Transcript School-based group intervention with adolescent alcohol

WHY PEOPLE USE SUBSTANCES
Semi-medicinal uses
• alcohol to intoxicate a weary mind
• belladonna to calm an angry intestine or to poison
an adversary
• opium to overcome worry and strain.
• the relief of pain, in particular, is an age-old aim
of humankind
• various narcotic and sleep-producing agents were
probably used by primitive people.
WHY PEOPLE USE SUBSTANCES
Consciousness changing uses
• expand their vision
• enhance their appreciation of their world
• change their mood
• alter their inner existence
• stupefy their awareness
Some Important Historical Instances
• Genesis (9:20)—Noah planted a vineyard, "and he drank
of the wine, and became drunk, and lay uncovered in his
tent." Alcohol has been used by many cultures and has
been worshipped as a god
• Homer tells how some of Odysseus' crew succumbed to
forgetfulness in the land of the Lotus-eaters; Opium has
also been used extensively, at least since the time of
ancient Greece
• the ancient Vedic philosophers of India spoke of soma, a
mysterious and probably mythical plant
HISTORY OF ALCOHOL
• Fermentation--any sugar-containing mishmash,
left exposed in a warm atmosphere, yeasts
converting sugar to alcohol and carbon dioxide
• Alcoholic beverages probably discovered
accidentally
• early man presumably liked the effects, and
proceeded to purposeful production & regular
cultivation of the vine and other suitable crops
• Few preliterate people did not learn to convert
some of the fruit of the earth into alcohol
Primitive Society Motivations for
Alcohol Use
• important nutritional value
• best medicine available for some illnesses and especially
in relieving pain
• facilitated religious ecstasy and communion with
mystical powers
• enabled periodic social festivity, personal jollification,
mediator of popular recreation
• helped reduce anxiety, tension, and fears connected with
concerns over subsistence, safety, warfare, etc.
Primitive Society Motivations for
Alcohol Use (cont’d)
• calm anger or tranquillize hostility and reduce suspicion,
making possible peaceful associations and commercial or
ceremonial relations
• in individuals with extraordinary responsibilities, helped
to assuage the personal anxieties
• formalized public binge, permissive loosener of
interpersonal aggressions, which otherwise the mores of
the cohesive small society necessarily forbade
earliest civilizations manufactured &
sold alcoholic beverages
• oldest known code of laws, Hammurabi of Babylonia (c.
1770 BC), regulated drinking houses
• Sumerian physician-pharmacists prescribed beer (c. 2100
BC)
• Egyptian doctors (c. 1500 BC) included beer or wine in
15% percent of their prescriptions
• Semitic cuneiform literature of the northern Canaanites
contains abundant references to the ubiquitous religious
and household uses
Turning Water Into Wine
• Water probably the original fluid used as offering in worship rites
• alcoholic beverages displaced water due to its capacity to help
priest/participants reach a desired state of ecstasy
• This ectasy naturally attributed to supernatural spirits and gods
• The red wine eventually perceived as symbolizing the blood of
life, ultimately passed into the Christian Eucharist
• Egyptian & Mesopotamian civilizations drinking and drunkenness
became common practice, often troublesome to government and
accompanied by acute and chronic illnesses
Drunkenness
• The Roman philosopher Seneca classified it as a form of
insanity
• “alcoholism” appears first in the classical essay
"Alcoholismus Chronicus" (1849) by the Swedish
physician Magnus Huss
• rapidly became a medical term for the condition of
habitual inebriety conceived as a disease
• the bearer of the disease was called an alcoholic or
alcoholist (e.g., Italian alcoolisto, French alcoolique,
German Alkoholiker, Spanish alcohólico, Swedish
alkoholist)
Alcohol control in modern societies
• lack of consensus around many issues of right and
wrong or proper and improper behavior
• drinking, since the latter part of the 18th century,
has been a focus of disagreement
• In US, the late 18th-century temperance
movement became 19th century anti-alcohol
movement that culminated 20th century
Prohibition (1919-1933)
• Currently crazy quilt of local regulations
U.S. Regulations vary across municipalities
• total prohibition
• prohibition only of distilled spirits and strong
wines
• liquor sold only by the bottle, not by the drink
• liquor sold only in “airplane bottles”
• drinks may be served only together with food, in
others only without food
• Etc.
HISTORY OF DRUG CONTROL
• first major national efforts by Chinese in the 19th century
• commerce in poppy (opium) and coca leaf (cocaine)
organized basis during the 1700sEnglish East India
Company was engaged in the profitable export of opium
from India to China
• monopoly of the China trade was eventually abolished in
1839-42
• the Opium War between the Chinese and the British
followed
U.S. Drug Control
• the nation most preoccupied with drug control
• largely the "Americanized" countries have made
narcotics regulation a matter of public policy
• principal U.S. legislation has been:
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Harrison Narcotics Act of 1914
Opium Poppy Control Act of 1942
Narcotic Drug Control Act of 1956
Drug Abuse Control Amendment of 1965
Opium & Cocaine Addiction in U.S.
• 1800s opiates and cocaine were mostly unregulated drugs
• 1890s the Sears & Roebuck catalogue offered a syringe and a
small amount of cocaine for $1.50
• 1886, Coca-Cola was named after its two key ingredients -- coca
leaves and kola nuts.; by 1904 it was as little as 1/400th of a grain
per once of Coca-Cola syrup; by 1929, Coke became cocaine-free
• estimated that one US. citizen of 400 was an addict of opium in
1914; user were mostly white or Chinese.
• "Of all the nations of the world,the United States consumes most
habit-forming drugs per capita. Opium, the most pernicious drug
known to humanity, is surrounded, in this country, with far fewer
safeguards than any other nation in Europe fences it with." (Dr.
Hamilton Wright, United States first Opium Commissioner, New
York Times, 1911)
Early U.S. Drug Regulations and Racism
• JAMA (1900) editorial “Negroes in the South are reported as being addicted to a
new form of vice--that of 'cocaine sniffing' or the 'coke habit'.”
• newspapers claimed cocaine caused blacks to rape white women and was
improving their pistol marksmanship
• Chinese immigrants blamed for importing the opium-smoking habit
• 1903 Committee on the Acquirement of the Drug Habit concluded, "If the
Chinaman cannot get along without his dope we can get along without him".
• Dr. Hamilton Wright stated
– "Cocaine is often the direct incentive to the crime of rape by the Negroes of the South and other
sections of the country;“
– "One of the most unfortunate phases of smoking opium in this country is the large number of
women who have become involved and were living as common law wives or cohabitating with
Chinese in the Chinatowns of our various cities".
Continuum of substance involvement
Abuse/Dependence
Treatment
Secondary
Intervention
Secondary
Prevention
Prevention
Hazardous Use
Users
No Use
Treatment Models of Addiction
MODEL
PROBLEM ORIGIN
TREATMENT ACTION
MORAL
Individual
Willpower
TEMPERANCE
The substance
Ban the substance
SPIRITUAL
Individual
Turn life over to higher power
DISPOSITIONAL/DISEASE Individual, w/o blame
Medical treatment
EDUCATIONAL
Deficient knowledge
Educate
CHARACTEROLOGICAL
Personality abnormalities
Character restructuring
CONDITIONING
Learned behavior
Relearn behaviors
SOCIAL LEARNING
Social pressures/examples Relearn behaviors; alter interactions
COGNITIVE
Thoughts and expectancies Challenge and restructure cognitions
SOCIOCULTURAL
Societal controls
Decrease/regulate availability/desirability
SYSTEMS
Family
Alter family patterns
BIOLOGICAL
Genes
Counsel the susceptible
PUBLIC HEALTH
Agent/host/risk factors
Harm reduction
Stepped Care
• used in situations where the same condition
– can have a wide degree of manifestations
– may vary in severity from person to person
• the level and degree of medical intervention
may be increased incrementally, "step by step”
• used with "spectrum disorders" for which one
standard solution would not cover all patients’
needs
Continuum of Care
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Inpatient
day hospital
intensive outpatient
standard outpatient
brief treatment
mailed feedback
medication (addiction and/or psychotropic)