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Integrated Alcohol and other Drug
Assessment and Intervention (IAODAI) Program
Voluntary AOD services are provided by the IAODAI Program, which includes substance abuse and personality assessment and brief and long term individual and group counseling. The program goal is to help students identify and process risks related to alcohol and other drug use as well as coexisting problems related to emotional and behavioral issues. Low risk choices are identified and a plan of action is developed with the student to help that student make the environmental and personal changes necessary to consistently make low-risk decisions. Students who are in the IAODAI program are managed in AOD Treatment Team. The AOD Treatment Team is multidisciplinary, comprising UHC physicians, a psychiatrist, CAPS and HP substance abuse specialists. It meets weekly.
IAODAI model of Substance Abuse Treatment:
Evidence Based Approaches to Substance Abuse Assessment and Treatment
No one starts drinking in order to become an alcoholic, to develop cirrhosis, to beat his wife or to crash the car. So there is a long-term change in the individual that is not under volitional control. The nature of this change is a major subject of our genetics and neuroscience research. Individual episodes of drinking are not devoid of some voluntary component, but the totality of the behavior overtime is subject to a profound pathological control mechanism. . These issues will become increasingly difficult because as neuroscience explains more and more of brain mechanism of cognition, appetite and decision-making, the roles volition, free will, and responsibility will be harder to define. -- Enoch Gordis, 2002
Although most of the population consumes alcohol in moderation and safely, alcohol has been a problem for some drinkers. Numerous epidemiology studies indicate that alcohol use disorder is a disorder that afflicts between six and ten percent of the population (Nathan, 1990; Institute of Medicine, 1987; Grant et al., 1996). Among the ten percent who are suspected to have problem with alcohol, approximately six percent meet the criteria for alcohol dependence, and four percent meet the criteria for alcohol abuse (Institute of Medicine, 1989). According to this conservative estimate, there are more than 15 million individuals that meet the criteria for alcohol dependence in this country currently. The effect of alcohol use disorder on the individual, the family and the society at large is enormous, and the destructive course of this disorder is evident from the physical, familial, occupational, social and legal difficulties of the individual with this disorder (Butcher, 1988).
Alcohol plays a significant role in ten percent of all deaths and it plays a major role in at least four of the most common causes of death, especially for men between twenty and forty years old (Valiant, 1983; Moss et al., 1990). Among young people between the ages of 15 and 24, alcohol is the leading cause of death because of accidents (Moss et al., 1990). Ross (1992), citing NIAA research, states that "half of all traffic fatalities, 64 percent of all homicides, 70 percent of suicides, 40 percent of fatal accidents in industry, 50 percent of fatal falls, 85 percent of adult drowning victims, and 83 percent of fire fatalities are alcohol related" (p. 10).
According to the United States Department of Health and Human Services (USDHHS), the etiology of alcohol use disorder is multidetermined, and factors contributing to the vulnerability of alcoholism include genetics, neurochemical, neurophysiological, psychological, sociocultural, and economics (USDHHS, 1993). The IAODAI program views alcohol use disorder from a Bio-Psycho-Social model. Here is some evidence for this model: The role of genetics in the development of alcohol use disorder was dismissed in 1930 and 1940 during the heyday of Behaviorism, but regained its rightful place in 1950 (Cook & Gurling, 2001). In the last half century cumulative evidence from animal studies, molecular genetics, human studies of twins and adoption, and animal studies suggests that at least one form of alcoholism (type II) has a significant genetic basis (Blum et al., 1990; Cloninger et al., 1981; Cook & Gurling, 2001; Goodwin, 1976, 1979; Petrakis, 1985). Alcohol use disorder is partly a polygenetic disease, which are several genes contributing to the development of alcoholism, explaining between 40% and 60% of alcohol dependence for the type II alcoholism.
The research also identifies personality and temperamental vulnerabilities to alcohol use disorder. They include, childhood conduct disorder, antisocial behavior as an adolescent and as an adult, difficult temperament that includes high activity level, low cognitive flexibility and task orientation, mood instability, and social withdrawal, as well as behavioral undercontrol reflecting impulsivity, aggressivity, acting out, and sensation seeking. In addition high on novelty seeking and low harm avoidance are associated with the severe form of alcoholism, the type II alcoholism. The research on temperament was also able to link genetics and personality traits, by highlighting how a single gene could play part in creating vulnerabilities in more than one area of risk factor, including personality, temperament, and neurophysiological factors.
Some of the social aspect of alcohol use disorder identified by the "social control" theory proposed by Petraitis (1995) focus on the experience of early development especially acceptance or strong attachment with family, and a positive social and educational experience in school and around the community as protective factors, lessening the risk of development of later alcoholism. These protective factors prevent the adolescent from engaging in deviant behaviors and associating with deviant peer groups that are risk factors in the development of alcoholism.
The model of assessment and treatment at CAPS recognizes the multidimensional nature of alcohol use disorder. As a result we put a strong emphasis in using empirically validated assessment instruments in identifying the nature of alcohol use, personality factors that exacerbate alcohol use, comorbidity issues with other Axis I or Axis II diagnosis that complicate the person's ability to respond to education and treatment, and social factors that may be either protective or risky. The process of feedback on the outcome of testing has a strong educational component, and given adequate information, students are capable of complying with a short term treatment that could allow them to reduce alcohol and other drug consumption and reduce high risk behavior. Additional treatment possibilities are also available in other facilities in the community for those students that have developed a full-blown substance use disorder.
One of the recent advances in the treatment of alcoholism is the conceptualization of alcoholism and recovery in Piagetian style dynamic developmental stages (Ross, 1992). In this context, the course of alcoholism is predictable, as a progressive disorder with recognizable and diagnosable alcohol-based symptomotology (Brown, 1985; Downing, 1989; Edwards, 1982; Gorski & Miller, 1986; Vaillant, 1983). Recovery in the context of developmental theory has distinct stages with "sobriety-based" symptoms (Ross, 1992). A thorough assessment will identify the possible stage of the disorder in which the student currently operates, and tailor the feedback and treatment planning according to testing data and students' motivation and openness to suggestions.
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