21/10/2007
On test: only class – no articles
3 basic concepts: à3 A's
ALCOHOL -1st A
alcohol as a chemical
5 Main alcohol drink category
àthey
wanted to get to the «spirit» of the drink, when they started
to distill, and thus the name «spirits»)
=can of beer (330ml) =
wine glass (100ml) = stiff drink (30ml)
-by the way – 1.5% of alcohol
and less is not considered alcoholic for the laws sake
Alcohol as a drug
-alcohol is a depressor - it slows down the nervous system
àincluding our «brakes» (takes away the brakes – not add relaxation)
àyou can see it clearly in someone who is currently drunk – in his lethargic movements and speech
-the alcohol spreads to the
whole body, unlike other drugs
-alcohol is not bad – just
dangerous. So unlike other drugs, you can use it, but cautiously
Trickiness:
àin hypothermia, alcohol can even kill
Why do drink (carefully): religious or social àproportion/not fast or empty stomach = good!
Why not drink? When it is a
ritual onto itself – serves relaxation/excitation =bad! Youths
try to get straight to feeling
=can't do intricate stuff,
i.e. drive
Alcohol as a medication
Longevity: moderate
drinkingßno
drinkersßheavy
drinkers
Danger:- Mixing alcohol and medications or other chemicals
-it alter the medical effect – i.e. increases (i.e. valium)/cancels it (antibiotics)
àwhen
you mix chemicals of opposing effects, it is dangerous = i.e. red-bull
(arouser) and alcohol (depressor) could kill!
Another danger: in 2
cases, mixing alcohol and the specific drugs could kill, and thus it
is used for withdrawal
Alcohol as a source of energy
-alcohol is loaded with calories.
-besides being overweight (b/c
of the alcohol) or underweight (b/c alcoholics don't bother eating)
= they are malnourished
Social alcohol
class – 29/10/2007
ALCOHOLISM – 2nd A
alcoholism: a disease caused from too much alcohol consumption and is expressed in loss of control over the alcohol
WHO: 1) progressive, 2) chronic
and 3) potentially 4) fatal disease – dependency and tolerance
ñáéìåú åúìåú - and bodily changes based on the drinking
-in historical times, it was
seen as a crime and not a disease.
Prohibition: 13 years of no drinking in early 20th cent. Its process started about 20 years before that – especially w/ puritans in Utah. Then in 30s, people started speaking of disease. But it was still not clear to the people of the time, since, «it did not hurt anywhere»!
-then people started seeing the deeper problem – beyond the actual drinking
Healthy -- Sick -- Dead - - - - - - - - - -> Time
Types of diseases:
1) Some kinds of diseases are sudden.
2) Terminal diseases - gradual process towards death (e.g. AIDS; cancer)
3) Disabilities - an injury and a stable process
4) Viral diseases: A person becomes sick and then healthy again.
5) A person is sick, stabilizes, but is at risk of falling again. The more this spirals the more chance he has of falling. These are chronic diseases and a person will never be healthy. There is a gradual degeneration of the person.
In addiction a person becomes
sick over a space of years. He gets treatment and becomes healthy again
and can function but he is at a constant risk of falling again. It is
like being allergic to something and a person remains allergic for life.
Theory (which also allows diagnosis and understanding):
Question: where does
alcoholism stand vs. other diseases
Answer:
Graph:
Healthy
/ - fast death
/ -
/ -
/ --
Sick
------------------------------
/ - -----
/ - -------
/ - --------slow death
/ -
/Death////////////////////////
àtime
axis
-chronic disease: is seen as a zigzag: remission and regression
-one time disease: get sick
once and get better
-alcoholism is a kind of chronic
disease. Only solution is to stop drinking. He still has a «alcohol
disease» which means each drink will bring a regression.
Disease of alcohol:
-the disease is the sensitivity
Loss of control can be expressed in (increasingly problematic levels):
-so the alcoholism disease
has a process of development
-70% of people leave therapy
in beginning. Often they come back, b/c the problem does not get better
Characteristics:
Bio-psycho-social
Learning theory
Infantile personality is shown in:
-so alcohol relaxes such people
and then he learns that this is the thing that does him good/calms him
down.
-also those only psychologically addicted are also alcoholics
-out of the 20% who are psychologically addicted, 20% of them are addicted, biologically. (4/100)
àit
is not only to relax, but the body starts using it as part of its metabolism
Possibilities of explaining the biological addiction:
2 at-risk populations
The resulting damages are also bio-psycho-social
Bio:
-the organ damages are severe
and often irreversible
Alcohol damages
Psych:
Stages
of alcoholism development:
|
| Short term physiological and psychological influences of alcohol | Long term physiological and psychological influences of alcohol |
|
|
îúðæøéí – Avoid it completely.
îæãîðéí – Opportunity drinkers.
ùúééðéí – Enjoy drinking, a culture of drinking but are able to control themselves.
îëåøéí - Addicts
Class – 5.11.2007
Alcoholic – 3rd A
Q) how can we draw a profile of the alcoholic?
a) you can only deal with the
reaction to alcohol – not the specific drunken episode
Definition an alcoholic is person who develops a dependency and shows a loss of control over the substance
àit
is now a personal profile but rather a disease - i.e. an ICD number.
But it is important not to catalogue the person but his disease. It
is not important Iif it is inborn or developed in his life course
4 kinds of people:
-we are dealing the regulars
and the addicts. The regulars because they are getting closer to addictions
and might be starting small problems
The diff. b/w regulars and
addicts is that the regulars = habit and addicts = uncontrolable
Habit drinking
Addiction
Definition of addiction -increasing amounts to get the same feeling = «progressive«
-addiction is when you need increasing amounts in order to get the same effect – the body gets used to it
àall
addictions start small
Loss of control is seen in
Evaluation of alcoholic - factors
-you can not evaluate and diagnose by just how he looks/smalls – you need more standardized factors. They include:
questionnaires: cage/must
– 2 short questionnaires which are initial filters for alcoholism
common Israeli alcoholic profile
Drunkenness: - definition there is an immediate and temporary distortion of function due to alcohol consumption
It depends on
-2 enzymes in liver break down
he alcohol – the slower it works, the more alcohol in your blood and
for longer
-some drunkards are active
drunks others are passive drunks
Drunkenness is expressed in
«middle stage»
– latent drinking = when alcohol damages function but
you can't tell yet on the outside. This is quite dangerous because he
will drive w/o noticing he is drunk. His friends don't notice it either.
-also, statistics show that
the passengers get more injured than the driver in car in car accident
-there is nothing to do with
drunks – you have to deal w/the main problem – and definitely not
when they are drunk.
12/11/2007
Treating alcohol victims
-we need to know what the alcoholic
goes through in treatment [and at a later class, will discuss family]
-person usually comes after many failed attempts at quitting alcohol
-the request that the therapist usually asks for is «to drink like everyone else»
àby coming, he has already admitted that he has a problem. But he sees others who also drink but without getting into trouble
Problem: he can't! he has a chronic, life-long problem = he has a inborn extra sensitivity to alcohol, so he cannot drink like «everyone else». so part of the problem is that he is not. We have to help him through that notion
àparallel
to the handicapped who does not want to be different.
àwith
that, we have to teach him that we do not have a «magic pill»
to change him
rehabilitation
definition
operational definition
-rehabilitation is to help
the alcoholic live a normal, happy and successful life and
without alcohol
àthat's
why the AA – alcoholic anonymous has a motto: to avoid the
first cup
Weaning – quitting
Quitting âîéìä
Definition: stopping the dependency on the drinking
-in treatment programs they
use time definition, since it is even part of definition: so you might
hear a therapist say: «welcome! In 2 months, you are clean»
Change
-3 levels of change:
-alcohol therapy usually takes
up to 2 years. It could take anywhere from 6 months up to 5 years at
times
-addiction will not go away w/o change, yet there is no change w/o addiction.
ài.e. I want to lose weight but it won't happen before I change something in my life. That is why many diets fail
àso
in the context of alcohol, so after the initial stopping, there needs
to be dealing with the low self-esteem and other problems. If not –
the alcoholic will fall eventually big time. So in practice, the abstaining
guy who has not deal with the main issues behind the alcohol will come
out big-time. The guy who abstains with falls, yet is dealing with the
alcoholism's background problem in therapy will eventually be in better
shape
-Many therapists ask for addiction
treatment before proceeding with other therapies. The alcohol just gets
in the way
Harm reduction
-an approach in addiction therapy where you can't deal with the problem, so you at least reduce the problem.
àfor
example, there is a problem with addicts where Tel Aviv gives them syringe
-so least they won't have other problems as well. Those are people who
nothing worked for them
-there are programs giving
Methadone – a less addictive and less harmful form of heroine. This
lets them lead normal lives. This is actually the main question: how
does a person function in life
-in the context of alcohol,
harm reduction is to let the guy fall, because he will come out stronger.
This is better than one who in not functioning – yet had no falls
in his abstinence
Physiological intervention
psychological intervention
social intervention
prognosis of the alcohol
«öôé ääçìîä»
= prognosis in Hebrew
-prognosis in alcoholism is different from other diseases
àin other diseases, the early you find it – the better the prognosis is better
àin
addiction, it is opposite: the smaller the problem, the harder it is
to treat – since the person who has hit rock bottom is easier to treat,
since otherwise, they will secretly drink on. So the worse the drinking
problem is, the better the prognosis is
Measures:
-the more he suffers from the drinking, the more he wants to quit
-measure of suffering vs. pleasure
àso when a person quits, he gives up the pleasure. At beginning, he doesn't suffer much [though others might] – great pleasure vs. little suffering = a lot to give up. Vs. those who had hit rock bottom = he gets a lot of pain and a little pleasure form the drinking [yet is by now addicted] = so there is a little pleasure to give up, but a lot of suffering to give up. The first case, the person is probably not ready to go through alcohol treatment
àso you can either wait the [possibly
long] time, it might be harmful in the waiting. The better approach
is to «raise the bottom» – i.e. ask the people around him
to take his problem more seriously – i.e. ask the boss to threaten
him to stop drinking or be fired/ask wife to leave [take her own threats
seriously]/etc… àwe «create» a crisis
Back to the weaning issue:
-abstinence is the first step in the process [a wretched stage]
àin
therapy can't go on w/o abstinence
Preparation for the weaning:
The actual weaning
Results:
Success rate: - 90%
of people who turn to therapy eventually quit [for a bit] – but only
30% are able to maintain the results
19/11/2007 –rehabilitation
Awareness vs. denial
-how do we raise awareness
and lower denial
Awareness
Based on:
Important: often, there is a confusion b/w knowledge and awareness.
àpeople who have knowledge do not necessarily have awareness
àand
they hide behind their knowledge – and don't deal with the issue and
with themselves
-so, we want to raise their awareness in 4 categories
-one of the first steps of Alcoholic Anonymous is to admit your problems:
(12 steps program)
à) admitting the weakness/handicapped:
«We admit that we are helpless b/c of alcohol (or anything else)
and we lost our control over my life b/c of that»
àthe «only for today» motto is strong in AA
àin
open sessions of AA – where all are welcome – to see how they are
run. There are a lot of marketing in such meetings.
àthis
is faulty logic b/c: after event you b/c helpless and you drink b/c
of your helplessness – so rephrasing the question «why»
with «for what», you can tap into the mediating internal state.
It is not the even but our internal state or our interpretation of the
event. At we remember the alcohol that we once had and it relaxed us.
So one thing e can do is show the alcoholic the alternatives to dealing
with the event. Get the alcoholic to take responsibility over his
reaction – he can't control the situation but he can control his
reaction. We expect that alternate behavior will happen in small steps
and not in one shot – especially w/ those w/ no frustration tolerance.
-we will not deal event [its normal], and with the alcohol. We will not deal with the eventàalcohol link since we reject that logic. But in the eventàhopelessàdrinking logic – especially hopelessàdrinking axis, since we all sometimes have sucky events and we all sometimes feel helpless, but then reacting to hopelessness w/ drinking is the problem. We need to show him alternates to dealing with this sucky, but normative situation
àbut you may need to start off with
his logic.
-important for the alcoholic to see how they harmed others
àwhen
the alcoholics tell of damages, they phrase in the «payback»/humor/storytelling
àraising
awareness of the damages, you can also know how to deal better with
life's crisis better
-all processes have «falls»
Slangs:
-this is a fall in awareness
as well. The alcoholics «fall» because they test their ability
– you give in to the question of «am I really an alcoholic?»
– there is a reduction of awareness of the problem and responsibility/an
increase in denial
Denial:
Definition: a defense mechanism that allows unconscious content to come up to awareness, on condition that the claim is that the content is not true
àthis is sometimes important (i.e. as part of the morning period)
àit b/c a problem when overdone or done
in incorrect times
-the problem with denial
is that you convince yourself, and this hinders your development/processes
Cycles of denial
àwhen
a person comes to therapy, he admits 1) he has a problem and 2) that
he can't deal w/ it himself. At that point, the other denials come in:
Denials of therapy – once he came:
-beyond the denial, I project
the problems onto others. – i.e.
Dealing w/ the denial
-movie about Mrs. Betty Ford
– family confrontation
Class – 26/11/2006
Family disease – family illness
We will have 2 meetings about
this topic, since the family has a large role in the alcoholic's disease.
You can treat the system, but you can also look at the system's illness
systems theory – explains that the individual's experiences are not only tied to himself but also tied to his surroundings
àthat’s
why you can not change the individual w/o doing some change in the system.
They might try to disrupt therapy
-we still haven't proven that this is a genetic thing or a socialized thing.
àbut we see the whole family being in
denial, the whole family deteriorates and then they all need therapy.
We see them going through a parallel process to the individual alcoholic
-we have to remember that the
alcohol itself is a family member – it is always there! It is the
one who dictates the family experience. The whole family's experience
is altered depending on the mere presence or lack of alcohol
Co-dependency
-Dr. Amnon Michael wrote about this. He coined this term and called
«Codependents» those who are addicted to the others' addiction
àsimilar
to those parents who totally cancel themselves out for their alcoholic
partner/parent/kid/etc…
«The wife of the alcoholic»
-the feminine is use for convenience,
since most alcoholics are men. And the women alcoholics tend to stay
single
Question: is it a coincidence
that she married someone and only then found out of the alcohol problem?
Answer: no! they knew
about it and chose it.
Statistics
43.2% had alcohol problem in family of origin
25.4% had an alcoholic dad
20.2% had an alcoholic brother
12.2% had other
significant people who were alcoholic
àthis shows the socialization:
what happens in the family
-some wives leave/divorce.
About 25% complained in the police. Few stayed in shelters out of fear.
the disruptive wife
-the wife who has secondary benefit from the drinking, so she disrupts the alcoholic's recovery
alcoholic's children
-they are the true victims
of alcohol. They have no choice over the matter. The alcoholic can decide
to quit. The wife can choose to live. bit they do not have any choices
over the alcohol problem
Damages to kids:
-47.5% of alcoholics in therapists
had a parent who was an alcoholic
Kids of alcoholics has «Code of secrets» that they get from their parents
4 types of kids:
Class
– 3/12/2007
Alcoholic family characteristics
-they function on the
survival basis àthey are always in a war situation.
You can not plan anything. –i.e. can't even attend wedding!
Several family emotional themes
Weaning off the alcohol = positive crisis
-there is a false sense that
all will be fine without the alcohol. This is a fallacy. It won't take
away all the problems. It will just make you live a normal life.
Metaphor: someone sinking
in a mud-puddle – yet the fog is making him unaware that he is sinking.
Quitting alcohol takes away the fog so he can see what is happening
in his life and can deal with daily problems.
-so – when the alcoholic
quits, there is a family crisis since it changes everyone's roles, and
that is why there is a family crisis (positive crisis). People had secondary
benefits – i.e. even knowing what to expect is a secondary benefit
– so there might be some who will «lose» from the alcoholic
quitting. So a common question asked of alcoholics who want to quit
is: «why do you wanna quit? – you are giving up an escape mechanism!»
3 things of quitting alcohol that might cause tension
17/12/2007
Group therapy for alcohol victims
-one of the more practical
tools of alcoholic's therapy - or any addiction for that matter.
-therapeutic tools are measured by:
-the group is befitting –
since it does benefit w/o harming anyone. The alcoholic group is one
that unifies people on one sole basis – a disease called alcohol àthis
may be a problem since people do not want the stigma. One attempt is
to change the name.
Why a group?
4 reasons
-the combination of individual
and group therapy is the best way for addiction treatment of alcoholic.
4 secondary/fringe benefits
Self-help groups –AA
Bill Wilson develops the 12 step system develops in the 30s. he was a broker. In the great depression, he lost $ - so he b/c alcoholic. He found out that that speaking to other alcoholics –it made him feel better. He tried doing so w/ alcoholics on the street – it failed – because, as Billyboy discovered – the person has to decide to quit.
-so Billy discovered that having
another alcoholic beside you
Principles of AA – as developed by Bill Wilson
1) Way of life: AA groups are not therapeutic – it is not a type of treatment, rather it is a way of life. Treatment is a situation in which there are at least two people, on different levels (one is a practitioner, the other the client) and time-limited. In AA group everyone is equal and it is not limited by duration of session and length of treatment. AA becomes a way of life. People choose how many times a day or per week to come. Some are dry 30 something years while others are clean one day.
2) A spiritual aspect: These groups insert a deity into the group and each one can define his own god. There is something stronger than I that can help me. There are many Christian motives, but spirituality is universal. – «God as we understand him» is the terminology used –to be more inclusive
3) The 12 steps: This is the process that each AA member goes through till he reaches a level of purity
12 steps:
1) admitting that alcohol controls us
2-3 – we can't deal w/ it ourselves
4-8 - confessing
4) we did a soul searching process
5) we confessed to God as we see him and another person about our failures
6) we accept that God will free us of our characteristic faults
7) we ask Him to free us of our downsides
8) we listed the people we harmed and apologize to them
9-11 help others
12 – convincing others to
quit
AA terms
«12 traditions:»
Beurocratic rules, such as: they do not take donations and they do not have leaders. They have sponsors: someone more advanced in his addiction treatment to the individual who advises the person. He is available 24 hours for advice. They do it for themselves too. Again, the commitment is «just for today». If you have no clue what is flying there, the message is – «90 days, 90 meetings» – if you come enough, you will understand. The group leader is one of them. Opening ceremony: choosing a leader for the session. Opening ritual «name + I am alcoholic». Then you speak of how the week was. Then there might be a minute of silence to remember those who can not take the steps to stop. Then there are discussions. In the discussions, no one tells anyone else how to think or solve the issue. Just share ideas. The group leaders chose topic to be discussed. They may choose to speak about a level of the 12-step levels. Doesn't have to be in order. Usually, people drunk, they sit in the side and are not allowed to speak in the group. But the won't be kicked out. Some sessions are open, usually, they are closed. The open sessions are for new people or visitors. There are many rituals, including in birthdays. There is the real birthday and the «dry birthday». Family is invited to birthday rituals. Each meeting ends with «the prayer for peace»
Other groups
Na – narcotics annonymus
OA – overeaters anonymous
GA – gamblers annonymous
SAA- sex addict annonymous
DA – debt anonymous
Al-annon – self-help groups for those arounf the alcoholic
AL-ATEEN – kids of annonyous
24/12/2007
Dealing with the issue – äúîåããåú
Withdrawal [physical] and Change [adaptive skills]
-Dealing with the issue really
starts with the first phone call
We have o deal w/ the fantasy that after withdrawal, all my problems will be normal/awesome = without any problems
àbut we have to teach that alcohol just
deal w/ your daily problems that everyone has. Alcohol just made the
person run away from them instead of them.
-we have to remind out clients
that alcohol is a chronic disease = when you quit, you still have sensitivity
to addiction especially of alcohol. A clean addict is not a healthy
person but a surviving person.
-the withdrawal is the peak
– after it, there is just a downfall. The process is reversed –
firth you reach the peak – withdrawal – the rest is post-peak –
dealing w/ surviving a day w/o alcohol – vs. regular processes where
you build up over time to a peak
Levels of dealing – îéùåøé äúîåããåú
-working on surviving the day
basis
Critical points of the alcoholic's recovery:
Points of coping
Links
Eventàhelplessnessàalcohol
The helplessnessàalcohol
link is the problem
-we have to help the alcoholic
question this link – i.e. by perhaps asking if it is worth it to have
it at home, or around social events
-some «dry alcoholics»
hand around bars but drink non-alcoholic drinks. This is bad for
him since he will be tempted to drink and eventually drink alcohol too.
We need to weaken the helplessnessàalcohol link by even distancing the
alcoholic physically from sources of alcohol
Criticism of hospitalization
– it is sterile, so you don't have contact w/ the real stressors.
Parallel to this idea is the alcoholic going to a «treatment village»
which distances from the real context that the alcoholic need to cope
with. Real coping means to learn how to distance oneself from specific
context-real alcohol situations [i.e. weddings, bars, etc…]
àthe
second step is to deal w/ the helplessness itself, and its link to the
event [go backwards in the Eventàhelplessnessàalcohol link.] i.e. how to deal
w/ frustration. i.e. teach the guy how to withhold his reaction for
a few moments before reacting. Usually, w/ frustrations, initial reactions
may be too anger filled to deal w/ the issues at hand. Waiting a few
moments allow for further thought and thus better coping techniques.
Helplessness: are situations
where we do not know what to do. Those are the hardest situations. For
example, parents usually hit b/c of their own helplessness – when
they themselves do not know how to deal w/ the kid's disposition, and
those parents do not know how to deal w/ helplessness. You have to help
the alcoholic detach feeling from action. Feelings [including helplessness],
or any fantasy does not need immediate action. You can deal w/ it in
other ways except immediate answers. Part of this coping style learning
means to teach healthy options – so he won't replace alcoholism w/
other bad solutions [i.e. violence instead of alcohol]
-alcoholism is a chronic disease
– but the specific choice o drink or no is a choice to be made
Coping tools
«Prayer for peace»
-used in AA – every culture changes it a bit to fit itself
àaccept the things that you can not change, and change what you can
àdo not fight that which you can not
change.
àin
AA, you teach the person to pick the right things to change out of a
list that they made of things that bother them
Setbacks
îòéãä = small fall
ðôéìä = big fall
-some people try to «suicide»
the process. Most «falls» are just tests where
the alcoholic wants to see if «he really has the problem»
àthere
will thus be falls all the time – the thing is to return to the therapy
process
Relapse prevention
-learning how not to «fall»
– return to the bottle
-the concept is: some things
return us to drinking, and others distance us from the alcohol.
-for example, family holidays – holidays where the family gathers, are tough for the alcoholic. Some places are tough for alcoholic, i.e. vacation towns. Self-mercy also is a risky thing for the alcoholic
àso
knowing the hard things, which brings alcohol closer helps prepare for
it.
-so just identifying the alcohol
stimuli helps prevent a relapse.
31/12/2007
Alcoholism = Bio-psycho-social problem
-today, we will deal w/ the social part of the problem
-the social part does not make
someone addicted – just allows for the problem to develop and continue
-alcoholism is unique
- ùúééðåú – alcoholism has a term referring to the social element
of alcoholism. No other addictions have that term.
Drinking – ùúééðåú
-third causer of death, third to cancer and heart problems
-Kuchin, India has the worst
per capita alcohol problem
Drinking -
ùúééðåú - Accepted norm in a certain society regarding
the consumption of alcohol
Israel might be low in alcoholism,
relative to other countries, but it is on the increase
What can increase or decrease alcoholism at the societal level?
Secondary influence
social influences:
Date
Drinking
Israeli law= 5/1000 alcohol
in blood. This equals to about 2 alcoholic drinks
In 2006, 5043 drivers were caught under the influence, vs. 1412 he previous year. This is possibly because of increased police supervision over drinking-under-influence.--> but 10% of accidents which are alcoholic related, is still a significant number
Reasons for increase:
what alcohol does to the driver:
changes in driver's thinking
-speed and distance calculation
-sight sharpness is reduced
-increased risk-taking
-the only thing that «wakes
up» the alcoholic is time
Beer (330ml) = wine (100ml)
= hard liquor (30ml) = one unit = 40-45 minutes to get out of the blood
system
Latent drunk
-those who drank just a bit
too fast, and are drunk yet it is not noticeable to anyone including
themselves – yet the alcohol still influences them
Hangover – when the
body wakes up, and the body systems/senses are increased. The headaches
are b/c of the dehydration
Instead of just saying «say
no to alcohol» but «use your friends». Tip – do not
get into a car w/ a drunk driveràusually, the passengers are more injured
than the driver/ the worst is the one next to the driver
Alcohol and violence
-most alcohol violence happens in the family. This is b/c the alcoholic feels that the family members are theirs – owned by them. Thus they feel safe enough to be violence. Second most violence place is áéìåé places.
Third most alcohol-violence
places is public places, i.e. welfare offices, where people come to
let out steam.
-the myth that alcoholics are less criminal than other addicts is false. This is not so. They just do other crime. Addicts do things like selling the illegal drugs/prostitution/property crime. The alcoholic is consuming a legal drug. But the crimes happen once they're drunk – i.e. driving under influence and violence (after consumption), public peace issues. The drug addict is criminal b/f the drugs. The alcoholic is criminal after the drug (alcohol)
By the way, it is illegal to
make your own wine in Israel. You need a license (probably to protect
the alcohol market).
Youth drinking
Drinking and alcoholism in Israel
4 periods
The dry period – before creation of state
-no stats on alcoholism
-idealistic purpose. As a minority,
the Jews had to «be nice»
Distress period – with creation of state
-related o immigration and
social periphery and crime/violence. The popular treatment was to «save
the children» – take the alcoholic's kids to a «better»
place – Kibbutz/boarding school
Welfare drinking – in 1970s
-pubs – with increased standard of living/more exposure to western world – social/non-heavy drinking. This was the point where the alcohol seeped into mainstream society, and the Israeli society started dealing w/ alcohol as a problem
-therapy was geared towards
the addict (and not his context)
Drinking culture -90
-came with the Russian immigration
to Israel. This was a alcohol culture, b/c alcohol is deep-rooted into
the Russian culture. The treatment at this period is geared t/w the
alcoholic and his family.
So there are 60,000 alcoholics
in Israel, but 270,000 alcohol victims (i.e. alcoholics and their families,
who are also hurt by the alcohol drunk by their alcoholic family-member)
Experimental alcohol treatment center – 1974 – Beit Shemesh
Based on 3 principles
new developments
1991 – privatization of alcohol treatment. There is an organization called «efshar» who took it upon themselves from the Israeli government
2001 – «efshar« took on gambling addictions treatment
2004 – «efshar«
amalgamated w/ drug treatment centers
Ambulatory services include:
-various hospitalization services
-hostels
-treatment communities
-day centers
-self-help groups
-here are some 30 community ambulatory centers in Israel – who then refer to specific hospitalizations
-those centers work as a medical
center – refer to «hospitalization» if needed
-another thing they do is lecturing
7/1/2008
Ending therapy/therapy dropout/success in therapy
Dropouts
-70% dropout rate in community (ambulatory) settings
-40% dropout rate in hospitalized
settings
-we have to take into account,
as addiction therapy, that most won't make it. so too, do we need to
work on increasing motivation especially in beginning stages, so at
least he will have something. And we need to give him enough tips so
he will have enough tools to know where to return to when he is ready.
When planning programs, we also need to take into account the high dropout
rate. So when working on treatment plans, work on giving tools to those
also bound to drop out.
Dropout reasons – 3 phases pf dropout
beginning stage dropout
Client's fault
Therapist's fault
within the therapy process: - 50% chance of dropout
client's fault
Therapist's fault
over 10 meetings – the long haul
client's fault
therapist's fault
Success in therapy
-dropout is a usually lack
of therapeutic success. But sometimes he has enough tools and so this
is a successful intervention! And most who complete therapy do not drink
– yet some do have falls
Dealing w/ the dropout
Why end the therapy when alcoholism is a chronic disease?
-we have to show the client
alternatives: AA/support groups/etc…
Reactions to the finishing of the therapy:
--
--
what is success in alcohol therapy?
Question:
Success rate:
-2 years after ending of the
file (regardless of whether he finished therapy or dropped out) = 35%
àthis
is a nice figure for addiction treatment! But we should not forget that
those are not figures but people. Also, there are fringe benefits for
those who did not succeed to become fully dry in their drinking
Question: is the cost worth it for this success rate?
Answer: this is higher
than the number of people actually buying in a given store. Also, giving
good service means people spreading by word of mouth even if they don't
buy anything. This is true too for the addiction therapy services
Exam
Has choice
-Do not only write headlines but the details!