Presented by Jason Schwartz at the Washtenaw Counseling Association Spring Conference in March 2009.

1. ADDICTION 101
A primer on addiction

2. Definition of addiction
“Alcoholism is a primary, chronic
disease with genetic,
psychosocial and
environmental factors
influencing its development
and manifestations. The
disease is often progressive
and fatal.
It is characterized by continuous
or periodic impaired control
over drinking, preoccupation
with the drug alcohol, use of
alcohol despite adverse
consequences, and
distortions in thinking, most
notably denial.”
(National Council on Alcoholism and Drug Dependence, Inc. 2/3/90)

3. What is a disease?
The causal model:
1. cell, organ or system
2. defect or injury
3. measurable symptoms

4. A broken leg?
The causal model:
1. bone
2. defect?
3. symptoms?
4. treatment?

5. Diabetes?
The causal model:
1. pancreas
2. defect?
3. symptoms?
4. treatment?

6. Alcoholism?
The causal model:
1. brain? liver?
2. defect?
3. symptoms?
4. treatment?

7. The causal model works
for easy diagnosis
• The model favors simple • In the absence of easy
organs. causality, what models
work?
– Addiction?
– Moral
– Brain disease? Liver
disease? – Personality
– Environment

8. Learning to drink
priming
early experimentation
being adult
designated driver

9. The mathematics of drinking
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience

10. More is better
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience

11. The rules of drinking
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience

12. How alcoholism develops
priming
early experimentation
building trust
reliable effect
learning how to use
signature experience

13. THE HIJACKED BRAIN

14. The Hijacked Brain

15. The limbic
system

17. Maslow’s Hierarchy of Needs
Self
Actualization
Esteem
Belonging
Safety
Physiological
(Food, air, water)

18. Maslow’s Hierarchy of Needs
(Revised by addiction)
Self
Actualization
Esteem
Belonging
Safety
Physiological
(Food, air, water & DRUGS)

21. HOW POWERFUL IS THIS?

23. Here’s your number
0239
or
0923489

26. We’d like to thank you!

27. AN IMPERFECT ANALOGY

28. I’m concerned
about you,
but…

38. HOW HAVE WE RESPONDED?

39. Souce: (Mark & Coffey, 2004. Health
Affairs 23:6)

40. Length of Stay
28 days
to 7 days
(in 1998)
Source: NAPHS

41. Type of Care
Outpatient
Inpatient

42. The other winner

43. Treatment and Prevention Spending

44. Federal prison inmates whose most
serious conviction was a drug crime
rose from 4,749 in 1980 to 77,867 in
2004. (1540%)
Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal Justice
Statistics [Online]. Available: http://www.albany.edu/sourcebook/ [7/3/05].

45. State prison inmates
whose most serious
conviction was a drug
crime rose from
19,000 in 1980 to
246,100 in 2001.
(1195%)
Source: Prisoners in 2002 & Prisoners in 1994, Bureau of Justice
Statistics [Online]. Available:
http://www.ojp.usdoj.gov/bjs/pubalp2.htm#Prisoners [7/3/05]

46. Jail inmates whose most
serious charge was a drug
crime rose from 20,420 in
1983 to 155,249 in 2002.
(660%)
Source: Maguire, Kathleen and Ann L.Pastore, eds. Sourcebook of Criminal
Justice Statistics [Online]. Available: http://www.albany.edu/sourcebook/
[7/3/05].

47. From 1986 to 1999 the average
term drug offenders entering prison
could expect to serve rose from an
average 30 months to 66 months.
(120%)
Source: Federal Drug Offenders, 1999 with Trends, 1984-99, Bureau of Justice Statistics [Online].
Available: http://www.ojp.usdoj.gov/bjs/abstract/fdo99.htm [7/3/05]

48. Think We’re Immune?

49. “Our clients
are not your
typical irresponsible
alcoholics”

50. “Some of these people
will never get better.
The most humane
thing that we can do
for them is provide
hospice care.”

51. Local hospital
cabs woman to
detox in nothing
but a hospital
gown.

52. G et
O ut of
My
E mergency
R oom

53. ARE WE VIEWING ADDICTION
TREATMENT APPROPRIATELY?

54. Treatment for Hypertension:
Did Treatment Work?
Blood Pressure: mm Hg
No Tx Tx Tx No Tx
Tx
Treatment Status Over Time

55. Treatment for Alcoholism:
Did Treatment Work?
Alcohol Consumption
No Tx Tx Tx Tx No Tx
Treatment Status Over Time

56. IS ADDICTION TREATMENT
AS EFFECTIVE AS
TREATMENT FOR OTHER
HEALTH PROBLEMS?

57. How does
asthma compare?
Medication compliance: 30%
Relapse Rate: 60 to 80%

58. How does
hypertension
compare?
Medication
And Diet
Compliance: 30%
Relapse Rate: 60-80%

59. How does
diabetes compare?
Medication, diet
and foot care
Compliance: <50%
Relapse: 30-50%

60. Alcoholism?
Compliance: 30-50%
Relapse: 50%

61. Opiates?
Compliance: 30-50%
Relapse: 40%

62. Tobacco?
Compliance: 30-50%
Relapse: 70%

63. Cocaine?
Compliance: 30-50%
Relapse: 45%

64. Is the addicted
person viewed
as…
Dr. Jekyll: Real Mr. Hyde: Real
person is the sober person revealed by
self; addiction is intoxication and
about goodness disinhibition;
corrupted by addiction is the
sickness revelation of badness
(White, 2004)

65. “If you want to treat an illness
that has no easy cure, first of all,
treat them with hope”
George Vaillant