Power Point for Addiction Treatment: a strengths Perspective 3rd Edition Katherine van Wormer Diane Rae Davis Cengage Publishing Company 2012 copyright Part I: Introduction



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Power Point for Addiction Treatment: A Strengths Perspective 3rd Edition Katherine van Wormer Diane Rae Davis Cengage Publishing Company 2012 copyright

Part I: Introduction

  • Addiction affects us all. Strengths perspective—strengths of clients and strengths of the contemporary models:
    • Harm reduction
    • 12 Step approach.
  • Rift in field.
  • Book in 3 parts: bio-psycho-social

Chapter I Nature of Addiction

  • Examples of addiction---smoker dying of emphysema, crack addict arrested, pregnant mother drinking heavily, girl hooked on meth she started using to lose weight
  • Economic cost—health, war on drugs, over 1 million in prison for drug involvement. Big business—gambling, Philip Morris, beer

What is addiction?

  • (Latin) addictus---attached to something, positive. Today alcoholism called a “brain disease”or bad habit or sin. Leading assumption of the text: Addiction is the key, not the substance or behavior
  • Addiction defined by researchers as “a bad habit,” “a brain disease,” “helplessness,” “a problem of motivation”

DSM-5

  • Changes to DSM in new edition: no longer dichotomy between abuse and dependence
  • Addiction now the preferred term instead of dependence.
  • Addiction now seen as a continuum.
  • Substance use disorder requires 2 of following:
  • tolerance inability to stop
  • withdrawal problems excessive spending or effort
  • use more than intended to obtain
  • reduced involvement continued use
  • Definitions
  • Addiction—pattern of compulsive use.
    • Has physical, psychological, social aspects.
    • Emphasis on process rather than outcome.
  • Gambling now considered an addiction in DSM-5
  • Pattern of preoccupation, lack of control, form of escape, chasing one’s losses, serious consequences.

Box 1.1 A Social Work Major Working in a Casino

  • What is the ethical dilemma here?
  • How do the managers ensure that the gamblers keep spending their money?
  • How are the employees controlled by the establishment?

The Disease Concept

  • Is alcoholism a disease?
  • Arguments pro:
  • Arguments con:

First, Define Disease

  • Disease - as metaphor by Jellinek: “alcoholism is like a disease”
  • Random House Dictionary, disease is a condition of the body in which this is incorrect function.
  • Oxford University Dictionary– disease is absence of ease (in treatment – disease as: primary, progressive, chronic, and possibly fatal).
  • Illness – term preferred here, less controversial, less medical.
  • Best arguments pro disease: alcoholism is a brain disease because the addicted brain has changed.
  • Best arguments against: just a habit, a behavior, need to take responsibility, people mature out of it.

Biopsychosocial-spiritual Model

  • Why (bio), what (psycho), where (social)
  • Need for spiritual healing, connection with Higher Power
  • Interactionism and cycle of pain: pain and suffering  loss  pain, stress and drinking more pain
  • Family as a system in interaction, roles

Why Do We Need to Know about Addiction?

  • 80% of people behind bars have problems, pervasive in child welfare system, alcoholism in the workplace.
  • 71% of social workers worked with clients with substance use disorders in the past year.
  • Headlines:
  • -“When Tanning Turns into an Addiction”
  • -“Help! I’m Addicted to Facebook”
  • Relevant movies: 28 days, Traffic, Walk the Line

Table 1.1 Contrast Traditional Approach and Strengths Perspective Traditional approach dichotomizes alcoholic and non-alcoholic Use of labels—I am an alcoholic, addict, dysfunctional family Focus on losses, client in denial, resistant Strengths approach—avoids labels, focus on strengths, family as resource

Two Approaches to Treatment

  • Traditional
  • Bio
  • Dichotomy
  • Psycho
  • Problems mandate—one size fits all
  • Social
  • Identify family dysfunction
  • Strengths-based
  • Bio
  • Continuum
  • Psycho
  • Strengths-motivation
  • Social
  • Holistic family as resource
  •  

Addiction Recovery Management Strengths-based treatment approach endorsed by UN Case management Community resources for long-term care Interventions relate to personal needs in society—mental health care, housing Success measured in drinking, using less, not total abstinence

  • Strengths Perspective
  • Rapp and Goscha:
  • Six critical elements: person is not the illness, choice, hope, purpose, achievement, presence of one key person to help.
  • Finding the strengths in divergent models—harm reduction and 12 Step approach
  • Different models for different folks.
  • Very negative view of disease model: Stanton Peele: Resisting 12 Step Coercion
  • Harm reduction and the strengths perspective— “meet the client where the client is.”
  • Policy issues of reducing harm.

Empirical Research

  • Project MATCH
  • Directed by NIAAA – 2,000 clients over 8 yrs.
  • What works? 12 step facilitation, cognitive, motivational enhancement therapy (MET)
  • MET most effective for those with low motivation, 12 Step with religious
  • persons.
  • Criticism: lack of a control group. MET, a shorter intervention. Models only
  • tested on alcoholic clients.
  • Project MATCH confirms the effectiveness of diverse treatments. New measure for recovery is improvement, not total abstinence.
  • Vaillant’s Research
  • 40 year longitudinal study—those who recovered had crisis with alcohol or joined AA or entered a stable relationship or had a religious conversion.


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