Review for the Alcohol and Drug Counselor Exam
• Past 30 Day statistics, According to the 2012 National Survey on Drug Use and Health,
• 6.5% of the population over 12 reported heavy drinking
• 9.2% reported illicit drug use
• The majority of people who use recreationally will not need treatment
• Addiction is characterized by compulsive craving for the substance and using that substance despite negative consequences
• Cravings and compulsive behavior are caused in large part as a consequence of substance use or addictive behaviors on the brain causing
• Emotional
• Cognitive
• Physical
• Behavioral changes
Definition of Addiction
• Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.
• Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations reflected in pathological pursuit of a reward and/or relief by a substance.
• Without treatment and/or engagement, addiction is progressive and can result in disability or premature death. (ASAM 2011, NIDA 2007)
Characteristics of Chronic Disease
• Disrupts normal functioning
• Have serious, harmful consequences
• Are preventable and treatable
• Can last a lifetime
• May be fatal if untreated
Addiction—A description, not a Diagnosis
• Addiction is a description, not a diagnostic term.
• Addiction erodes a person’s self-control and ability to make sound decisions
• The DSM V has 2 diagnostic categories
• Substance abuse
• Substance dependence (The medical definition of addiction)
• Dependence is always characterized by dependence and withdrawal
Factors Influencing Addiction
• No single factor is causative
• General Categories
• Biological/genetic makeup
• Gender
• Ethnicity
• Developmental stage/early use
• Social environment
• Proximal (neighborhood, school/work, friends, family)
• Cultural/Media/Availability
• Method of administration
Factors Influencing Addiction
• Genetic Factors
• 40-60 % of a person’s vulnerability is genetic.
• Expression of these genes is influenced by:
• Effects of the environment
• Reactions/effects of addictive behaviors
• Genetic predisposition to mental health issues (self-medication)
• Social Environment & Peer and School
• Access
• Social learning of acceptability and use patterns
• Exposure to peers/family who engage in criminal behavior
• Academic/work failure
• Poor social skills / unstable relationships
Factors Influencing Addiction
• Developmental/Early Use
• The earlier the initiation, the greater the likelihood it progresses to addiction
• Addictive behaviors have a stronger impact on the developing brain (esp. the prefrontal cortex)
• Indicative of a set of vulnerabilities/triggers
• Genetics
• Mental Illness
• Unstable family relationships
Factors Influencing Addiction
• Method of Administration
• Smoking and injection increase addictive potential due to
• Rapid transit to the brain (seconds)
• Rapid fade of effects (crash)
• Moral Model
• Addiction is the result of defects of character
• Rejects any biological basis
• Focuses on individual choices and values retraining
• Disease Model
• Addiction is an illness resulting from an impairment of neurochemical or behavioral processes
• Presented by Jellinek leading the APA and AMA adopting the disease model
• Addiction is a primary disease and not caused by anything else
Theories of Causation
• Genetic Model
• Individuals have a genetic predisposition
• Difficult to separate social cause