Transcript Disease Model

MODELS OF ADDICTION:
A SUMMARY
Moral / Temperance Model *
Addiction as Sin or Crime
Personal Irresponsibility
Disease Model *
Genetic and Biological Factors **
12-Step Framework; Abstinence
Education as Treatment
Behavioral and CognitiveBehavioral Models *
Conditioning and Reinforcement
Social Learning and Modeling
Drug Expectancies and other
Cognitive Factors / RP
Family Models
Family Disease
Family Systems
Behavioral Marital/Family Tx
MODELS OF ADDICTION:
A SUMMARY
Psychological / Psychoanalytic
Disordered /Addictive Personality
Sociocultural Models
Cultural Factors
Socioeconomics/ Social Policy
Drug Subcultures
Public Health Model
Agent, Host, Environment
Interactions
THE BIOPSYCHOSOCIAL MODEL:
AN INTEGRATION
MODELS OF ADDICTION
Assumptions of Disease Model
addiction seen as a “primary” disease process
alcoholics qualitatively different from non
alcoholics: can’t drink in moderation
central symptom of addiction is loss of control
(e.g., one drink, one drunk)
addiction is chronic and progressive; no cure,
can only be arrested with total abstinence
(e.g. progression models - Johnson…learning &
seeking the mood swing; harmful dependence;
drinking to feel normal)
Disease Model - Treatment
• Early identification
• Education about diagnosis
• Acceptance of disease and
overcoming “denial”
• Abstinence
• 12-steps essential for real recovery
12 Steps of Alcoholics
Anonymous
1. We admitted we were powerless over alcohol - that
our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could
restore us to sanity.
3. Made a decision to turn our will and our lives over to the
care of God as we understood Him.
4. Made a searching and fearless moral inventory of
ourselves.
5. Admitted to God, to ourselves, and to another human being
the exact nature of our wrongs.
12 Steps of AA
(con’t)
6. Were entirely ready to have God remove all these
defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became
willing to make amends to them all.
9. Made direct amends to such people wherever
possible, except when to do so would injure them or
others.
10. Continued to take moral inventory and when we
were wrong promptly admitted to it.
12 Steps of AA
(con’t)
11. Sought through prayer and meditation to improve
our conscious contact with God as we understood
Him, praying only for knowledge of His will for
us and the power to carry that out.
12. Having had a spiritual awakening as the result of
these steps, we tried to carry this message to
alcoholics, and to practice these principles in all
our affairs.
CRITIQUE OF DISEASE MODEL
Strengths
- perception shift: from sin to TX
- eases guilt, self-blame
- disease is a good metaphor that fits the
experience
- 12-step support and framework works for
many (prevalence of meetings; 24-hour
support…)
- Other strengths?
_______________________
Disease Model - Research Support
• Adoption study of Goodwin
• 18% probands alcoholic vs. 5% controls
• Twin Studies
• male vs. female twin pairs
• Metabolic Studies
• P3 Wave Studies
CRITIQUE OF DISEASE MODEL
Limitations
- Assumptions not all data-based
addiction as “primary”
loss of control
chronic / progressive
alcoholics qualitatively different
- Dichotomous thinking dangerous; no middle
ground (you’re an alcoholic or not)
- Loss of control and responsibility paradox
- Other flaws? ___________________
SUBSTANCE USE DISORDERS
GENERAL METHODS OF TREATMENT
Inpatient Detoxification and Rehabilitation
Outpatient Individual, Couple, or Family
Counseling
Self-help Groups (Alcoholics Anonymous;
NA, CA, OA, GA, Al-Anon etc.)
Residential Facilities & Therapeutic
Communities
Medications
Project MATCH Treatment Conditions – Modalities You Will Learn
Type of
Treatment
Goal of
Treatment
Description
Frequency
CBT
(Cognitive
Behavioral
Therapy)
Learn skills to
achieve and
maintain sobriety
Coping and drink-refusal
skills taught by therapist to
handle states and situations
known to precipitate relapse
12 weekly
sessions
TSF
(Twelve Step
Facilitation)
Acceptance of the
disease of
alcoholism and
loss of control
over drinking
Patients introduced by
therapist to the first steps of
Alcoholics Anonymous and
encouraged to attend meetings
12 weekly
sessions
MET
(Motivational
Enhancement
Therapy)
Mobilize the
person’s own
commitment and
motivation to
change
Therapist applies motivational 4 sessions
psychology to examine effect in 12 weeks
of drinking on patient’s life,
and develop and implement a
plan to stop drinking