Trauma and Addiction Final Flashcards by Olimpia Dominguez

Theories of Addiction (5)

The moral model (A disorder of choice)
Biological theory
Psychological theory
Sociological theory
Biopsychosocial model/Public health model

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3 aspects of the moral model

Personal Choice
Values
Responsibility

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Explains addiction as a consequence of personal choice
Places full responsibility on the users
Addictive behavior is influenced by preexisting values. Thus society should attempt to instill values that are incompatible with addiction and substance abusing behaviors

The moral model

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Addiction counselors may carry internalized biases that reflect moral model attitudes and should work to increase their awareness so that they do not influence their work with clients.
Whereas public sensitivity to the struggles of addicted people has increased, many challenges and barriers continue to prevent some from accessing needed treatment

Stigma

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Biological theories talk about…

Certain biological traits (inherited or acquired) may increase the likelihood of eventual drug abuse or addiction, particularly in the presence of other external influences

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Biological traits (inherited/acquired)
A Brain Disease Model of Addiction
Self-medicating (Biological/Psychological)
The factors of gender, race, and age

Biological Theories

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Biological Traits

Inherited
-Reward deficiency syndrome
-Genetic factor

Acquired (Neuroadaptation)
-Frequent and chronic use

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Addiction is a brain disease

There is convincing evidence that drugs of abuse act directly on brain mechanisms responsible for reward and punishment

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Drugs are usurping brain circuits and motivational priorities

Addiction changes brain circuits
-Reward/saliency
-Motivational/drive
-Memory/learning
-Inhibitory/control

all is explained under the…

Addiction is a brain disease

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Four circuits that are involved in addiction

-Reward: Located in the nucleus accubens (NAc) and the ventral pallidum
-Motivation/Drive: Located in the orbitofrontal cortex (OFC)
-Memory and Learning: Located in the amygdala and the hippocampus
-Control: Located in the prefrontal cortex and the anterior cingulate gyrus (CG)

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-Tolerance
-Withdrawal
-Blackout
-Craving/Urge
-Impulsivity
-Compulsivity
-Habit
Are explained by the

Addiction is a brain disease

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Gender factor

Women have a higher BAC than men when a comparable amount of alcohol is consumed:
-Women weigh less than men
-Women have more fat and less water in their bodies
-Women metabolize less alcohol in their stomach and esophagus

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In women, the liver is more prone to the toxic effects of chronic alcohol use than in men (Liver injury progresses more rapidly over a shorter period of time and with less alcohol consumed and/or alcoholic liver cirrhosis is more likely to develop and more likely to cause death.)
It is an explanation related to…

Gender factor

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Race factor

The chemical breakdown of alcohol

Alcohol Dehydrogenase (ADH) to Aldehyde dehydrogenase (ALDH)
Alcohol —– Acetaldehyde —– Acetate

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Age factor

Older people have a higher BAC than younger people when a comparable amount of alcohol is consumed.

-Older people metabolize alcohol more slowly than younger people. (also “increased brain susceptibility to the depressant effects” of alcohol and “decreased percentages of body water.”
-Alcohol-drug interaction effect

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Gene-Environment Interactions

-Genetic effects on behavior occur because they affect an individual’s susceptibility to adverse environments

-Adverse environments, such as negative or inadequate parenting, may create a risk, depending on genetic susceptibility factors

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Psychological Theories

Social Learning Theory
Co-occurring Disorders (COD)
Adverse Childhood Experiences (ACEs)
Sense of Well-being (love, worth,
relatedness, spirituality, etc.)

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Theory that states we learn…

by observing others.
by modeling or imitation of significant others (indirect learning).
by the formation of conditioned responses (e.g., positive or negative reinforcement, punishment)(direct learning).

Social Learning Theory (Bandura)

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Co-occurring Disorders (COD)

Although the field has well recognized the existence of the co-occurring disorder of addiction and other mental disorders, knowledge regarding its underling mechanisms and treatment is still very limited.

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(a) The two co-occur not necessarily because one causes the other, but because they both share similar risk factors (e.g., trauma, genetic vulnerability, stress)

(b) The two may share similar symptoms and, therefore, are wrongly diagnosed as COD

(d) Psychopathology or a psychiatric disorder is secondary to addiction (a psychiatric disorder is induced by the pharmacologic or psychological effects of alcohol or drugs).

(e) The “hybrid model”
An initially secondary disorder may later become a primary disorder.

Theories explaining COD

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Self-medication (COD):
Biological/Psychological Theories

Self-medicating a preexisting disorder
(physical [pain, sleep disturbance]or
psychological [anxiety, depression, trauma])

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Psychopathology or a Psychiatric Disorder is Secondary to Addiction (COD)

A long-term six-time wave study: chronic concurrent use of cigarette, alcohol, and marijuana was related to a greater likelihood of occurrence of Antisocial Personality Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder later in adulthood.

Caspi and colleagues: adolescent-onset cannabis use may trigger adult schizophreniform disorder if the person possesses certain genes.

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Personality disorders

Antisocial personality disorder
Borderline personality disorder

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The prevalence rate of antisocial personality disorder (ASPD) is about 3-4% in the general population; the rate is approximately 40-50% among the drug treatment study samples.

About 90% of people with a dx of ASPD have coexistent substance use disorders.

That is an explanation of the…

Antisocial Personality Disorder

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Among individuals who had nicotine dependence, alcohol dependence, or cannabis use disorder at baseline and who were interviewed again at the 3-year-post baseline, Axis I disorders did not play a strong role regarding persistent substance use disorder (SUD); rather, ASPD, borderline personality disorder (BPD), and schizotypal personality disorder are strongly and consistently associated with persistent SUD (Hasin et al., 2011). (Note: the DSM-5 no longer uses the multiaxial system) A 10-year prospective study found that ASPD is one major predictor for sustained opiate use and stimulant use (Lauritzen & Nordfjaern, 2018). That is an explanation of the...

Antisocial Personality Disorder (ASPD)

Since their early formulations, theories explaining mental illness or psychopathology have emphasized the lasting impact of early childhood experience, but it is only recently that systematic scientific research on childhood adversity ad its impact has emerged. It is an explanation of the theory...

Adverse Childhood Experience Theory (ACEs)

ACEs affect an adult in various areas:

-Addictions -Other psychiatric disorders -Chronic physical illnesses -Low life opportunities -Intimate partner violence -Etc.

Adverse childhood experience (ACE) is defined as a child’s experiencing of one or more of the following 10 categories:

Emotional abuse, Emotional neglect Physical abuse, Physical neglect Sexual abuse, Spousal abuse between parents, Parental divorce or separation, Household substance abuse, Mental illness in household, Criminal household member,

Childhood abuse (physical abuse, emotional abuse, and sexual abuse) Childhood neglect (physical neglect and emotional neglect) Household dysfunction (household substance abuse, an incarcerated household member, a mentally ill household member, a battered mother/stepmother, parental divorce or separation) Other types of interpersonal loss: parental death, being placed in foster care, life-threatening physical illness during childhood, extreme childhood poverty Are characteristics of

Adverse Childhood Experiences (ACE)

Sun’s theory: Unequal footing to begin with

Unequal footing to begin with: A challenge to the “free will” theory Generalized only to substance-abusing women of the middle or lower socioeconomic groups.

Fetal alcohol syndrome (FAS) The turbulent and unstable family situation Growing up in an environment where grandmother, mother, father, aunts, sibling, and/or cousins all used AOD Physical and/or sexual abuse or exploitation during childhood AOD use at an early age caused many to drop out of school before completing 6th or 7th grade Are characteristics of...

Unequal footing to begin with

Maslow’s needs hierarchy (Safety, love, and worth) William Glasser’s “Weak” Model Sun’s ACQS: Quality of Life Are elements required for a...

Sense of Well-being

William Glasser’s “ Weak” Model “Not Sufficient Love and Worth?”

Each choice is a pain-reducing step: The first choice of “the weak”: Giving up The second choice of “the weak”: The symptoms The third choice of “the weak”: Negative addiction

The first choice of “the weak” Giving Up --

They give up because it hurts more to keep trying when the effort always fails. We quit because the pain of attempting to find happiness and not finding it hurts much more than giving up.

“Impulsive” “Immediate gratification” “Low frustration tolerance” “Avoidance” “Lack of problem solving skills” *resilience *life skills *long-term goal

The first choice of “the weak” Giving Up --

The second choice of “the weak”: To become depressed

For him the first choice in dealing with life’s problems—go give up—is no longer satisfactory; the pain has returned and in a further attempt to reduce his suffering he has made one of the common second choices—to become depressed (or to act out, to become psychotic, psychosomatic . . .) The second choice is less painful than the first choice.

The third choice of “the weak”: Negative addiction

Negative addiction is the third, and in terms of pain, essentially successful choice in the series of choices made by people who are unable to find sufficient love and worth. Not only is the pain gone but it is replaced by an intense pleasure that the person has never before experienced.

Sociological Theories (3)

1. Strain theory 2. Subcultural theory 3. Social factors/Macro factors (e.g., social policies)

Anomie occurs when people are denied opportunities to fulfill needs and achieve cultural goals. (e.g., middle- and low-level traffickers in the inner cities of the U.S.) (Sociological Theories)

Strain Theory

Crime occurred most often in those subcultures where the values that support breaking the law were more prevalent than the values that support obeying the laws. (Sociological Theories)

Subculture Theory

Macro Factors

Social change Social policies

Biopsychosocial Model

-Biopsychosocial model -Multivariate model -Public Health model -The ACQS model (Sun, 2018)

Public Health Model (3)

-The agent -The host -The environment

The ACQS Model (Sun, 2018)

-A: the fundamentals of Addiction -C: Co-occurring disorders -Q: Quality of life -S: Social factors

Neurobiological Processes

* Impulsivity (early stages) * Compulsivity (later stages) * Habit

* Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. * People with addiction use substance or engage in behaviors that become compulsive and often continue despite harmful consequences. * Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.

ASAM’s Definition of Addiction

Occurs when a user discontinues drug administration and may include several symptoms of pain and dysphoria, including vomiting, nausea, diarrhea, headache, depression, irritability, anxiety, stomach cramps. Are symptoms of...

Withdrawal

The need to increase the dosage of a drug to produce the same effect—the user becomes increasingly insensitive to the drug’s effects. Are symptoms of...

Tolerance

* Are typically associated with consuming excessive amounts of alcohol that can lead to impaired memory of events that transpired while intoxicated. * They can occur in anyone who drinks alcohol, no matter their age or level of experience with drinking.

Blackouts (Alcohol-Induced)

Blackouts (2 types)

- Brownouts (Grayouts): most common type, fragmentary blackout, characterized by spotty memories of events. - “En bloc” blackout is complete amnesia.

Blackouts vs. Passing out.

Passing out means either falling asleep or losing consciousness. During a blackout, a person is still awake but their brain is not creating new memories. Depending on how much the person drank, it is possible to transition from having a blackout to passing out.

What is the Synergistic Effect?

With respect to drug effects, when a combination of two or more drugs are taken, the effects will be multiplicative, rather than simply additive.

Drug Effects May be Determined by:

* Pharmacological properties * Age * Gender * Race * Weight * Set * Setting * Etc.

What are Set and Setting?

Certain conditions not directly related to the drug’s pharmacology or the user’s biology may also profoundly influence and determine drug effects.

Characteristics of Set:

The effects of psychedelic drugs are dependent first and foremost upon set -- personality, preparation, expectation, and intention of the person having the experience.

The effects of psychedelic drugs are dependent first and foremost upon setting – the physical, social, and cultural environment in which the experience takes place. If the surroundings are unfamiliar or hostile, the user may become fearful, uncomfortable, or have a “bad trip.” Are characteristics of"

Setting

Differences between set, setting, and substances:

Marijuana and the hallucinogens are more affected by the set than heroin, amphetamines, barbiturates, and PCP.

How much is the Standard Drink (Source: NIAAA)

12 fl oz of regular beer 8-9 fl oz malt liquor 5 fl oz of table wine 1.5 fl oz shot of distilled spirits (gin, rum, tequila, vodka, whiskey, etc.)

Define habit

These conditionings lead to the formation of habit; the initially voluntary behavior now becomes a habit which compels the person to continue the use or the act even in the absence of pleasure and reward.

How the habit changes in terms of addictions?

“Transition from voluntary drug use to involuntary drug addiction may be seen as a transition from prefrontal cortex-dependent goal-directed to dorsolateral striatum- dependent habitual action”

The survival mechanism

* Amygdala * Hypothalamus * Autonomic Nervous System (Sympathetic nervous system and parasympathetic nervous system) * HPA Axis (hypothalamus, the pituitary gland, and adrenal glands)

* The sympathetic nervous system: -- is like “a gas pedal in a car” -- is fight-or-flight response -- provides the body with a burst of energy in response to a perceived danger * The parasympathetic nervous system: -- is like “a brake in a car” -- fosters the “rest and digest” response that settles down the body after the danger has gone Are part of the...

Autonomic Nervous System

Human beings have 3 essential psychological needs: autonomy, competence, and relatedness—which if filled can result in integrity, well- being, and continuous psychological growth. Are elements of the...

Self Determination Theory:

* An evidence-based treatment approach * A Relational Component * A Technical Component Are part of the...

Motivational Interviewing

Explain OARS

* Open-ended Questions * Affirming * Reflective Listening * Summarizing OARS are interviewing strategies that facilitate empathy from a clinician to a client, which helps to build an alliance and a sense of relatedness between the client and the clinician.

Accentuates its opening strategies, including open-ended questions, affirmations, reflections, and summaries (OARS). Among these, affirmations serve to recognize a client’s strengths and positive characteristics. It is a directive client-centered approach. Are components of the...

Motivational Interview

Stages of change

* Precontemplation * Contemplation * Preparation * Action * Maintenance * (Relapse)

* Any client language that supports movement toward change. Is considered...

Change Talk

* Any client language that supports the status quo. Is considered...

Sustain Talk

Change talk may include two subcategories: DARN and CAT Define both:

* The DARN D: Desire A: Ability R: Reason N: Need * The CAT C: Commitment A: Activation T: Taking steps

1. Help the client prepare a plan for change 2. Guide him/her to clarify goals for change 3. Explore his/her options for change/treatment 4. Negotiate a treatment plan/a change plan 5. Explore the barriers to change 6. Encourage him/her to recruit the support of significant others 7. With permission, offer information and advice. They are part of the stage...

Preparation/Determination Stage

1. Affirm the client’s successful changes and support him/her in addressing barriers to change 2. Continue to engage him/her in treatment 3. Encourage small steps toward change 4. Assist him/her in identifying and managing relapse triggers 5. Reinforce positive changes 6. Continue to identify social supports and offer information/advice, with permission. They are part of the stage...

Action Stage

1. Support the client’s commitment to change 2. Affirm his/her ability to change 3. Acknowledge his/her positive change 4. Assist him/her in practicing coping strategies 5. Review his/her progress toward long-term goals. They are part of the...

Maintenance Stage

Maintenance/Relapse Stage

Emphasize that relapse/psychological symptoms should not interrupt or stop the counseling relationship.

SBIRT means

* S: Screening * BI: Brief Intervention * RT: Referral to Treatment

* AUDIT (a positive screen: a total score of 8 or more) * S2BI (Screening to Brief Intervention)(for youth aged 12 – 17 years) * CRAFFT (for adolescents aged 14 – 21 years) * CAGE (a positive screen: two or more “yes” answers) Are tools utilized for...

Screening Tools

Types of Therapeutic Communication

* Supportive: communicates acceptance, concern, interest * Facilitative: promote awareness, problem solving, growth

* Non-verbal: SOLER * Verbal: accurate verbal following - paraphrasing - reflection of feeling - summarizing What type of communications are?

Types of Therapeutic Communication: Supportive

Types of Therapeutic Communication: Facilitative (5)

* Probing * Focusing * Interpreting * Confrontation * Self-disclosure

* Is the deliberate use of a question or statement by the worker to induce the client to face what the worker thinks the client is avoiding. It is known as...

Confrontation

Trauma and Addiction Final Flashcards

(80 cards)