See Also
1. Chemical Dependency
2. Substance Abuse Evaluation
Step 1: Child of Substance Abuser (e.g. Alcoholic)
1. Childhood rejection by Alcoholic parent
2. Maladaptive Family response
  1. Co-dependent spouse overprotects child
  2. Child given premature responsibility
3. Excessive Dependent Needs develop in child
4. Rejection triggers worsening of above
5. Anxiety reaction results in:
  1. Denial or
  2. Reactive grandiosity
    1. "I don't need anyone"
    2. False sense of well being
Step 2: Children of Alcoholics become Alcoholics
1. Adaptive mechanisms fail
  1. Anger
  2. Depression
  3. Anxiety
  4. Guilt
2. Genetic Predisposition to Alcoholism
3. Permissive environment for drinking (e.g. Military)
Step 3: Substance Abusers
1. Obsessive Thought
  1. Patient becomes more and more self centered
  2. Relationships become less important
  3. Patient becomes alienated from self
    1. Avoid guilt by avoiding self awareness
2. Compulsive Behavior
  1. All work is centered at feeding addiction
Step 3: Substance Abuse Phases
1. Contact with Substance
  1. Socially introduced
  2. Mind altering effect
    1. "The hook of addiction"
    2. Provides some benefit or relief
2. Prodromal
3. Acute Substance Abuse
4. Chronic Substance Abuse
Step 4: Recovery
1. Abstain from substance
2. Attain serenity (12 step AA program)
  1. Spirituality
  2. Rebuild relationships
Step 5: Relapse
1. Craving
  1. Similar to waves (wax and wane)
  2. Craving goes away if not responded to
2. Maladaptive decision making
  1. Self Efficacy
    1. Comfort with high risk situations
  2. Outcome Expectation
    1. What will come of reusing substance
  3. Response to Trigger or environmental cues
    1. Prior associations with substance use
      1. Paycheck
      2. Sexual partner

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.