alcohol and drugs

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alcohol and drugs
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2012-03-08 15:28:49
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first half of semester
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  1. Miracle Method/Solution Focused Therapy
    • How do we construct solutions?
    • basic beliefs: there are more than one solution, can be constructed, invented not discovered
    • steps: define what client wants, look for what is working, do something different

    • Solution-Focused Therapy:
    • not a collection of techniques, reflects notions of change/interactions, about reaching goals

    • Presuppositions:
    • 1. presuppositions to minimize hierarchies
    • 2. identifying assumptions (presuppositions)
    • 3. risk imposing values and beliefts on people
    • 4. avoiding/indentify completely is simple sounding

    • Assumptions of the SF Approach:
    • 1. advantages of a focus onthe positive
    • 2. exceptions suggest solutions
    • 3. nothing is always the same
    • 4. small change is generative
    • 5. cooperation is inevitable
    • 6. people are resourceful
    • 7. meaning and experience are constructed thru interactions
    • 8. meaning is in the response
    • 9. the person is the expert
    • 10. treatment group membership

    • Miracle Method and SF apprach:
    • 1. no single approach works for all
    • 2. there are many possible solutions
    • 3. the solution and the problem are not necessarily related
    • 4. simplist and least invasive is the best
    • 5. people can and do get better quickly
    • 6. change is happening all the time
    • 7. focus on strenghts and resources rather than deficits
    • 8. focus on future than past
  2. Well-defined Goals
    Goals/Solutions: process-like, client driven, consumer apprach

    • Criteria for well-defined goal:
    • 1. in a positive representation (will be doing)
    • 2. in a process form (phased with verbs)
    • 3. in the here and now (start immediately)
    • 4. be as specific as possible (more compelling)
    • 5. within client's control (not contingent on someone else)
    • 6. in the clients language (using their words)

    • The door to solution:
    • people given a choice- more likely to work hard, ask for help, not be forced, "the desire must come from within"

    • The miracle question: helps to find own doors to solutions, shift into new perspective, visualize the solutions, consider all avenues
    • Six keys:
    • 1. make sure your miracle is important
    • 2. keep it small
    • 3. make it specific, concrete, and behavorial
    • 4. state what you will be doing rather than won't be doing
    • 5. state how you will start, not on ending it
    • 6. be clear about who, when, where not on why

    • Wishes: affective statement, want/desire, not goals
    • complaint: statement of discontent, grief, pain, not goals
    • Diagnosis: of their own making or by prof, labels that desribe a state/condition, not goals

    • The exceptions frame:
    • 1. exceptions elicitation
    • 2. contrasting for contexual differences
    • 3. specification
    • 4. bridging the exceptions as the goal of therapy
    • 5. pursuing the goal of continuing to perform the exceptions

    • Butterflies, Snowballs, Ripples:
    • The Butterfly effect: small changes that can lead to larger change, complex series of interactions
    • rolling a snowball down the hill: small change becoming larger, far-reaching consequences

    • Setback: normalizing setbacks:
    • 1.positive approach introduces the idea tha change usually includes setback
    • 2. explain that it is normal and mistakenly perceive a setback as a failure and give up on what is working
    • 3. setback perceived as a failure
    • 4. inquiring about the difficulties

    • Agency: presupposing agency and responsibility
    • 1. faciliating agency and responsibility
    • 2. focusing on the expectations of the future
    • 3. asking directly
  3. The nature of addiction
    • Use/Abuse/addiction/dependence:
    • moral or religious, social stigma and social stigma, political motivation, legalization of drugs

    • models explaining addiction:
    • lifestyle model: persistant heavy drinking is a central activity of the indvidiual's way of life
    • moral model: part of human sinful nature
    • disease model: genetic predisposition to drug dependence, predictible progression, loss of control over use

    • Institutional Explanation:
    • Alan Lesner, changes in brain function
    • not a permanent condition, "disease"

    • Moving toward diagnosis:
    • DSM-IV-TR: manua, transform the term "addiction" to "dependence", human behavior became defined within categories

    • dependence: maladaptaive pattern of use, leading to impairment/distress of the following in 12months:
    • 1. tolerance (need to increase to feel effect)
    • 2. withdrawal: syndrome
    • 3. substance is taken in larger amounts or longer period
    • 4. persistant desire, unsuccessful efforts to cut down
    • 5. great deal of time spent to obtain
    • 6. regular activities given up or reduced
    • 7. use is continued despite knowlege and phy problems

    dependence diagnosis: compuslion, loss of control, continued use

    • Bio-psycho-Social-Spritual model: chemical dependency:
    • bio-based on presupposition, genetics, neurotransmitters (brain chemistry, pleasure center)
    • psycho: result of psycho and emotional need
    • social: availability, assessibility, customs, rituals ect, systems perspective (interactionalism)
    • spiritual: crucial in recovery, positive forgiving

    Strenghts perspective: holistic and systematic approach in treating addiction, focus on positive aspects (hope, guidance, relationships)

    • critical elements of recovery:
    • 1. indentify "migration"
    • 2. need for personal control or choice
    • 3. need for hope
    • 4. need for purpose
    • 5. need for sense of achievement
    • 6. presnece of at least one key person
  4. historical perspectives
    European context: political/socioligical tool, safer than water, health concerns, a way to escape pain, gin

    Colonial America: casual drinking practices, wine, Jamaican rum, disruption in society

    • Temperance approach: why did problem exist, how occur? movement was originally sought to encourage controlled use of "distilled spirits" not beer or wine, joined with other groups, abstinence was important, conflict, gaining momentum
    • Medical approach: why did problem exist, how occur?

    Alcohol in America: used to be in the home, in American west (saloon proliferaions )

    • Prohibition of tobacco: illegal to sell cigarettes in 14 states, chewing tobacco was acceptable, hard drugs sold over counter, attitude shift, fear leads to regulation,
    • Harrison Act of 1914: severly restricted the amound of opiods w/o perscrition, lead to increase in demand/ crime/ price

    • Marijuana: Aisa and China, common with Mexican workers, racism was key factor in crimiliazation of weed
    • Marijuana tax act of 1937:

    Prohibition of Alcohol: continued to drink, shift from beer, women began drinking openly

    AA: Wilson/Bob, members of the oxford group 12 step program

    modern war on drugs: supply of drugs reduced, street value increases, DEA had the Controlled Substance Act lead to increase use of drugs
  5. Family Systems and Chemical Health Problems
    Family Systems Theory: 50s, entity unto itself, CD considered a symptom o fdysfunction in the system, focuses on the ind'l and interactions between them, not designed to treat addiction of one person specifically

    Family Responses to alcoholism: coping mechanisms: withdrawal, protection of the alcoholic, safeguarding family interests, acting out

    Impaired Family Relationships Infidelity, separation, divorce Economic Insecurity Caring of children is jeopardized Fetal Alcohol Effects/Syndrome

    • Wegscheiders' six typical family roles:
    • 1. Dependant: losses willpower to control uses, anger, less interest, stress affects life
    • 2. Enabler - Co-dependent (significant other): takes over, tries to stop usage, pressure, shuns, "hooked" on emotions
    • 3. Hero: not feel important, tension, fear of separation, perfectionism, isolation
    • 4. Scapegoat: same as hero, feels separate, poweless, mission, withdrawal, accepts attention
    • 5. Lost child: same as scapegoat, easier to become loner, family finds relief in "never needing to worry"
    • 6. Mascot: works hard to get noticed, distraction, temp relif, doubt self worth

    Families Therapy: undeseriable behavior of child, family may present with CD , may enter therapy w or w/o addressing CD

    • Families facing alcohol and drug abuse: stages
    • 1: careful assessment of family fucntioning and CD
    • 2. family detoixication
    • 3. address famili's emotional insability
    • 4. family stabilization of reorgzanization

    Behavioral Perspecive: learned thru envir and social consequences, address adciton of the the ind'l, include marital and familyy relationshipds

    Stress coping model: like th ebehavioral model, family is viewed as context, substance use represents habitual maladaptive coping repsonse to temp decrease life stress and strain

    • Developmental Model:
    • Stage 1: drinking (family envir/dynamics, tasks of counseling)
    • Stage 2: transition: work

    Specific Effects on Children 1 in 4 children (28.6%) in the U. S. is exposed toalcohol abuse or dependence in the family Children w/one or more parent(s) w/alcoholism: One & one half to three times as likely to developalcoholism as a child from a non-alcoholic parent.
  6. Classes of Drugs
    Depressants slow the functions of the central nervous system. People who use the drugs often experience lowered inhibitions, a lack of concentration and/or feelings of euphoria. The category of depressants includes GHB, barbiturates, alcohol, Rohypnol and valium. alohol, cannibis

    Stimulants, such as cocaine, nicotine, Ritalin, amphetamines and methamphetamines, can cause people to become overly alert, attentive and energetic.

    Hallucinogenic drugs distort the user's perceptions of reality. These drugs include:LSD (lysergic acid diethylamide): also known as 'trips', 'acid' and 'microdots';magic mushrooms (psilocybin): also known as 'mushies';mescaline (peyote cactus); andecstasy (MDMA/methylenedioxymethamphetamine): also known as 'E', 'XTC' and 'Eccies', produces a combination of hallucinogenic and stimulant effects; andketamine: also known as 'K' and 'Special K'.

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