Crisis intervention strategies chapter 11

• Big business for legal and illegal drugs• Big business for drug-related medical care • Lost productivity • Murders, fractured families, suicide • Insurance, property crime, law enforce

Chapter Eleven: Chemical

Dependency:

The Crisis of Addiction

• Big business for legal and illegal drugs

• Big business for drug-related medical care

• Lost productivity

• Murders, fractured families, suicide

• Insurance, property crime, law enforcement

• Treatment

Prevalence in US

• 10% of those who drink, consume 50% of the alcohol

• 16M people who are heavy drinkers

• 55M binge drinkers (5 or more drinks at one setting)

• 18.7M who need treatment for alcohol use

• 22M who need treatment for legal and illegal drugs

• 71.5 M Tobacco use

• Controlled use

• Is this a reality for an abuser or an addict?

Sociocultural Determinants of

Substance Abuse

• Set vs setting - have a great effect on the

behavior of the drug used

• Set = the mental and emotional state of the user

• - including expectations, intelligence,

personality, feelings, and so on

• Setting = the social and physical

environment of the user at the time of use

• -immediate surrounding, such as a living

room, bar, legal and religious perspective

Alcohol: Number One Abused

Substance

• Duration (longevity, legacy, and history)

• Legality (limited conditions for jail)

Definitions of Commonly Used Terms (Pg

354-356)

• Chronic, recurrent misuse of chemicals.

• One or more of the following occur in a maladaptive pattern during a 12 month period:

• Failure to fulfill major role obligations (work, school, or family)

• Physical impairment that creates a hazard

• Recurrent legal or social problems

• Preferred by many in the field because it focuses on behavior.

• Is used to describe a broad spectrum of problematic compulsions.

• Addiction to alcohol.

Definitions of Commonly Used Terms

Cont

• Addiction to drugs.

• Reciprocal dependency of the addict in need of care and a

caretaker’s need to control the addict’s behavior.

• Cognitive, behavioral, and physiological symptoms indicating

that the individual continues to use the substance despite significant chemical-related problems

• Drug

• Psychoactive substance that has a direct and significant impact

on the processes of the mind with respect to thinking, feeling, and acting.

• A person who allows the addict to continue the addiction rather

than suffering the full extent of the substance-related consequences.

Definitions of Commonly Used Terms

Cont

• Degree to which one is accustomed to taking a certain drug.

• Use of a substance with some adverse physical, psychological,

social, or legal consequence.

• The intake of a chemical substance with the intent of altering

one’s state of consciousness.

• Physical and psychological symptoms as a result of the reduction

or cessation of a drug.

Defense Mechanisms (pg

356-357)

• Denial - (refuse to acknowledge)

• Displacement - (venting toward another)

• Fantasy - Escape

• Projection - (Attribute motives to others)

• Rationalization (Excuses)

• Intellectualization (impersonalization)

• Minimizing (Play down the seriousness)

• Reaction formation (defense against perceived threat)

• Regression (reverting back)

• Repression (burying in unconscious)

Enabling and Codependency

Enabling - has to do with one's behavior toward a chemical dependent.

Codependency - has to do with one's

relationship to the chemical dependent

Enabling and Codependency

details/control)

addict)

physical complaints)

Children in Alcoholic

Families

• Personality Roles

• The Scapegoat (acting out child)

• The Hero (the little adult)

• The Lost Child (adjusts without feelings)

• The Family Mascot (placates and comforts everyone)

• Family Rules in Alcoholic Families - that

children have to adopt to survive)

• Do not talk/do not have problems

• Do not trust

• Do not feel

• Do not behave differently

• Do not blame chemical dependency

• Do behave as I want

• Do be better and more responsible

• Do not have fun

Adult Children of Alcoholics

(ACOA)

• Facts

• Addiction has a genetic component

• Addictive behavior can be learned

• ACOA’s tend to marry addicts

• Identification and expression of feelings

• Effects of childhood roles

• Adaptive roles from childhood follow them into adulthood

• (heroes, lost child, placaters, family mascots, acting-out)

• Outpatient Programs (1-2 times per

week, with much criticism)

• Contingency Management (CM)

(reward/reinforcement based)

Intervention

Strategies

change with continued work)

emotional changes, support system in place)

Assessment

• Can be a serious medical process

• Addict may be given small, controlled amount

of the addicted substance to reduce severe

Principles of

Treatment

cognitive behavioral, reinforcement based, emotive behavioral)

life problems)

Principles of Treatment

Cont.

• Overcoming Environmental Cues That Lead

to Drinking (playmates and playgrounds)

• Treating the Family

• Family Therapy Session

• Therapy for the Children

• Aftercare and Relapse Prevention

• Cognitive-Behavioral Boosters (statements, messages)

• Pharmacology

• Euphoria (over kill)

• AA's Role in Aftercare