Compare And Contrast Two Models Of Substance Abuse And Addiction
Compare and Contrast two Models to Explain Substance Use, Abuse and Addiction.
Use, as the term infers is any use of a drug. The majority of people use a form of drug in one way or another, ranging from the use of prescribed medication over the counter, to alcohol, tobacco, caffeine or illicit drugs such as cannabis, or amphetamines. In reference to use, abuse and addiction two models will be addressed as a way to explain this epidemic. Exploring the disease model, from the 1930’s post-Prohibition it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal. Moreover use, abuse and addiction will be explored through …show more content…
a psychological perspective where a psychodynamic modality will be discussed as a way to explain substance abuse.
The Australian Drug Foundation (2010) notes, there is no safe level of drug use. The use of any drug always carries some risk even medications can produce unwanted side effects, thus it is important to be careful when there is a level of any drug use.
Abuse, the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV, 2000) outlines substance abuse as a ‘maladaptive pattern of use leading to clinically significant impairment or distress.’
Dependence and addiction, the definitions of these two terms are somewhat debatable. There is also some debate over the use of these terms to describe how people use drugs. This is because the language used can affect perspectives on treatments, outcomes, motives and behaviors of those who use them. For an example; some people do not like the term addiction as it implies that the person is powerless over their use of the drug, however others argue that this powerlessness is the foundation of diagnosis and treatment. Furthermore, others argue that substance use and dependency are not psychiatric disorders, as the DSM IV classification suggests.
The DSM IV limits it classification of substance related disorders to dependence, it does not include a classification for addiction.
“In 1964 the World health organization recommended using the term ‘dependence’ in place of terms ‘addiction’ and ‘alcoholism’ (World Health Organization Technical Report series: No. 273, 1964). In 1981, ‘dependence’ as a socio-psycho-biological syndrome manifested by a behavioral pattern in which the use of a given psychoactive drug (or class of drugs) is given a sharply higher priority over other behaviors which once had significantly greater value (for example drug use comes to have a grater relative value).” (Edwards et al., 1980, p.240).
The two terms dependence and addiction are very closely intertwined as it is argued that the tolerance and withdrawal associated with dependence are what exactly defines addictions. However, the DSM IV classification more so describes what is known as a physical dependence, and does not take account of psychological dependence. Moreover, psychological dependence is when the person believes that they need to use the drug in order to feel emotionally stable or function efficiently. According to the Centre for Addiction and Mental Health (2011), addiction is:
“A primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors that influence its development and manifestations. It is characterized by behaviors that include one or more of the following: loss of control over drug use, continued use despite harm, compulsive use and craving.”
Use, Abuse and addiction and the disease model:
In the 1930’s post-Prohibition it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal.
In the same year Alcoholics Anonymous was founded by Bill Wilson and Dr. Robert Smith, Alcoholics Anonymous or (AA) holds the stance that the “primary purpose is to stay sober and help other alcoholics achieve sobriety” (Gross, 2010).
With other members the founders Wilson and Smith developed the twelve-step program of spiritual character development, basically the principals speak about having an addiction so intense that it leaves you powerless to avoid temptation.
Followed by twelve traditions of the twelve-step program, which provided guidelines for relationships between the twelve step groups, members, other groups, the global fellowship and the society at large. These twelve traditions were put into place in 1946 to help Alcoholics Anonymous stabilize and grow. Traditions placed emphasis that members and groups remain anonymous in public media, intrinsically help other alcoholics, including all who wish to stop drinking who do not affiliate with ‘AA’ or any other organizations. Traditions also recommend that members acting on behalf of the program stay away from dogma, governing hierarchies and involvement in public issues. Subsequent fellowships such Narcotics Anonymous (NA) adapted and adopted the twelve steps, and traditions to their respective primary purpose although the disease model was introduced as a theory for alcoholism it has evolved into the standard model for treatment of practically all forms of drug addiction (Chapel, 1999).
Foremost, the disease model for drug and alcohol addiction is the most readily available treatment for the general public. It gives those who don 't have the means help that they wouldn 't have otherwise. From AA/NA meetings that are available for free in nearly every city to the insurance coverage for treatment that is available because addiction is regarded as a disease, the advantages are widespread. Some say looking at addiction as a disease also allows addicts to deal with the guilt that often accompanies a lifetime of chemically induced missteps. …the loss of control is a disease condition per se which results from a process that superimposes itself upon those abnormal psychological conditions of which excessive drinking is a symptom… (Jelleinek, 1951).
People who disagree with the disease model cite an array of disadvantages to its use. One of the most prevalent disadvantages relates to the statement cited by Peele, in that it defies common sense and is therefore dishonest. Those that subscribe to that concept often believe that the disease model actually renders addicts helpless rather than empowering them to change (Clark, 2006).
Furthermore others who dispute the disease model state that no biological or genetic mechanisms have been identified that account for addictive behaviour.
Arguing how could an addiction like smoking be genetic, and why are some types of people more likely to smoke than others. Does believing that an addiction like smoking is genetic help the person quit (are all those smokers who quit not “genetically” addicted) and in relation to alcohol, are people really predestined biologically to become alcoholics and thus to become A.A. members. For example; the rock group Aerosmith; all five members of this group now belong to A.A., just as they previously all drank and took drugs together. Thus, how improbable a coincidence it is that five unrelated people with the alcoholic/addictive inheritance should bump into one another and form a band (Peele, …show more content…
1992).
Use, Abuse and addiction from a psychological perspective:
Psychodynamic therapy focuses on unconscious processes as they are manifested in the client 's present behavior. The objectives of psychodynamic therapy are client self-awareness and an understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach allows the client to observe unresolved conflicts and symptoms that arise from past dysfunctional affiliations and manifest themselves in the necessary desire to abuse substances.
Short-term psychodynamic therapies can contribute to the armamentarium of treatments for substance abuse disorders.
Brief psychodynamic therapies probably have the best chance to be effective when they are integrated into a relatively comprehensive substance abuse treatment program that includes drug-focused interventions such as regular urinalysis, drug counseling, and, for opioid-dependents, methadone maintenance pharmacotherapy. Brief psychodynamic therapies are perhaps more helpful after abstinence is well established. They may be more beneficial for clients with no greater than moderate severity of substance abuse. It is also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step
programs.
The theory supporting psychodynamic therapy originated in and is informed by psychoanalytic theory. There are four major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. The four schools are: Freudian, Ego Psychology, Object Relations, and Self Psychology.
Freudian psychology is based on the theories first conveyed by Sigmund Freud in the early part of this century and is occasionally referred to as the drive or structural model. The substance of Freud 's theory is that sexual and aggressive energies originating in the id (or unconscious) are controlled by the ego, which is a set of functions that regulates between the id and external reality. Defense mechanisms are constructions of the ego that operate to minimize pain and to maintain psychic equilibrium. The superego, formed during latency (between age 5 and puberty), operates to control id drives through guilt (Messer and Warren, 1995).
Ego Psychology began from Freudian psychology. Its followers center their work on increasing and sustaining ego function in harmony with the demands of reality. Ego Psychology stresses the individual 's capacity for defense, adaptation, and reality testing (Pine, 1990).
Supportive-expressive psychotherapy is one brief psychodynamic approach that has been adapted for use with people who have substance abuse conditions. It has been revised for use with opiate addiction in conjunction with methadone maintenance treatment and for cocaine use disorders (Luborsky, et, al 1997). There have been numerous findings of the use of supportive expressive therapy for substance abuse disorders, resulting in a substantial body of pragmatic data on its effectiveness in treating these problems.
Only since the 1980s that psychosocial components of the treatment of substance abuse disorders have become the subject of scientific examination. Most research on the effectiveness of psychotherapy for the treatment of substance abuse disorders has concluded that it can be an effective treatment modality (Woody et al., 1994). Comparisons among specific models of therapy have become the focus of much interest.
As previously mentioned, supportive Expressive (SE) psychotherapy has been adapted for use with methadone-maintained opiate dependents and for cocaine dependents. In SE therapy, the client is assisted to recognize and talk about core relationship patterns and how they correspond to substance abuse.
Furthermore, The relationship that develops between therapist and client is a very important factor for effective therapeutic outcomes (Luborsky, 1985).
This is true irrespective of the modality of therapy. The psychodynamic model has always regarded the therapist-client relationship as a fundamental and the vehicle through which change occurs. Of all the brief psychotherapies, psychodynamic approaches place the most importance on the therapeutic relationship and deliver the most unambiguous and comprehensive rationalizations of how to use this relationship effectively.
To conclude, two models were used to explain use, abuse and addiction, the disease model explored the 1930’s post-Prohibition, as it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal. In the same year Alcoholics Anonymous was founded by Bill Wilson and Dr. Robert Smith, Alcoholics Anonymous or (AA) holds the stance that the “primary purpose is to stay sober and help other alcoholics achieve sobriety” Twelve-step programs were discussed as this was when alcoholism was more so viewed as a disease rather than a moral failure. A psychological perspective was also addressed where psychodynamic therapy was the focus. Short-term psychodynamic therapies were seen to contribute to the armamentarium of treatments for substance abuse disorders. Brief psychodynamic therapies were viewed as having the best chance to be effective when integrated into a relatively comprehensive substance abuse treatment program. It was also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step programs.
References:
The Australian Drug Foundation – DrugInfo. (2010) Drugs – the facts, Melbourne. Available: http://druginfo.adf.org.au/treatment-options/what-kind-of -help-is-available#pharmacotherapy
Clark, D. 2006. The disease Model of addiction. London: www.drinkanddrugs.net/backgroundinformation.breifings/sep2506/background_breifing.pdf
Edwards, G. & Arif, A. (1980). Drug problems in the sociocultural context: a basis for policies and programme planning, World Health Organization, Geneva. http://archives.drugabuse.gov/adac/ADAC10.html Morse. R., & Flavin. D,. (1992) The definition of Alcoholism. JAM Med association.
Edwards, & Griffith (2002) “Alcoholics Anonymous”. Alcohol: the worlds favorite drug. Thomas Dunne Books.
Gross. M., Ph.D (2010) American Journal of Public Health.
Chappel. J. (1999) Twelve step and mutual help programs for addictive disorders. Psychiatric clinics of North America
Dr. Peele on America’s Fixation on the Disease Model of Addiction: (2007) Interview by Andrew Proscyk. Edited by Britt Winston. Copyright Andrew Proscyk. http://lifeprocessprogram.com/lp-blog/library/dr-peele-on-americas-fixation-on-the-disease-model-of-addiction/ Stanton Peele, Ph.D., and Archie Brodsky with Mary Arnold (1992), The Truth About Addiction and Recovery. N.Y.: Simon & Schuster.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O 'Brien, C.P. (1995), Psychotherapy in community methadone programs: A validation study. American Journal of Psychiatry.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O 'Brien, C.P. (1998), Psychotherapy with opioid-dependent patients. Psychiatric Times.
Messer, S. B., & Warren, C. S. (1995). Models of brief psychodynamic therapy: A comparative approach. New York: NY: Guilford. Pine, F. (1990). Drive, ego, object, and self. New York: Basic Books
Luborsky, l., Diguer, L, Seligman, D.A., Rosenthal, R.,. Krause, E.D., Johnson, S., Halperin, G., Bishop, M., Berman, J.S., Schweizer, E. (1999). The researcher’s own therapy allegiances: A “wild card” incomparisons of treatment efficacy.
Use, as the term infers is any use of a drug. The majority of people use a form of drug in one way or another, ranging from the use of prescribed medication over the counter, to alcohol, tobacco, caffeine or illicit drugs such as cannabis, or amphetamines. In reference to use, abuse and addiction two models will be addressed as a way to explain this epidemic. Exploring the disease model, from the 1930’s post-Prohibition it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal. Moreover use, abuse and addiction will be explored through …show more content…
a psychological perspective where a psychodynamic modality will be discussed as a way to explain substance abuse.
The Australian Drug Foundation (2010) notes, there is no safe level of drug use. The use of any drug always carries some risk even medications can produce unwanted side effects, thus it is important to be careful when there is a level of any drug use.
Abuse, the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV, 2000) outlines substance abuse as a ‘maladaptive pattern of use leading to clinically significant impairment or distress.’
Dependence and addiction, the definitions of these two terms are somewhat debatable. There is also some debate over the use of these terms to describe how people use drugs. This is because the language used can affect perspectives on treatments, outcomes, motives and behaviors of those who use them. For an example; some people do not like the term addiction as it implies that the person is powerless over their use of the drug, however others argue that this powerlessness is the foundation of diagnosis and treatment. Furthermore, others argue that substance use and dependency are not psychiatric disorders, as the DSM IV classification suggests.
The DSM IV limits it classification of substance related disorders to dependence, it does not include a classification for addiction.
“In 1964 the World health organization recommended using the term ‘dependence’ in place of terms ‘addiction’ and ‘alcoholism’ (World Health Organization Technical Report series: No. 273, 1964). In 1981, ‘dependence’ as a socio-psycho-biological syndrome manifested by a behavioral pattern in which the use of a given psychoactive drug (or class of drugs) is given a sharply higher priority over other behaviors which once had significantly greater value (for example drug use comes to have a grater relative value).” (Edwards et al., 1980, p.240).
The two terms dependence and addiction are very closely intertwined as it is argued that the tolerance and withdrawal associated with dependence are what exactly defines addictions. However, the DSM IV classification more so describes what is known as a physical dependence, and does not take account of psychological dependence. Moreover, psychological dependence is when the person believes that they need to use the drug in order to feel emotionally stable or function efficiently. According to the Centre for Addiction and Mental Health (2011), addiction is:
“A primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors that influence its development and manifestations. It is characterized by behaviors that include one or more of the following: loss of control over drug use, continued use despite harm, compulsive use and craving.”
Use, Abuse and addiction and the disease model:
In the 1930’s post-Prohibition it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal.
In the same year Alcoholics Anonymous was founded by Bill Wilson and Dr. Robert Smith, Alcoholics Anonymous or (AA) holds the stance that the “primary purpose is to stay sober and help other alcoholics achieve sobriety” (Gross, 2010).
With other members the founders Wilson and Smith developed the twelve-step program of spiritual character development, basically the principals speak about having an addiction so intense that it leaves you powerless to avoid temptation.
Followed by twelve traditions of the twelve-step program, which provided guidelines for relationships between the twelve step groups, members, other groups, the global fellowship and the society at large. These twelve traditions were put into place in 1946 to help Alcoholics Anonymous stabilize and grow. Traditions placed emphasis that members and groups remain anonymous in public media, intrinsically help other alcoholics, including all who wish to stop drinking who do not affiliate with ‘AA’ or any other organizations. Traditions also recommend that members acting on behalf of the program stay away from dogma, governing hierarchies and involvement in public issues. Subsequent fellowships such Narcotics Anonymous (NA) adapted and adopted the twelve steps, and traditions to their respective primary purpose although the disease model was introduced as a theory for alcoholism it has evolved into the standard model for treatment of practically all forms of drug addiction (Chapel, 1999).
Foremost, the disease model for drug and alcohol addiction is the most readily available treatment for the general public. It gives those who don 't have the means help that they wouldn 't have otherwise. From AA/NA meetings that are available for free in nearly every city to the insurance coverage for treatment that is available because addiction is regarded as a disease, the advantages are widespread. Some say looking at addiction as a disease also allows addicts to deal with the guilt that often accompanies a lifetime of chemically induced missteps. …the loss of control is a disease condition per se which results from a process that superimposes itself upon those abnormal psychological conditions of which excessive drinking is a symptom… (Jelleinek, 1951).
People who disagree with the disease model cite an array of disadvantages to its use. One of the most prevalent disadvantages relates to the statement cited by Peele, in that it defies common sense and is therefore dishonest. Those that subscribe to that concept often believe that the disease model actually renders addicts helpless rather than empowering them to change (Clark, 2006).
Furthermore others who dispute the disease model state that no biological or genetic mechanisms have been identified that account for addictive behaviour.
Arguing how could an addiction like smoking be genetic, and why are some types of people more likely to smoke than others. Does believing that an addiction like smoking is genetic help the person quit (are all those smokers who quit not “genetically” addicted) and in relation to alcohol, are people really predestined biologically to become alcoholics and thus to become A.A. members. For example; the rock group Aerosmith; all five members of this group now belong to A.A., just as they previously all drank and took drugs together. Thus, how improbable a coincidence it is that five unrelated people with the alcoholic/addictive inheritance should bump into one another and form a band (Peele, …show more content…
1992).
Use, Abuse and addiction from a psychological perspective:
Psychodynamic therapy focuses on unconscious processes as they are manifested in the client 's present behavior. The objectives of psychodynamic therapy are client self-awareness and an understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach allows the client to observe unresolved conflicts and symptoms that arise from past dysfunctional affiliations and manifest themselves in the necessary desire to abuse substances.
Short-term psychodynamic therapies can contribute to the armamentarium of treatments for substance abuse disorders.
Brief psychodynamic therapies probably have the best chance to be effective when they are integrated into a relatively comprehensive substance abuse treatment program that includes drug-focused interventions such as regular urinalysis, drug counseling, and, for opioid-dependents, methadone maintenance pharmacotherapy. Brief psychodynamic therapies are perhaps more helpful after abstinence is well established. They may be more beneficial for clients with no greater than moderate severity of substance abuse. It is also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step
programs.
The theory supporting psychodynamic therapy originated in and is informed by psychoanalytic theory. There are four major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. The four schools are: Freudian, Ego Psychology, Object Relations, and Self Psychology.
Freudian psychology is based on the theories first conveyed by Sigmund Freud in the early part of this century and is occasionally referred to as the drive or structural model. The substance of Freud 's theory is that sexual and aggressive energies originating in the id (or unconscious) are controlled by the ego, which is a set of functions that regulates between the id and external reality. Defense mechanisms are constructions of the ego that operate to minimize pain and to maintain psychic equilibrium. The superego, formed during latency (between age 5 and puberty), operates to control id drives through guilt (Messer and Warren, 1995).
Ego Psychology began from Freudian psychology. Its followers center their work on increasing and sustaining ego function in harmony with the demands of reality. Ego Psychology stresses the individual 's capacity for defense, adaptation, and reality testing (Pine, 1990).
Supportive-expressive psychotherapy is one brief psychodynamic approach that has been adapted for use with people who have substance abuse conditions. It has been revised for use with opiate addiction in conjunction with methadone maintenance treatment and for cocaine use disorders (Luborsky, et, al 1997). There have been numerous findings of the use of supportive expressive therapy for substance abuse disorders, resulting in a substantial body of pragmatic data on its effectiveness in treating these problems.
Only since the 1980s that psychosocial components of the treatment of substance abuse disorders have become the subject of scientific examination. Most research on the effectiveness of psychotherapy for the treatment of substance abuse disorders has concluded that it can be an effective treatment modality (Woody et al., 1994). Comparisons among specific models of therapy have become the focus of much interest.
As previously mentioned, supportive Expressive (SE) psychotherapy has been adapted for use with methadone-maintained opiate dependents and for cocaine dependents. In SE therapy, the client is assisted to recognize and talk about core relationship patterns and how they correspond to substance abuse.
Furthermore, The relationship that develops between therapist and client is a very important factor for effective therapeutic outcomes (Luborsky, 1985).
This is true irrespective of the modality of therapy. The psychodynamic model has always regarded the therapist-client relationship as a fundamental and the vehicle through which change occurs. Of all the brief psychotherapies, psychodynamic approaches place the most importance on the therapeutic relationship and deliver the most unambiguous and comprehensive rationalizations of how to use this relationship effectively.
To conclude, two models were used to explain use, abuse and addiction, the disease model explored the 1930’s post-Prohibition, as it was a common perception that alcoholism was a moral failure. Medical and professional standards of the time treated it as a condition that was expected to be incurable and lethal. In the same year Alcoholics Anonymous was founded by Bill Wilson and Dr. Robert Smith, Alcoholics Anonymous or (AA) holds the stance that the “primary purpose is to stay sober and help other alcoholics achieve sobriety” Twelve-step programs were discussed as this was when alcoholism was more so viewed as a disease rather than a moral failure. A psychological perspective was also addressed where psychodynamic therapy was the focus. Short-term psychodynamic therapies were seen to contribute to the armamentarium of treatments for substance abuse disorders. Brief psychodynamic therapies were viewed as having the best chance to be effective when integrated into a relatively comprehensive substance abuse treatment program. It was also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step programs.
References:
The Australian Drug Foundation – DrugInfo. (2010) Drugs – the facts, Melbourne. Available: http://druginfo.adf.org.au/treatment-options/what-kind-of -help-is-available#pharmacotherapy
Clark, D. 2006. The disease Model of addiction. London: www.drinkanddrugs.net/backgroundinformation.breifings/sep2506/background_breifing.pdf
Edwards, G. & Arif, A. (1980). Drug problems in the sociocultural context: a basis for policies and programme planning, World Health Organization, Geneva. http://archives.drugabuse.gov/adac/ADAC10.html Morse. R., & Flavin. D,. (1992) The definition of Alcoholism. JAM Med association.
Edwards, & Griffith (2002) “Alcoholics Anonymous”. Alcohol: the worlds favorite drug. Thomas Dunne Books.
Gross. M., Ph.D (2010) American Journal of Public Health.
Chappel. J. (1999) Twelve step and mutual help programs for addictive disorders. Psychiatric clinics of North America
Dr. Peele on America’s Fixation on the Disease Model of Addiction: (2007) Interview by Andrew Proscyk. Edited by Britt Winston. Copyright Andrew Proscyk. http://lifeprocessprogram.com/lp-blog/library/dr-peele-on-americas-fixation-on-the-disease-model-of-addiction/ Stanton Peele, Ph.D., and Archie Brodsky with Mary Arnold (1992), The Truth About Addiction and Recovery. N.Y.: Simon & Schuster.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O 'Brien, C.P. (1995), Psychotherapy in community methadone programs: A validation study. American Journal of Psychiatry.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O 'Brien, C.P. (1998), Psychotherapy with opioid-dependent patients. Psychiatric Times.
Messer, S. B., & Warren, C. S. (1995). Models of brief psychodynamic therapy: A comparative approach. New York: NY: Guilford. Pine, F. (1990). Drive, ego, object, and self. New York: Basic Books
Luborsky, l., Diguer, L, Seligman, D.A., Rosenthal, R.,. Krause, E.D., Johnson, S., Halperin, G., Bishop, M., Berman, J.S., Schweizer, E. (1999). The researcher’s own therapy allegiances: A “wild card” incomparisons of treatment efficacy.