Foundations of Addiction
This model views addiction as influenced by the person, substance, and environment.
Public health / biopsychosocial model
The fastest route of administration with highest addiction risk.
Injection (IV)
Why screening tools aim to be “over-inclusive.”
To favor sensitivity (avoid missing people)
What ambivalence means.
Feeling two ways about change
Two types of triggers.
Internal and External
Why involving family improves outcomes.
Increases support, retention, and accountability
One benefit of group therapy.
Social support / shared experience
One benefit of MOUD.
Reduces overdose risk
This approach emphasizes that continued engagement matters more than perfect abstinence.
Reframing resumed use (or engagement over perfection)
The three core features that define addiction
Repetition, loss of control, continued use despite harm
What “half-life” tells us clinically.
How long a drug stays in the body / influences addiction risk
Key difference between screening and assessment.
Screening = identify risk; Assessment = guide treatment
The most important predictor of MI effectiveness.
Empathy
What “urge surfing” means.
Riding out cravings without acting on them
One key principle of the CRAFT model.
Reinforce sobriety / don’t reinforce use
Type of group with the strongest evidence.
CBT or skills-based groups
Why MOUD is underutilized.
Stigma, access barriers
These two clinical factors are more important than whether a client returns to use.
retention and therapeutic alliance
Why the DSM moved away from “abuse vs dependence.”
Evidence showed a single continuum (not separate disorders)
Difference between pharmacokinetics and pharmacodynamics.
Body → drug vs drug → body
Why treatment should not be delayed for full assessment.
Chronic disease model / early intervention matters
What OARS stands for.
Open questions, Affirmations, Reflections, Summaries
Core idea behind addiction as a learned behavior.
Conditioning (reinforcement + cues)
Why “just wait until they’re ready” is ineffective.
Delays treatment / misses intervention opportunities
Key difference between 12-step and SMART Recovery.
Spiritual vs secular / surrender vs self-management
Why calling it “medication-assisted treatment” can be problematic.
Implies it’s secondary, increases stigma
The first step in responding to resumed use focuses on understanding the situation without judgment and monitoring your tone.
What’s Up?
A client drinks daily but has no major consequences yet. What concept explains why this still matters clinically?
Continuum of addiction / early intervention
A client drinks alcohol while taking benzodiazepines. Why is this dangerous?
Potentiation/additive CNS depression possible overdose risk
You have 10 minutes in primary care with a patient who is using substances. What is the most appropriate step?
Brief screening + brief intervention (SBIRT approach)
Client says: “I know drinking is a problem, but it’s the only way I relax.”
What should you do?
Reflect ambivalence / evoke change talk (not confront)
A client always uses after work when stressed. What’s the intervention focus?
Identify trigger + build alternative coping strategies
A partner keeps covering for a client’s missed work. What’s happening?
Reinforcing substance use (enabling)
Name one reason a client might not fit well with AA.
Preference mismatch (spirituality, abstinence, identity, etc.)
A client says “Suboxone is just replacing one drug with another.”
How do you respond?
Normalize as evidence-based treatment, reduces harm and mortality
This ethical principle is challenged when a clinician lets personal bias affect how much care or attention different clients receive.
Justice