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Psychiatry, Psychology and the Mind > Changing Addiction > Flashcards

Changing Addiction Flashcards

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1
Q

What are two treatment types for treating addiction?

A
  • First contact

- Detoxification

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2
Q

What is the biggest barrier to patients?

A

-Initial contact with patients

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3
Q

What 3 groups are part of the first contact process?

A

-Primary healthcare workers, GPs and outreach teams

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4
Q

What strategies are required in first contact?

A

-Strategies are required to help individuals view treatment as something ‘for them’

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5
Q

Purpose of detoxification

A

-The earliest stages of abstinence can be very tough, and so detox programmes are designed to support individuals through this phase of the treatment process

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6
Q

Purpose of methadone?

A
  • long-acting opioid therapy to heroin

- alleviate the aversive symptoms associated with heroin withdrawal

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7
Q

What is blocking therapy?

A

-administration of drugs which minimise or totally counteract the effects of a drug of abuse (blocking- naltrexone for heroin)

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8
Q

What is aversive therapy?

A
  • interacts with the drug of abuse to create extremely aversive effects (aversive- disulfiram or ‘Antabuse’ for alcohol)
  • makes them feel bad for taking the drug
  • feel sick when drinking
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9
Q

What are psychological interventions?

A
  • dealing with the psychological dependence towards drug or behaviour
  • address why they became addicted, any underlying issue that led to this and consequences of being addicted
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10
Q

Why are psychological interventions important?

A

-Addressing the problems of physical dependence is less difficult than dealing with the psychological dependence

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11
Q

What is motivational interviewing?

A
  • Aimed at increasing motivation to change
  • Creates ‘psychological squirm’
  • Conflicted view of themselves as an addict
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12
Q

What is the basic idea behind behavioural therapy?

A
  • Basic idea that addiction is learned and therefore can be unlearned
  • use aversive pharmacologies as punishment
  • looks at factors that precipitate drug use, to avoid triggers
  • contingency management provides rewards for non-use
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13
Q

What is cognitive based therapy?

A
  • A more broad-based approach than traditional behavioural therapies
  • Involves identifying triggers to drug use, and provides patients with training in various key skills
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14
Q

What are the various key skills provided in CBT?

A
  • Relaxation training
  • Drug refusal skills
  • Problem solving skills
  • Cognitive restructuring “to see meaning behind action to themselves”
  • Relapse prevention training
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15
Q

Why is peer support groups so effective?

A
  • They use people who were once addicts themselves to run meeting
  • sense of camaraderie
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16
Q

What did the meta analysis on psychological interventions?

A

-all behavioral therapies were just as effective

17
Q

Why do NHS recommend CBT most of the time?

A
  • shorter duration
  • cheaper
  • can train people to deliver this much quicker (1 YEAR OR 2)
18
Q

Briefly describe what Project MATCH is, the demographics and what they looked at

A
  • Matching Alcoholics to Treatment based on Client Heterogeneity
  • Largest ever clinical trial of psychotherapies
  • Recruited 1726 alcohol dependent patients
  • Each receiving one of
  • 12 step facilitation therapy
  • Cognitive behavioural therapy
  • Motivational enhancement therapy

-Predicted that patient characteristics would predict treatment success

19
Q

What were the characteristics of project MATCH?

A
  • number of days abstinence
  • number of drinks per drinking day, post-treatment completion
  • psychosocial functioning
  • quality of life measures
  • utilisation of treatment services
20
Q

What were the primary findings?

A
  • MATCH participants demonstrated improvements in abstinence and reduced drinks per drinking day across all treatments
  • Treatments were equally effective
  • no evidence that matching patients to different treatments would be more or less effective
21
Q

What were the general secondary findings?

A
  • small differences
  • high in anger and received MET had better drinking outcomes than those given CBT
  • these results were inconsistent
  • at 12 months were statistically non-significant
22
Q

What were the 3 year outcomes from MATCH?

A
  • Included 952 clients across the 5 outpatient sites
  • Client anger was the most consistent predictor of treatment outcome
  • High-anger clients responded better to MET in contrast to CBT and TSF
  • Still no major differences between matched and unmatched clients
23
Q

What is UKATT and what was its purpose?

A

-United Kingdom Alcohol Treatment Trial
-Developed from MATCH
-Whether less intensive treatments should replace CBT
because MATCH found that treatment intensity did not predict positive outcomes

24
Q

Demographics for UKATT

A
  • N= 742

- MET and SBMT (social behaviour network therapy)

25
Q

UKAAT findings?

A
  • no significant difference in outcomes for either MET or SBNT were found
  • both positive effects on drinking reduction and abstinence
  • no characteristics predicted patient outcome
26
Q

What is COMBINE?

A
  • Combined Pharmacotherapies and Behavioural Interventions for Alcohol Dependence
  • Looks to combine pharmacotherapies and behavioural interventions for alcohol dependence
27
Q

Demographic for COMBINE

A
  • 1,383 harmful drinkers

- drinking > 21/15 units a week (male and female)

28
Q

What were patients given in COMBINE?

A

-Naltrexone (100 mg/d) or Acamprosate (3 g/d), both, and/or both placebos, with or without a combined behavioural intervention (CBI), or CBI alone

29
Q

What were findings for COMBINE?

A
  • Participants given Naltrexone, CBI or both had more days abstinent than placebo groups
  • Acamprosate appears not to efficacious
  • Placebo only patients had better outcome than CBI only
  • After 1 year no sig difference but similar trends
30
Q

Summary of findings for MATCH UKATT COMBINE

A

MATCH - ‘Careful’ matching of patients to different treatments does not improve outcome
UKATT - MET was not found to differ significantly from a novel intervention (SBNT)
- Patient characteristics failed to predict outcomes based on intervention type
COMBINE - Combinations of pharmaco- and behavioural therapies seemed to produce some positive treatment effects, but placebos were also efficacious in some cases, and
- overall effects were small and short-lived

31
Q

Does treatment work?

A
  • People end up quitting more often than not
  • economic terms yes, less money spent on treatments for stuff like HIV, less days off work, less crime rate
  • broad definition of improvement, for example if they take drugs with clean needles in safe setting it can be improvement

Psychiatry, Psychology and the Mind (32 decks)

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