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

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.