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Chapter 12


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University of Toronto Mississauga
Ayesha Khan

PSY240 CHAPTER 12 – ADDICTION DISORDERS  Individual lifestyles and personality features thought to play important roles in development of addictive disorders and are central themes in some types of treatment Addictive behaviour – behaviour based on the pathological need for a substance or activity  Most common used problem substances are those drugs that affect our mental functioning, psychoactive drugs [diagnostic purposes] – addiction or substance-related disorders divided into two major categories: 1) Includes conditions that involve organic impairment resulting from prolonged and excessive ingestion of psychoactive substances 2) Includes substance-induced organic mental disorders and syndromes, stem from toxicity [poisonous nature of the substance or from physiological changes in brain due to vitamin deficiency] DSM-IV-TR and ICD-10 provides two major categories: substance-dependence disorders and substance- abuse disorders Substance abuse – involves pathological use of a substance resulting in 1) potentially hazardous behaviour, or 2) continued use despite a persistent social, psychological, occupational, or health problem Substance dependence – includes more severe forms of substance-use disorders and usually involves a marked physiological need for increasing amounts of a substance to achieve the desired effects Dependence means that individual will show a tolerance for a drug and/or experience withdrawal symptoms when drug is unavailable Tolerance – need for increased amounts of substance to achieve the desired effects [result from biochemical changes in body that affect rate of metabolism and of elimination of substance from body] Withdrawal symptoms – physical symptoms that accompany abstinence from the drug ALCOHOL ABUSE AND DEPENDENCE WHO recommends term alcoholism but prefers the term alcohol dependence syndrome – “a state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioural and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence; tolerance may or may not be present” The Prevalence, Comorbidity, and Demographics of Alcohol Abuse and Dependence Lifetime prevalence of alcohol dependence: 12% Life span of average person with alcohol dependence is about 12 years shorter than that of the average person without this disorder Alcohol is leading cause of death of young people Alcohol lowers performance on cognitive tasks, organic impairment [brain shrinkage] Over 37% of alcohol abusers suffer from at least on coexisting mental disorder Alcohol is depressant, depression ranks high among mental disorders often comorbid with alcoholism 28.6% had at least one personality disorder Alcohol abuse associated with about 40-50% of all murders, 40% of all assaults, and over 50% of rapes - Found that alcohol more frequently associated with both violent and nonviolent crime than other drugs, and people with violence-related injuries more likely to have positive Breathalyzer test Most problem drinkers – people experiencing life problems as a result of alcohol abuse – are men; men become problem drinkers at about five times frequency of women Marriage, higher levels of education, and being older associated with lower incidence of alcoholism Course of alcohol-related problems can be both erratic and fluctuating Course of alcohol abuse and dependence can vary and may even include periods of remission PSY240 CHAPTER 12 – ADDICTION DISORDERS The Clinical Picture of Alcohol Abuse and Dependence Physiological effects: 1) Tendency toward decreased sexual inhibition, but lowered sexual performance 2) Experience blackouts – lapses of memory [first occur at high blood alcohol levels, and drinker may carry on rational conversation or engage in other relatively complex activities but have no trace of recall the next day, for heavy drinkers – moderate drinking can cause memory lapses] 3) Hangover – drinkers experience at one time or another, experience symptoms of headache, nausea, and fatigue Alcohol’s Effects on the Brain @ lower levels – alcohol stimulates certain brain cells and activates brain’s “pleasure areas” which release opium like endogenous opioids that are stored in the body @ higher levels – alcohol depresses brain functioning, inhibiting one of the brain’s excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain  Inhibition of glutamate in brain impairs organism’s ability to learn and affects higher brain centres, impairing judgment and other rational processes and lowering self-control  Typically drinker experiences sense of warmth, expansiveness, and well-being – unpleasant realities are screened out and drinker’s feelings of self-esteem and adequacy rise Amount of alcohol actually concentrated in bodily fluids, not amount consumed, that determines intoxication – effects vary for different drinkers [depending on physical condition, amount of food in their stomach, and duration of their drinking] - Alcohol users may gradually build up a tolerance for drug to that ever-increasing amounts may be needed to produce desired effects – women metabolize alcohol less effectively than men Development of Alcohol Dependence Believe that in moderate amounts it is not harmful to most people [Pregnant women] – Moderate amounts believed to be dangerous; no safe level has been established Fetal Alcohol Syndrome – condition caused by excessive alcohol consumption by mother during pregnancy and results in birth defects [ex. Mental retardation] The Physical Effects of Chronic Alcohol Use Alcohol that is taken in must be assimilated by body, except for about 5-10% that is eliminated through breath, urine, and perspiration – work of assimilation done by liver; but when large amounts ingested, liver may be seriously overworked and suffer irreversible damage  15-30% of heavy drinkers develop cirrhosis of liver – disorder that involves extensive stiffening of the blood vessels  High-calorie drug, so reduces drinker’s appetite for other food, and alcohol has no nutritional value so drinker can suffer from malnutrition  Impairs body’s ability to utilize nutrients, so nutritional deficiency cannot be made up by popping vitamins  Experience increased gastrointestinal symptoms [ex. Stomach pains] Psychosocial Effects of Alcohol Abuse and Dependence Excessive drinker usually suffers from chronic fatigue, oversensitivity, and depression Excessive use of alcohol eventually becomes counterproductive, and can result in impaired reasoning, poor judgment, and gradual personality deterioration, behaviour becomes coarse and inappropriate, and drinker assumes increasingly less responsibility loses pride in personal appearance, neglects spouse and family, and becomes generally touchy, irritable, and unwilling to discuss the problem Generally becomes unqualified to cope with new demands that arise because they are unable to hold a job In alcoholic’s brain – accumulating diffuse organic damage even when no extreme organic symptoms are present, even mild to moderate drinking can affect memory and problem solving PSY240 CHAPTER 12 – ADDICTION DISORDERS Psychoses Associated with Severe Alcohol Abuse Acute psychotic reactions fit diagnostic classification of substance-induced disorders – reactions may develop in people who have been drinking excessively over long periods of time or who have reduced tolerance for alcohol for other reasons, acute reactions only last short time and generally consist of confusion, excitement, and delirium  Some evidence that delirium associated with lower levels of thiamine in alcoholics, these disorders often called “alcoholic psychoses” – marked by temporary loss of contact with reality Drink excessively for long time – reaction “alcohol withdrawal delirium” may occur, usually happens following prolonged drinking spree when person is in state of withdrawal – slight noises or suddenly moving objects may cause excitement and agitation Full-blown symptoms include: 1) disorientation for time and place, 2) vivid hallucinations, 3) acute fear, 4) extreme suggestibility, 5) marked tremors of the hands, tongue and lips, and 6) other symptoms including perspiration, fever, rapid and weak heartbeat, coated tongue, and foul breath  Delirium can last from three to six days and generally followed by deep sleep, when person awakens, few symptoms remain, but individual is badly scared and may not resume drinking for several weeks or months [usually drinking resumed followed by return to hospital with new attack] – death rate from withdrawal delirium about 10% Alcohol amnestic disorder [severe alcohol-related disorder] – memory defect which is sometimes accompanied by falsification of events [confabulation], tend to fill memory gaps with reminiscences and fanciful tales that lead to unconnected and distorted associations – individuals may appear to be delirious, delusional, and disoriented for time and place, but their confusion and disordered actions are closely related to their attempts to fill in memory gaps  Research has shown that people with alcohol amnestic disorders show cortical lesions  Symptoms thought to be due to vitamin B (thiamine) defiency and other dietary inadequacies  Reported that alcohol amnestic disorder did not respond well to thiamine replacement [many people believe that diet rich in vitamins and minerals generally restores patient to more normal physical and mental health]  Some memory functioning appears to be restored with prolonged abstinence  Some personality deteoration remains in form of memory impairment, blunted intellectual capacity, and lowered moral and ethical standards 12.1 – Fetal Alcohol Syndrome: How Much Drinking is too much? Newborn infants whose mothers drank heavily during pregnancy found to have frequent physical and behavioural abnormalities [aggressiveness, destructiveness, and may experience symptoms of alcohol withdrawal  shown growth defiencies, facial and limb irregularities, damage to the central nervous system, and impairment in cognitive functioning] Fetal alcohol syndrome associated with development of mental disorder in adults Actual amount of alcohol that can be safely ingested during pregnancy is not known, but existing evidence for fetal alcohol syndrome is strongest when applied to binge drinkers or heavy alcohol users rather than to light or moderate users Biological Factors in the Abuse of and Dependence on Alcohol and Other Substances How do substances come to have such powerful effects –an overpowering hold that occurs in some people after only a few uses of the drug? 1) Addictive drugs tend to activate brain areas that produce intrinsic pleasure and sometimes immediate, powerful reward 2) Person’s biological makeup – including their genetic inheritance and the environmental influences [learning factors] that enter into the need to seek mind-altering substances to an increasing degree as use continues PSY240 CHAPTER 12 – ADDICTION DISORDERS The Neurobiology of Addiction Role drugs play in activating the “pleasure pathway”  Mesocorticolimbic dopamine pathway [MCLP] – centre of psychoactive drug activation in the brain  Made up of axons or neuronal cells in middle portion of brain known as ventral tegmental area and connects to other brain centres like the nucleus accumbens and then to prefrontal cortex  Neuronal system involved in functions like control of emotions, memory, and gratification o Alcohol produces euphoria by stimulating this area in the brain  Alcohol promotes dopamine release in brain, specifically in nucleus accumbens – findings consistent with hypothesis that mesolimbic dopamine activation mediates reinforcing effects of abused substance  Alcohol may stimulate mesolimbic dopamine pathway directly or may act indirectly decreasing activity of GABA neurons [which normally inhibit dopamine neurons]  Other psychoactive drugs operate to change brain’s normal functioning and activate pleasure pathway – drug ingestion or behaviours that lead to activation of brain reward system are reinforced so further use is promoted  Exposure of brain to addictive drug alters neurochemicals structure and results in number of behavioural effects – with continued use of drug, neuroadaptation or tolerance and dependence on substance develop Genetic Vulnerability Study showed that almost 1/3 of alcoholics had at least one parent with an alcohol problem Found that males having one alcoholic parent increased rate of alcoholism from 12.4 % to 29.5 % and having two alcoholic parents increased rate to 41.2 % Found that females having no alcoholic parents rate was 5.0 % and for those having one alcoholic parent, rate was 9.5% and for those with two alcoholic parents it was 25% Studies show that some people ex. Sons of alcoholics, have high risk for developing problems with alcohol because of inherent motivation to drink or sensitivity to drug Found that children of alcoholic parents who had been adopted by nonalcoholic foster parents were nearly twice as likely to have alcohol problems by their late twenties as a control group of adopted children whose real parents were not alcoholics Other investigators concluded that being born to an alcoholic parent, rather than being raised by one, increased risk of son’s becoming an alcoholic *Both genetic factors and environmental factors play important role in shaping risk for alcohol problems Found that Asian and Inuit people showed hypersensitive reaction [flushing of the skin, drop in blood pressure, heart palpitations, and nausea following ingestion of alcohol] called “alcohol flush reaction”  results from mutant enzyme that fails to break down alcohol molecules in liver during metabolic process Genetics – The Whole Story? Genetic mechanism or model for generally agreed-upon observation that alcoholism is familial is insufficient to explain behaviour fully – genetic transmission [in alcoholism] does not follow hereditary pattern found in strictly genetic disorders Some researchers say genetics plays a stronger role in men than in women to question relative power of genetics as explanatory factor in substance abuse Great majority of children who have alcoholic parents do not themselves become alcoholics – whether or not they are raised by their real parents Research suggests the genetic-environmental interactions in development of substance-use disorders, where people with a particular genetic makeup most likely to develop problems with abuse or dependence when exposed to substances PSY240 CHAPTER 12 – ADDICTION DISORDERS Genetic Influences and Learning Learning factors play role in development of constitutional reaction tendencies - Having genetic predisposition or biological vulnerability to alcohol abuse is NOT sufficient cause of disorder – person MUST be exposed to substance to a SUFFICIENT degree for addictive behaviour to appear - Develop of alcohol-related problems involves living in environment that promotes initial and continuing use of substance - People become conditioned to stimuli and tend to respond in particular ways as result of learning Drug stimulates pleasure centres in the brain and develops reward system of its own Psychosocial Causal Factors in Alcohol Abuse and Dependence Failures in Parental Guidance Children who have parents who are extensive alcohol or drug abusers are vulnerable to developing substance-abuse and related problems themselves Parent substance use associated with early adolescent substance use Early experiences can have direct influence on whether youngster becomes involved in maladaptive behaviour [ex. Alcohol or drug abuse] – negative parental models can have longer-range negative consequences once children leave family situation Study found that parenting skills or parental behaviour was associated with substance use in adolescents – alcohol-abusing parents less likely to keep track of what their children are doing, and this lack of monitoring often leads to adolescents’ affiliation with drug-using peers Study found that stress and negative affect [more prevalent in families with alcoholic parent] associated with alcohol use in adolescents – reported that “parental alcoholism was associated with increase in negative uncontrollable life events which were linked to negative affect to associations with drug-using peers and to substance use Psychological Vulnerability Found that many potential alcohol abusers tend to be emotionally immature, expect a great deal of the world, require inordinate amount of praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male or female roles  people high risk for developing alcohol-related problems significantly more impulsive and aggressive than those at low risk for abusing alcohol Research has suggested that there is relationship between depressive disorder and alcohol abuse, may be gender differences in association between these disorders –researchers found that degree of association between depression and alcohol abuse problems stronger among women Presence of other mental disorders in alcohol- or drug-abusing patients is important when considering treatment  To ensure more effective treatment with these complicated problems, recommend that treatment of co-occurring mental health problems involve more cross-disciplinary collaboration, greater integration of substance-abuse and mental health treatments, and modification of training of caregivers to sensitize them to difficulties of treating patients with comorbid disorders Stress, Tension Reduction, and Reinforcement Reported high degree of association between alcohol consumption and negative affectivity such as anxiety and somatic complaints – meaning alcoholics drink to relax  tension-reduction hypothesis Tension-reduction hypothesis – anyone who finds alcohol to be tension-reducing is in danger of becoming an alcoholic, even without an especially stressful life situation Found that for alcohol-abusing women seen in clinical settings, 24-85% have history of sexual abuse, sexually abuse typically precedes alcohol abuse [laboratory studies have provided inconsistent support PSY240 CHAPTER 12 – ADDICTION DISORDERS for the hypothesis – tension does play role, but difficult to accept as sole explanatory hypothesis, we would expect alcoholism to be far more common than it is and model does not explain why some excessive drinkers are able to maintain control over their drinking and continue to function in society while others are not] Expectations of Social Success Reciprocal Influence model – adolescents begin drinking as a result of expectations that using alcohol will increase their popularity and acceptance by their peers – research has shown that expectations of social benefit can influence adolescents’ decisions to start drinking and predict their consumption of alcohol  From this view, alcohol use in teenagers can be countered by providing young people with more effective social tools and with ways of altering these expectancies before drinking begins  Suggested that prevention efforts should be targeted at children before they begin to drink so that the positive feedback cycle of reciprocal reinforcement between expectancy and drinking will never be established Time and experience moderating variables for alcohol expectancies – significant decrease in outcome expectancy overtime – older students showed less expectation of the benefits of alcohol than beginning students Moderating variable – variable that influences association between two other variables Marital and Other Intimate Relationships Excessive drinking often begins during crisis periods in marital or other intimate personal relationships, particularly crises that lead to hurt and self-devaluation Marital relationship may serve to maintain pattern of excessive drinking Marital partners may behave toward each other in ways that promote or enable a spouse’s excessive drinking Important concern in treatment programs involves identifying personality or lifestyle factors in relationship that tend to foster drinking in alcohol-abusing person Excessive drinking common cause of divorce and often hidden factor in two most common causes – financial and sexual problems Family relationship problems also been found to be central to development of alcoholism – most important family variables that were considered to predispose individual to substance-use problems were presence of alcoholic father, acute marital conflict, lax maternal supervision and inconsistent discipline, many moves during family’s early years, lack of “attachment” to father, and lack of family cohesiveness 12.2 – Binge Drinking in College and University On average, students consumed five or more drinks about twice a month, so average student was binge drinking every two weeks, prevalence of binge drinking higher in male than female students Various reasons: expressing independence from parental influence, developing and asserting gender role [particularly for men adopting a “macho” role], and holding beliefs that alcohol can help make positive transformations Strong association between frequency of binge drinking and alcohol-related health and life problems – binge drinkers nearly 10 times more likely than those who did not indulge in binge drinking to engage in unplanned sexual activity, to fail to use protection when having sex, to get into trouble with campus police, to damage property, and to get hurt after drinking One study suggested that drinkers from sororities and fraternities might be determined to a great extent by situational factors – and being member of a fraternity or sorority did not predict postcollege drinking Follow-up study indicated that heavy drinking during college did not relate to heavy drinking during later years PSY240 CHAPTER 12 – ADDICTION DISORDERS Sociocultural Factors Alcohol often seen as a “social lubricant” or tension reducer than enhances social events Incidence of alcohol use among Muslims and Mormons [religious values prohibit use of alcohol], and by Orthodox Jews [limited its use largely to religious ritiuals] Incidence of alcoholism among Europeans is high French appear to have highest rate of alcoholism in the world [15% of the population] – France has highest per capita alcohol consumption and highest death rate from cirrhosis of liver Sweden also has high rates of alcoholism  Appears that religious sanctions and social customs can influence whether alcohol is one of the coping methods commonly used in a given group or society  Behaviour that is manifested under influence of alcohol seems to be influenced by cultural factors  study found that most people expressed view that aggressive behaviour frequently followed their drinking “many” drinks – but expectation that alcohol leads to aggression is related to cultural traditions and early exposure to violent or aggressive behaviour *** exact combination of factors that result in a person’s becoming an alcoholic are still unknown 12.1 – Alcohol Use among Canadian Aboriginal Peoples The abuse of alcohol and drugs in First Nations communities indicates that these problems are linked to poverty Alcohol abuse in Aboriginal communities often associated with other forms of drug abuse [ex. Inhalant abuse] Aboriginal Canadians, compared to non-Aboriginal counterparts are no more likely to drink alcohol  Aboriginal population has higher percentage of abstainers, compared to general population  But those Aboriginal people who do drink are more likely to drink more heavily, even when socioeconomic status is taken into consideration  Aboriginals have more heavy drinkers [5 or more drinks] – same found in women [those who drank had more drinks] Psychosocial factors within cultures may influence differences in drinking patterns between Aboriginal and non-Aboriginal people – number of one’s friends who used alcohol or drugs was strongest predictor of alcohol or drug use for both Aboriginal and non-Aboriginal students, peer attitudes about drug or alcohol use was also predictor for Aboriginal students Development of problem drinking among Canadian Aboriginals was learned behaviour modeled by European traders, along with increased availability of alcohol because before first contact with Europeans, drug and alcohol use was strictly controlled by social customs Others argued that abuse is consequence of forced attempt by European colonists to eradicate tribal language and culture, leading to a loss of cultural identity that sets stage for alcoholism, drug abuse, and depression Abuse and neglect contribute to feelings of hopelessness and depression among adolescents, who then seek to escape their feelings through alcohol and other drugs Treatment of Alcohol Abuse Disorders Refer to addictions as “diseases of denial” Reported that 2/3 of studies show large and significant decreases in drinking and related problems Multidisciplinary approach to treatment of drinking problems appears to be most effective, because problems are often complex, requiring flexibility and individualization of treatment procedures and substance abusers needs change as treatment progresses Objectives of treatment: detoxification, physical rehabilitation, control over alcohol-abuse behaviour, and individual’s realizing that he or she can cope with problems of living and lead a much more rewarding life without alcohol PSY240 CHAPTER 12 – ADDICTION DISORDERS Traditional treatment programs usually have as their goal – abstinence from alcohol, but some programs attempt to promote controlled drinking as treatment goal for problem drinkers - Relapse is common and many see relapse as factor that must be addressed in treatment and recovery process Use of Medications in Treating Alcohol Abusers  Medications to Block the Desire to Drink Disulfiram – drug that causes violent vomiting when followed by ingestion of alcohol, may be administered to prevent an immediate return to drinking Pharmacological methods alone have not proved effective in treating alcoholism Antabuse – because drug is self-administered, alcohol-dependent person may simply discontinue the use when they are released from hospital or clinic, and begin to drink again *primary value of drugs of this type seems to be their ability to interrupt the alcohol-abuse cycle for a period of time, during which therapy may be undertaken, and uncomfortable side effects may accompany use of Antabuse Naltrexone – opiate antagonist that helps reduce the “craving” for alcohol by blocking pleasure- producing effects of alcohol – researchers have shown that naltrexone reduced alcohol intake and lowered incentive to drink for alcohol abusers [compared with control sample given a placebo] and some research suggested that naltrexone is particularly effective with individuals who have high level of craving [some research has found naltrexone failure as reducing craving]  Medications to Reduce the Side Effects of Acute Withdrawal Initial focus on detoxification [elimination of alcoholic substances from an individual’s body] on treatment of withdrawal symptoms described earlier, and on medical regimen for physical rehabilitation Primary goals in treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of the syndrome like insomnia, headache, gastrointestinal distress, and tremulousness Central to medical treatment approaches – prevention of heart arrhythmias, seizures, delirium, and death Steps can usually be handled best in hospital or clinic, where drugs like Valium have revolutionized treatment of withdrawal symptoms  drugs overcome most excitement, nausea, and vomiting; prevent withdrawal delirium and convulsions; and help alleviate the tension and anxiety associated with withdrawal Pharmacological treatments with long-lasting benzodiazepines [diazepam] reduce severity of withdrawal symptoms have been shown to be effective - Concern is growing that the use of tranquilizers at this stage does not promote long-term recovery and may foster addiction to another substance so some clinics exploring alternative approaches like gradual weaning from alcohol instead of a sudden cut-off Maintenance doses of mild tranquilizers sometimes given to patients withdrawing from alcohol to reduce anxiety and help them sleep – but use of mild tranquilizers may be less effective than no treatment at all – usually patients must learn to abstain from tranquilizers as well as from alcohol because they tend to misuse both and under influence of tranquilizers, patients may return to alcohol use Psychological Treatment Approaches  Group Therapy Shown to be effective for many clinical problems, especially substance-abuse disorders Alcohol abusers forced to face their problems and their tendencies to deny or minimize them Group situations can be extremely difficult for those who have engrossed in denial of their own responsibilities, but such treatment also helps them see new possibilities for coping with circumstances that have led to their difficulties so often paves the way to learning more effective ways of coping and other positive steps toward dealing with their drinking problem PSY240 CHAPTER 12 – ADDICTION DISORDERS Sometimes spouse of alcohol abusers invited to join in therapy meetings, or family treatment is central focus of therapeutic efforts [in this case, alcohol abuser seen as member of disturbed family where all members have responsibility for co-operating in treatment] because family members often the people most victimized by the alcohol abuser’s addiction, they tend to be judgmental and punitive, and person in treatment who has already passed harsh judgment on themselves may tolerate this further source of devaluation poorly and sometimes family members may encourage alcohol abuser to remain addicted  Environmental Intervention Total treatment program for alcohol abuse usually requires measures to alleviate a patient’s aversive life situation – environmental support shown to be important ingredient of an alcohol abuser’s recovery Typically, reaction of those around an alcohol abuser is not as understanding or as supportive as it would be if alcohol abuser had physical illness of comparable magnitude Helping people with alcohol-abuse problems to learn more effective coping techniques may not be enough if their social environment remains hostile and threatening Halfway houses – designed to assist them in their return to family and community – important adjuncts to their total treatment program  Behavioural and Cognitive-Behavioural Therapy Behavioural therapy – involves presentation of wide range of noxious stimuli with alcohol consumption in order to suppress drinking behaviour – variety of pharmacological and other deterrent measures can be used in behavioural therapy after detoxification, one approach involves intramuscular injection of emetine hydrochloride, an emetic – before experiencing nausea that comes from injection, patient given alcohol, so that the sight, smell, and taste of beverage become associated with severe retching and vomiting  conditioned aversion to taste and smell of alcohol develops and with repetition, classical conditioning procedure acts as strong deterrent to further drinking probably because it adds immediate and unpleasant physiological consequence to the more general socially aversive consequences of excessive drinking Cognitive-behavioural therapy – combines cognitive-behavioural strategies of intervention with social- learning theory and modeling of behaviour – often referred to as “skills training procedure” – usually aimed at younger problem drinkers who are considered to be at risk for developing more severe drinking problems because of an alcohol-abuse history in their family or their heavy current consumption – approach relies on techniques as imparting specific knowledge about alcohol, developing coping skills in situations associated with increased risk of alcohol use, modifying cognitions and expectancies, acquiring stress-management skills, and providing training in life skills – treatments have been shown to be effective Self-control training techniques – goal of therapy is to reduce alcohol intake without necessarily abstaining altogether  Controlled Drinking versus Abstinence Based on hypothesis that some problem drinkers need not give up drinking altogether but rather, can learn to drink moderately Research has suggested that some alcoholics can learn to control their alcohol intake Evaluated results of four long-term follow-up studies of controlled-drinking treatment programs – found a clear trend of increased numbers of abstainers and relapsed cases at long-term follow-up, found that consistent percentage of subjects across four studies controlled their drinking – concluded that controlled drinking was more likely to be successful in persons with less severe alcohol problems Many people in the field have rejected the idea that alcohol abusers can learn to control their drinking, and these theorists insist on total abstinence approach  Alcoholics Anonymous Operates primarily as self-help counseling program in which both person-to-person and group relationships are emphasized, accepts both teenagers and adults with drinking problems, has no dues or PSY240 CHAPTER 12 – ADDICTION DISORDERS fees, does not keep records or case histories, does not participate in political causes, and not affiliated with any religious sect, although spiritual development is key aspect of its treatment approach Meetings devoted partly to social activities, but they consist of discussions of participants’ problems with alcohol, often with testimonials from those who have stopped drinking – these members usually contrast their lives before they broke their alcohol dependence with lives they now live without alcohol Alcoholic used by AA and affiliates to refer to either to persons who currently are drinking excessively or to people who have stopped drinking but must, according to AA philosophy, continue to abstain from alcohol consumption in the future - In AA view, one is an alcoholic for life, whether or not one is drinking: one is never “cured” of alcoholism but is instead “in recovery” Appears to life the burden of personal responsibility by helping alcoholics accept that alcoholism is bigger than they are – they can see themselves not as weak-willed or lacking in moral strength, but having an affliction – they cannot drink – and through mutual help and reassurance from group members who have had similar experiences, many alcoholics acquire insight into their problems, new sense of purpose, greater ego strength, and more effective coping techniques Affiliated movements – Al-Anon family groups and Alateen – designed to bring family members together to share experiences and problems, to gain understanding of the nature of alcoholism, and to learn techniques for dealing with their own problems living in a family with one or more affected individuals Reported success of AA based primarily on anecdotal information rather than on objective study of treatment outcomes Outcome Studies and Issues in Treatment Outcome varies considerably, depending on population studied and on treatment facilities and procedures employed Substance abusers who also diagnosed as having personality disorder or mood disorder tended to have poorer outcomes in alcohol treatment than those for whom diagnosis was simply alcohol-abuse problems Treatment most likely to be effective when individual realized that they need help, when adequate treatment facilities are available, and when individual attends treatment regularly Having positive relationship with therapist associated with better treatment outcome One new treatment strategy aimed at reinforcing treatment motivation and abstinence early in treatment process by providing “check-up” follow-ups on drinking behaviour “Drinking Check-Up” sessions during early stages of therapy resulted in reduction of drinking in first six weeks of therapy, compared with clients who did not have check-up sessions Patients with certain personality characteristics or with differing degrees of severity might do better in one specific therapeutic approach rather than in another so patient characteristics should be taken into account in order for treatment to be more effective Patient-treatment matching – Project MATCH – study involved 1726 patients who were treated in 26 treatment programs by 80 different therapists representing three treatment approaches – research design included both inpatient and outpatient treatment component Project MATCH – compared treatment effectiveness of three different approaches to alcohol treatment: 1) 12-step program along lines of AA and referred to as “Twelve-Step Facilitation Therapy” [TSF]; 2) cognitive-behavioural therapy program [CBT]; and 3) treatment technique referred to as Motivational Enhancement Therapy” [MET] which attempts to get clients to assume responsibility for helping t
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