10/2/2018. Welcome! Agenda. Governors State University Recovery Coaching Training Program

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1 Governors State University Recovery Coaching Training Program (Illinois Department of Health & Human Services Division of Substance Abuse Prevention & Recovery (SUPR) grant funded) Module 2: Etiological Models & Understanding Addiction 1 Welcome! Morning workshop 1:00 PM - 5:00 PM Breaks Presenter: Darrin Aase, Ph.D. Licensed Clinical Psychologist Associate Professor Materials: See attachments Shaffer et al. (2004) and Hyman (2007) GSU Recovery Coaching Training - Module 8 2 Agenda Introduction/Etiology Concepts Specific Etiological Models Integrative Etiological Models Case Studies/Application Large Group Case Studies/Application Small Groups Discussing Models with Clients/Families GSU Recovery Coaching Training - Module 8 3 1

2 Competencies Understand and explain the meaning of etiological models. Describe both specific and integrative etiological models of addiction. Apply etiological models towards treatment planning for patients. Discuss etiological models in a way that clients and families can understand. GSU Recovery Coaching Training - Module 8 4 Introductions! Briefly What is your background where have you come from and what brings you to this training? What is one thing that you hope to learn today? 5 Introduction: Etiology Concepts Etiology The study of causation, or origination the Why What causes addiction? Sometimes, this can be linked to a theoretical model of treatment However, a treatment model is different than an etiological model (usually) 6 2

3 Introduction: Purpose of Models What is the purpose of a model or theory for why someone used AODs? An infallible way to view addiction (that cannot be questioned)? A guiding philosophy? Does it involve values and beliefs? A way to think about the causes, so that we can get to effective ways to treat the problems? 7 Introduction: Types of Models Specific Models Take a particular stance/position on why AOD occurs to begin with. Typically emphasize a particular viewpoint/frame of reference. Integrative Models Take into account multiple etiological factors to explain AOD use. 8 Etiological Models: Moral Model The Moral Model A consequence of personal choice Some religious groups, legal system 1988 Supreme Court Case VA attempt to deny benefits Willful misconduct and not alcoholism the consumption of alcohol is not regarded as wholly involuntary Public perceptions Contribution to stigma 9 3

4 Etiological Models: Moral Model Is it wrong to view some behaviors as a choice? Consider some made-up scenarios. Is legal action appropriate? Ex-con decides to get high driving on the way to a new job and hits a biker. Woman finds out her husband cheated on her, uses alcohol, and attacks a man at a bar who asks for her number politely. College student experiments with cocaine on spring break and assaults someone Difference between chronic and acute? 1st DUI vs. 7th DUI? 10 Etiological Models: Moral Model Implications for Treatment/Practice View of addiction as a personal choice Emphasis on personal responsibility Stigmatization of individuals Potential deterrent to seeking treatment Other thoughts? 11 Etiological Models: Disease Jellinek (1960) initially presented the idea. Concept: Addiction to substances is a progressive disease, but is a treatable illness (NOT curable). Comparable to other medical conditions (diabetes mellitus, hypertension, etc.) Major underlying rationale for total-abstinence models and 12-step groups. Accepted by American Medical Association, and the focus of the health-care delivery system. 12 4

5 Etiological Models: Disease Jellinek s stages (alcohol) Stage 1 increasing tolerance, blackouts, sneaking/gulping, feelings of guilt Stage 2 Loss of control, personality changes, lose friends/jobs, preoccupied with keeping an alcohol supply Stage 3 Morning drinking, withdrawal, violating ethical standards A little bit broad, but the concept is that it is progressive and not reversible Eventually death without treatment Adapted from Fisher & Harrison (2013) Etiological Models: Disease 14 Etiological Models: Disease Evidence Genetic heritability Chronic progression similar to other medical diseases Similar treatment compliance and relapse rates to other illnesses Voluntary and so are diet, exercise, stress hypertension can be voluntary too Alterations in brain functioning Adapted from Fisher & Harrison (2013) 5

6 Etiological Models: Disease Critics: Stages/progression questionable Political issues Concept of control controversial What about the people who stop on their own? Adapted from Fisher & Harrison (2013) Etiological Models: Disease Implications for treatment/practice Progression (regardless of sobriety time) Total abstinence model Cross-tolerance and other AODs Reduction of stigmatization Other thoughts? Problems? 17 Etiological Models: Moral vs. Disease Small Groups What are the implications of these two models in your practice? Both models are emphasized in society. How can you help a client understand the mixed messages? 6

7 Etiological Models: Concept Diathesis-stress concept Etiological Models: Concept Diathesis-Stress Applies to just about any addiction/mental health condition. Contributions of how predisposed you are based on genetics, but also how likely you are to display those symptoms based on environmental stressors and experiences. Two identical twins one could develop schizophrenia and the other may not. 20 Etiological Models: Concept Syndrome Shaffer et al. (2004) 21 7

8 Etiological Models: Sociocultural Focus on environmental factors Regional/cultural patterns Exposure Group membership/culture Decrease or increase use Role theory Availability, lack of social restraint, role strain Apply to specific groups (e.g., Vietnam veterans, college students, etc) 22 Etiological Models: Sociocultural Small groups Consider binge drinking on college campuses To what extent does culture have on this phenomenon? What approaches would be important to incorporate if we want to reduce binge drinking on college campuses? 23 Etiological Models: Sociocultural Implications for treatment/practice Importance of cultural competence as a clinician Understanding of broader context in consideration of treatment plan 24 8

9 Etiological Models: Psychological Use secondary to a primary psychological problem Self medication Khantzian s 1985 theory Use AOD to relieve negative emotions Drug of choice is specific to the symptoms Symptom exacerbation AOD use causes psychological problems Social learning theory Behaviors modeled Norms established in social groups 25 Etiological Models: Psychological Common-factors models Common Factor Substance Use Psychiatric Etiological Models: Psychological Secondary substance use models Psychiatric Disorder Substance Use Disorder 9

10 Etiological Models: Psychological Secondary psychopathology models Substance Use Disorder Psychiatric Disorder Etiological Models: Psychological Bidirectional models Substance Use Disorder Psychiatric Disorder Mueser et al. (2003) Etiological Models: Psychological Implications for treatment/practice Historically, these models have sometimes impacted the sequence of treatments E.g., Comorbid PTSD and AUD treatment Was used as a reason to deny treatment Importance of considering other psychological variables More common to have other psychiatric problems when presenting for treatment 30 10

11 Etiological Models: Integrative Biopsychosocial Model Most scientific authorities in the field of alcoholism now concur that the construct of alcoholism is most accurately construed as a multivariate syndrome. Pattison and Kaufman Effort to reflect the wide variety of factors involved in addiction. Biological, psychological, cognitive, social, developmental, environmental variables. Integrates other models of addiction Good treatment practice consider multiple factors and don t be too rigid. 31 Societal Community Work/Other Family/peers Individual 32 Etiological Models: Integrative Implications for treatment/practice Usually, there is a high degree of complexity with AOD use and comorbid conditions Heterogenous clinical presentations require individualized approaches to treatment planning Approaching the etiology using multiple levels of analysis is good for treatment planning Allows for holistic approaches Does not disregard important contributing factors Can also have a positive influence on other psychiatric problems Often involves teamwork 33 11

12 Case Studies/Application We will review a video synopsis of an individual and their AOD use history. During the video, please consider the various etiological models we discussed. After the video, we will review the case and discuss etiological factors as a group. 34 Case Studies/Application Which etiological models could provide an explanation for the AOD use in the video? Why? What are the pros and cons of selecting specific vs. integrative models for this specific case? What treatment planning implications might you see based on what model you select? 35 Case Studies/Application Small Group Activity Review the cases that are presented on the worksheet As a group, you will decide which etiological model you believe fits the description best for each case that is listed, and a rationale for why. We will review these cases as a larger group afterwards

13 Case Studies/Application Small Group Activity Case #1 Case #2 Case #3 Case #4 Case #5 Case #6 37 Etiological Models: Families Why are families important? Many clients live with family or have close contact Family stress impacts AOD and also other psychiatric disorders Families can be educated Increased risks for family members 38 Etiological Models: Families Goals: Educate about AOD and dual diagnosis Reduce stress Improve adherence/compliance Improve communication Coordinate efforts Reduce effects of use on family 39 13

14 Etiological Models: Families Principles Engage them on their terms Ongoing education Minimize tension/conflict Keep the work collaborative Keep the work future-oriented Address needs of whole family Avoid blaming the family 40 Etiological Models: Families Discussing etiological models with clients and families. #1 Help them to understand how addiction has multiple causes. #2 Help them to understand that recovery involves multiple areas of a person s life. #3 Meet them where they are at and work from there. 41 Closing thoughts Review of concepts Review of models Implications for treatment practice? Communication with clients and families? Other questions? My contact info: daase@govst.edu GSU Recovery Coaching Training - Module