Fluent Essays

Please see attachment for assignment Assignment 1: At least 250 words, cite relevant sources, APA format What does empirical research say about the effectiveness of these three therapies with people who have addiction problems: solution-focused therapy? Motivational interviewing? Cognitive-behavioral? Assignment 2: Please see videos and attachment  “Define Addictions.” Write a one to two page paper, defining Addictions. Include theories of addiction and sources of addictive behavior.  You may also include any of the following: Your experience with addictions or someone you know with addictions;  Type of treatment that you have seen used or experienced and its success.  Remember to use APA 6th Ed Format, formal English, and properly credit at least two resources Videos on Addiction: https://www.youtube.com/watch?v=T5sOh4gKPIg&t=50s https://www.youtube.com/watch?v=ZZNY0p5oX80 Textbook: Van Wormer, K., & Davis, D. R. (2018). (4th ed.). Belmont, MA: Brooks/Cole, Cengage Publishing. Information from textbook: What Is Addiction? Addiction is seen in the man in the detox unit of a hospital who is cringing from the pain of pancreatitis. He has no plans to quit drinking, his wife says. Addiction is evidenced in the two-pack-a-day smoker who coughs steadily from emphysema. Addiction is implicated in the actions of the trusted employee who was imprisoned for embezzlement; she needed more money to gamble, and when she won, she’d slip the money back. The economic cost of addiction is incalculable. Certainly, billions of dollars are involved. There is the health toll of alcohol and drug misuse, the astronomical expenditures in running the war on drugs and in incarcerating the over one million persons whose crime was related to alcohol or some other drug. Catering to people’s addictions is big business that ranges from marketing tobacco to special populations, to setting up state lotteries, to organized crime. So, what is addiction? According to the Dictionary of Word Origins (Ayto, 1990), the roots of the word addiction are in the Latin past participle addictus, meaning “having given over or awarded to someone or being attached to a person or cause.” The original connotations were highly positive. Originally used as an adjective in English, its meaning has become increasingly negative over time. The way in which substance misuse is perceived has important practical implications for how individuals with drinking and drug problems are treated—by their families, by medical and mental health professionals, and by the state. In the substance misuse literature, addiction is variously defined as a “moral and spiritual condition” (Dalrymple, 2006, p. 6); “poverty of the spirit” (Alexander, 2010, book title); “a sense of helplessness” (Dodes & Dodes, 2014, p. 136); “excessive appetite” (Orford, 2001, p. 2); “a bad habit” (Peele, 2004); and “the search for emotional satisfaction” (Peele & Thompson, 2015, p. 91); “a stigmatizing label” (Szasz, 2003, p. 7); “a disorder of choice” (Heyman, 2009, book title); and, more compassionately, as “a chronic relapsing brain disease” (Volkow, 2010, p. 5). From a systems perspective, Pycroft (2015a) defines addiction as “a complex adaptive system” (p. 57). And to Miller and Rollnick (2012), addiction is fundamentally a problem of motivation. For an official definition, we first turn to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association [APA], 2013). The significance of the DSM cannot be exaggerated; the diagnoses that are finally agreed upon by the panel of experts are used almost universally by mental health professionals to diagnose and receive insurance reimbursement for treatment for behavioral disorders. The starting point for conceptualizing and treating substance use disorders is terminology. The DSM-IV-TR avoided use of the term addiction in favor of the seemingly more scientific term dependence. We disagreed with this terminology, as shown in our choice of Addiction Treatment as the title for our book in its earlier editions. Now the members of the DSM-5 substance-related work group have come around to the same conclusion. The term  drug dependence  will now be reserved for physiological dependence on a drug, for example, withdrawal symptoms. Along these lines, the decision was made to include cannabis withdrawal in the fifth edition. “Substance-Related and Addictive Disorders” is the heading to be used for this section of the manual. The DSM-IV differentiated substance use disorders into substance dependence and substance abuse. As denoted by the APA (2000), the major difference between them was the presence of tolerance and withdrawal problems. We, in previous editions of this text, disagreed with this dichotomization and conceptualized addiction as occurring along a continuum of severity. There is some concern, however, as Straussner (2014) indicates that the expanded definition of addiction might result in pinning the “addict” label on persons who deliberately drink to get drunk, for example, or take other drugs to get high, but who are not on the road to addiction. Moreover, the changed diagnostic criteria may limit the provision of insurance coverage to only those whose symptoms are deemed to be severe. In their extensive national survey of over 36,000 Americans, researchers from the National Institute on Alcoholism and Alcohol Abuse looked at drinking problems based on the new DSM-5 criteria (Grant, Goldstein, et al., 2015). They found that 14\% of Americans have an alcohol use disorder, only 20\% of whom had sought treatment. This compares with the previous estimates using the DSM-IV criteria 7\% with alcohol use disorder. Although the researchers are optimistic that more people are now included as in need of treatment, the risk is in having too expansive a definition of alcoholism. Addiction, according to our understanding of the term, denotes loss of control over a substance or behavior. Although intervention may be required for reckless and potentially harmful behavior, the diagnosis of addiction disorder may not be helpful or accurate for many acting-out youths. How practitioners handle this diagnostic change in the DSM remains to be seen. In any case, substance use disorder now joins the abuse and dependence criteria into one unitary diagnosis. Substance use disorder now is dimensional, in the sense that the larger the number of criteria met, the more severe is the disorder and the associated dysfunction. For all DSM-5 disorders there is a range denoting severity that extends from: mild (two criteria), moderate (four criteria) to severe (six or more criteria). As provided by the APA (2013), these criteria are: 1-1aSubstance Use Disorder 1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by two (or more) of the following, occurring within a 12-month period: 1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) 2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) 4. tolerance, as defined by either of the following: 1. a need for markedly increased amounts of the substance to achieve intoxication or desired effect 2. markedly diminished effect with continued use of the same amount of the substance (Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications, or beta-blockers.) 5. withdrawal, as manifested by either of the following: 1. the characteristic withdrawal syndrome for the substance (refer to criteria A and B of the criteria sets for withdrawal from the specific substances) 2. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications, or beta-blockers.) 6. the substance is often taken in larger amounts or over a longer period than was intended 7. there is a persistent desire or unsuccessful efforts to cut down or control substance use 8. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects 9. important social, occupational, or recreational activities are given up or reduced because of substance use 10. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance 11. craving or a strong desire or urge to use a specific substance The DSM-5 also includes the addition of diagnostic criteria for conditions not previously included in the DSM, such as cannabis withdrawal and caffeine withdrawal. And the concept of “polysubstance dependence” is removed as a separate disorder. In recognition of the similarity of gambling addictive behavior to substance use disorders, according to the APA (2013), gambling disorder now has been reclassified and placed under the category, Substance-Related and Addictive Disorders as a behavioral disorder. Internet addiction and sex addiction are not included, however, but are placed in the Appendix as in need of further study. Previously, pathological gambling was listed as an Impulse Control Disorder and not considered as a form of dependence. Nevertheless, the diagnostic criteria for gambling disorder are relatively similar in the earlier and later versions of the DSM with a focus on preoccupation with gambling, sense of euphoria when anticipating a win, increasing signs of loss of control over this habit, and cover-up and deceit to hide one’s destructive behavior. The significance of the inclusion of gambling addiction in the DSM-5 should not be overlooked. As Peele and Thompson (2015) indicate, this is a recognition that addiction can occur with something other than psychoactive chemicals. And as neuropsychologist Marc Lewis (2015) argues, brain changes do take place with all forms of addiction, but the way it changes has to do with learning and development, not only a response to the chemicals consumed. Before we progress any further into the maze of classification and word usage, let us consider just how far into the depths of madness the addictive urge can lead us. In A Common Struggle: A Personal Journey through the Past and Future of Mental Illness and Addiction, Patrick J. Kennedy (2015), the son of the late Senator Edward (Ted) Kennedy writes in moving terms of the grip that alcoholism had on his whole family and opiate use and drinking had on himself: Amid this daily grind of self-medicating, I would intermittently go out for a planned “lost night” to blow off all the stress. I went out with friends, had five Glenlivets right away, almost blacked out, and just kept drinking; it wasn’t uncommon for me to have fifteen to twenty drinks in an evening …. I remember after one of these nights I had to wake up and give a speech to a group of drug and alcohol counselors. (p. 220) In his book on lifestyle theory, Glenn Walters (2006) strenuously objects to the use of such criteria that relate to a loss of control over a substance; to the disease model of Alcoholics Anonymous, which he finds disempowering; and to the word addiction itself. He proposes an alternative concept—the lifestyle concept—that allows for an emphasis on personal choice. The lifestyle concept, however, in our opinion, has problems of its own, chiefly in its rejection of the biological component in behavior that impedes the ability of many individuals to make healthy choices. A too-heavy emphasis on individual responsibility in the use of mood-altering substances can play into the punitive response so much in evidence regarding drug use in U.S. society. (We delve into this matter more in a later section, Treatment Trends.) To define addictive behavior in terms of a lack of responsibility is fraught with political and treatment difficulties, as Joranby, Pineda, and Gold (2005) and Lewis (2015) suggest. If eating disorders, for example, are viewed as stemming from a lack of self-control, treatment resources will be hard to come by. And there is every indication of a close similarity between dependence on drugs and dependence on food. That food is a powerful mood-altering substance is borne out in scientific findings about brain reward systems and neurotransmitter aberrations, as, for example, among bulimics. Classification of eating disorders as an addiction, as these authors further argue, would help in our prevention and educational efforts. Many of the addictive chronic disorders, such as compulsive overeating and pathological gambling, are characterized by loss of control, relapse, compulsiveness, and continuation despite negative consequences. The DSM-5 (APA, 2013) now does include binge eating disorder under the category, “Feeding and Eating Disorders” and although not as an addiction, its characteristics of marked distress, and feelings of lack of control closely resemble the characteristics of substance use disorders. Since food is a substance with addictive qualities, it could be classified as a substance use disorder. At least now, people who are endangering their health and relationships due to severe overeating can obtain the medical or psychological treatment they need thanks to the inclusion of this condition in the diagnostic manual. The addiction concept, as stated previously, perceives addiction as occurring along a continuum. Severe life-threatening dependence may be placed at one end, the misuse of substances somewhere in the center, and a use of substances without problems at the other end. Individuals or their behaviors can be placed along a continuum according to levels of misuse or addiction at various points in their lives. The revised version of the DSM thankfully has discarded the overly simplified the either–or categories of substance use that existed in the previous edition to now help us appreciate the individual dimensions of human behavior. From this perspective there are no rigid boundaries between normal and pathological populations or between common diagnostic categories. From a contemporary perspective, in marked contrast to the earlier view of alcohol dependence as a progressive and irreversible disease, most problem drinkers move in and out of periods of excessive drinking. And we know that the majority of people who meet the criteria for addiction in their teens and 20s have become moderate drinkers or drug users by their 30s, as Harvard psychologist Gene Heyman (2009) informs us. And most of them will never set foot in a treatment center. We need to keep in mind, of course, that people who present themselves at specialist treatment agencies (often by court order, as is typical in the United States) are apt to have severe problems including a history of legal violations and to represent the extreme end of the continuum. For this reason, we should refrain from generalizing about addiction and recovery to the general population based on the biased sample from the treatment population when more than three-fourths of all persons with addiction problems, as Heyman estimates, never enter treatment and recover on their own. We can take issue with the DSM, even in its improved format, for one other reason as well: the incompatibility of such labeling and diagnosis with the tenets of the strengths perspective. As the name would indicate,  the strengths perspective  is an approach geared to look for strengths rather than liabilities, not because they are “truer” but because an approach geared toward a person’s possibilities is more effective than an approach focusing on a person’s problems. The entire mental health field, as strengths-based theorists Rapp and Goscha (2012) indicate, is “dominated by assessment protocols and devices that seek to identify all that is wrong, problematic, deficient, or pathological in the client” (p. 93). Still, in the United States, mental health practitioners, rehabilitation counselors, and social workers in many fields use APA criteria for substance use disorders as a means of obtaining insurance reimbursement and vocational rehabilitation services for their clients (Heyman, 2009; Lewis, 2015). The physical, psychological, and social aspects of addiction disorders, as spelled out in this diagnostic manual, can be helpful in assessment and communication among professionals and in giving testimony before the court. A welcome change to the DSM is the use of the term substance use in place of substance abuse. A semantic problem with the term substance abuse is that the substance is not being abused. The individual may be committing self-abuse, but the substance is merely consumed or otherwise ingested; it is hard to abuse an inanimate object, after all. The terms substance use and substance misuse are more accurate and even more sensible, and they are used in this text to refer more specifically to general and harmful drug use, respectively. The terms substance abuse treatment and substance abuse counseling are used because of their familiarity rather than due to any descriptive accuracy. Addiction treatment, however, is our preferred term. The concept of addiction offers us the flexibility to cover various forms of problematic behavior. It is also highly compatible with the biopsychosocial model, which attends to the subjective as well as objective factors in human behavior.  Addiction  can be defined as a pattern of compulsive substance use or behavior. The Social Work Dictionary (Barker, 2014) defines addiction as follows: ADDICTION: Physiological and psychological dependence on a behavior or substance. Behavioral addictions (sex, gambling, spending, obsessive Internet use) and consumptive addictions (alcohol, drugs, food) often have similar etiologies, prognoses, and treatment procedures. (p. 6) Although the tendency is to equate addiction with loss of control, the extent to which the individual is truly beyond self-control cannot be proven but can be inferred only from external behavior or from an individual’s self-reporting of this phenomenon. To what extent addiction is an involuntary disease is open to question. Heyman (2009), for example, argues that addiction is not an illness; the individual’s decision to continue to use a harmful drug or to abstain depends on what the stakes are. People who have incentives to remain drug free, such as a good job, are more likely to do so than are people who have less to lose. Most addictions experts would agree with this supposition; what they would disagree with is the presupposition stated in the title of Heyman’s book, Addiction: A Disorder of Choice. Few people, in fact, would choose to have any disorder, much less to be addicted to a substance or behavior. What’s missing but needed in scientific research is a way to determine the point at which self-control over a craving for an addictive substance has gone beyond the level that it can be controlled. Without getting inside the mind of a drug user, compulsive gambler, or chain smoker, we do not know how hard it is to resist temptation. We will never be able to read people’s minds, but we can gain a great deal of insight into this dimension from the recent advances in brain research. Through newer technologies such as magnetic resonance imaging (MRI), neurologists can now observe, for example, the impact that gambling has on neurotransmitters in the brains of pathological gamblers. Research on biogenetic vulnerabilities in gamblers is showing promising results as well. “Brain imaging studies from drug-addicted individuals,” according to psychiatric researcher Nora Volkow (2010), “show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors.” (p. 7) To understand the pain connected with addictive and compulsive behavior, one must first understand the pleasure side of these activities (i.e., their attractiveness). Pete Hamill (1994) captured this attractiveness very well in his autobiography, A Drinking Life. “The culture of drink endures,” he wrote, “because it offers so many rewards: confidence for the shy, clarity for the uncertain, solace to the wounded and lonely” (Introduction). Books on treatment, whether written by scholars or by self-help authors, focus almost exclusively on the harm of substance use, a harm inherent in the substances themselves. Yet, according to Lewis (2015), it is crucial to learn why substances such as alcohol and licit or illicit drugs are useful as well as attractive. Volkow (2010) lists three major uses or attractions of intoxicating substances in answer to the question, Why do people take drugs? First, they take drugs to feel good, to enhance their sense of pleasure. “For example, with stimulants such as cocaine,” she states, “the ‘high’ is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction” (p. 6). Second, people who suffer from anxiety and stress-related disorders may be attracted to intoxicants to feel better. The third temptation to use drugs is to do better, such as to enhance athletic or work performance. Then we also need to take into account the fact that substance use in itself is not always wrong or harmful, despite attempts by various factions to convince us otherwise. Human cultures have learned to use psychoactive drugs positively (for pleasure and to alleviate pain) and negatively (as through the marketing of unhealthy products such as tobacco) (Barnes, 2015; Stevens, 2011). Alcohol, for example, when used in moderation, has many health-giving properties and, like the opiates, has been used for centuries to relieve pain. Apart from nicotine, which is highly addictive, as Stevens indicates, only a small percentage of drinkers, marijuana users, or heroin users exhibit the kind of problems that would define them as sick, criminal, or in need of treatment. Few areas of human life exist where individual differences are more pronounced than in regard to people’s taste (or distaste) for mood-altering substances, including food. Some crave uppers, ranging from caffeine to methamphetamines; others go to incredible lengths to obtain downers, such as alcohol and diazepam (Valium). Still others use such substances to enhance their sensual pleasures, but then only occasionally. Medical science is rapidly uncovering clues to these individual differences, clues that go beyond pharmacology or even environmental circumstances and into the realm of brain chemistry. But that is the topic of another chapter. Of all the addictions, alcoholism is the most studied and the most common, next to nicotine addiction. The American Medical Association (AMA) (1956) declared that alcoholism was an illness. In 1968, the AMA offered the following definition, which is still widely used: Alcoholism  is an illness characterized by preoccupation with alcohol and loss of control over its consumption such as to lead usually to intoxication if drinking is begun; by chronicity; by progression; and by tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational, and/or social adjustments as a direct consequence of persistent and excessive use of alcohol. (p. 6) The AMA definition identifies the three basic areas of ecological concern: the physical, the psychological, and the social. Thus, it is the definition chosen for this text. The selection of the word illness to describe alcoholism provides a clear acknowledgment of alcoholism as a medical problem with widespread ramifications (social and moral). Illness is a nonjudgmental, nonvictim-blaming term. At the present time, on their website, the AMA (2011) “endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice” (Definition H-95.983: Drug Dependencies as Diseases H-95.983). The word disease originally was applied to alcoholism by Jellinek (1960), who said that alcoholism was like a disease. It was a short road from “like a disease” to “a disease,” one with vast political and medical connotations. In the United States in recent years, a trend toward the “diseasing” of behavior not ordinarily considered pathological (e.g., codependence) has been pronounced. Simultaneously, there has been a countertrend stressing individual responsibility for a range of addictive behaviors, now labeled “bad habits.” This movement away from the disease models carries some risk of “throwing the baby out with the bath water,” of turning the clock back on treatment availability. Disregarding the political aspects for the moment, let us draw upon the dictionary definition of disease. Disease 1. (Middle English) A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infections, genetic defect. 2. A condition or tendency, as of society, regarded as abnormal or harmful. 3. Obsolete, lack of ease, trouble. (American Heritage Dictionary of the English Language, 2000, p. 517) Similarly, the Shorter Oxford English Dictionary (2007, p. 702) defines disease as 1. Absence of ease; inconvenience; trouble. 2. [A] disorder of structure or function in an animal or plant of such a degree as to produce or threaten to produce detectable illness or disorder; a definable variety of such a disorder, usually with specific signs or symptoms or affecting a specific location; (an) illness, (a) sickness. According to this, as in most dictionary definitions, alcoholism certainly qualifies, along with diabetes and certain heart conditions, for consideration as a disease. McNeece and DiNitto (2012), however, warn against use of the term disease for two reasons. The first is that the word is generally used as simply a metaphor and not in a literal sense. The second reason is because “if a phenomenon is a disease then we expect a cure in the form of a drug or other medical treatment” (p. 6). Alcohol and drug dependence are viewed by McNeece and DiNitto as addictions but not diseases, except when discussing the consequences of alcoholism, such as pancreatitis. To denote the extensive pain and suffering wrought by the condition of alcoholism, we have chosen, as in the AMA definition, to favor use of the word illness over disease. Illness, in medical terminology, is the experience of being sick or diseased; it is a social psychological state caused by the disease (Larsen, 2014). Thus, pathologists treat disease, whereas patients experience illness. The subjective level of illness, as previously suggested, makes this term more relevant to helping professions’ focus on the person in the environment and on the interaction between the person and the world outside. Understanding the illness experience is essential when providing holistic care. The concept of addiction as an illness of body, mind, and soul is part and parcel of the biopsychosocial-spiritual understanding of this phenomenon. Through the initial act of drinking or drug ingestion, the body adapts remarkably, sometimes to the extent of permanent biochemical and psychological changes. As thought processes in the brain are altered, one’s ability to adapt to stress may be weakened. Socially, the hard-drinking, drug-using life determines the company one keeps (and the company one loses); one’s family members are affected in dramatic and devastating ways. The consequences of substance misuse raise stress levels; this, in combination with the physiological craving associated with heavy use, reinforces the urge to partake.