Addictions
are a societal problem that is a growing concern and responsible for destroying
families and communities. Research has shown that there is a strong correlation
between disrupted family relationships and alcohol and drug addiction. This
article includes interviews that were taken with 12 individuals who live and
lived in the Higher Ground Alcohol and Drug Rehabilitation Trust. Results
showed that the majority of the participants had experienced painful and
traumatic childhoods in their families, which contributed to their addiction
behavior and felt affected their current families. All participants and their
families had suffered from different forms of family disruption such as loss of
custody, marital breakdown, abuse, depression, and loss of employment. Other
participants who were addicted and committed drug-related crimes experienced
issues that also affected their relationships with their families (Schäfer,
2011).
Four
main themes were created after the interviews; however the most salient finding
was that all participants felt they had not been able to develop functional
relationships with their family. Substance use and dysfunctional family
relationships yielded a strong connected according to the data. Overall, this
demonstrates how addictions affect not only the individual but also the entire
family (Schäfer, 2011).
ThoughtsandConnections:
According
to our textbook, addiction often is an illness that affects the entire family,
not just the individual. This is not hard to believe considering most people in
the family care about one another. Frequently the upset is so intense that the
family can barely function at all, and children growing up in these families
cannot receive proper nurturing and care that they need. Due to these needs not
being met, this addiction process commonly spreads through generations. This
connects with the article I read because an issue they spoke about was not
being able to develop functional relationships with their family (as a child)
in the past and now they cannot form those relationships as an older person
with their own family (as a parent) (Schäfer, 2011).
When
addiction is involved, the focus tends to lie on just that and not on the
things and people who matter most. Not only does the person with the addiction have
pain and complications, but also so does the rest of the family. Their problems
revolve around how to deal with this person and their own strong feelings of
upset. Addictions are also a source of major stress (emotional or financial)
that spreads across and within the family system and affects the family dynamic
and interactions with other systems in the community.
ArticleReference:
Schäfer,
G. (2011). Family functioning in families with alcohol and other drug addiction.
SocialPolicyJournalOfNewZealand, (37), 135-151.
The
movie I chose to watch for this assignment is Thirteen. I saw it once when I was younger and remembered many different addictions involved, and I thought I would look at it
through a different lens after taking this class. The movie involves drug
addiction (inhalants and cocaine), alcohol addiction, and anorexia.
GeneralOverview:
The
general overview of the movie includes an adolescent girl, Tracy, who wants
desperately to fit in with the popular crowd. She lives with her mother,
brother, and little sister. Her parents are divorced and she very rarely sees
her father. Her mother is a recovering alcoholic, and her mother’s boyfriend is
a recovering cocaine addict. Tracy then meets a girl at school named Evie who
is a bad influence on this honor roll student and encourages her to steal, do
drugs, drink alcohol, have sexual encounters, and fight. This movie deals with
Tracy’s battle with peer-pressure, drugs, alcohol, and self harm.
Below is a short video clip that summarizes the movie and allows clips of Tracy's addictions to be seen (Inhalants, marijuana, and alcohol). Toward the end of the clip you can see her behavioral addiction to cutting herself as well.
Howdidthemovie’sportrayalofaddictionmakeyoufeel?
The
movie’s portrayal of addiction made me feel uncomfortable. It was shown in a
very personal way and the emotions and feelings felt so real. After studying
the side effects in class, this movie allowed the viewers to get a good look at
how it affects not only the abuser, but also the entire family. After Tracy’s
downward slope in life, grades, and attitude, the entire household was turned
upside-down. These were obvious signs that she had an addiction because her
life was changing around her actions and took over her leisure time along with
her work, school, and family time.
I
felt angry towards Tracy, not empathetic. I should have felt bad for her,
because of the situation, but she brought it upon her self very clearly at
first. All she wanted to do was fit in with the popular crowd, and she did so
by starting to smoke, drink, and steal. This then lead to her cutting herself,
which is another behavioral addiction that she could not stop.
Howdidthecharactersinthemoviereacttotheperson(s) with an addiction?
The
characters in the movie reacted in ways that were detrimental to Tracy. Her
original friends, who were hard workers and good students, did not do anything;
they just let her go. In fact, outside of the first 15 minutes of the movie
they were nowhere to be seen. As for her mother, she is pretty clueless and is
constantly busy with her job, boyfriend, and other two children. Her mother
does see that something is going on; however it is more serious than she
thought, or so she said at the end of the movie when an adult brought all the
facts to her attention. Tracy’s mother should have been paying closer attention
to her daughter’s life and she would have seen the signals of her additions and
been able to help her before it got as far as it did. As for Tracy’s brother,
he is distracted by her friend who he thinks is attractive at first, but then
notices her constantly getting drunk and high and does not tell anyone because
he is getting stoned with his friends every day. Her sister is too young to
notice and act upon Tracy’s behavior. Evie, the popular girl who influenced
Tracy’s bad behaviors, supports her behavior obviously since she has the same
addictions.
Do you believe the portrayal of this
addiction and/or societal reaction is accurate, given what you know from your
own experiences?
I
believe that the portrayal of the addictions and societal reaction is pretty
accurate. After having been a teenager, I can understand the peer pressure
aspect, but not the desire to do drugs, steal, and cause self-harm. However,
because Tracy’s mother is a recovering alcoholic, and her boyfriend is a
recovering cocaine addict, they both did not see her behaviors changing and did
not act to help Tracy. They should have seen the beginning warning signs and
tried to get her help before the situation escalated. That aspect of the movie
I feel was a little off, unless they really were too busy to notice or in
denial, which is possible. Tracy’s addictions made her moody, angry, change her
normal schedule, and an uncontrollable desire to fulfill her different drug and
behavioral addictions.
How can you connect what you’ve learned
through assigned readings and in-class discussions with what you observed in
the movie?
Through
assigned readings and in-class discussions I was able to make many connections
through the movie. Tracy uses inhalants to get high with her friend and it
distorts her thinking and feelings. She yells, “Hit me! I can’t feel it!” In
response her friend, who is also high, hits her. She also said, “ I think my
nose is melting off,” and is hearing sounds that are not really there. Tracy
and her friend both go to all different extents to get drugs. They are
dependent on them. On numerous occasions, Tracy pays for drugs from a
“mysterious man” at the park and does not really know what she is getting or
taking. She also does sexual things in exchange for drugs frequently. She then
starts smoking and drinking on a regular basis. She is very moody and
aggressive, starting fights with her mom and brother. In addition to her
drinking and drug addictions she is also showing anorexic tendencies. Her
mother asks her on 4 separate occasions if she has eaten and she responds with
“No, I’m not hungry!” or “I’m on a diet!” She also makes a comment that if you
drink 10 glasses of ice water a day, you burn 300 calories. In addition to the
drugs, alcohol, and anorexia, she also cuts herself. It is seen 5 different
times throughout the movie. She displays similar actions and behaviors to when
she does not receive alcohol. She is fidgety, angry, and is anxious until she
gets to a place where she can cut her wrist with what ever she can find
(scissors, razor).
This
article explains the Better Life
group program and how it was developed to help individuals with co-occurring
disorders reduce their substance misuse. In the past, the article states that
Norway did not integrate concurrent treatments of the two disorders and treated
one followed by the second. However, through weekly sessions in close-ended
groups for four to six months, the program, Better
Life, is now helping individuals overcome their addiction. This is through
the use of education about co-occurring disorders, motivational enhancement,
social skills training, peer support, and establishing healthy friendships and
leisure activities. This program is meant for individuals in the preparation or
action stages of change (Grawe, Hagen, Espenland, and Mueser, 2007).
Nine
mental health centers or hospitals were used in the study and agreed to
complete two Better Life groups each;
this included eighty-two patients. As an implementation of the study, the goal
was to examine its effects on substance use and mental health outcomes and to
explore individual predictors of outcome. In addition, the main skill areas
taught in the Better Life program
were problem solving, basic communication, assertiveness, refusing offers to
use substances, coping with cravings, and prevention relapses, friendship
skills, and developing alternative leisure activities. Individuals that
completed the treatment showed significant reductions in substance misuse and
improvement in global functioning. Overall, this pilot study supports the Better Life
program and suggests that it can improve substance misuse and mental health
outcomes (Grawe, et. al., 2007).
ThoughtsandConnections:
The
Better Life program was created to
help the treatment of co-occurring conditions, which was discussed in our book
as a problem for not only the individuals but also helping professionals. The
article by Grawe et. al., states how the two conditions are either
treated one at a time, or one following the other, not together (2007). This
study is trying to solve the problem by addressing the actual conditions both
at the same time and was proven successful. I think this is a study that
can help other professionals see how treating both conditions together can be
successful and help motivate more programs to treat both conditions simultaneously.
This
article also relates to our class discussions in that it is very difficult to
diagnose one condition over the other as “primary,” therefore, supporting the
idea of treating both the addiction and the mental illness at the same time.
This would make the process for the patient and the professional more effective
and will hopefully lead to a proper, permanent recovery. Ideally, this is what all helping professionals wish for their patients.
Source:
Gråwe, R. W., Hagen, R., Espeland, B., &
Mueser, K. T. (2007). The better life program: Effects
of group skills training for persons with severe mentalillness
and substance use disorders. Journal Of Mental Health, 16(5),
625-634.
Men and women, in an inpatient hospital setting, with mental health diagnoses and nicotine and alcohol addictions attended this meeting. Most of them appeared to be wearing comfortable clothing and were not dressed up. (The clothing attire is due to hospital code because of safety concerns. The patients are not allowed to have their shoes, belts, strings, cell phones, or any of their belongings that could be considered dangerous.) The majority of the individuals were from the city of Lancaster and appeared to be 30-50 years old. There was also a combination of people who were there by choice, and others who were there because they had to attend. Since everyone present had a mental health condition and an addiction, my session was different than going to an AA or NA meeting where the individuals come and go as they please as you will be able to tell immediately. (Some additional background information: the hospital breaks up the patients into 3 groups: A, B, and C. They are based on function and participation levels. The highest functioning group is "A" and the lowest is "C." The group I chose to write about was the "C" group because it was very different compared to the "A" group session and a typical AA meeting.)
A registered nurse ran the meeting. It was an open group format, run in a mental health section of the hospital. Everyone was in a class room with chairs positioned in a circle, and the meeting lasted 45 minutes. The format was pretty free flowing with directions and prompting questions lead by the leader. Since the conversation was lacking, the leader probed with different questions and received some responses. Once the leader saw that the individuals were not as talkative as she had hoped, she switched to another activity, not focusing on their addictions, and more people participated.
What did you observe in the meeting as far as interactions?
There were very few
interactions. Everyone appeared to be in a bad mood and on edge. They rated
their happiness on a scale of 1-10 (10 being the happiest) and almost everyone said that they felt like a 2. There was little to no eye contact and most people spoke quietly. After being able to review the individuals' charts, I was able to see that the reasons why they were in the hospital. A few included visual/auditory hallucinations, paranoia, bipolar episodes, suicide attempts, depression, and anxiety. Also, in addition to the meeting I took part in, the patients have 2 other group sessions that they are supposed to attend each day they are in the hospital. The meeting I was in was the last one of the day.
I was involved. I told
everyone my name and participated in the activity. Certain questions I was unable to answer and participate in though because I do not have an addiction to alcohol or nicotine, but I tried to be as involved as possible through out the session.
Do you think it was helpful to the participants?
Yes, I think it was helpful. It focused on their addictions for some parts but other parts were more relaxed and allowed them to get their mind
off of their addiction. At the end of the session, everyone rated their happiness again and
it was at least 2 points higher, which was great to see. They also appeared more pleasurable at the end of the meeting.
How does this connect to information you have learned through assigned readings and in-class discussions?
The withdrawal aspects connected directly to what we learned in class; it fit their actions exactly. They were fidgety and appeared to be on edge, irritable, depressed, and angry. Also, the few people who spoke about their addictions were really focusing on how irritable they were because all they wanted to do was smoke. They also spoke about how difficult it was and how they really need to change their lifestyle in order to try and make quitting possible. In class we spoke about how some people would feel intimidated or less likely to share in front of outsiders and I thought maybe that was the case for my recovery group, but maybe the group was just having an off day. Pictures From: http://www.drugfree.org/prevent?utm_expid=37310244-0 http://widowsvoice-sslf.blogspot.com/2012/01/happy.html http://widowsvoice-sslf.blogspot.com/2012/01/happy.html
Solution-focused therapy is based on the assumption that the future can be changed and negotiated regardless of the problem. It is focused around strengths and positivity that can be seen in the following quote from our text book, "The future is not a slave of the past events in a person's life; therefore, in spite of past traumatic events, a person can negotiate and implement many useful steps that are likely to lead him/her to a more satisfying life" (Wormer & Davis, p.106). Solution focused therapy also has an unintended consequence of helping counselors feel less burned out, more optimistic, and less likely to be captured by despair (Berg, 2013). Who Created This Approach?
http://www.sfbta.org/about_sfbt.html
The origins are found in Milton Erickson's work which strongly believed that solving the problem was more important than finding and elaborating on the root cause of the problem, and that clients had the ability within themselves and/or their social system to bring about change. (Wormer & Davis, 2008)
The
approach actually began in 1978 with Insoo Kim Berg and Steve deShazer. They borrowed money
and put up their house for collateral to open a small brief therapy office in
Milwaukee. Since this time, solution-focused therapy was no longer a “different
paradigm” and is practiced all over the world (Wormer & Davis, 2008).
Key Components/Several Techniques:
The Miracle Question is a helpful technique in supporting hope that things can be different in spite of many past attempts and failures. It leads the client directly into imagining, describing, creating, and embellishing on a day in the future without the burden of the particular problem. Through persistent questioning about what the person would be doing differently on this new, problem-free day, you see a natural progression to find out what small step the person could take in reality to reach a little bit of the whole, new picture. Below is a great explanation of the miracle question and how it can be helpful in therapy (Wormer& Davis, 2008).
Another example from our text book includes a young woman, who has anorexia, who wants to get taller. After learning from a dietitian that her low intake of calcium will impact bone growth, she began to add previously rejected foods to her diet. She was able to take more food in because the food became "medicine" rather than calories (Wormer & Davis, 2008).
Scaling Questions can be used in a variety of ways to help the client assess level of hope, determination, confidence, sadness, and how much change has occurred. This is similar to the motivational interviewing scales (1-10 how are you feelings today? 1 is the worst; 10 is the best.) (Wormer & Davis, 2008).
Coping Questions can be used to bring out the survival strategies of people who have been managing somehow in spite of their addictions. This helps build hope and self-efficacy. For example, "You've been through a lot in this past month with your gambling. How have you coped with so much, while still holding down a job?" (Wormer & Davis, 2008)
An Example of Solution-Focused Therapy: Mr. Glue-Head
http://www.elmers.com/msds/painterswat.htm
The individual is a young man who had to undergo treatment because of his desire to sniff glue and then be seen intoxicated in public. He had a long history of arrests and treatment episodes, but nothing had changed. Then while using a solution-focused approach that emphasized cooperation with the client, the therapist asked what he wanted to accomplish with this referral. The individual did not want to stop his glue sniffing, which he made known and very clear. All he wanted to do was stop getting arrested, so the therapist then offered an alternative solution. It was said that his sniffing could continue, just not in a public area or where people could see him. The individual agreed to try out the new idea and would return in a week to report his findings. A week later, he reported that the police never bothered him, even when they drove by to check on him. The results yielded that he did not get arrested any more and therefor did not get referred to any more treatment. This occurrence began to curtail his use of inhalants on his own (Wormer & Davis, 2008).
This example of Mr. Glue Head illustrates several main factors of the solution-focused approach. First, the therapist avoided issues that had always been considered problems by the therapist and others but that were not identified as problems by Elmer. Also, the therapist's focus was shifted to a problem that Elmer identified (not getting arrested). By following Elmer's lead, the therapist worked on doing something different than focusing on past solutions (Wormer & Davis, 2008)
Another example, below, from one of the founders of solution-focused therapy, Insoo Kim Berg, allows you to see how she performs her solution-focused therapy session. Notice how she steers away from the negatives of the relationship and strives toward the positives, and when the talking gets fast and negative, she redirects the conversation. The viewers can also see the difference between the first session and the last session and how different their interactions are. The couple went from being mad and yelling at each other to being happy and laughing, overall supporting solution-focused therapy.
Research:
There are not many research studies proving the effectiveness of this therapy, so many more need to be done. However, through some clinical trials, it has been shown to not only be as effective as other therapies, but also cost effective (Wormer & Davis, 2008).
In a national sample of 284 alcoholism counselors, it showed that 79% of the counselors endorsed solution-focused principles which includes identifying using client strengths and abilities, client-counselor collaboration throughout the course of treatment, highlighting and promoting already occurring non problem behavior, meeting the client's goal(s), and constructing solutions rather than resolving client problems (2008). This is helpful in the strides toward research and providing its effectiveness; however, more studies need to be performed.
The Cycle of Addiction is Characterized By: Frustration and internal pain lead to anxiety and a demand for relief of these symptoms. Then, fantasizing about using or behaviors to relieve the symptoms emerge. Obsessing about using drugs and alcohol occurs and how his/her life will be after the use of substances. After that, engaging in the addictive activity usually results and then losing control over the behavior. Resulting is feelings of remorse, guilt and shame. Finally a promise to oneself to stop the behavior occurs, and then the cycle continues from the beginning ("Cycle of Addiction," 2013).
Impact on addiction cycle:
Solution-focused therapy could impact the addiction cycle for the better. It could be responsible for breaking the cycle and leading to recovery through implementing the questions (listed above) to distract the individual and think about the future without the addiction. This could be effective in the very first stage of frustration and internal pain because it could allow him/her to think of something else, which would throw off the cycle ("Cycle of Addiction," 2013).
My Thoughts:
This approach may be extremely helpful in my career as an occupational therapist. Addictions can be found everywhere whether it is problems with gambling, substance dependence and misuse, and eating disorders (Wormer & Davis, 2008). There are many people in the world who are fighting an addiction and using this solution-focused therapy would be a great technique to use in occupational therapy. Particularly if an occupational therapist is located in a mental health unit because co-occurring conditions are common and to work on occupations and activities that effect one's life, you need to address the addiction if it is interfering. By using "big questions" to be a form of distraction, you might be able to introduce a new leisure activity into his/her life that might be enjoyed more than their addiction, or at least deter them for a short while.
http://occupationaltherapystories.wordpress.com/
Sources:
Berg, Insoo Kim. "What is SFBT?" Received on February 17, 2013 from
http://www.sfbta.org/about_sfbt.html
"Cycle of Addiction" (2013) Recovery Connection. Received on February 17, 2013 from
According to the DSM-IV-TR, individuals with
anorexia "weigh less than 85% of normal body weight, have an intense fear of
weight gain, and young women miss at least three consecutive menstrual cycles" (Van Wormer & Davis, 2008). Many of the physical signs and
symptoms are attributable to starvation including: cold intolerance, lethargy,
constipation, and the appearance of fine body hair (2008).
Addiction Criteria: (No longer a Bad Habit)
-An extreme fear of gaining weight or becoming
fat, even when underweight
-Refusal to keep their weight at what is
considered normal for their height and age. (Specifically 15% or more below the
normal weight)
-Have a body image that is distorted, focused on
body weight or shape, and refuse to admit that this weight loss is dangerous
The image to the left shows how anorexia affects the entire body.
The video clip (below) is of a girl and her fight with anorexia. Take notice of how it was never enough weight loss, and as soon as she reached her goal, she created another. Also, in her case, she knew she was loosing too much weight so she had to be deceptive and trick the scale when she weighed in. She was addicted to loosing weight, even when she knew it was bad for her.
The video below is of an interesting Italian, anti-anorexia campaign you must watch!
Statistics:
Eating Disorders Overall: -Eating disorders have the highest mortality rate
of any other mental illness (“Eating Disorders Statistics,” 2013)
-Women are much more likely than men to develop an
eating disorder (90% women; 10% men) (2013) -Only 1 in 10 men and women with eating disorders receive treatment (“Eating Disorders Statistics,” 2013) -95% of those who have eating disorders are between the ages of 12 and 16 (2013)
Anorexia: -One in 100 individuals with anorexia, who have sought
treatment, die each year (“Diagnosing Eating
Disorders,” 2012)
-Up to 20% of people with anorexia die, over a 20 year period, as a result of
complications brought on by the illness and/or suicide (2012)
-One in 200 American women suffer from anorexia (“Eating Disorder Statistics, 2006)
-Anorexia is the third most common chronic
illness among adolescents ("Eating Disorders Statistics," 2013)
-Men are less likely to seek treatment because
it is seen as a “woman’s disease” (2013)
-Over 20% of gay men suffer from anorexia (2013)
-The average lifetime duration for
anorexia is only 1.7 years (Van Wormer & Davis, 2008)
Although the majority of cases dealing with anorexia are from women, men can be anorexic too.
Helping an individual recognize that they have an eating disorder is the biggest challenge in treating the disease. Most individuals with anorexia will deny it and only go for help after their condition has gotten too serious. The goal of
treatment is to restore normal body weights and eating habits and then to maintain it. (Usually this is
a gain of 1-3 pounds a week.) (“Anorexia Nervosa,” 2012)
TreatmentPlansInclude:
-Increase social activity
-Reduce amount of physical activity
-Use scheduled eating
-Cognitive behavioral therapy
-Group therapy
-Family therapy
-Support groups online and/or in person
-Medications such as antidepressants (SSRIs) and
antipsychotics (Olanzapine)
to help treat depression or anxiety
(“Anorexia Nervosa,” 2012)
Sources:
“Anorexia Nervosa.” (2012). PubMedHealth. Received
February 2, 2013 from
