Substance Abuse and Addiction: Terms, Models, and Ethical Issues in Treatment

1. CHAPTER 2: Terms, Models, and Ethical Issues in Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Introduction • Substance abuse and addiction are a rampant problem in today’s society, affecting individuals, relationships and society at large. • The prevalence of substance abuse is highlighted in the media (television, celebrities, news, music, etc.) • The scope of the problem demonstrates a need for clinicians to become competent and familiar with the language of addiction. • In this chapter statistics, basic terms and concepts, models of addiction and legal and ethical issues are introduced.

3. The Scope of Substance Abuse and Addiction • According to the National Survey on Drug Use and Health, 20.1 million Americans over the age of 12 currently (or in the past month) use illicit drugs and 58.1 million report heavy, episodic drinking (OAS, 2008). • Alcohol and drug use costs the United states billions of dollars each year. • Other substance related problems include: interpersonal violence, broken relationships, physical and medical problems, and suicide.

4. Basic Terminology of Addiction • Substance misuse • Using a prescription substance in a manner other than prescribed • Experiencing of negative consequences as a result of excessive substance use • Substance abuse • Continued use of substances despite negative consequences

5. Basic Terminology of Addiction Cont. • Substance addiction • The compulsive, persistent use of substances despite negative consequences • Engaging in behaviors to obtain the drug • Unsuccessful attempts to quit using • Major interferences with personal or work life • Tolerance • The need for increased doses of a drug to achieve the desired effect • Can be physiological or behavioral

6. Basic Terminology of Addiction Cont. • Withdrawal • Physiological and psychological symptoms when an addicted person stops using a drug • Symptoms are often opposite of those produced by the drug • Addiction • A compulsive need for and use of a habit forming substance • Characterized by tolerance and withdrawal • Similar to dependence (a clinical term)

7. Models of Addiction • Disease Model • Addiction is a disease of the brain • Susceptibility camp- addiction is a genetic or biological condition and a person is born susceptible to addiction • Exposure camp- a diseased brain is the result of exposure to toxic chemicals such as illicit substances • Addiction is likely a result of a combination of the two camps • Abstinence is the only acceptable treatment • Problems: the claim that addiction is a progressive disease and maturing out

8. Models of Addiction Continued • Moral Model • Addiction is a matter of making poor choices • Can lead to guilt and shame in the individual • Addiction is sinful and spiritual intervention is needed • Interventions: help clients to make better choices, help strengthen their spiritual lives, and punitive measures (prison or jail) • Psychological Model • Addiction stems from a psychological disturbance and is secondary to that disturbance • Addiction is a coping mechanism for psychological problems

9. Models of Addiction Continued • Sociocultural Model • External factors (family, peers, culture, socioeconomic status) impact the development of addiction • Four sociological functions of substance abuse: • 1. facilitation of social interactions • 2. serving as a time-out from social obligations • 3. promoting group solidarity • 4. Repudiation of middle class values • (Thombs, 1996)

10. Models of Addiction Continued • Biopsychosocial Model • Biological, psychological and sociological factors all play a role in the development of addiction • Final common pathway (FCP)-substance addiction is the end result of a multitude of factors that increase risk for substance use • Public Health Model-describes three key components of addiction: • the drug • the person • and the environment

11. Ethical and Legal Issues • Ethical codes provide guidance for clinicians to act in the best interest of the client while maintaining integrity in their profession. • 4 main moral principles: • Autonomy • Nonmalfeasance • Beneficence • Justice

12. Ethical and Legal Issues Continued • Codes of federal regulations (CFR), specifically 42 CFR protects client confidentiality when disclosing substance abuse. • Exceptions to disclosure under 42 CFR: • With client written consent • Communications among staff within an organization • Medical emergencies • Committing a crime by the client at the agency

13. Ethical and Legal Issues Continued • Informed consent • Clients must be provided information essential for making an informed decision about their treatment • Dual relationships • Entering into a secondary relationship with a client that interferes with the primary therapeutic relationship • Clinician self-care • Clinicians who better care for themselves are more effective

14. Ethical and Legal Issues Continued • Navigating legal and ethical issues can be tricky. Remember, when in doubt, CONSULT!