LCSW Study Notes

• Stage 1 Romance 
• Stage 2 Power struggle 
• Stage 3 Stability 
• Stage 4 Commitment 
• Stage 5 Co-Creation

• common interest, attached to one another. 
• consists of conversations and dates ti learn more about other partner. Focus is attachment - filled with passion, nurturing and selfless attention to the needs of others. Romantic bound is the foundation that is critical to the health of the relationship in the future. Symbiotic orMutualistic relationships - often putting the needs of others before their own.

couples see their differences; these unique qualities ...require ongoing process of defining oneself and managing conflict which threatens intimacy. begin to notice differences and annoyances that were once overlooked. Critical effort needed balance desire for self-discovery w/ desire for intimacy. 

To survive - acknowledge difference, learn to share power, forfeit fantasies of complete harmony, and accept partners w/o the need to change them. 

Differentiation or seeing oneself as distinct within a relationship, must be managed to avoid break-up

• Characterized by redirection of personal attention, time and activities away from partners and towards one's self. 
• Focus on personal need in a respectful manner. 
• Autonomy and Individuality are Key 
• Relationship more mature and disagreements occur with both party winning. 
• "Practicing" a sub-phase of separation-individuation in infant development. - begin to explore on their, but sill see themselves as part of their mothers/caregivers. this mirrored as partners learn to live independent lives while still identifying as and seeing the being part of intimate relationship. 
• Another sub-phrase "rapprochement" - times when crises threaten individual identities or separateness. -

Ultimate goal is intimacy that does not sacrifice separateness.

When image is ideal however it often occurs earlier in the romance stage, perhaps explaining high rate of divorce cased by inability to resolve power struggles. Having stablized they are able to embrace the realitity that each person is human, resulting in shortcomings in all relationships. acknowledge that they want to be with each other, the good outweights the bad. much work done, but much work still needed to effectively function in the next and last stage of couplehood.

• Constancy is the hallmark. 
• Couples are able to value and respect the separateness of the other. foundation of relationship no longer a personal need, but the appreciation and love of the other and the support and respect for mutual growth. 

couples are aim to create or nurture things that are enduring - work on projects together, such a businesses, charities and or families. create positive changes to benefit others, leading to feelings of usefulness and accomplishment

• 1. Family (use of substances, dysfunction, trauma)
• 2. Social (peer use, cultural norms
• 3. Psychiatric (Depression etc..
• 4. Behavior (impulsive, risk taking, childhood aggression)

• 1. Bio-psycho-social Model 
• 2. Medical Model 
• 3. Self-Medication Model 
• 4. Family Environmental Model 
• 5. Social Model

Provides the most comprehensive explanation. It incorporates hereditary predisposition, emotional problems, psychological problems, social  influences and environmental problems

• Addiction is considered chronic, progress, relapsing and potentially fatal medical disease 
• 1. Genetic causes - inherited vulnerability 
• 2. Brain reward mechanisms - produce pleasurable feelings 
• 3.Altered brain chemistry - change in brain chemistry from use require continued use to deal with discomfort from imbalance

substances relieve symptoms of a psychiatric disorder and continued use is reinforced by relief of symptoms

Behaviors shaped by family and peers, personality factors, physical and sexual abuse, disorganized communities and school factors

Learned and reinforced from others who serve as role models. user and potential user. Share the same values and activities; racism, poverty, sexism and so on, contribute to the cause.

• On a continuum from mild to severe. 
• 2-3 Mild 
• 4-5 Moderate 
• 6+ severe
•  
• Each specific substance is diagnosed as substance disorder (i.e., alcohol use disorder, stimulant use disorder

• 1. taking larger amount or longer than you meant 
• 2. wanting to cut down or use, but can't mange to
• 3. spend a lot o time getting, using, or recovering from use 
• 4. craving and urges to use the substance 
• 5. Not managing to do what you should at work, home or school b/c of substance use. 
• 6. continuing t use, even when it causes problems in relationships
• 7. Giving up important social, occupational or recreational activities b/c of substance use. 
• 8. Using substance again and again even when it puts you in danger
• 9. Continuing use, even he you know you have a physical or psychological program that could have been caused or made worse by the substance 
• 10 Needing more of the substance to get effect you want (tolerance)
• 11. Development of withdrawal symptoms, which cam be relieved by taking more of the substance.

• 1. Abstinence from substances 
• 2. Maximizing life functioning 
• 3. Preventing or reducing the frequency and severity of relapse

Programs, policy, or interventions that seeks to reduce or minimize the adverse health and social consequences associated with substance use without requiring a client to discontinue use.

• 1. Stabilization (1. establishing abstinence, 2. accepting the problem, committing to change)
• 2. Rehabilitation/Habilitation (focus on remaining substance free - establishing stable lifestyle, gaining coping and living skills, support an grieve loss of substance use
• 3. Maintenance -remaining substance free, developing coping and living skills, increasing supports and grieving loss of substance use.

• Interfering with symptoms associated with use.
• Example:
• Methadone - used as detox from opiates or as a daily substitute for heroin 
• Antabuse - as an aversion therapy for alcoholic. It produces flushing, nausea, vomiting hypotension and anxiety
• Naltrexone - used to reduce cravings for alcohol; also blocks the effects of opioids

• Modify manipulative feelings, attitudes, and behaviors through individual, group, marital or family therapy.
• Example the roles adopted by the family in which substance abuse occur. 
• "Family Hero, scapegoat, lost child, mascot - alleviates pain by joking around

Ameliorate or extinguish undesirable behaviors and encourage desired ones through behavior modification

• AA or NA
• Provide mutual support and encouragement while becoming abstinent or in remaining abstinent. 12 step groups are utilized throughout all phase of treatment. 
• Recovering person can attend indefinitely as means of maintaining sobriety.

Delirium Termens (DTs) - alcohol w/d that includes hallucinations, rapid respiration, temperature abnormalities and body tremors

Cocaine - dilated pupils, hyperactivity, restlessness, perspiration, anxiety and impaired judgment

Wernicke's encephalopathy and Korsakoff's syndrome - disordered associated with chronic abuse of alcohol  caused by thiamine (Vitamin B1) Deficiency resulting in memory issues/mental confusion

Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss

Dilated pupils, hyperactivity; euphoria, irrititability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and noise

contracted puils; no response of puils to light; needle marks; sleeping at unusual times; sweating vomiting; coughing, sniffling; twitching; loss of appetite

Occurs when a partner/spouse or members of the family, out of love or fear of consequences, inadvertently enables a client to continue using substances by covering up, supplying money, or denying there is a problem

The Patient Self-Determination Act - concerned with implementing advance directive (living wills/health care proxy)  policies across an array of healthcare environments. 

Health Insurance Portability and Accountability Act (HIPPA) -1996 Federal law that restricts access to individuals' private medical intoformation 

Americans with disabilities Act (ADA) - main Fed Law protecting the disabled from discrimination...

The patient Protection and Affordable Care Act (PPACA-Obamacare) Makes provisions that require most individuals to secure health insurance or pay fines, made coverage easier and less costly to obtain and cracked down on abusive insurance practices.

Authority Complex - individual has repressed concepts of authority in which they satisfy by projecting power on certain individuals

Oedipus complex i when a young child develops an erotic interest and attachment for the parent of the opposite sex and and feelings of rivalry for the parent of the same sex. 

Electra complex - when a young female child develops an unconscious sexual attraction to her father. 

Interior complex - when an individual acquires persistent feelings of inadequacy.

• 1. Formative evaluation - such as needs assessment, is a practice evaluation done while services are still underway 
• 2. Summative practice evaluation is completed after service delivery is completed.
• examples of summative eval: 
• 1. cost benefit analysis
• 2. an impact evaluation 
• 3. effectiveness survey