18injuries as ‘self-inflicted’. You have also heard a member of the OT team expressing opinions suchas “I don’t know why they think they should get help from us, we are stretched enough already”.INCIDENCE AND FORMS OF ADDICTIONAlcohol misuse and addiction issues have long been considered areas of public health priority. Alcohol misuse and harmful drinking in particular have become the focus of a host of recent initiatives, policies, and public health guidelines. According to current estimates drawn from within the NHS, around 9% of men in the UK and 4% of UK women show signs of alcohol dependency (Drink Aware 2016). Investment in specialist services, however, remains low and has recently faced renewed cuts. Within mental health, rates of substance misuse can be high; many people with mental health problems can have a harmful relationshipwith alcohol or street drugs. People who have co-occurring mental health and substance misuse issues are commonly referred to having a ‘dual diagnosis’. Addiction can assume a myriad of different forms – including alcohol, drugs, tobacco, gambling, prescriptionpain-killers, food, sex or damaging or difficult interpersonal relationships etc. Some can lead to physical dependency (in addition to psychological), e.g. alcohol, heroin. Others are more closely associated with the psychological effects of an activity or behaviour – i.e. mental states which become addictive or rewarding. Such activities can be associated with the release of dopamine (i.e. the ‘pleasure chemical’) and / or adrenaline, which can become associated with thrill-seeking and risk-taking behaviour (e.g. gambling). Regardless of the specific focus of addiction, they all share similar patterns of thinking and behaving. They can also have a similar effect over a person’s life in terms of becoming increasingly consuming. Addictions / dependency upon substances can also have serious implications for physical and mental health, as well as aspects such as social functioning and relationships. (Ghodse 2010)MODELS OF ADDICTION AND ADDICTIVE BEHAVIOURVarious theoretical models continue to be applied to understanding addictions and addictive behaviour. Major examples include:Moral model - historically dominant, but still informs many people’s attitudes to addiction. Addictive behaviour is based on repeated personal choice born of immoral values.Genetic models– a strong family history appears to pre-dispose individuals to addiction, particularly if a person has grown up with a parent with addiction issues. However, this may also involve ‘learned behaviour’ and the personal ideas / relationship that one develops towards an addictive substance or activity. The exact genes involved and the ways in which these may contribute to developing addictive What are your initial impressions? Are these positive, negative or mixed? What would you like to know more about / ask Vanda about? What, initially, do you think may be of help to her?
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