Lesson 1: Introduction to the Course Attention Personality tests allow us to develop an understanding of ourselves that we can apply to our personal and work lives. This test is based upon one of the most famous personality tests, the Myers-Briggs Typology. Take this test prior to starting this Lesson, you will apply the results in this Lesson. Click here to take the Jung Typology Test! Learning Outcomes Upon completion of this lesson's material, students will be able
Teaching
This class will have fifteen content sections. Each content section will have learning objectives, instructional materials and evaluative activities including Discussions, Tests and Assignments. There will be a final Special Assignment. Final grade will be a summation of points earned on all evaluative activities. Each evaluative activity will have different due dates and the student is responsible for submitting work by the due date. Multidimensional Nature of Substance Use Substance use becomes a concern when it causes distress and/or dysfunction (DSM V, p. 20: "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above.") If substance use is NOT causing distress or dysfunction (potential or current) it is not a concern for us as helpers. Examples of use that is not a concern is the normal recreational use of alcohol or marijuana in States where it has been legalized. But even such use may eventually cause problems with anxiety, depression, impaired driving, missing work, family conflict. One thing that we do as professionals is to assess whether substance use is within non-problematic boundaries or whether it has progressed to a problem level. When does Substance Use become a concern? Substance use usually must be heavy and prolonged to cause problems. This is because substance use disorders are brain disorders resulting from changes that take place in the brain due to the chemical effects of substances on the brain. The first change that takes place is to change how the person is functioning here and now. This happens even with a single use of the chemical and is one of the reasons people use substances. For example, a single drink of alcohol causes disinhibition so that a person is more sociable and less reserved (this is caused by changes in the frontal lobe of the brain). Most people like this effect and that’s why alcohol is used at parties. But sometimes this disinhibition causes problems (saying something you shouldn’t) and the person may learn to be more careful with their drinking. At a higher level of substance use, we may see cognitive and emotional changes that also result in problems. For example, a person who drinks and drives and is stopped by police because of impairment. Or a person who smokes a lot of marijuana and starts to have memory problems. Or a person who becomes depressed or anxious or angry due to substance use and starts to have problems in relationships or daily function. In these cases also, the person may spontaneously decide to change. Friends and relatives may encourage change and be heeded. We are not yet talking about addiction. At a higher level of use there is an alteration of brain sensitivity to the chemical so that it takes more to achieve the same effect. This is called tolerance. After this change, the brain may begin to be unable to function normally without the substance and the person may experience extreme distress if deprived of the substance. This is called withdrawal. When these changes take place, we are in the realm of addiction where the person loses control of his or her behavior. It becomes harder and harder to make changes even when the person knows they should and wants to. Most people who have been daily cigarette smokers know how this works and that’s why tobacco is considered to be so addictive. The sad fact is that without medical help, most people can’t quit at this point and even with help it may not work well without repeated episodes of treatment. With cigarettes, almost half of daily smokers are unable to quit even though they want to quit and try to quit multiple times. In fact, the average number of quit attempts before a smoker succeeds is seven. Scientists believe that some brains are genetically programmed to be susceptible to the effects of substances. And that without this genetic predisposition, the development of addiction is unlikely. But there probably still are cases where simply using too much of the substance can cause the brain changes that result in problems. However, we will come to discover as we study the various problems that people have with substances and the underlying brain physiology that the likelihood of people using too much of a substance is also mostly determined by genes. Once problems have developed in the brain, stopping use of the substance becomes very difficult and the changes in the brain make relapse probable even though the person is motivated to stop. All of this calls into question the frequent belief that all addicts need is to use their will power and that they don’t do that because they are still enjoying their substances. They may indeed feel that they can’t live without the substance but usually any real enjoyment is only a dim memory of the distant past. When are human problems not psychiatric disorders? An expectable or culturally approved response to a common stressor or loss, such as grief over the death of a loved one, is not a mental disorder. Such grief may become a mental disorder if it is too severe or too prolonged. Values Associated with this Work Understanding and helping people who are having problems in living presumes a compassionate, non-judgmental willingness to learn. This is especially true for substance related problems which tend to evoke judgement and condemnation because of their frequent association with socially unacceptable behavior. We have to make the distinction between addiction --- which is a medical problem, a brain disease--- and the behavior which addicted people may engage in. Because their brains are impaired and they are driven by the need to keep the addictive chemical flowing, people who are addicted may be impulsive and show poor judgement and irresponsibility. They may engage in illegal or immoral behavior. But once the underlying disease is medically managed and the person begins to recover, the problem behavior will stop. So the basic issue is not a criminal justice or moral matter but a public health concern calling for education, prevention and treatment. With these public health initiatives, the blight of addiction will disappear from our society just as malaria and yellow fever disappeared with the drying up of the swamps that harbored mosquitoes and the development of appropriate treatments. As we will see, when we study Opiate Use Disorder, simply substituting a safer, more long-acting opiate may result in significantly lower levels of distress and dysfunction so that the addict is able to resume normal life activities. But eventually, we may be able to make genetic changes in embryos and even in adults that will end the addictive cycle in the brain.
Click HERE for an explanation of Carl Rogers' concepts of "Empathy, Unconditional Positive Regard, and Congruence"
Click HERE to watch this video directly on YouTube These characteristics can also be summarized as faith, hope and love or the development of mutual trust, expecting and working for the best and putting the other person first Models of Helping There are different models of helping. The "expert" knows best and the helpee is wise to follow their orders (e.g. doctors and lawyers). Here is what the State of Maine will consider you competent to do as an MHRT/C What are your strengths and areas of needed growth for helping? Personality tests, such as the Typology test you took in the Attention section of this Lesson, help you to identify your own personal preferences, strengths, and needs. Additionally, you would also consider experiences you have had and what those experiences have taught you. Your strengths and needs What are your strengths and areas of needed growth for helping? A strength that you want in order to help people with substance issues is the ability to see the world through the eyes of the person you are helping. This takes practice and careful listening and the ability to lay our prejudices aside even when we consider them justified by our life experiences. Remember, it is not your life experience but that of the person you are helping which is primary. Your experiences may get in the way of hearing and understanding the other person and only become helpful when the other person has been thoroughly heard and valued. Another strength for this kind of work is keeping an open mind to learn new things. In order to treat substance use disorders, you will need to keep on learning the rest of your life. Every day, we are gaining new knowledge that is opening doors to recovery You are continually developing as a helper from novice to skilled. Most of you are just beginning and that is good because you can open your hearts and minds to continual growth. Supervision In this regard, you need someone who understands the work that you are attempting to do and who also understands you and your level of skill. This person, as your supervisor, can help you do your best work. He or she can oversee your growth from beginner to master helper.
Assessment Lesson 1 Quiz Taking into consideration the results of your Typology test (see the Attention section) and experiences you have had in the past five years, consider what it takes to help a person with substance use issues and also what strengths and areas of needed growth you have and what you expect to do as an MHRT/C to help with these issues. Answer the following question with a paragraph for each:
Lesson 1 Discussion According to the DSM, some behaviors do not meet the criteria of "Mental Disorder” because they are considered an "expectable or culturally approved response" or a “socially deviant behavior” (see the Lesson for a discussion of what “social deviance” means) that does not occur because of an underlying psychiatric dysfunction. Describe an example of the use of a substance that would fit into one of these categories and thus would not be considered a psychiatric problem. Explain why the culturally approved or socially deviant substance use is not a substance use disorder and does not require treatment. When would such use cross the boundary and actually become a substance use disorder?
For full credit on the graded discussions you have to post ONE response to the discussion prompt in the lesson and reply to at least TWO others' posts...this is a total of THREE posts, minimum. You are, of course, encouraged to participate much more. These instructions apply to all graded discussions, they will not be repeated.
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