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Foundations Week 2.Pdf Foundations of Addictions Week 2 Glenn Maynard LPC Overview of Addictions • Debate in US continues on whether addiction is a disease, poor behavioral decision making or a moral failing • Prior to Prohibition, Temperance Movement placed the cause in the substance and then in the user • AA- moved the cause to the user and formed the basis of the disease model and behavioral model Addictions Counseling • Full cycle from mental health orientation to separate field and back to mental health under the name behavioral health • Long history of people in recovery working as lay counselors • Standards for addictions counselors began to evolve in the 1970’s Addictions Certification • 1972 JCAH developed accreditation standards that brought addictions into the mainstream • NIDA and NIAAA developed standards for training including 2 years recovery; one year counseling experience and written examination • Current certifications- CADC, NCADC, MAC Reuniting Addictions and Mental Health • Increased Federal and State interest in dual dx • Behavioral health includes addictions as a focus of interest • Administrative for AOD acknowledge licensed professionals as providers Brickman Schema Is the person responsible for changing the Addictive Behavior? Is the person responsible for the development of the Addictive Behavior? Yes No Yes Moral Model (War on Spiritual Model (AA and Drugs) 12-Step) Lack of willpower Loss of contact with higher power No Compensatory Model Disease Model (Heredity (Cognitive) and Physiology) Errors in judgement Activation of disease state Characteristics of Effective Counselors • Meta analysis of tx • Positive relationship r outcomes show with positive stronger therapist than outcomes tx effects • Adherence to a manual • Therapist attributes- or technique improves few gross effects outcomes • Recovery status does • Mixed research not predict tx outcome outcomes on confrontational tx Overview of Epidemiology • Study of disease in populations • Groups studied in order to understand the etiology and prevention of disease • Web of causation- agent (vector), host, environment Prevalence and Incidence • Prevalence= # of persons with a disease total number in population • Incidence= # of persons developing disease total population at risk Lifetime Prevalence Rates for Substance Use Disorders • Any Substance Use Disorder 16.7% • Alcohol Abuse 5.6% • Alcohol Dependence 7.9% • Drug Abuse 2.6% • Drug Dependence 3.5% • Marijuana Dependence/Abuse 4.3% • Cocaine Dependence/Abuse 0.2% • Opiate Dependence/Abuse 0.7% • Barbiturate Dependence/Abuse 1.2% • Amphetamine Dependence/Abuse 1.7% • Hallucinogen Dependence/Abuse 0.3% Co-Morbidity Between Mental Disorders and Substance Use Disorders • Any Substance Use Disorder and: – Schizophrenia 47% – Anxiety Disorder 23.7% – Antisocial Personality Disorder 83.6% Co-Morbidity Between Mental Disorders and Substance Use Disorders • Any Mental Disorder and: – Any Alcohol 36.6% – Any Drug 53.1% • Schizophrenia and: – Any Alcohol 3.8% – Any Drug 6.8% • Affective Disorder and: – Any Alcohol 13.4% – Any Drug 26.4% • Anxiety Disorder and: – Any Alcohol 19.4% – Any Drug 28.3% Alcohol Surveillance Data • Per capita alcohol • Regional patterns: consumption in 1997 NE- decrease 0.5% lowest in 35 years South- decrease 0.9% Midwest- no change • Consumption by state West- decrease 0.4% shows a consistent pattern of decreased • NIAAA goal for 2000 consumption except was annual for AR and MS consumption of 2 gals/capita Trends in Alcohol Use • 105 million Americans older that 12 reported current use of alcohol (30 day prevalence) • 45 million engaged in binge drinking (30 day prevalence) • 10.4 million are age 12-20 • 6.8 million of 12-20 engaged in binge drinking • 1999 National Household Survey on Drug Abuse Epidemiologic Trends in Drug Abuse • Data collection differs from alcohol due to all non-prescribed drugs being illegal • Drug use more variable than alcohol use based on location and local customs about drug use • 14.8 million 30-day prevalence in 1999 • Peak use of illicit drugs in 1979 was 25 million Cocaine • Peak use of 5.8 million in 1985 • 1.75 million users in 1996 • 1995 estimated incidence was 652,000 • Profile- most users are inner-city crack users, older users • New trend- teenagers using crack and MJ (blunts) Cocaine • Decrease since 1985 has stabilized and may be on the rise for teenagers • Women users are exceeding male users according to arrest records in some areas • As m-amphetamine used declines, cocaine use may increase Heroin • Two types- Black Tar and White Powder • Black Tar- used primarily in West and SW; injected; has more impurities • White Powder- East Coast and SE; intranasal and smoked; appealing to teens • Increasingly popular with college students • Increasing use with other drugs • Most CEWG cities report increased use DAWN Heroin Data • Seattle • Newark 97.5% IV 43.6% IV • San Francisco • Philadelphia 96.6% IV 66.8% IV • Los Angeles • Boston 95.0% IV 73.3% IV • New York City • San Diego 74.6% IV 93.3% IV Marijuana • Incidence in 1995 was • Considered less risky 2.5 million than other drugs • Drop in prevalence • MJ is being mixed rate for 12th graders with other drugs from 50.8% in 1979 to • DAWN data for MJ 23% have increased. See • Young adult use may chart account for incidence M-Amphetamine • DAWN data report sharp declines in m- amphetamine admissions from 1994-1998 • May be due to community prevention programs • Aggressive legal action • Precursor laws • Decreased potency and purity Developing Trends • Rave or club drugs • Ecstasy (MDMA)- 1996-7 14% of male and 7% of female 12th graders reported using MDMA at least once • GHB (g-hydroxybutrate)- too early to evaluate DAWN data • Ketamine- as above Epidemiological Correlates • AOD abuse more • African-Americans common among men begin abusive drinking than women (note later than Whites higher recent • A-A have more health incidence of alcohol consequences than and cocaine use Whites among young women • Hispanics have higher • Alcohol and drug life time prevalence prevalence decreases for alcohol, lower for with age drugs Epidemiological Correlates • Twins typically show • Prevalence rates for a 40-50% concordance alcohol disorders for alcohol abuse increase for people • Alcoholic are 6X more unemployed for six likely to come from months in 5 years homes with parental • Higher rates of alcoholism alcoholism in entry • 1/3 to 2/3 of people level and blue collar with alcohol disorders jobs report no parental risk Epidemiological Correlates • ECA data do not show • Marital status- life- appreciable drug effect time prevalence for on employment stable marriages is • Drug use among 8.9%; cohabitating is employed men is 29.2% higher on low income • For drug use- married jobs men at 3.6% and • Leaving school r with women at 1.8%; increased risk cohabitating men at 30.2% and women 19.9%.
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