Chemical Dependency/

Addiction
Holland Crowe, Carlyn Morones, & Annie Sperr
AGENDA

● Understanding Addiction
● Symptomatology
● Etiology
● Treatment and Intervention
○ Prescription Medication
○ Non-prescription Intervention
Strategies

2
 20 million people
need treatment for serious alcohol-
related problems

17.7 million people

over the age of 12 are dependent
on alcohol

$250 million
is spent annually in the
US
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WHAT IS ADDICTION?

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Progression of Addiction

Use Abuse Dependence Addiction

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 Neurochemical Responses

● Arousal
○ Engage in high-risk behaviors
● Satiation
○ Feel pleasure/fullness
● Fantasy
○ Preoccupation of the desired
object

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(Sinacola & Peters-
 Classes of Drugs

● 10 separate classes of drugs:

alcohol, caffeine, cannabis,
hallucinogens, inhalants, opioids,
sedatives, hypnotics and
anxiolytics, stimulants, tobacco,
and other/unknown
○ Other than gambling disorder,
the DSM does not include
behavioral addictions (e.g. sex, 7
(DSM-V,
 Classifications

Substance-Use Substance-Induced
Disorders Disorders
“A pattern of ____ use ● Intoxication
leading to clinically ● Withdrawal
significant impairment ● Other Mental
or distress, as Disorders
manifested by at least ○ Psychotic,
two of the following, Bipolar,
occurring within a 12- Depressive,
month period:” Anxiety, 8
DSM-V, 2013) Obsessive-
 DSM-5: Substance Use Disorder

1. Alcohol is often taken in larger amounts or over a longer period than was
intended Replace
2. There is a persistent desire or unsuccessful efforts to cut down or control “alcohol” with
alcohol use any of the
3. A great deal of time is spent in activities necessary to obtain alcohol, use
other classes
alcohol, or recover from its effects
4. Craving, or a strong desire or urge to use alcohol of drugs
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at (except
work, school, or home caffeine), and
6. Continued alcohol use despite having persistent or recurrent social or you have the
interpersonal problems caused or exacerbated by the effects of alcohol DSM criteria
7. Important social, occupational, or recreational activities are given up or for that
reduced because of alcohol use specific
8. Recurrent alcohol use in situations in which it is physically hazardous
substance use
9. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or
disorder.
(DSM-V, 2013)

exacerbated by alcohol
10. Tolerance, as defined by either of the following: 9
a. A need for markedly increased amounts of alcohol to achieve intoxication
Main Concerns

● Loss of control
○ When a person cannot stop or
limit substance use
● Tolerance
○ The need to use more and more
of a substance to avoid
withdrawal or to maintain a
desired state (Sinacola & Peters-
Strickland, 2012)
● Impairment in functioning 10
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SYMPTOMS
Across Developmental Span

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 Symptoms of Dependence/Addiction
Physical
● Impaired thinking
● Memory loss
● Loss of motor coordination
● Difficulty with problem solving
● Blackouts
● Slowed reaction times
● Slurred speech
● Euphoria
● Infection
● Long term health problems such
as cancer or heart disease
(AAC, 2019; SAMHSA, 2019)
Behavioral/Social
● Engaging in risky behavior
● Missing work
● Poor work performance
● Spending less time with friends
and family
● Being secretive about the
amount of substance abused in
order to protect it
● Denial about the extent of the
problem
● Becoming distressed at not
having access to the substance.
● Obsession with substance
● Stealing for money to buy the
substance
● Neglecting appearance
Symptoms of Withdrawal

Alcohol Dependence Opioid Dependence

● Anxiety ● Agitation
● Depression ● Anxiety
● Fatigue ● Muscle aches
● Irritability ● Increased tearing
● Shakiness ● Insomnia
● Mood swings ● Runny nose
● Nightmares and tremors ● Sweating
● Persistent thinking ● Yawning
● Insomnia ● Abdominal cramping
● Loss of appetite ● Diarrhea
● Increased heart rate ● Nausea
● Excessive perspiration ● Vomiting
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 Co-Occurring Disorders

● 61% of those with Bipolar Disorder

● 47% of those with Schizophrenia
● Also have a
39% of those with Personality Disorders
● problem with
33% of those with Obsessive Compulsive
substance
Disorder
● 32% of those abuse
with Affective Disorders

Theory that individuals with lower levels of self-control may be

particularly predisposed to develop substance use disorders
- Lower level of self control reflects impairment in brain
inhibitory mechanisms 14
M-V, 2013; Sinacola & Peters-Strickland,
3
ETIOLOGY
Models

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Models

Personal Responsibility Model Agent Model Dispositional Model

● Assumption that ● Primary emphasis on ● Primary cause of
alcohol/drug use is a the drug itself addiction is within
voluntary and ● Anyone exposed to the person
personal choice the drug is at risk ● The addiction is
● Suggest remedies because of the beyond the person’s
such as punishment, addictive and control
education, or destructive ● Humane treatment
legislation properties of the rather than
● Some suggest focus drug punishment
on spiritual/religious ● “War on drugs” ● The responsibility for
factors and ● Prohibition recovery still
character flaws Movement remains within the
person

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Models, continued

Social Learning Model Sociocultural Model Public Health Perspective

● Emphasize the role ● Influence of societal ● Takes into account
of experience in and cultural factors all other models
shaping addiction ● Availability and price ● 3 categories
● People are affect level of use ○ Agent (drug)
influenced by ● Advertising and ○ Host (person)
modeling or social perceived norms ○ Environment
environments ● Interventions focus ● Considering all
● Drug expectancies on drug and alcohol factors and
● Interventions focus policies addresses most
on changing a likely factors to yield
person’s relationship benefits for the
with their social person or
environment environment

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4
TREATMENT & References:
Ingersoll & Rak,

INTERVENTION
2013; McGovern
& Carroll, 2003;
National Institute
on Drug Abuse,
Medication & Therapy 2018; Sinacola &
Peters-Strickland,
2012

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Medications for Alcohol Dependence

Naltrexone (Revia)
● Blocks opioid receptors
○ Intercedes the pleasurable consequences
of alcohol
● Administered to patients who are steady
drinkers and in early recovery
● Goal: Decrease in craving urges
● SE: Nausea, headaches, dizziness, insomnia,
anxious feelings, & restlessness

Did you know: Naltrexone was originally approved 19

for the treatment of opioid dependence.
Medications for Alcohol Dependence

Acamprosate (Campral)
● Mechanism of action is widely debated
○ Acts on GABA and/or glutamate systems
● Goal: Alleviate or decrease the physical and
psychological discomfort symptoms that
accompany withdrawal
● SE: Diarrhea

Fun Fact: The largest clinical pharmacotherapy trial

in the US conducted for alcohol-related disorders
looked at Acamprosate. 20
Medications for Alcohol Dependence

Disulfiram (Antabuse)
● Blocks the expression of the enzyme necessary
for the metabolism/breakdown of ethanol
(alcohol)
○ Allows toxic acetaldehyde to accumulate
● Produces extremely unpleasant physiological
responses when alcohol is ingested
● Recommended for those who are very
motivated to abstain

However, it is not a cure for alcohol-use disorder. 21

Medications for Opioid Dependence

Methadone (Dolophine)
● Fuses itself to receptors and can inhibit or
eliminate effects of other opioid agents
○ Tricks the brain into believing it is still
getting the drug
○ Prevents withdrawal symptoms →
reduction in craving urges
● Slowly introduce in to approximate the
patient’s opioid tolerance levels with respect to
methadone
● Higher risk of poisonous reactions, including
overdose-related fatalities 22
Medications for Opioid Dependence

Buprenorphine (Butrans)
● Mixed, opioid agonist-antagonist: Sets into
motion activity that constitute familiar opioid
effects
● Produces a moderate psychoactive response
that decreases craving urges
● Also offered as a mixed compound:
Buprenorphine/Naloxone (Suboxone)
○ Goal: abstinence from opioid using
behaviors (as opposed to maintenance)

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Medications for Opioid Dependence

Naloxone (Narcan)
● Used to reverse the effects of an opioid
overdose

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Therapy

● Motivational Interviewing 1, 2, 3
● Cognitive-Behavioral Therapy 1, 2, 3
● Contingency Management 1, 2, 3
● Community Reinforcement
Approach 1, 2
● 12-Step Approaches 1, 2, 3
● Behavioral Couples Therapy 1, 2 1. McGovern & Carroll, 2003
2. Miller, Forcehimes, & Zweben, 2011
● Brief Strategic Family Therapy 1, 2,3.3National Institute on Drug Abuse, 2018
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 Therapy

Motivational Interviewing
● Based on the stages of change
● Helps people resolve ambivalence
○ Gives them autonomy
○ Counselor must have accurate empathy
● Activates the client’s own motivation for
change
● Strengthens motivation and builds a plan for
change
● Effectiveness depends on the type of drug
○ Overall- great results!
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(McGovern & Carroll, 2003; National Institute on
 Therapy, continued

Cognitive Behavioral Therapy Contingency Management Community Reinforcement

Approach
● Identify and ● Systematically
correct problem reinforcing ● 24-week
behaviors by abstinence via outpatient therapy
teaching skills rewards for those addicted
● Anticipate ● Tangible rewards to cocaine and
problems and for drug-free drug alcohol
enhance the tests ● Goal is to make
client’s self-control ● Positive outcomes non-drug lifestyle
and self-efficacy for drug and more rewarding
● The skills taught alcohol users than one with
remain well after substance use
treatment is over
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(McGovern & Carroll, 2003; National Institute on
 Therapy, continued

12-Step Approaches Brief Couples Therapy Brief Strategic Family Therapy

● Alcoholics ● Behavioral ● Targets family
Anonymous, treatment for drug interactions that are
Narcotics and alcohol use thought to maintain
Anonymous, disorders drug use or other
Cocaine ● Reinforces problem behaviors
Anonymous abstinence and ● Identifies patterns of
● Based on 12-step appropriate use of behaviors and assists
model medications in changing them
● Added layer of ● Increases ● Reduces drug use and
social support to abstinence, improves family
help clients improves relationships
maintain sobriety relationship, and
● Good outcomes for decreases
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retention and domestic violence
(McGovern & Carroll, 2003; National Institute on
abstinence
 Other Considerations

● Stigma
● Cultural biases and attitudes
● Barriers to treatment
○ Insurance/Financial resources
○ Lack of knowledge/Suspicion
○ Access to resources

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(Ingersoll & Rak,
References

American Addiction Center. (2019, June 18). What are some addiction signs? Retrieved from:
https://americanaddictioncenters.org/adult-addiction-treatment-programs/signs
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). Arlington, VA: Author.
Ingersoll, E., & Rak, C. (2016). Psychopharmacology for mental health professionals: An integrative
approach. (2nd ed.). Boston, MA:
Cengage Learning.
Ista, E., van Dijk, M., Tibboel, D., & de Hoog, M. (2008). Withdrawal symptoms in critically ill children
after long-term administration of
sedatives and/or analgesics: a first evaluation. Critical Care Medicine, 36(8). 2427-2432. doi:
10.1097/CCM.0b013e318181600d.
McGovern, M. P., & Carroll, K. M. (2003). Evidence-based practices for substance use disorders.
Psychiatric Clinics of North America,
26(4), 991-1010.
Miller, W. R., Forcehimes, A. A., & Zweben, A. (2011). Treating addiction: A guide for professionals.
Guilford Press.
National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based
guide. (3rd ed.). Retrieved from:
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-
guide-third-edition/evidence-bas
ed-approaches-to-drug-addiction-treatment
Substance Abuse and Mental Health Services Administration (2019, Jan. 30). Alcohol, tobacco, and 30
other drugs. Retrieved from:
THANKS!
Any questions?

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