Clinical Psych: Addiction

What should clinicians do and how should someone with addiction be viewed

Addiction: Medical Def

Addiction is viewed as a chronic brain disease caused by changes in the brain due to substance use, causing neurochemical imbalances, withdrawal and tolerance. Treatment: Methadone and detox

Biopsychosocial Def

Psychological: Trauma, coping strategy, emotional dysregulation, learned behavior. Social: Environment, norms, relationship, money

Gabour Mate Def

Craving, Relief, pleasure, suffering, impaired control

Trauma: Why

Unresolved emotional pain to treat the overwhelming stress and adverse experiences. Addiction can numb the pain from trauma like neglect, loss, or abuse

Trauma: How

Trauma dysregulates the nervous system. It impacts the autonomic nervous system (involuntary body reactions) making the individual seeking temporary relief in emotional states to maintain control.

Trauma: result

Addiction is reframed as an adaptive response to an unbearable circumstance NOT a lack of willpower. Response involves no judgement, empathy, safety and supportive relationships.

ACE slides

Individuals who experience early childhood adversity will seek ritualized compulsive comfort seeking. ACE include: chronic stress, abuse, or inconsistent caregiving, attachments, emotional/self disconnection

ACE broader

Discrimination, economic insecurity, violence, bullying, Capitalism culture, chromic stress

DSM-5

Addiction is places under the category of substance-re addictive disorders. Aka a mental problem that significantly impairs individual functioning

Diagnosis requirements

inability to control usage, social impairments, risky use and pharamalogical (withdrawal/tolerance) symptoms twice in a 12 month period. Mild only needs 2-3 criteria markers. Relapse and co-morbid disorders are often evaluated as well to see if they affect the addiction.

Subtance induced disorders

Intoxication, Withdrawal/ Substance-induced mental disorders.

Non subtance related addictive disorders

Gambling: persistent and recurring problematic gambling. Possibility for future technological addictions like video games.

Assessments

Behaviors: intoxication, withdrawal, functional impairments. Medical: toxicology screening. Interviews: history, psychosocial life, functionality. Self reporting and collateral info are done as well

Intervention: Psychosocial

Obvious ones, CBT EFT ACT, cultural competence, relapse prevention planning, Motivational interviewing and trauma care

Intervention: Biological

Detox and targeting dopamine pathways with meds(eg naltrexone) and transcranial magnetic stimulation

Stages of Change Model: Determination

To help the clinician must determine which stage the client is in. 5 stages. Excluded is relapse which is normal and an opportunity to learn about underlying trauma and support groups. Stability towards being clean is the goal.

Precontemplation

Unaware, denfensive and in denial. Open ended question. Empower and support the client. “What needs to happen for this to become a problem?”

Contemplation

Acknowledging the impact, Mixed feeling about change. Unpacking trauma. Questions on contemplating changes

Preparation stage

Clients are planning or starting to take small action. Questions around goals, barriers, support. Work together to make achievable plan

Action stage

Predicting triggers, tackling trauma, building support network and structured step plan. Question surround what’s going good and bad

Maintenance

Ongoing emotional healing, strengthen social connections, continue using strategies and relapse prevention. Questions on improvements, motivation, and celebration

US ACE screen usage study

45% of adolescents report being online almost constantly