1 / 40

Center for Integrated Behavioral Health Policy

Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center. The Importance of Alcohol Abstinence. Deterrence and Behavior Change. Eric Goplerud, Ph.D. Conference of Western Attorneys General Sun Valley, Idaho August 4, 2009.

lucien
Download Presentation

Center for Integrated Behavioral Health Policy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center The Importance of Alcohol Abstinence Deterrence and Behavior Change Eric Goplerud, Ph.D. Conference of Western Attorneys General Sun Valley, Idaho August 4, 2009

  2. Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center Transforming practice. Expanding access. Improving health.

  3. How important is abstinence?

  4. Top 10 Leading Causes of Death in the United States for 2001, by Age Group

  5. 13,000 in US die annually due to alcohol impaired driving. More than 500,000 injuries and $16 billion in property damage. • Alcohol involved in: • 33% of suicides • 57% sexual assaults • 28.5% domestic • violence cases • 44% PMV accidents

  6. What are we trying to accomplish? • Deterrence? • Behavior change? • Punishment? • Prevention?

  7. State Power • Restrict movement • Restrict pleasurable activities • Require payment of fines and fees

  8. Thinking About Deterrence • Threat of punishment deters bad behavior • Rationality • Cause and effect • Perception of fairness • Risk of detection

  9. Thinking About Addiction • Compulsion • Ignore negative consequences • Denial

  10. Impact of heavy, long term alcohol use on the brain

  11. Cognitive Impairment and Abstinence

  12. A Problematic Pattern • Focus on deterrence • Limited assessment • Same intervention for everyone • Limited treatment • Ineffective treatments

  13. What we don’t do that’s effective! SBI, CBT, Medications

  14. What do we really do? What doesn’t work! AA, Counseling, Educational Lectures

  15. Cognitive Behavioral Model • Social learning • Rewards and costs • Stages of change

  16. Coping • Self-efficacy • Reduced risk • Trigger • Lapse • Relapse Preventing Relapse

  17. Deterrence & Addiction A pathway to prison -- or worse.

  18. Two Models • Deterrence • Detention • Fines • Cognitive Behavioral • Coaching • Therapy

  19. (Gentillelo, 2008)

  20. (Gentillelo, 2008)

  21. (Gentillelo, 2008)

  22. (Gentillelo, 2008)

  23. Irrational Rational Spectrum of Offenders Susceptible to deterrence Resistant to deterrence

  24. Reason for Plateau Population affected by deterrence Population resistant to deterrence

  25. 70% (87.5 million) No Problem Never exceed daily limits. 5% (6.25 million) Harmful Use Exceed daily limits. Related problems. 3% (3.75 million) Dependence Daily or near-daily heavy drinking. Related problems. Withdrawal. 1% (1.25 million) Chronic Dependence Almost daily heavy drinking. Related problems. Withdrawal. Chronic or relapsing. 21% (26.25 million) At Risk Exceed daily limits. 5% Harmful Use Spectrum of Alcohol Problems Willenbring, 2007

  26. The Need for Abstinence • Not always necessary • Short-term vs. Long-term • Support for behavior change • Effective part of relapse prevention

  27. Effective Response to Alcohol-related Crime

  28. Deterrence & Prevention • Social marketing • Regulation • Enforcement

  29. Screening & Assessment • Golden opportunity to identify problems • Screen • Assess • Determine appropriate intervention

  30. Recovery Support • Individual and group therapy • Medical monitoring and medication • Technology as part of relapse prevention • Interlock • Testing • Remote alcohol monitoring

  31. https://webmeeting.nih.gov/intro

  32. Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center Eric Goplerud Director 2021 K St. NW, Suite 800 Washington, DC goplerud@gwu.edu integratedbehavioralhealth .org

More Related