Risky business: emotion,decision-making,and addiction

Although metabolic abnormalities in the orbitofrontal cortex have been observed in substance dependent individuals (SDI) for several years, very little attention was paid to the role of this brain region in addiction. However, patients with damage to the ventromedial (VM) sector of the prefrontal cortex and SDI show similar behaviors. (1) They often deny, or they are not aware, that they have a problem. (2) When faced with a choice to pursue a course of action that brings an immediate reward at the risk of incurring future negative consequences, they choose the immediate reward and ignore the future consequences. Studies of patients with bilateral lesions of the VM prefrontal cortex support the view that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. Parallel lines of study have revealed that VM cortex dysfunction is also evident in subgroups of individuals who are addicted to substances. Thus, understanding the neural mechanisms of decision-making has direct implications for understanding disorders of addiction and pathological gambling, and the switch from a controlled to uncontrolled and compulsive behavior. On the clinical front, the approach to treat addictive disorders has been dominated by a diagnostic system that focuses on behaviors, physical symptoms, or choice of drugs. The article emphasizes the concept of using neurocognitive criteria for subtyping addictive disorders. This is a significant paradigm shift with significant implications for guiding diagnosis and treatment. Using neurocognitive criteria could lead to more accurate subtyping of addictive disorders, and perhaps serve as a guide for more specific, and potentially more successful, behavioral and pharmacological interventions.     

A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction

Opioid addiction has become a U.S. epidemic. It is important to determine whether psychosocial interventions help prevent relapse. A total of 14 studies were included in this systematic review. Most studies compared psychosocial interventions in conjunction with pharmacological maintenance. Only 2 studies found that psychosocial interventions led to statistically significant benefits for outcomes related to opioid abuse when compared to maintenance and less or no psychosocial intervention. Psychosocial interventions were not found to be additive to pharmacological treatments during induction or maintenance stages. Further research is needed to determine effectiveness of psychosocial interventions during dose reduction and long-term relapse prevention.     

Preparing social workers for practice with LGBT populations affected by substance use: perceptions from students,alumni, and service providers

Trends in the field of service among those with alcohol and other drug addictions highlight the urgent need for schools of social work to effectively train students to serve clients with substance use disorders, and have cultural humility to effectively serve disproportionately affected LGBT consumers. Online surveys and interviews examined perceptions of graduate social work students and alumni in a certified alcohol and drug counselor program, along with several service providers within an urban setting in the US. Results indicated that students and alumni did not feel adequately prepared through coursework to practice with LGBT populations affected by substance use, while feeling more clinically competent to practice with LGB individuals, than with transgender consumers. Similar findings related to unique differences associated with perceptions of faculty support, along with field preparedness to practice with LGB individuals when compared to transgender individuals. Service providers noted an overall commitment and to serve LGBT consumers as well as positive perceptions of students and alumni to do the same. Implications examine the role of faculty in addressing challenges related to preparation of social work students to practice with LGBT consumers affected by substance use disorders, along with suggestions for curricular changes, and ongoing field trainings.     

A Common Struggle in Seeking Social Justice

This essay is an unconventional book review(s) that aims to integrate the messages of two books, one a personal memoir by leading U.S. mental health consumer-advocate Patrick J. Kennedy, youngest son of the late Senator Edward “Ted” Kennedy, and the other, an edited volume by two group work educators that is informed by liberation health social work.     

Health Care Reform and the Behavioral Health Workforce

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field.     

Measuring Attitudes Toward Empirically Supported Treatment in Real-World Addiction Services

Mental health workers with favorable attitudes toward empirically supported treatments (ESTs) are more likely to break through implementation barriers. The Evidence-Based Practice Attitude Scale has been shown to be reliable for mental health workers, but it has not been validated with addiction workers. This study investigates the use of the scale with a convenience sample of addiction workers from 4 agencies in 1 city. Results show that compared to mental health providers, addiction workers were more likely to view ESTs favorably if they were mandated and intuitively appealing. They also tended to rely more heavily on practical experience in forming attitudes toward treatment options. These results might help addiction agencies understand which types of workers are more likely to implement ESTs and inform effective engagement approaches specific to addiction workers.     

The role of cognitive distortion in online game addiction among Chinese adolescents

The aim of the present study was to examine the role of cognitive distortions in the development of on-line game addiction among Chinese adolescents. In Study 1, the sample comprised 495 adolescents aged 12 to 19 who recruited from two middle schools in Guangzhou, China. They were administered questionnaires relating background variables, the Internet Addiction Scale (IAS), Cognitive Distortions Scale (CDS) and Online Game Cognitive Addiction Scale (OGCAS). In Study 2, Twenty eight adolescents with excessive on-line game play recruited from a local mental hospital were randomly divided into to a CBT group (N = 14) and a clinical control group (N = 14). Measures of severity of on-line game playing, anxiety, depression, and cognitive distortions were assessed on baseline and after the 6 week intervention. Results of the present study showed that rumination and short-term thinking were the most predictors of online game addiction, and all-or-nothing thinking predict online game addiction at marginal significant levels. Males are at a greater risk of developing online game addiction than do females. CBT and basic counseling had different treatment effects on the all-or-nothing thinking scores, online comfort scores and short-term thinking scores, SDS scores and SAS scores. Interestingly, CBT and basic counseling had similar treatment effects on IAS scores and OGCAS scores. Applications of these findings to etiological research and clinical treatment programs are discussed.     

‘It wasn't a very encouraging environment’: influence of early family experiences on problem and at-risk gamblers in Victoria,Australia

Prior research suggests that at-risk and problem gamblers are more likely to have experienced early family dysfunction and exposure to gambling within the family in early childhood. However, little is known about the ways in which early childhood experiences contribute to at-risk and problem gambling in adulthood. Drawing on life history interviews with 48 participants, this article shows that the vast majority of regular gamblers in our study had been exposed to gambling as children in their family of origin. It also shows that different experiences of gambling within the early family were associated with contrasting gambling forms and risk levels in adulthood. Several at-risk and problem gamblers reported having had a parent or other family member with problematic gambling behaviour, while low-risk gamblers had experienced gambling in their early family life as purely recreational. In addition, the majority of the problem and at-risk gamblers had experienced conflicts, lack of encouragement and support, negativity, emotional distance and lack of communication in their early family life. A few also reported experiencing various forms of abuse as children. This paper shows that early exposure to problematic gambling and early family dysfunction impacted substantially on the participants' lives as adults and contributed to problem gambling.     

Incorporating Spirituality and the Strengths Perspective into Social Work Practice with Addicted Individuals

Abstract

In the last two decades, the social work profession began to confront the professional avoidance of alcoholics and other drug addicts, and discussions of spirituality. While acknowledging the importance of 12-Step Programs of Alcoholics/Narcotics Anonymous, we also acknowledge that spirituality is a major aspect of addiction and recovery from an addiction. The authors present the Strengths Perspective and apply key concepts to Steps 1-3 of the 12-Steps to increase our understanding of addiction and recovery from alcoholism and other drug addiction. The article concludes that social workers must continue to increase their understanding of the recovery and spiritual issues of alcoholics and other drug addicts.