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Forum on Public Policy Online

Vol 2010 no.1 (Posted September 2010)

Vol 2010 no2|| Vol 201 no3||

Substance Abuse

Contemporary Family Systems Approach to Substance Abuse
Judith I. Adelson, Assistant Professor Psychology and Human Services, Lynn University


This paper will address theoretical and clinical issues that challenge family therapists treating families dealing with substance abuse, specifically alcohol. A contemporary family systems approach to substance abuse seeks to understand how the relational patterns of family members are not only recursively shaped by the presence of a family member actively abusing substances, but also how the families’ potential for growth and development throughout the family life cycle may be restricted. Research has demonstrated the utility of examining family rituals as a reflection of family process. When families are organized around a substance abusing member, family rituals become embedded with multiple levels of distortion and accommodations. As a method of examining family relational processes and development, this paper will present a current review of literature that highlights the significance of parental drinking patterns in the context of family rituals, and the impact this has on the values, attitudes, and belief systems of young adults as they differentiate from their families of origin.

Paternal Alcoholism: Consequences for Female Children
Julia Dehn, Instructor, Behavioral Science Department, Dutchess Community College, NY

The consequences of substance abuse and addiction are profound and depredating. The desolation is incalculable in estimating the psychological damage and trauma inflicted on the children of addicted parents. According to studies and statistics gathered by the National Association for Children of Alcoholics, “there are more than 20 million children of alcoholics in the United States, nearly 11 million are under the age of 18, one of every four children are living in an alcoholic environment. This figure is magnified by the countless number of others who are affected by parents who are impaired by other psychoactive drugs.” These children are prone to extensive social, psychological, educational, medical and future socio-economic struggles. The children of addicted parents are at a higher risk of developing addiction. The remedies and solutions for these children must include intensive counseling and programs focused on the healing of these traumatic events to safeguard their future well being, independence and self-efficacy. If not helped, these children often carry their sadness and insecurities into adulthood.

Addiction Treatment in the Era of Translational Medicine
Daniel K. Hall-Flavin, Terry D. Schneekloth, Mark A. Frye, David A. Mrazek

A number of recent advances have added to our understanding of addiction as a complex brain disease. These include: 1) the identification of the human genome and rapid technological advances in the field of genomics; 2) the establishment of related fields of inquiry in molecular biology including proteomics, metabolomics, and epigenetics; 3) the evolution of genome-wide association studies;  4) the increasing sophistication of neuroimaging techniques making visible at ever smaller resolution functioning in specific brain regions; 5) continued investigation into brain neuroplasticity and how this contributes to and is shaped by pathophysiologic states; 6) an emphasis on the identification and application of best-evidence and best-practices in the clinical practice of addiction medicine; and, 7) an expanding armamentarium of useful already established pharmacologic agents which have anti-addiction properties and the promise of new agents based on specific causation. These technological and scientific advances coupled with informed clinical inquiry offer the promise of more direct and expeditious bidirectional communication between the research and clinical communities, a process that has come to be known as translational medicine. The application of these principles to individual clinical care offers the promise of care based on an individual’s particular biology rather than disease state; this field of endeavor has come to be labeled personalized medicine.

Within the field of addiction psychiatry, both translational and personalized medicine offer the promise of more steady progress where substantive change has occurred incrementally over the past three and one-half decades. Despite the progress and promise, there exists a need to proceed judiciously, and barriers to change need to be understood and addressed in the historical context in which addiction treatment has developed in the United States. The paper will address this history, key definitions, forces likely to advance the practice of addiction medicine in the next decade, potential barriers to change, and the changing dynamics of the physician-patient relationship in treatment and recovery.




The Evolutionary Bases of Substance Use and Abuse
Christopher D. Kacir, Associate Professor and Coordinator, Psychology, Shawnee State University

he abuse of psychoactive substances is a pattern of maladaptive and self-destructive behavior that, seemingly, offers little or no advantage to the substance user.  Traditional explanations (whether they be psychosocial, behavioral, or neurobiological) of substance abuse focus on the pleasurable effects inherent in many psychoactive substances.  According to these theories, use of psychoactive substances is rewarded with pleasure, while discontinuation is punished via painful withdrawal symptoms


Assessing the Consequences For Children and Families When a Parent Has A Problem With Substance Use and Abuse:  Considerations For Social Workers and Other Helping Professionals
Dennis Kimberley, Professor, School of Social Work, Memorial University, Newfoundland, Canada

The intent of this paper is to contribute to scholarship, knowledge and public policy regarding child maltreatment and parenting capacity within the context of parental substance use and abuse. One goal is to give voice to the children who have moved to, or who are approaching, the threshold for needing a type of protection that is neither governed by the best interest of the parent (even by default) nor by fixation by professionals on an ideology of family preservation—in the face of competing logical possibilities. In their best interest, many children and youth with drug addicted parents, who present repeated risks with known harm, are now more likely to require continuous care and a permanency plan (Brown and Hohman, 2006; Covey, 2007; Hogan, 2007; Schmittroth, 1994).
Among the objectives of this analysis are included:

  • to contribute to policy analysis and debate with respect to children’s protection programming and practices within the context of repeated parental substance use or abuse, which pose imminent and highly likely risks and associated valid concerns with parental capacity and child-youth care;
  • to apply child risk-need-harm assessment knowledge, gained from the qualitative review of 50 cases from one clinical practice, that integrated assessments of parental capacity and care issues associated with substance use, abuse and/or addictions—cases where expert professional opinion was requested by the court and/or by children’s services;
  • to explore the risk-need implications of parent capacity issues associated with co­occurring (concurrent) disorders - addictions and mental health;
  • to analyze some program implications of treating parental addiction as a form of child maltreatment and of defining increasing numbers of children as in need of continuous out of home care.

This policy-practice analysis relies on selected literature and on published studies and analyses within some current and emerging contexts. Part of the analysis is informed an analysis of fifty case files, exploring an available sample of expert assessment processes and classifications associated with parental capacity and child-risk need—where parental capacity has been repeatedly compromised by substance use, abuse and addictions. The analysis applied pre-determined broad child-risk-need-harm dimensions, expanded upon within the context of interpretations arising from the case content and findings from the literature, to enable formulation of conclusions regarding how some drug effects, substance use and abuse, and/or drug using lifestyle, interact with parental capacity and child risk-need-harm.

You can be Anti-Drug and Pro-Reform
Peter J. Lewis, Lecturer in Criminology, Deakin University, Geelong, Victoria, Australia

This paper presents an overview of my own experiences as a university lecturer in offering an under-graduate unit that centers on the drug debate.  Most drug education and certainly that funded by government is couched in ‘say no’ terms.  My role has been to nurture the inquiring mind and expose the historical nuances that have led to a somewhat confused approach to dealing with the fall-out of drug misuse.  While harm reduction continues to be tolerated there seems little doubt that in the last decade we have drifted back to the bad old days when total abstinence and zero-tolerance were seen as the guiding principles.

My starting place is 1995 when the Victorian State Government (Australia) commissioned a panel of experts headed by an eminent scholar, Professor David Penington, to conduct an intensive public investigation into the trade and use of illicit drugs.  At the end of its short yet intensive investigation, the panel concluded that Victoria’s response to illicit drugs should be remodeled and extended if current levels of use and costs of misuse were to be reduced.

Despite an overwhelming consensus that the evidence based recommendations were a step in the right direction, nothing much has changed.  I ask, why not?  From here my discussion exposes some of the difficulties ‘reformers’ face in their quest to bring about an ‘informed’ change.  The debate is complex and comprehensive. I give only a brief overview of the impact of so-called ‘morality laws’ that seek to denounce any challenge to the status quo and the hypocrisy exposed through the actions of governments and multi-national companies.

Substance Abuse and the Criminal Law
Arnold H. Loewy, George Killam Professor of Criminal Law, Texas Tech School of Law

The United States, and to a lesser extent, much of the rest of the free world are plagued by two drug problems: (1) The harm that drugs do to people and (2) the harm that criminal laws against drugs do to people. The first group of harms are pretty well documented, and have been presented at this conference among other places. There is no doubt that illegal drugs have caused great harm to much of the populace (though it is worth noting that probably legal drugs like tobacco and alcohol have done far more harm). Of course, defenders of anti-drug laws note that the reason marijuana, cocaine, and heroin cause less harm than cigarettes and alcohol is that the very fact of their illegality reduces their overall consumption. Consequently, they argue that unless such drugs remain illegal, they will cause as or greater problems than tobacco and alcohol.


Substance Abuse Control:  How Do We Measure Success?
Jim Mann, Assistant Professor, Criminal Justice Program, Lamar University

Because of the criminalization of drug use, measures of recidivism have been used to evaluate our progress in controlling substance abuse.   However, there is no consistently agreed upon measure of recidivism.  Relapse prevention is used in clinical settings to measure drug treatment success, but the definition of relapse varies among treatment providers.  There are other methods of measuring success in managing the problems associated with substance abuse.  However, these measures may require a reorganization of our perception of success.  The goal of this paper is to examine the boundaries surrounding our measurement processes, and provide recommendations for gauging meaningful results.

Brain Changes in Substance Abuse: Implications for Treatment
Timothy W. Parker, Professor of Psychology, Augustana Campus, University of Alberta

Because the phenomenon of drug abuse generates a wide range of serious problems within society, much attention has been paid to understanding how the brain reacts to drugs, and how it changes in addicted individuals, as a result of prolonged exposure. Neuroscience research has revealed much about processes underlying drug abuse, and every day the story grows more coherent. This article provides a brief survey of the key changes that occur in the brain as the user progresses through the stages of drug abuse. This is intended to serve as an accessible introduction to the biological basis of drug abuse and addiction. In particular, it is important to have some understanding of the relatively long-lasting brain changes that make the user susceptible to recidivism, clearly one of the most difficult problems related to this topic.
Understanding the mechanisms by which stressful events or drug-related stimuli can reactivate strong cravings is fundamental to designing effective ways to reduce recidivism. The presentation will also discuss how a significant classical conditioning component underlies the activation of cravings, which has important implications for treatment programs.

Motivational Interviewing
William J. Payne, Associate Professor, Metropolitan State University

Motivational Interviewing (MI) is an evidence-based practice for intentional human behavior change.  First described by William Miller in 1983, as a practice to be used in substance abuse, it has now been applied to over 20 problem behaviors and translated into 39 languages.  (1) (2) (3)

This article first briefly describes the main theoretical foundations of MI and then the basic counseling skills which are attributed to it.

To begin, the main theoretical foundations of MI include; the definition, its spirit, the four main principles, the research which supports it as an evidence-based practice.


Selected Beliefs about Alcoholism and other Addictions Held by Recovering Psychologists
Fred Ponder, Diane Way, Christine A. Contreras and John Slate

Abstract: In this study, the beliefs and attitudes of 76 doctoral level psychologists and/or health care providers who were recovering alcoholics/addicts were obtained regarding alcoholism and other addictions held by these recovering psychologists. Through a survey of 20 personal beliefs and attitudes, our sample of recovering psychologists responded that they had positive feelings about their addiction; considered addiction to be a disease; had others in their immediate families with an addiction; believed that genetics contributed to their addiction; were raised in families that were dysfunctional; and that addictions were the greatest behavioral and social problem in the U.S.. Implications of our findings are discussed.

Family of Origin Addiction Patterns Amongst Counseling and Psychology Students
Fred T. Ponder and John R. Slate

In this investigation, the authors surveyed graduate students (n = 129) in counseling and psychology regarding the extent to which addiction was present in their families. A high percentage of respondents, particularly females, reported that their families had alcoholism/drug addiction present. A statistically significant difference was yielded between the self-reported presence of alcoholism/drug addiction between Hispanic and Anglo females. Hispanic females reported a higher percentage of their families having alcoholism/drug addiction (86%) than was reported by Anglo females (78%). Implications of these findings are discussed.






The significance of socio-political context on substance abuse risks and management
Lyn Talbot, Senior Lecturer, School of Public Health, La Trobe University, Australia.

This paper will present an argument that it is not possible to ‘explore the consequences and remedies of substance use’ without considering the socio-political context in which the abuse occurs.  The causes and consequences of widespread substance abuse problems are to some extent the product of growing social inequalities within and between communities and nations. Thus, when planning preventive and rehabilitation services and activities, it is essential to consider the national and global socio-political changes which influence substance abuse risks and management. Challenges for achieving successful prevention and treatment approaches centre on the allocation of resources through national policy and social welfare approaches which provide a continuum of strategies from primary prevention to community building.

Dispelling myths and developing a framework for reducing the risk of alcohol-exposed pregnancies
Suzanne Tough, Scientific Director, Alberta Centre for Child, Family and Community Research and Associate Professor, Departments of Paediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary

For many years, society has explored and experienced the consequences of substance abuse, however, it may be suggested that substance abuse is related to preceding events and circumstances. Indeed, risk factors and antecedent events related to substance use have been described, and it is conceivable that effective remedies for reducing the impact of the consequences of substance abuse would focus on remediation of these. This paper will present a prevention framework with specific discussion of alcohol-exposed pregnancies. Fetal alcohol spectrum disorder (FASD) is the leading cause of preventable birth defects and mental retardation. FASD is a consequence of alcohol consumption during pregnancy. No safe level of alcohol consumption during pregnancy has been determined. Women most likely to suffer from alcohol dependence, and those least able to refrain from alcohol use during pregnancy, can be identified by numerous risk factors, including a past history of addiction, poor social support, depression, poverty, smoking, housing insecurity and domestic violence.

In considering remedies for reducing the risk of alcohol-exposed pregnancies, it is important to recognize that there will always be a need for high quality intensive interventions for women with identified alcohol problems who are at immediate risk of exposing a fetus to alcohol. Approaching the problem of substance abuse from a community health perspective, however, brings to light the opportunity for primary prevention and the early identification of risk for substance use, and intervention prior to development of substance dependence. This manuscript will use research evidence as a basis for discussing potential strategies to reduce the risk of alcohol abuse among women and to reduce the risk of FASD.


Substance Abuse: Personal Construct Processes and Psychotherapy with Children and Adolescents
Deborah Truneckova and Linda L. Viney

The effects of substance abuse on children and adolescents, their families and other significant people in their lives, is profound, and possibly life-threatening.  In response to these concerns, there has been increased research emphasis on establishing evidence for the benefits of psychological treatment for children and adolescents substance abuse.  Many options for psychological interventions have included pharmacologic treatment, as well as individual, family or group therapy in an inpatient or outpatient setting.  As well, there has been a need to establish which treatment methods are most useful while also investigating what factors might facilitate these processes of change.  In response to these challenges, we will present a personal construct model of treatment for child and adolescent substance abuse that adopts a truly listening approach.  Personal construct theory views substance abuse as a way of developing meaning in a social world.  Our model explores, with children and adolescents, the significance of the substance-abuse to them, the self-perceptions and identity-defining nature of abuse, and then creates with them personal solutions to their problems.  The factors in this approach which, we believe facilitate the psychological processes of change in children and adolescents, will also be explored.



The role of customs and beliefs in legitimating community development participation in Botoku, rural Ghana: implications for substance abuse prevention (Part 1 of 2)
Komla Tsey, Research Professor & Senior Fellow, School of Education and The Cairns Institute, James Cook University, Australia.

Abstract: Customs, belief systems and values, enshrined in specific societal norms and sanctions, provide those involved as members of the society with a sense of belonging, confidence and guidance in their efforts to negotiate complex demands and challenges of modern life. Rapid modernization and social change accompanied by a philosophy of individualism, risks separating people from community values and responsibilities and is a precursor to serious social problems, such as alcohol and other substance abuse. While change is inevitable, there are models for managing this in ways that do not undermine the social strength and cohesion associated with traditional values and customs. Autonomous individualism, or a liberated self, freed from religious, political and social bonds needs to be carefully balanced by respect for self and others, as well as a premium on the cooperative nature of morality. This paper explores the role of customs and beliefs as protective factors against a rising threat of alcohol abuse in rural Ghana. Based on a community development oral history research, the paper shows the high premium that the study community places on the performance of funeral rites for the dead on ancestral lands, irrespective of one’s place of residency at the time of death. This process legitimizes and reproduces a social expectation among citizens, both resident and non resident, to participate or contribute their fair share to improving the ancestral village. The implications of the findings for substance abuse and other social dysfunction protective factors are highlighted. The role that empowerment-based social research can play in offering a lens to a community about past strength and achievements and provide space for reflection, clarification and where needed, adaptation of values, norms and customs is also highlighted.

Tackling endemic substance abuse among Indigenous Australians: the contribution of values- based family empowerment education (Part 2 of 2)
Komla Tsey, The Cairns Institute, James Cook University, Australia.

The extent to which endemic substance abuse and other negative outcomes of historical and continued disadvantage and loss has persisted and possibly grown among Indigenous Australian communities reflects the failure of policy and practice to achieve a critical impact. This paper supports current thinking that tackling these complex issues requires among other things a rebuilding of community social norms based on personal and social responsibility; the essence of the concept of ‘principled autonomy’. The best chance of success in rebuilding social norms lies in multi-level approaches where macro social policy reforms are complemented by effective community interventions that engage and empower the intended beneficiaries to take greater control and responsibility for their situation. Unfortunately, despite their complementary goals, recent Federal Government macro policy reforms designed to curb Indigenous substance abuse is caught in a dichotomizing discourse between options based on compulsory, emergency type approaches versus those which place individual, group and community empowerment at the core of change efforts.

The paper provides a detailed case study of an Indigenous developed family empowerment program as an example of an effective community initiative that both empowers people to take greater control and also builds social norms. The aim is to contribute to the current policy direction by providing a middle path between the polarized positions. It highlights an urgent need to move beyond the binary positions and recognize and support proven local initiatives if new government policy reform agendas are to achieve their goals.


The Brain Injury Definition of Addiction: Why and How the Drug Court Model of Treatment Works
William Zollweg, Professor of Sociology, University of Wisconsin-La Crosse

The Drug Court model started in the Miami, Florida, USA in 1989 as an attempt to divert the addicted offender from incarceration into a coerced treatment program. Although the program proved successful, the idea of coerced treatment did not find widespread acceptance for many years. Two factors inhibited the acceptance of the Drug Court model. First, acceptance was hindered by an ideological mindset that perceived the offender as having a moral defect. The moral defect perception demanded severe punishment to force the offender to repent. The severe punishment also served as a deterrent for other drug-addicted criminals. Ultimately, the consequence of the moral defect model of addiction led to over crowded jails and tremendous local and national criminal justice expenditures and, the severe punishments have done nothing to ameliorate the problems caused by drug abuse in society. Second, treatment providers resisted the use of coerced treatment, believing that the addict needed to want to recover before treatment could be successful. In other words, the addict had to volunteer before treatment could be effective. The idea of voluntary treatment meant, the addict had to reach rock bottom and the negative experience would provide the prime motivating impetus for recovery. The voluntary treatment perception is widespread among treatment providers’.



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