Upgrade to remove ads
Drug and Behavior: Treatment
Terms in this set (32)
PRINCIPLES OF EFFECTIVE TREATMENT (NIDA, 2012)
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual
- Remaining in treatment for an adequate period of time is critical.
- Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
PRINCIPLES OF EFFECTIVE TREATMENT (cont.)
- An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
-Many drug-addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
- Treatment programs should test patients for the presence of infectious diseases.
Why do drug-addicted individuals keep using drugs?
Long-term drug use results in changes in brain function that can persist long after the individual stops using drugs.
These changes decrease ability to exert control over the impulse to use drugs despite adverse consequences—the defining characteristic of addiction.
Stress, interpersonal problems, mental and medical issues, and social and environmental cues can trigger cravings and make relapse more likely.
Is drug addiction treatment worth its cost?
- US annual costs of $600 billion for substance abuse
- Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself.
- Treatment is much less expensive than its alternatives, such as incarcerating addicted persons.
- Estimated $4-$7 return in reduced drug-related crime, criminal justice costs, and theft for every $1 invested in treatment
How long does drug addiction treatment usually last?
Good outcomes are contingent on adequate treatment length
participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes.
For methadone maintenance, 12 months is considered the minimum -some need longer
What helps people stay in treatment?
Factors related to the individual:
- Motivation to change drug-using behavior
- Degree of support from family and friends
- Pressure from criminal justice system, child protection services, employers, family
Factors related to the treatment:
- Therapeutic relationship
- Cooperative approach to developing the treatment plan
- Ensuring that the program is followed
- Making treatment expectations explicit
- Availability of medical, psychiatric, and social services
"Treatment gap" - in 2011, 21.6 million people aged 12+ required treatment; only 2.3 million received treatment at a specialty substance abuse facility
Multipronged approach to reduce the treatment gap
- Increasing access to effective treatment
- Achieving insurance parity
- Reducing stigma
- Raising awareness of the value of addiction treatment
- Increased use of screening, brief intervention, and referral to treatment (SBIRT) tools in primary care settings
- Shown to be effective against alcohol and tobacco use
How can the workplace place a role in treatment?
Employee Assistance Programs (EAPS) - short-term counseling and/or assistance linking employees to local treatment resources (e.g., peer support/recovery groups)
- Therapeutic work environments - drug-abusing individuals are required to demonstrate abstinence
* Need for urine testing facilities, trained personnel, and workplace monitors
* Johns Hopkins University
What is the role of the criminal justice system?
- ½ of State and Federal prisoners abuse or are addicted to drugs; few receive treatment
- Combining prison- and community-based treatment for addicted offenders reduces the risk of both recidivism to drug-related criminal behavior and relapse to drug use
- Individuals who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily.
- Mandated treatment for some offenders under community supervision as a stipulation and alternative to incarceration
Prescription drug addiction
Includes opioid pain relievers, stimulants used to treat ADHD, and benzodiazepines to treat anxiety or sleep disorders
2010 - approx. 2.4 million people 12+ met criteria for abuse of or dependence on prescription drugs
2nd most common illicit drug use after marijuana
Physicians should screen patients for prior or current substance abuse problems and assess their family history of substance abuse or addiction before prescribing psychoactive medications
Physical dependence versus addiction
Addiction, Drug Use Disorder - characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and sometimes tolerance and withdrawal
Physical dependence - includes tolerance and withdrawal; does not by itself constitute addiction but often accompanies addiction
Role of 12-step and self-help programs
Self-help groups can complement and extend the effects of professional treatment.
Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA) - based on the 12-step model
Can be helpful during recovery, offering an added layer of community-level social support
Role of exercise in treatment
Exercise combined with CBT has been shown to be effective at helping people quit smoking
Exercise addresses psychosocial and physiological needs that nicotine replacement alone does not, by reducing negative feelings and stress, and by helping prevent weight gain following cessation.
Sud treatment reduces spread of infectious diseases
Drug abuse treatment is HIV and HCV prevention
Injection drug users who do not enter treatment are up to 6X more likely to become infected with
HIV than those who enter and remain in treatment.
Reduces activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity
Counseling that targets a range of HIV/HCV risk behaviors
Opportunities for HIV screening and referral to early HIV treatment
- Opioid - methadone, buprenorphine, naltrexone
- Tobacco - NRTs, bupripion, varenicline
- Alcohol - naltrexone, acamprosate, disulfiram,
- CBT/Relapse Prevention
- Contingency management
- Community Reinforcement Approach plus vouchers
Motivational Enhancement Therapy
-The Matrix Model
-12-step Facilitation Therapy/AA
-Family Behavior Therapy
-All pharmacological approaches are more effective when combined with behavioral treatment
- Heroin/opioids methadone, buprenorphine, naltrexone
- Nicotine/smoking nicotine replacement products (patches, gym, lozenges, nasal spray); oral medications -varenicline (Chantix) and bupropion (Wellbutrin)
- Alcohol disulfiram, acamprosate, and naltrexone
Cocaine/ stimulants none
- Marijuana none
- Medications for co-occurring mental disorders (e.g., depression, anxiety disorders, bipolar disorder, or schizophrenia)
Mechanisms by which medication can work
-Agonist drugs (simulate effects, reinforcing)
-Antagonist drugs (block effects, reduce reinforcement)
-Reducing craving/reduce withdrawal
-Make the drug aversive
-Method to prevent relapse when treating problem drinking, and later it was adapted for all drugs.
-Maladaptive behavior patterns (not disease).
Skills based, lifestyle based
-Anticipating high risk situations and enhancing patients' self-control/delay of gratification by helping them develop cognitive and behavioral coping strategies.
-Explore positive and negative consequences of continued drug use,
-Self-monitoring drug use and cravings
-Coping with cravings and avoiding those high-risk situations.
-Lifestyle changes, exercise, social support, mindfulness
Common mind games
-I just have one as a test of my personal control
-I'll just have one to see if I still like to drink
-I will just have one and then never drink again
-I'll just have one to see if I still like it
Apparently Irrelevant Decisions"Set ups"
- Go visit an old drinking buddy because all of a sudden you really miss hearing his war stories
- Pick a fight with a spouse
- You have two ways to get home-take the path that passes by your favorite bar
Abstinence violation effect
-Negative cognitive, emotional and behavioral reactions to a slip (lapse)
-All or nothing thinking
-Increases risk of future use
-Based on operant condition (reinforcement)
-Voucher Based Approach
* Patients receive vouchers for verified abstinence (clean urine samples)
*The value of the vouchers increases with consecutive verified abstinence
*"Reset" if patient lapses
*Patients may exchange vouchers for retail goods
*Encourages attendance and improves outcomes
-Chance based approach
*Earn chances to win prizes, fishbowl technique
Community Reinforcement Approach
- 24-week outpatient therapy
- recreational, familial, social, and vocational reinforcers, along with material incentives, to make a nondrug-using lifestyle more rewarding than substance use.
- Patients attend individual counseling sessions each week, where they focus on improving family relations, learn a variety of skills to minimize drug use, receive vocational counseling, and develop new recreational activities and social networks.
- Submit urine samples two or three times each week and receive vouchers for drug free samples.
- As in VBR, the value of the vouchers increases with consecutive clean samples, and the vouchers may be exchanged for retail goods that are consistent with a drugfree lifestyle.
Motivational ENHANCEMENT THERAPY (MET)
MI is directive client centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence
Motivation to change comes from the client (not persuasion or confrontation)
Help client resolve ambivalence
Counseling style is empathic, quiet and eliciting
*Therapeutic relationship is a partnership
Focuses on self-efficacy
* and resistance caused by environmental conditions not as personality traits ("roll with resistance")
MET- Counseling strategies
-Review a typical day-how does substance abuse fit into a person's life.
-Looking back: what was life like before substance use problems began.
-Good things about substance use and "not so good things"
- Alcoholics anonymous
- Narcotics anonymous
- Cocaine anonymous
- Gamblers anonymous
- Overeaters anonymous
Founded in 1935
Dr. Bob Smith
Today -most widely sought form of help for those with alcohol problems in the USA
More than 2 million members worldwide
- Drinking is not a moral problem
- Alcoholics have an "allergy to alcohol"
- Progressive disease, no cure except sobriety
- Spiritual disease
- Personality change
12 step programs—Key ideas
- (1) acceptance, realization that drug addiction is a chronic, progressive disease over which one has no control, that life has become unmanageable because of drugs, that willpower alone won't work and that abstinence is the only alternative;
- (2) surrender, which involves giving oneself over to a higher power, accepting the fellowship and support structure of other recovering addicted individuals, and following the recovery activities laid out by the 12-step program; and
- (3) active involvement in 12-step meetings and related activities, work the program.
Typical individual program of recovery
- Frequent attendance (90 in 90)
- Complete abstinence
- Working the steps
- Asking Higher Power for strength and guidance.
- Daily prayer and/or meditation
- Service work
- Avoid people places and things
- One drink, one drunk
- My worst day sober was better than my best day drunk
- HALT: Don't get too hungry, angry, lonely, tired
- Hitting bottom
- One day at a time
- Sobriety is a journey not a destination
- 90 meetings in 90 days
- "One [drink] is too many and a thousand [drinks] never enough."
- "staying away from slippery people and slippery places" or "changing playgrounds and playmates".
Sets with similar terms
Lec 17 (Ch. 18)
Drug use Chapter 17
primary, secondary, and tertiary prevention and ha…
DRUGS CH. 18
Other sets by this creator
Memory and Cognition 2
Memory and Cognition
Human Sexual Behavior 2
Human Sexual Behavior
Other Quizlet sets
Midterm Test Bank
Physics Exam 3
Single celled Eukaryotes and the Algae