On the subject of terminology, I thought it was rather odd that NHW made the statement that “the phrases ‘chemical dependency, addiction, and habit’ are still in use but less so than ‘substance abuse, use, or misuse;’” and then later citing “changes in the thinking in the field of chemical dependency.” (Netherton, Holmes, & Walker, 1999, p. 241) Perhaps that’s an indication that old habits are not easily broken.
The text again acknowledges that “the use of substances to cope, alter moods, or reach another level of consciousness has been an acceptable form of communication and expression for most of humankind.” (Netherton et al., 1999, p. 242) This statement alone suffices to encapsulate the difficulty of the task at hand. Quite simply, there is a significant portion of the population that doesn’t recognize there is a problem. “Substance use has become less stigmatizing among adolescents and is fiend less as a problem among their peers.” (Netherton et al., 1999, p. 242) Check and checkmate.
I have trouble “getting behind” the disease model for substance use and abuse. To my eyes, substance use appears more like a behavior than a disease. In my experience, alcoholism is typically a secondary symptom stemming from another underlying physical cause or emotional disorder. The degree and the prevalence of comorbidity would appear to support this position. While I don’t disagree that the behavior needs to be recognized and addressed, I believe that addressing the underlying emotional disorder is critical to the long term success of these individuals.
Other substance-related models include the developmental model, the gateway model, problem behavior theory, cognitive models, the social learning model, and finally… the addictive behavior model. I believe that social learning weighs heavily on the adolescent mind, and I wholly support the statement that “adolescents place great value on peer opinions and struggle to fit in.” (Netherton et al., 1999, p. 247) This serves as an entry point for the behavior, which then sets the tone for the addictive behavior model, which subsequently suggests that behaviors are a series of bad habits that have been over-conditioned to the extent that they become detrimental.
“Long-term substance use is related to psychiatric conditions such as suicide and depression, affective disorders, eating disorders, and personality disorders.” (Netherton et al., 1999, p. 248) This is only the second time in this class where we have listed entire categories as being comorbid with a specific disorder. Is this the first mention of dual diagnosis in this class, or have we previously addressed that?
Addressing treatment, the treatment options range from pretreatment services, through outpatient treatment, to intensive inpatient treatment and/or residential care. “Some of the fundamental treatment services include structure, dual diagnosis capabilities, pharmacological interventions, arrangements with medical care, role modeling, client participation in the therapeutic milieu, family groups, individual and group therapy, school/vocational training, recreational programs, relapse prevention, and 12-step support.” (Netherton et al., 1999, p. 255)
Of the specific treatment approaches and interventions, I most identified with the harm reduction approach. “Harm reduction, harm minimization, and risk reduction are terms that describe methods based on the assumption that habits can be placed along a continuum ranging from lowest risk to highest amount of risk.” (Netherton et al., 1999, p. 258) The object, or the goal, is the transition the individual along the continuum to a behavior that is less harmful. It seems to be more progressive in its approach, with its intent to “normalize rather than marginalize substance abusers.” I don’t think this is necessarily the ideal treatment for all people who suffer from alcohol-related problems, but I think it would be a less invasive and potentially better received option than some of the more stringent measures.
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.