Diseases, Disorders information

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So there are treatment approaches to deal with all of these and patients have different contributions of these. So the patient who goes for pleasure really needs their motivation enhanced but the person who is reinforced because of withdrawal like many IV heroin addicts I see they need an adequate duration of detox in addition to these other things, otherwise they’re sitting ducks for relapse.
Where there is a habit conditioned to positive or pleasure reinforcement, we need an intervention that takes away the pleasure of getting high or the associated pleasure and the cues. For instance, maybe somebody shouldn’t pick up their paycheck and cash it themselves. Maybe the spouse should cash the paycheck because the role of money starts to remind them of having a straw and having a straw starts to feel good and makes them fidgety and it’s very hard to resist that once the dopamine is starting to fly.
The genetic model. Here’s the genetic model in action. This bartender’s saying to this guy, “Your mom wants to buy you a drink.” I also like this because it typifies the isolation in addicted families but maybe I’m reading too much into it. Well, when we do and the one point you should take a look at in the outline is the genetic model is not just a model. Canadian pharmacy viagra 100 mg. There’s proof of it. In alcoholism it is quite strong. At least 50% of the vulnerability to becoming alcoholic is genetically transmitted and there are now good laboratory models in rats that have been recombinantly inbred, even genes being identified that support this. So it’s quite true and it’s important to teach patients about it because it helps them accept that the disease truly is a disease and not a moral weakness.
So there are these models. Take a look at the social model in the outline but what do we do with all that? Well we have to deliver some form of treatment and at the bottom of page 280 you’ll see this list of stages of change. Now, I assume many people have heard of the stages of change. How many people have heard of at least the idea of stages of change? Good. This is really taking hold not just in the world of addiction treatment but in psychotherapy in preventive medicine. It’s having a lot of benefit because it teaches us that it’s not just that somebody’s motivated to change or unmotivated, they’re in a process. It’s a transition from “I don’t even think I have a problem” to “I have a problem, I don’t know what I should do.” “I know what I should do but I need to get going on it. I’m doing what I need to do.” “I did it. I think of it once in awhile and I need to be careful.” Then perhaps relapse. Canadian cialis online.
So stages of change please be familiar with the terminology. Precontemplation. It’s exactly what it says. Before the patient is even thinking about it and the goal of the therapist is to say, “Did you ever think five years ago that this is where you’d be today?” That’s a very upsetting question to a heroin addict with cellulitis, hospitalized with diabetes in their arms and the patient that night, hopefully after a consultation, will sit with that and be upset as they lie on their pillow and the next day as you come back for followup they’ll be thinking, “Gee, that really bugged me when that guy said that to me. Things aren’t really going well for me at all.”
Now the patient’s in contemplation. Thinking about it but doesn’t know what to do or if he can even do something about it and we have to promote a concept that yes you can change. There is something called self efficacy that can be enhanced especially with support so we say to the patient, “Well, where do you want to be five years from now? “What would you like to be in your life? I realize you’re worried you’re going to lose your house. Your kids aren’t in your custody but what do you wish could be?” Then you say, “Well, what supports have you ever used to try and achieve that goal of five years and let’s talk about what you could have at your disposal.” At that point the patient will have some determination or preparation to act and we have to think, well, what’s the best action. So that’s where treatment planning comes in and we’re going to talk about that in the next slide.