CHAPTER 2: Terms, Models, and
Ethical Issues in Substance Abuse
and Addiction
Substance Abuse and Addiction Treatment:
Practical Application of Counseling Theory
First Edition
Todd F. Lewis
Developed by Katie A. Wachtel, University of North
Carolina at Greensboro
Introduction
•Substance
abuse and addiction are a rampant
problem in today’s society, affecting individuals,
relationships and society at large.
•The
prevalence of substance abuse is highlighted in
the media (television, celebrities, news, music, etc.)
•The
scope of the problem demonstrates a need for
clinicians to become competent and familiar with the
language of addiction.
•In
this chapter statistics, basic terms and concepts,
models of addiction and legal and ethical issues are
introduced.
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-2
The Scope of Substance Abuse and
Addiction
•According
to the National Survey on Drug Use and
Health, 20.1 million Americans over the age of 12
currently (or in the past month) use illicit drugs and
58.1 million report heavy, episodic drinking (OAS,
2008).
•Alcohol
and drug use costs the United states
billions of dollars each year.
•Other
substance related problems include:
interpersonal violence, broken relationships, physical
and medical problems, and suicide.
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-3
Basic Terminology of Addiction
Substance misuse
Using a prescription substance in a manner
other than prescribed
Experiencing of negative consequences as a
result of excessive substance use
Substance abuse
Continued use of substances despite negative
consequences
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-4
Basic Terminology of Addiction Cont.
Substance addiction
The compulsive, persistent use of substances
despite negative consequences
Engaging in behaviors to obtain the drug
Unsuccessful attempts to quit using
Major interferences with personal or work life
Tolerance
The need for increased doses of a drug to
achieve the desired effect
Can be physiological or behavioral
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-5
Basic Terminology of Addiction Cont.
Withdrawal
Physiological and psychological symptoms when
an addicted person stops using a drug
Symptoms are often opposite of those produced
by the drug
Addiction
A compulsive need for and use of a habit
forming substance
Characterized by tolerance and withdrawal
Similar to dependence (a clinical term)
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-6
Models of Addiction
Disease Model
•
Addiction is a disease of the brain
Susceptibility camp- addiction is a genetic or
biological condition and a person is born
susceptible to addiction
Exposure camp- a diseased brain is the result of
exposure to toxic chemicals such as illicit
substances
•
Addiction is likely a result of a combination of the two camps
Abstinence is the only acceptable treatment
Problems: the claim that addiction is a progressive
disease and maturing out
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-7
Models of Addiction Continued
Moral Model
Addiction is a matter of making poor choices
Can lead to guilt and shame in the individual
Addiction is sinful and spiritual intervention is needed
Interventions: help clients to make better choices, help
strengthen their spiritual lives, and punitive measures
(prison or jail)
Psychological Model
Addiction stems from a psychological disturbance and is
secondary to that disturbance
Addiction is a coping mechanism for psychological
problems
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-8
Models of Addiction Continued
Sociocultural Model
External factors (family, peers, culture, socioeconomic
status) impact the development of addiction
Four sociological functions of substance abuse:
1. facilitation of social interactions
2. serving as a time-out from social obligations
3. promoting group solidarity
4. Repudiation of middle class values
(Thombs, 1996)
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-9
Models of Addiction Continued
Biopsychosocial Model
•
Biological, psychological and sociological factors all play a
role in the development of addiction
•
Final common pathway (FCP)-substance addiction is the
end result of a multitude of factors that increase risk for
substance use
•
Public Health Model-describes three key components of
addiction:
the drug
the person
and the environment
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-10
Ethical and Legal Issues
Ethical codes provide guidance for clinicians to act in
the best interest of the client while maintaining
integrity in their profession.
4 main moral principles:
Autonomy
Nonmalfeasance
Beneficence
Justice
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-11
Ethical and Legal Issues Continued
Codes of federal regulations (CFR), specifically 42 CFR
protects client confidentiality when disclosing
substance abuse.
Exceptions to disclosure under 42 CFR:
With client written consent
Communications among staff within an
organization
Medical emergencies
Committing a crime by the client at the agency
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-12
Ethical and Legal Issues Continued
Informed consent
Clients must be provided information essential
for making an informed decision about their
treatment
Dual relationships
Entering into a secondary relationship with a
client that interferes with the primary therapeutic
relationship
Clinician self-care
Clinicians who better care for themselves are
more effective
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-13
Ethical and Legal Issues Continued
Navigating legal and ethical issues can be
tricky. Remember, when in doubt,
CONSULT!
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
2-14