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Presented by Jason Schwartz at the Washtenaw Counseling Association Spring Conference in March 2009.
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ADDICTION 101
A primer on addiction
Definition of addiction“Alcoholism is a primary, chronic
disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal.
It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.”
(National Council on Alcoholism and Drug Dependence, Inc. 2/3/90)
What is a disease?
The causal model:
1. cell, organ or system
2. defect or injury
3. measurable symptoms
A broken leg?
The causal model:
1. bone
2. defect?
3. symptoms?
4. treatment?
Diabetes?
The causal model:
1. pancreas
2. defect?
3. symptoms?
4. treatment?
Alcoholism?
The causal model:
1. brain? liver?
2. defect?
3. symptoms?
4. treatment?
The causal model works for easy diagnosis
• The model favors simple organs.
– Addiction?
– Brain disease? Liver disease?
• In the absence of easy causality, what models work?
– Moral
– Personality
– Environment
Learning to drink
priming
early experimentation
being adult
designated driver
The mathematics of drinking
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience
More is better
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience
The rules of drinking
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience
How alcoholism develops
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience
THE HIJACKED BRAIN
The Hijacked Brain
The limbic system
Maslow’s Hierarchy of Needs
Self Actualization
Esteem
Belonging
Safety
Physiological(Food, air, water)
Maslow’s Hierarchy of Needs(Revised by addiction)
Self Actualization
Esteem
Belonging
Safety
Physiological
(Food, air, water & DRUGS)
HOW POWERFUL IS THIS?
Here’s your number
0239
or
0923489
We’d like to thank you!
AN IMPERFECT ANALOGY
I’m concerned about you, but…
HOW HAVE WE RESPONDED?
Souce: (Mark & Coffey, 2004. Health
Affairs 23:6)
Length of Stay
28 daysto 7 days (in 1998)
Source: NAPHS
Type of Care
Outpatient
Inpatient
The other winner
Treatment and Prevention Spending
Federal prison inmates whose most serious conviction was a drug crime rose from 4,749 in 1980 to 77,867 in 2004. (1540%)Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics [Online]. Available: http://www.albany.edu/sourcebook/ [7/3/05].
State prison inmates whose most serious conviction was a drug crime rose from 19,000 in 1980 to 246,100 in 2001. (1195%)Source: Prisoners in 2002 & Prisoners in 1994, Bureau of Justice Statistics [Online]. Available: http://www.ojp.usdoj.gov/bjs/pubalp2.htm#Prisoners [7/3/05]
Jail inmates whose most serious charge was a drug crime rose from 20,420 in 1983 to 155,249 in 2002. (660%)Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice Statistics [Online]. Available: http://www.albany.edu/sourcebook/ [7/3/05].
From 1986 to 1999 the average term drug offenders entering prison could expect to serve rose from an average 30 months to 66 months. (120%)Source: Federal Drug Offenders, 1999 with Trends, 1984-99, Bureau of Justice Statistics [Online]. Available: http://www.ojp.usdoj.gov/bjs/abstract/fdo99.htm [7/3/05]
Think We’re Immune?
“Our clientsare not your
typical irresponsible alcoholics”
“Some of these people will never get better. The most humane thing that we can do for them is provide hospice care.”
Local hospital cabs woman to detox in nothing but a hospital gown.
G
O
M
E
R
et
ut of
y
mergency
oom
ARE WE VIEWING ADDICTION TREATMENT APPROPRIATELY?
Treatment for Hypertension:Did Treatment Work?
Treatment Status Over Time
Blo
od
Pre
ssu
re:
mm
Hg
No Tx Tx Tx Tx No Tx
Treatment Status Over Time
Alc
oh
ol C
on
sum
pti
on
No Tx Tx Tx Tx No Tx
Treatment for Alcoholism:Did Treatment Work?
IS ADDICTION TREATMENT
AS EFFECTIVE AS
TREATMENT FOR OTHER
HEALTH PROBLEMS?
How does
asthma compare?
Medication compliance: 30%
Relapse Rate: 60 to 80%
How does
hypertension
compare?
Medication
And Diet
Compliance: 30%
Relapse Rate: 60-80%
How does
diabetes compare?
Medication, diet
and foot care
Compliance: <50%
Relapse: 30-50%
Alcoholism?
Compliance: 30-50%
Relapse: 50%
Opiates?
Compliance: 30-50%
Relapse: 40%
Tobacco?
Compliance: 30-50%
Relapse: 70%
Cocaine?
Compliance: 30-50%
Relapse: 45%
Dr. Jekyll: Real person is the sober self; addiction is about goodness corrupted by sickness
Is the addicted person viewed as…
Mr. Hyde: Real person revealed by
intoxication and disinhibition;
addiction is the revelation of badness(White, 2004)
“If you want to treat an illness that has no easy cure, first of all,
treat them with hope”
George Vaillant
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