Foundations of Addictions

1
Foundations of Addictions

• Unit 1
• Glenn Maynard M.Ed., NCC, MAC, LPC

2
Overview of Addictions

• Debate in US continues on whether addiction is a
  disease, poor behavioral decision making or a
  moral failing
• Prior to Prohibition, Temperance Movement placed
  the cause in the substance and then in the user
• AA- moved the cause to the user and formed the
  basis of the disease model and behavioral model

3
Addictions Counseling

• Full cycle from mental health orientation to
  separate field and back to mental health under
  the name behavioral health
• Long history of people in recovery working as lay
  counselors
• Standards for addictions counselors began to
  evolve in the 1970s

4
Addictions Certification

• 1972 JCAH developed accreditation standards that
  brought addictions into the mainstream
• NIDA and NIAAA developed standards for training
  including 2 years recovery one year counseling
  experience and written examination
• Current certifications- CADC, NCADC, MAC

5
Reuniting Addictions and Mental Health

• Increased Federal and State interest in dual dx
• Behavioral health includes addictions as a focus
  of interest
• Administrative for AOD acknowledge licensed
  professionals as providers

6
Brickman Schema
7
Characteristics of Effective Counselors

• Meta analysis of tx outcomes show stronger
  therapist than tx effects
• Therapist attributes- few gross effects
• Recovery status does not predict tx outcome

• Positive relationship r with positive outcomes
• Adherence to a manual or technique improves
  outcomes
• Mixed research outcomes on confrontational tx

8
Overview of Epidemiology

• Study of disease in populations
• Groups studied in order to understand the
  etiology and prevention of disease
• Web of causation- agent (vector), host,
  environment

9
Prevalence and Incidence

• Prevalence of persons with a disease
  
  
  total number in population
• Incidence of persons developing disease
  
  
  
  
  total population
  at risk

10
Lifetime Prevalence Rates for Substance Use
Disorders

• Any Substance Use Disorder 16.7
• Alcohol Abuse 5.6
• Alcohol Dependence 7.9
• Drug Abuse 2.6
• Drug Dependence 3.5
• Marijuana Dependence/Abuse 4.3
• Cocaine Dependence/Abuse 0.2
• Opiate Dependence/Abuse 0.7
• Barbiturate Dependence/Abuse 1.2
• Amphetamine Dependence/Abuse 1.7
• Hallucinogen Dependence/Abuse 0.3

11
Co-Morbidity Between Mental Disorders and
Substance Use Disorders

• Any Substance Use Disorder and
• Schizophrenia 47
• Anxiety Disorder 23.7
• Antisocial Personality Disorder 83.6

12
Co-Morbidity Between Mental Disorders and
Substance Use Disorders

• Any Mental Disorder and
• Any Alcohol 36.6
• Any Drug 53.1
• Schizophrenia and
• Any Alcohol 3.8
• Any Drug 6.8
• Affective Disorder and
• Any Alcohol 13.4
• Any Drug 26.4
• Anxiety Disorder and
• Any Alcohol 19.4
• Any Drug 28.3

13
Alcohol Surveillance Data

• Per capita alcohol consumption in 1997 lowest in
  35 years
• Consumption by state shows a consistent pattern
  of decreased consumption except for AR and MS

• Regional patterns NE- decrease 0.5 South-
  decrease 0.9 Midwest- no change West- decrease
  0.4
• NIAAA goal for 2000 was annual consumption of 2
  gals/capita

14
Trends in Alcohol Use

• 105 million Americans older that 12 reported
  current use of alcohol (30 day prevalence)
• 45 million engaged in binge drinking (30 day
  prevalence)
• 10.4 million are age 12-20
• 6.8 million of 12-20 engaged in binge drinking
• 1999 National Household Survey on Drug Abuse

15
Epidemiologic Trends in Drug Abuse

• Data collection differs from alcohol due to all
  non-prescribed drugs being illegal
• Drug use more variable than alcohol use based on
  location and local customs about drug use
• 14.8 million 30-day prevalence in 1999
• Peak use of illicit drugs in 1979 was 25 million

16
Cocaine

• Peak use of 5.8 million in 1985
• 1.75 million users in 1996
• 1995 estimated incidence was 652,000
• Profile- most users are inner-city crack users,
  older users
• New trend- teenagers using crack and MJ (blunts)

17
Cocaine

• Decrease since 1985 has stabilized and may be on
  the rise for teenagers
• Women users are exceeding male users according to
  arrest records in some areas
• As m-amphetamine used declines, cocaine use may
  increase

18
Heroin

• Two types- Black Tar and White Powder
• Black Tar- used primarily in West and SW
  injected has more impurities
• White Powder- East Coast and SE intranasal and
  smoked appealing to teens
• Increasingly popular with college students
• Increasing use with other drugs
• Most CEWG cities report increased use

19
DAWN Heroin Data

• Seattle 97.5 IV
• San Francisco 96.6 IV
• Los Angeles 95.0 IV
• San Diego 93.3 IV

• Newark 43.6 IV
• Philadelphia 66.8 IV
• Boston 73.3 IV
• New York City 74.6 IV

20
Marijuana

• Incidence in 1995 was 2.5 million
• Drop in prevalence rate for 12th graders from
  50.8 in 1979 to 23
• Young adult use may account for incidence

• Considered less risky than other drugs
• MJ is being mixed with other drugs
• DAWN data for MJ have increased. See chart

21
M-Amphetamine

• DAWN data report sharp declines in m-amphetamine
  admissions from 1994-1998
• May be due to community prevention programs
• Aggressive legal action
• Precursor laws
• Decreased potency and purity

22
Developing Trends

• Rave or club drugs
• Ecstasy (MDMA)- 1996-7 14 of male and 7 of
  female 12th graders reported using MDMA at least
  once
• GHB (?-hydroxybutrate)- too early to evaluate
  DAWN data
• Ketamine- as above

23
Epidemiological Correlates

• AOD abuse more common among men than women (note
  higher recent incidence of alcohol and cocaine
  use among young women
• Alcohol and drug prevalence decreases with age

• African-Americans begin abusive drinking later
  than Whites
• A-A have more health consequences than Whites
• Hispanics have higher life time prevalence for
  alcohol, lower for drugs

24
Epidemiological Correlates

• Twins typically show a 40-50 concordance for
  alcohol abuse
• Alcoholic are 6X more likely to come from homes
  with parental alcoholism
• 1/3 to 2/3 of people with alcohol disorders
  report no parental risk

• Prevalence rates for alcohol disorders increase
  for people unemployed for six months in 5 years
• Higher rates of alcoholism in entry level and
  blue collar jobs

25
Epidemiological Correlates

• ECA data do not show appreciable drug effect on
  employment
• Drug use among employed men is higher on low
  income jobs
• Leaving school r with increased risk

• Marital status- life-time prevalence for stable
  marriages is 8.9 cohabitating is 29.2
• For drug use- married men at 3.6 and women at
  1.8 cohabitating men at 30.2 and women 19.9