Comprehensive definition and research overview of addiction

Crisis Intervention

Definition of addiction

Goodman (2007) suggested a comprehensive definition of addiction in behavioral terms: addiction defines "a condition in which a behavior that can function both to produce pleasure and to reduce painful affects is employed in a pattern that is characterized by two key features: (1) recurrent failure to control the behavior, and (2) continuation of the behavior despite significant harmful consequences." Some of the most common types of addictions are: drug addictions, alcohol and nicotine addiction, food addiction, pathological gambling, sex addiction, shopping, Internet, and computer, work, exercise.

Overview of research on addiction

Researchers have been interested in the various causes and components of addiction. For instance, Glantz and Pickens (1992) investigated social and environmental factors of addiction, Cadoret, Yates, Troughton, Woodworth, and Stewart (1996) and Gorski (1994) studied the interaction between biological, psychological, and social factors and addiction; Hanson (2003) approached addiction as a brain disease, while Curie (2003) examined recent trends in the misuse of prescription medications (cited in Wojtowicz, Liu and Hedgpeth, 2007).

Another body of research linked addiction to antisocial behavior, crime patterns and criminal choices, and intolerance for boredom (Yochelson and Samenow, 1986 cited in Wojtowicz, Liu and Hedgpeth, 2007). The National Center on Addiction and Substance Abuse at Columbia University (1998) researched on the family history of drug use and incarceration. De Leon (2000) (cited in Wojtowicz, Liu and Hedgpeth, 2007) studied the relationship between drug-driven crime and addiction with social interactions and peer influence, and Beck, Wright, Newman, and Liese (1993) linked addiction to co-occurring disorders. One important conclusion provided by Wojtowicz, Liu and Hedgpeth (2007) is that there is not enough evidence or definitive characteristics have not yet been identified to predict an individual's risk for drug and alcohol addiction. Their study discovered, however an interesting relation between some demographic variables - age, race, and county - and addiction. Two of the most important findings in the cited study are the progression of addiction with the progression of age and presumably with the associated cumulating criminal history, and the fact that white offenders are more likely than minority groups to be drug and alcohol addicted.

The causes of addiction were viewed prior to the 1980s by emphasizing the sociological (Davison & Neale, 1986, cited in Hirschman, 1995) and psychological characteristics (Orford, 1985, Zuckerman, 1979, cited in Hirschman, 1995). Addiction was seen essentially as a set of problematic personality characteristics. The sociological factors considered to correlate with tendencies toward addiction were for example child abuse, school absenteeism, minority racial membership etc. (Hirschman, 1995); moreover, several sociocultural factors were observed to direct the type of addiction engaged in, for instance White middle-class women and eating disorders, young professionals and cocaine, Black teenagers and crack, college students and alcohol / marijuana etc. (Hirschman, 1992, 1995). There were also studies that tried to underline inherited addiction tendencies. Studies on twins reared apart demonstrated that alcoholism is inherited (Collins, 1885, cited in Hirschman, 1995). Other studies suggested that persons suffering from addicted disorders had families with genetic histories of addicted behavior (Crabbe, McSwigan & Belknap, 1985, cited in Hirschman, 1995)

In recent years, starting with 1990s, due to progress in neurosciences the hypothesis has arisen that one contributing cause to addiction is hereditary abnormalities in brain chemistry. (Goodwin & Jamison, 1990, Kramer, 1993). Moreover, in conjunction with studying mental illness, researchers also discovered that many persons who suffer from mental illness also engage in addictive behaviors such as alcoholism, compulsive gambling, and heroin and cocaine addiction; on the other hand, many people who are addicts may also suffer from mental disorders such as manic-depression and generalized anxiety disorder (Goodwin & Jamison, 1990, Jones & Moorhouse, 1985, Mc Elroy, et al. 1991, Popkin, 1989, cited in Hirschman, 1995)

Case presentation on cocaine addiction

In order to illustrate the data above a succinct case study will be presented by taking in consideration a person who is a cocaine addict.

Mr. M., a White American male of 32 suffered from cocaine abuse since early adulthood. He is unmarried and lives with his mother and two cousins. He reported using 1/2 g cocaine daily. In time, though he participated in several treatment programs he continued to increase his cocaine use.

The symptoms of cocaine abuse have been defined as: red, bloodshot eyes, runny nose, frequently sniffing, or bloody nose, change in eating or sleeping patterns, losing interest in family, frequently needing money, anxiety, panic, rapid talk, rapid pulse and respiration, loss of job, social isolation and anger towards family members, tremor, confusion and impaired judgment, hallucinations, vomiting.

Risk factors: He was shocked by his parents' divorce in adolescence. His father was an alcoholic and was the actor of many violent scenes in the family. He then started to use marijuana and drink alcohol. Later on he developed addiction on cocaine, after several experimental uses. He began to develop an intensive sense of dependence on his mother. In his adulthood he held several jobs, but he did not succeeded to preserve his employment.

The most important risk factors are therefore prior histories of use of other drugs (alcohol, marijuana), disturbed family and social environments, clinical profiles marked by antisocial personality (Newcomb & Bentler, 1986), and genetic propensity for substance abuse.

He sometimes perceives his situation as a crisis from a social point-of-view, in that he would like to have some friends and relationships with women. He would be also pleased if he would be able to keep his job. The perception of the crisis is more evident for his family due to the negative consequences of his behaviors: the high costs of his addiction, the negative health outcomes, and the anger fits that disrupt all his relationships. His subjective experience of the condition is a crisis in itself in that it is described by the following: sense of craving, preoccupation, excitement during preparatory activity, mood altering effects of consuming cocaine, sense of loss of control. He also experienced tolerance, which led him to increase the cocaine quantities. Maybe the most disturbing part were the withdrawal symptoms experienced: depression, insomnia, anorexia, fatigue, irritability, restlessness, craving. At times he also used alternative ways of coping to lack of cocaine by using alcohol. His alcoholism only made the situation worse.

Interventions should take into account the culture of the addicted person. For instance, for a Chinese patient has more spiritual resources that may be involved in his recovery. Moreover, for Chinese patients intimidation and indoctrination may be ways of intervention, and are opposed to the peer-oriented treatment models from the U.S. For instance.

Crisis interventions for cocaine abuse may consist of medication and/or counseling. Seizures seem to be best treated with diazepam, hyperthermia and agitation with dopamine blockers such as haloperidol (Catravas et al., 1977, cited in van den Brink, van Ree, 2003), and cardiovascular incidents with sodium bicarbonate (Williams et al., 1996; Ortega-Carnicer et al., 2001 cited in van den Brink, van Ree, 2003). Detoxification and relapse prevention are important in planning the intervention and are both gradual processes. In the detoxification phase the patient has to reduce and finally stop the consumption of cocaine and become abstinent, and the relapse prevention phase is targeted at preserving abstinence.

Counseling is recommended all throughout the process. Behavioral techniques are very important as well as the therapist' attitude. The therapist should be flexible, empathic, directive, but collaborative, and should provide social reinforcement frequently for all appropriate efforts and changes exhibited by patient.

The most effective behavioral techniques for cocaine addictions have been suggested the following: behavioral contracting, effective goal-setting, modeling/role playing, shaping successive approximations, self-monitoring, therapist prompting/monitoring, the Premack principle, skills training (e.g., social skills, problem solving, task analysis, relaxation, time management) (cited in Therapy Manuals for Drug Abuse: Manual 2). Key interventions in cocaine addictions are: understanding, describing and coping with craving, establishing goals and motivation to change, refusal skills / assertiveness, decision making skills, case management, HIV risk reduction etc.

In this specific case, it is important to show the patient how consumption of cocaine and his thoughts about cocaine influence his behaviors and emotions (if the intervention is made from a cognitive behavioral point-of-view). Moreover, emphasis will be placed on the cocaine consumption as a dysfunctional behavior, which has been modeled by his father's alcoholism. The patient may be taught techniques of distraction or self-talk to cope with craving. Role-play may be used to develop refusal and assertiveness skills. Being a dependant person, these skills will help him to also gain a feeling of independence. The patient should be provided with a list of support phone numbers to call in times of need or crisis. It would be very good to identify a person that may support his efforts, but this is a difficult task with this patient who is rather isolated. Therefore, community support (Cocaine anonymous) or group activities may prove beneficial for him. In order to promote recovery it is very important to suggest the advantages of changing the negative behavior, which will reinforce a more adaptive coping. A very good coping strategy besides using distracters and avoiding high risk situations is learning a relaxation technique.

Recovery is defined by improvements in behavior, and affective states. In this case, becoming involved in positive activities such as employment, and giving up cocaine or substituting it with low doses of alcohol would mean the patient has recovered. After 5 years of abstinence studies show relapse is rare (Flynn, 2003).