*

11. 4/11/2024 11
How Does The Spouse
Present?
• Multiple Somatic Complaints
• Dysthymia/Depression
• Anxiety/Panic
• Dependent/Co-Dependent
• Note: Symptoms refractory or quickly
replaced by something else
• Asking For Help

12. 4/11/2024 12
What About The Kids?
• Delayed development
• Accidents from poor supervision
• Neglect/Abuse
• Withdrawn
• Conduct Disorder
• Depression
• Anxiety Disorders
• Somatic Complaints

13. 4/11/2024 13
Brief Intervention
Step 1: Screen all patients
Step 2: Assess problem severity
Step 3: Provide objective feedback / advise
Step 4: Assess the patient’s readiness to change
Step 5: Negotiate goals/strategies for change
Step 6: Monitor patient progress

14. 4/11/2024 14
Take The Long View
• Move Patient Through Stages of Change
• Move Patient Toward Treatment Center
• Consider Pharmacologic Adjuncts –
Tx Co-occurring issues, i.e. Depression
Recovery is a PROCESS not an EVENT
“Don’t judge each day by the harvest
You reap…but by the seeds you plant”
- Robert Louis Stevenson

15. 4/11/2024 15
Principles of Effective Treatment
1. No single treatment is appropriate for all individuals.
2. Treatment needs to be readily available.
3. An individual’s treatment attends to multiple needs of
the individual, not just his or her alcohol / drug use.
4. An individual's treatment and services plan must be
assessed continually and modified as necessary to
ensure that the plan meets the person's changing
needs.
5. Remaining in treatment for an adequate period of time
is critical for treatment effectiveness.
6. Medications are an important element of treatment for
many patients, especially when combined with
counseling and other behavioral therapies.

16. 4/11/2024 16
Assessments
– Substance use history
– Collaborative history
– Psychosocial assessment (relational, vocation, legal)
– Psychiatric evaluation
– Psychological testing
– Physical examination
– Laboratory work-up
– Other addictions
• Eating disorder
• Sexual addiction
• Pathological gambling

17. 4/11/2024 17
Treatment Planning
• Varying combinations of services and
treatment modalities through the course of
recovery
– Counseling
– Psychotherapy
– Medication
– Medical services
– Family services
– Vocational rehabilitation
– Legal services

18. 4/11/2024 18
Length of Treatment
• For most patients, the threshold of
significant improvement is reached at
about 3 months of treatment
• Must implement strategies to not only
engage, but retain, patients in treatment

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Counseling
• Motivational enhancement
• Skills to abstain
• Non-drug activities
• Improve problem solving abilities
• Interpersonal skills
• Family function
• Citizenship

20. 4/11/2024 20
Opioid Maintenance Therapy
• Reduction in death rates
• Reduction in IV drug use
• Reduction in crime days
• Reduction in HIV seroconversion
• Improvement in employment, health, and
social function