Chapter 16: Group Work: Addictions

1. Chapter 16: Group Work: Addictions Introduction to Group Work, 5th Edition Edited by David Capuzzi, Douglas R. Gross, and Mark D. Stauffer

2. Substance Dependence • Demonstrating an increase or decrease in tolerance • Showing symptoms of withdrawal or using to relieve or avoid symptoms • Using more of substance or increasing frequency of use • Having a strong desire to stop using and/or repeated unsuccessful attempts to stop • Spending more time than intended obtaining, using, or recovering from use • Avoiding or failing to meet social, family, occupational, or recreational activities because of use • Continued use in spite of the likelihood of negative consequences (DSM-IV-TR)

3. Substance Abuse • Significant degree of impairment or distress within the past 12 months • Recurrent failure to meet family, occupational, or school responsibilities due to use • Recurrent use under hazardous conditions • Persistent use in spite of negative consequences to health, family, social interactions, work or school performance • Must not have met criteria for substance dependence (DSM-IV-TR)

4. Models for Understanding Addictions and Compulsive Behaviors • The moral weakness model • The medical model • The sociocultural models • The biopsychosocial model

5. Moral Weakness Model • The oldest model • Addict has a character disorder and lacks the moral fortitude to do the right thing. • Addict is sinful and morally weak. • Addict likely feels ashamed and keeps the problem a secret from others. • Addict can be cured if he or she controls urges

6. Medical Model • Addiction = a disease that includes four stages • Pre-alcoholic stage (to relieve social stress and pressures) • Prodromal stage (includes blackouts, preoccupation with obtaining the substance, shame, guilt, concealment) • Crucial stage (physical dependence, malnutrition, loss of control, lowered self-esteem, abandonment of other activities) • Chronic stage (tremors, use of other drugs)

7. Medical Model • The conceptualization of alcoholism as a disease opened the door for systematic investigation of the problem and made treatment available to many people by allowing medical insurance to reimburse for treatment. • The genetic model for understanding addictions is a subcategory of the medical model and proposes that people become addicted to substances because they are genetically predisposed to addictions.

8. Sociocultural Models • Encompass the concepts of family systems, peer pressure, cultural norms, and modeling theories • Explain the addictive process from the perspective of forces in the environment that either encourage or inhibit the development of addictive behaviors

9. Biopsychosocial Model • Integrates aspects of the medical, sociocultural, and psychological models • Attributes addiction to a combination of factors including genetic predisposition, exposure, individual reaction to the substance or behavior, social factors, learning, and environmental influences

10. Substances of Abuse • Stimulants • Examples: caffeine, nicotine, Ritalin • Depressants • Examples: alcohol, benzodiazepines (e.g., Valium, Xanax), barbiturates (e.g., phenobarbital, Nembutal), opiates (e.g., morphine, Demerol) • Cannabinols • Examples: marijuana, hashish • Hallucinogens • Examples: LSD, PCP, Ecstasy, Psilocybin • Inhalants • Examples: household cleaning materials, nitrous oxide, ether

11. Kinds of Addictions • Substances • Gambling • Sex • Food

12. Treatment Modalities • Inpatient: Treatment usually combines the expertise of physicians, recovering addicts, counselors, psychologists, nurses, and social workers as treatment, detoxification, rehabilitation, & aftercare take place. Groups are often part of the entire process. • Partial hospitalization and intensive outpatient: Clients attend sessions in the hospital but sleep at home. Groups are often part of the entire process. • Support Groups: AA, Narcotics Anonymous, Cocaine Anonymous, Overeaters Anonymous, and Gamblers Anonymous are examples. Groups are often part of the entire process.

13. Advantages of Groups • Harness peer pressure to achieve treatment goals • Reduce the sense of isolation • Some members act as role models • Provides therapeutic factors • Less expensive than individual treatment

14. Issues to Consider • Structuring and ground rules • Closed vs. open • Homogeneity vs. heterogeneity • Leadership • Relapse prevention