10 addressing addiction Flashcards
Give a general overview of how addiction can be adressed.
Prevention
Harm reduction (on societal level, policy level as well)
Treatment (Detoxification)
Continued care (In-house; Aftercare)
What is the meaning of prevention?
universal approaches (those designed to reach everyone within a particular population regardless of their risk of substance misuse – e.g. school prevention programmes)
targeted approaches (focus on high-risk sub-groups of individuals or those already engaged in problematic behaviour)
How can the drug use process be conceptualised? How does that translate to intervention strategy?
1) initial drug use is driven primarily by social or environmental factors
(Glantz & Pickens, 1992);
2) discontinuation of initial use of some drugs is normative; and,
3) transitions to abuse and dependence seem to be more related to age of initiation rather than to duration of use (controlling for amount used)
⇒ likely points of intervention are prior to and after the time of initiation of use when drug is driven more by social factors and before progression to abuse when neurobiological factors begin to dominate
What is decision-making?
decision making = cognitive operation that requires and ability to process and evaluate information within a personal and social framework
cognitive competence to assess social and environmental cues
How does decision-making relate to social competencies?
development
socialisation
neuroplasticity
social skill enhancement
accurate behavioural decisions
deficits in cognitive development
→ vulnerability to environmental influences
adolescence - stress, erratic emotions
poor decision making
risk taking
ngative health and social outcomes
interpersonal attachements
sensitivity to social cues and social context
recognize the importance of behavioural inhibition
What levels of processes could be explored to understand engagement in high-risk behaviours?
- cognitive, emotional, and social developmental processes that make individuals vulnerable to negative coping behaviours
- micro- and macro-level influences or experiences that place vulnerable individuals at risk to engage in negative behaviours
- resilience: characteristics and skills that help individuals adapt to challenging experiences
What is socialisation?
Learning how to relate to other members of one’s social group is called socialization, i.e., “…the means by which social and cultural continuity are attained” (Clausen, 1968, p. 5)
internalisation of societal goals, norms, values
appropriate behaviour by gender and age
implied goals and norms that inform how information for decisions are evaluated and behaviours are selected
early exposure to caregivers responses to childrens needs and interaction with family members and influence of environmental factors
→ sets trajectory on how successful children grow into prosocial adolescents and adults
reinforcement of prosocial attitudes and behaviours
positive peer environment and stable relationships
What are socialisation agents?
→ represent guiding players
→ influencers at the micro-level environment such as parents, extended family, school staff
→ macro-level such as physical and social neighborhoods, organisations and mass media
⇒ each of those have different role and apply varying information
How can the prevention process be redefined under the lense of socialisation?
drug use prevention - socialisation agent
preventive interventions become part of the socialisation process to guide decision making and to provide the skills needed to effectively engage in prosocial and healthy behaviours
prevention can function to train socialisation agents to improve or enhance their socialisation roles
or function as socialisation agents themselces when they directly engage with young populations
What are examples of prevention programmes?
- strengthening families program
- family nurse partnership
- the good behaviour game
How did we get to the opioid epidemic?
number of prescriptions written for pain killers exceeded the total number of ppl living in the state (Maryland, US)
overprescription - medication will erase suffering
rising costs - ppl turn to heroin as cheaper alternative
addictive qualities - before realisation of whats happening
reducing withdrawal symptoms, helping prevent relapse
What assumptions do harm reduction concepts have?
- it is better to reduce the risks and harm than to focus on a “drug free” society
- drug control policies based on criminalisation should be replaced
What do new model of harm reductions adress?
- How can we reduce the likelihood contracting and spreading blood-borne infections and other diseases, overdoses and other medical problems?
- How can we reduce the likelihood of engaging in criminal and other undesirable behaviours?
- How can we increase the likelihood that people who use drugs will be good citizens and act responsibly?
- How can we develop drug policies that are both effective and humane while improving quality and access to effective prevention, treatment and rehabilitation services?
- How can we minimize the harms associated with prohibition drug policies and the criminalisation of drug users?
What are three important considerations for harm reduction approaches?
- drug prohibition policies remain the context for all HR efforts
”War on Drugs”
struggle with large hostile mechanisms of drug law enforcement and criminalisation - limits of research and science
illicit drug use and behaviour are shaped by so many societal influences
data collection and analysis regarding generally hidden and stigmatised illicit behaviour is very difficult
governments vary - cross-cultural comparisons are difficult - importance of different cultural contexts
advanced industrialised social democracies
What is the shift in viewpoint in harm reduction approaches?
based on methods of use, not only individual variables
human rights considerations - protecting drug users from discrimination, …
-> promote their health
How is harm reduction going in the US?
most politicians have rejected many HR premises and ignored the evidence supporting HR
europeans and australians expanded such programs in the 1980s
the US resisted needle syringe programmes (NSPs)
”sends the wrong message”
1988 - congress banned use of federal funds for needle and syringe programs
2009 - Obama
officials agreed to lift the ban
but HR is still not endorsed broadly
What services does harm reduction include?
- syringe exchange programs
- peer outreach and education
- overdose prevention
- initiatives supporting safer drug use
- drug consumer groups
- municipal zoning policies and open drug scenes
→ public opposition to certain forms of drug use relates to their visible presence in the community - Safe Spaces for People who use drugs
contact centers, street rooms, health rooms, HR centers, supervision consumption facilities, safe injecting rooms
How is addiction treatment incorporated in harm reduction?
drug substitution and maintenance treatment
- morphine
- methadone (for heroin)
- buprenorphine (alternative for methadone)
low-theshold maintenance
methadone busses - netherlands
methadone in correctional settings
- brief detoxification programs
other drug substitution initiatives
What are the stages in addiction treatment?
- Detoxification
- Intervention delivered in addiction services
- Aftercare/relapse prevention
What are some key psychosocial interventions for addiction?
+ motivational interviewing
+ harm reduction
+ contingency management (reinforcing desired behaviours)
→ psychosocial interventions tend to be universal to addicitions and are applicable across substances
→ it is central to treat cases where there are limited pharmacological interventions and no substitution therapy
What are examples of pharmacological treatments?
substitute drugs
opioids: methadone, buprenorphine
tobacco: nicotine patches, gum, e-cigs
alcohol:
disulfiram
naltrexone
acamprosate
What does recovery mean?
The word ‘recovery’ was first used in addiction by 12 step mutual aid groups.
Many argue recovery is not about not using, it’s also about creating a new life where you can continue not to use.
Some argue that recovery is not about not using, and it’s possible to be
in recovery even if you are taking substitute drugs such as methadone.
There is a politicised debate about harm reduction vs recovery.
What is the state of the art for treatments for behavioural addictions?
- New treatments constantly being explored
- Existing treatments constantly being improved
- Learning in one area of addiction often tried in others
- Drugs and behaviours have lots of overlap in terms of treatment
Pharmacological
* Naltrexone, nalmefene
Psychological
* Individual psychological support
* Behavioural couples therapy
* Support groups
What is common treatment for gambling?
- Less than 10% with a problem seek formal treatment
- There are validated screening and assessment tools to be applied in clinical
settings. Some of these are based on other areas of addiction - Family therapy shows promise
- CBT and MI often used, but not all gamblers benefit
- Different models of why a person gambles might be important for
treatment modalities and responses (e.g. behaviourally conditioned,
emotionally vulnerable, antisocially impulsive). - Naltrexone and nalmefene show the most promise as pharmacological
treatments - 12 step model has good results – Gamblers Anonymous
What are treatments for food addiction?
- Yale Food Addiction Scale is a validated screening and
identification tool - 12 step model; Overeaters Anonymous
- Often need to treat the psychological along with extreme weight gain
– in extreme cases this may involve gastric surgery.
What is the cognitive-behavioural model of relapse?
high risk situation
-> effective coping response
-> increased self-efficacy
-> decreased probability of relapse
-> ineffective coping response
-> decreased self-efficacy + positive outcome expectancies
-> initial use of substance
-> abstinence violation effect + perceived effects of substance
-> increased probability of relapse
What are the steps of policy development?
Steps:
- problem definition
- solution deliberation
- alternative solutions
- policy development
- policy implementation
