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 Cognitive- Conditioning and Reinforcement

Behavioral Models * Social Learning and ModelingDrug Expectancies and other Cognitive Factors / RP

Family Models Family DiseaseFamily SystemsBehavioral Marital/Family Tx

Psychological / Psychoanalytic Disordered /Addictive Personalities

Sociocultural Models Cultural Factors

Socioeconomics/ Social Policy

Drug Subcultures

Public Health Model Agent, Host, Environment

Interactions

THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION

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

Psychological / Psychoanalytic Disordered /Addictive Personalities

Behavioral and Cognitive- Conditioning and Behavioral Models Reinforcement

Social Learning / Modeling

Drug Expectancies and other Cognitive Factors / RP

Family Models Family Disease

Family Systems

Behavioral Marital/Family Therapy

Sociocultural Models Cultural Factors

Socioeconomic Factors

Drug Subcultures

Social Policy (e.g., drug control)

Public Health Model Interactions between

Agent Host Environment

THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION

MODELS OF ADDICTION: A SUMMARY

Psychological / Psychoanalytic Disordered /Addictive Personality

Sociocultural Models Cultural FactorsSocioeconomics/ Social Policy Drug Subcultures

Public Health Model Agent, Host, Environment Interactions

THE BIOPSYCHOSOCIAL MODEL:AN INTEGRATION

MODELS OF ADDICTION: A SUMMARY

MODELS OF ADDICTIONMODELS 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)

• Early identification

• Education about diagnosis

• Acceptance of disease and overcoming “denial”

• Abstinence

• 12-steps essential for real recovery

Disease Model - Treatment

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 MODELCRITIQUE 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? _______________________

• Adoption study of Goodwin• 18% probands alcoholic vs. 5% controls

• Twin Studies• male vs. female twin pairs

• Metabolic Studies

• P3 Wave Studies

Disease Model - Research Support

CRITIQUE OF DISEASE MODELCRITIQUE 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 DISORDERSSUBSTANCE 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 & TherapeuticCommunities

Medications

4 sessions in 12 weeks

Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking

Mobilize the person’s own commitment and motivation to change

MET

(Motivational Enhancement Therapy)

12 weekly sessions

Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings

Acceptance of the disease of alcoholism and loss of control over drinking

TSF

(Twelve Step Facilitation)

12 weekly sessions

Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse

Learn skills to achieve and maintain sobriety

CBT

(Cognitive Behavioral Therapy)

FrequencyDescriptionGoal of

TreatmentType of

Treatment

Project MATCH Treatment Conditions – Modalities You Will Learn