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Announcement

Substance Use Disorders III (Chapter 11) April 7, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. Announcement. Exam 3 is this Friday. From Last Class. Culture and alcohol use Health benefits of moderate drinking Fetal alcohol syndrome Disease (A.A.) model of alcoholism.

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Announcement

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  1. Substance Use Disorders III(Chapter 11)April 7, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

  2. Announcement • Exam 3 is this Friday

  3. From Last Class • Culture and alcohol use • Health benefits of moderate drinking • Fetal alcohol syndrome • Disease (A.A.) model of alcoholism

  4. Disease Model of Alcoholism • Controversies with disease model and treatment: • Are people really powerless over their alcohol use? • Are people personally responsible for their alcohol use? • Should permanent abstinence be the only treatment option for everyone? • Is denial a characteristic of alcoholism or of coercive treatment?

  5. Alcoholics Anonymous and the Disease Model of Alcoholism • http://www.southparkstudios.com/clips/155147/dads-drunk • http://www.southparkstudios.com/clips/103662/randys-dui • http://www.southparkstudios.com/clips/155150/a-big-loser-like-stans-dad • http://www.southparkstudios.com/clips/103665 • http://www.southparkstudios.com/clips/155157 • http://www.southparkstudios.com/clips/155164

  6. Disease Model of Alcoholism • First developed by E. M. Jellinek (1946) • Surveyed members of Alcoholics Anonymous • 98/1600 response rate, all men • Developed model of progression of alcoholism from initial use to chronic problem

  7. Modern Disease Model of Alcoholism • Central tenets of the disease model • 1. Loss of control • Powerlessness over addictive substance • Inability to regulate use in any way

  8. Modern Disease Model of Alcoholism • “It was then discovered that when one alcoholic had planted in the mind of another the true nature of his malady, that person could never be the same again. Following every spree, he would say to himself, ‘Maybe those AA's were right . . . .’ After a few such experiences, often years before the onset of extreme difficulties, he would return to us convinced. He had hit bottom as truly as any of us. John Barleycorn himself had become our best advocate.” • From Twelve Steps and Twelve Traditions

  9. Modern Disease Model of Alcoholism • One interesting effect of the loss of control notion of addiction: • Abstinence violation effect (AVE): belief that one cannot control use leads to uncontrolled use when any amount of substance is used • Alan Marlatt’s research on AVE and expectancies

  10. Modern Disease Model of Alcoholism • Central tenets of the disease model • 2. Biological (genetic) basis • Inherited biological allergy to alcohol (original AA view) • Genetic inheritance as cause

  11. Modern Disease Model of Alcoholism • Central tenets of the disease model • 3. Inevitable progression • Addiction can only get worse • Treatment is necessary for recovery

  12. Modern Disease Model of Alcoholism • National Institute on Alcohol Abuse and Alcoholism (NIAAA) survey of 43,000 Americans http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx • 20 years after onset of alcohol dependence, about three-fourths of individuals are in full recovery. • More than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence. • About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help.

  13. Modern Disease Model of Alcoholism • Central tenets of the disease model • 4. Alcoholics Anonymous is all that works • “It was a statistical fact that alcoholics almost never recovered on their own resources. And this had been true, apparently, ever since man had first crushed grapes.” –from Twelve Steps and Twelve Traditions

  14. Modern Disease Model of Alcoholism • Most alcoholics recover without treatment • Quality of research on AA effectiveness is poor • Some studies suggest benefits, others do not • A review of 8 studies involving a total of 3,417 individuals, published between 1967 and 2005, found "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism.

  15. Modern Disease Model of Alcoholism • Central tenets of the disease model • 5. The Catch-22 of denial • Denial is (supposedly) a symptom of addiction • What if you are told you are an alcoholic and must abstain for life, and you disagree? • Why might individuals evidence denial and/or resistance?

  16. Effects of the Disease Model on Personal Responsibility • From Former Congressman Mark Foley, chair of the Congressional Missing and Exploited Children’s Caucus, who resigned after it became known that he was soliciting sex from underage, male congressional pages: • "Painfully, the events that led to my resignation have crystallized recognition of my long-standing significant alcohol and emotional difficulties. I strongly believe that I am an alcoholic and have accepted the need for immediate treatment for alcoholism and other behavioral problems."

  17. Effects of the Disease Model on Personal Responsibility • Foley's attorney, David Roth, acknowledged Monday that his client checked into a treatment center in Florida, and said that Foley is "absolutely, positively not a pedophile" and "has never, ever had an inappropriate sexual contact with a minor in his life." He said Foley wrote the e-mails "under the influence of alcohol" and was "suffering from mental illness."

  18. Disease Model of Alcoholism • Disease model popularized by Alcoholics Anonymous (AA) and Twelve Step treatments • This model dominates addictions treatment in the US • AA is by far the most common alcohol treatment program in the world • The self-contained world of addictions treatment • Description of the Twelve Steps…

  19. Twelve Steps of Alcoholics Anonymous • We admitted we were powerless over alcohol - that our lives had become unmanageable. • From Twelve Steps and Twelve Traditions: “We had approached AA expecting to be taught self-confidence. Then we had been told that so far as alcohol is concerned, self-confidence was no good whatever; in fact, it was a total liability.”

  20. Twelve Steps of Alcoholics Anonymous 2. Came to believe that a Power greater than ourselves could restore us to sanity.

  21. Twelve Steps of Alcoholics Anonymous 3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

  22. Twelve Steps of Alcoholics Anonymous 4. Made a searching and fearless moral inventory of ourselves.

  23. Twelve Steps of Alcoholics Anonymous 5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.

  24. Twelve Steps of Alcoholics Anonymous 6. Were entirely ready to have God remove all these defects of character.

  25. Twelve Steps of Alcoholics Anonymous 7. Humbly asked Him to remove our shortcomings.

  26. Twelve Steps of Alcoholics Anonymous 8. Made a list of all persons we had harmed, and became willing to make amends to them all.

  27. Twelve Steps of Alcoholics Anonymous 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

  28. Twelve Steps of Alcoholics Anonymous 10. Continued to take personal inventory and when we were wrong promptly admitted it.

  29. Twelve Steps of Alcoholics Anonymous 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

  30. Twelve Steps of Alcoholics Anonymous 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

  31. Alcoholics Anonymous • Critical analysis of Twelve Steps? • Suitability for all alcoholics? • Role of religion? • the Establishment Clause and state mandated treatment – court findings

  32. Twelve Steps of Alcoholics Anonymous • Twelve Step treatment critical analysis: • http://www.youtube.com/watch?v=8tPNgHrIkgo • http://www.youtube.com/watch?v=5uwx2P5LJgk&feature=related • http://www.youtube.com/watch?v=7PjpOsE3xoY

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