Changing Addiction Flashcards
What are two treatment types for treating addiction?
- First contact
- Detoxification
What is the biggest barrier to patients?
-Initial contact with patients
What 3 groups are part of the first contact process?
-Primary healthcare workers, GPs and outreach teams
What strategies are required in first contact?
-Strategies are required to help individuals view treatment as something ‘for them’
Purpose of detoxification
-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
Purpose of methadone?
- long-acting opioid therapy to heroin
- alleviate the aversive symptoms associated with heroin withdrawal
What is blocking therapy?
-administration of drugs which minimise or totally counteract the effects of a drug of abuse (blocking- naltrexone for heroin)
What is aversive therapy?
- 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
What are psychological interventions?
- 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
Why are psychological interventions important?
-Addressing the problems of physical dependence is less difficult than dealing with the psychological dependence
What is motivational interviewing?
- Aimed at increasing motivation to change
- Creates ‘psychological squirm’
- Conflicted view of themselves as an addict
What is the basic idea behind behavioural therapy?
- 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
What is cognitive based therapy?
- A more broad-based approach than traditional behavioural therapies
- Involves identifying triggers to drug use, and provides patients with training in various key skills
What are the various key skills provided in CBT?
- Relaxation training
- Drug refusal skills
- Problem solving skills
- Cognitive restructuring “to see meaning behind action to themselves”
- Relapse prevention training
Why is peer support groups so effective?
- They use people who were once addicts themselves to run meeting
- sense of camaraderie
What did the meta analysis on psychological interventions?
-all behavioral therapies were just as effective
Why do NHS recommend CBT most of the time?
- shorter duration
- cheaper
- can train people to deliver this much quicker (1 YEAR OR 2)
Briefly describe what Project MATCH is, the demographics and what they looked at
- 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
What were the characteristics of project MATCH?
- number of days abstinence
- number of drinks per drinking day, post-treatment completion
- psychosocial functioning
- quality of life measures
- utilisation of treatment services
What were the primary findings?
- 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
What were the general secondary findings?
- 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
What were the 3 year outcomes from MATCH?
- 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
What is UKATT and what was its purpose?
-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
Demographics for UKATT
- N= 742
- MET and SBMT (social behaviour network therapy)
UKAAT findings?
- 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
What is COMBINE?
- Combined Pharmacotherapies and Behavioural Interventions for Alcohol Dependence
- Looks to combine pharmacotherapies and behavioural interventions for alcohol dependence
Demographic for COMBINE
- 1,383 harmful drinkers
- drinking > 21/15 units a week (male and female)
What were patients given in COMBINE?
-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
What were findings for COMBINE?
- 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
Summary of findings for MATCH UKATT COMBINE
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
Does treatment work?
- 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
