Chap 9 (Methods for Treatment) Flashcards
Screening:
Purpose
“Is there a problem”
Identify at-risk individuals &/or individuals who are experiencing problematic substance use
Basic screening questions must be asked in a universal (standardized) & non judgemental manner
It is important to also identify any barriers which may impede recovery
“Positive” screen 🡪 assessment
Basic screening questions must be asked in a ______________
universal (standardized) & non-judgemental manner
Diagnostic Process
DSM-5
Individuals diagnosed with severe/moderate SUD (DSM-5) 🡪 more intensive treatment
Assessment
Gathering more detailed information about the existing problem(s)
Collaboratively with the client, deciding on the next steps
Enhancing client motivation through motivational interviewing (if needed)
When client is ready to make a commitment of change (readiness ruler) 🡪 move towards actively planning for change
Higher scores on importance & confidence dimensions 🡪 client is ready to enter, participate in, & benefit from treatment
Motivation is a consistent predictor of client engagement & outcome
________ is a consistent predictor of client engagement & outcome
Motivation
Mutual Help Groups
A way to provide support from peer recovery networks
Focus on Reciprocal supports & active group engagement 🡪 promotes
abstinence/moderation in substance use
Provides the opportunity to develop personal & social resources
Goal 🡪 build substance-free social networks & lasting support structures to aid with long-term recovery
i.e., AA (Alcohol Anonymous) & NA (Narcotics anonymous) & CA (Cocaine anonymous)
Not formal therapies, but widely incorporated into treatment plans
The combination of formal treatment & mutual help groups 🡪 better outcomes
(Always most effective)
Alcoholics anonymous (AA)
12-step program
Helps patients recognize: 1) that alcoholism is a disease , 2) their addiction & 3) its destructive power over them
The addiction is viewed as more powerful than the individual 🡪 seeking help from a higher
power
Advantages:
Providing social support through group meetings
Meetings are attended anonymously
Free & Offered at flexible times
However, not ideal for all individuals:
Those experiencing co-occurring conditions (other substance-use or psych disorders) (May
benefit more from normal/formal treatments)
Those feeling intimidated or stigmatized by group interactions
Success of Alcoholics anonymous (AA) depends on
Client Fit
- Explicitly religious vs spiritual vs secular groups
- Specialized groups (i.e., for women, adolescents, LGBTQIA+ individuals)
- Alcoholics Anonymous (AA) Attendees are typically ____________
2.
1.more committed to abstinence
2. but groups vary in how much abstinence is emphasized
AA (Alcohol Anonymous) & NA (Narcotics anonymous) & CA (Cocaine anonymous) are
Not formal therapies, but widely incorporated into treatment plans
- The combination of _______ & _________ leads to
- ________
- formal treatment & mutual help groups
- better outcomes** (Always most effective)**
Mutual Help Groups However, not ideal for all individuals:
Those experiencing co-occurring conditions (other substance-use or psych disorders) (May benefit more from normal/formal treatments)
Those feeling intimidated or stigmatized by group interactions
- Mutual help groups vary in how strongly ____ is emphasized
- i.e., ____ focus heavily on abstinence, while ____________ promote
moderation as the final step or a step along the way to abstinence
- Abstinence
- AA & NA, moderation management programs
Harm reduction Primary goal:
minimize harm associated with substance use
abstinence may be the final goal
clients are taught to drink in moderation (as opposed to
complete abstinence)
Controlled Drinking Interventions
Controlled Drinking Interventions are highly ________
Controversial
- Only a few continue to drink in moderation in the long-run
- Vs similar effectiveness as total abstinence in the long-run
- More research is needed
provide clean equipment to allow legal injection under medical
supervision
Safe Injection Sites (SSIs)
Goals of Safe Injection Sites
Reduce risks of overdose & infection
Opponents of Safe Injection Sites believe they
Encourage Drug Use
Proponents of Safe Injection Sites believe they
- Offering safer, more hygienic place to inject with access to medical interventions
- Benefit the community by reducing drug use in streets
- Appropriate referrals may be made through sites
A safer drug that has a chemical makeup similar to the addictive drug is offered
Agonist substitution
Examples of Agonist substitutions are
Methadone treatments
Buprenorphine treatments
Nicotine Replacement therapys
Methadone is an
An opioid agonist (given as a heroine substitute)
A synthetic narcotic that provides the same reduction of pain & sedative effects of heroine
Aims of Methadone treatment
Harm Reduction
Additional benefits: reduce risk of HIV infection & hepatitis
Methadone Treatments are most effective when ________
combined with counselling
Disadvantages of Methadone Treatment
Heroine & Methadone are cross-tolerant (act on the same neurotransmitter receptors), thus may result in dependence on methadone instead
some individuals may become dependent on methadone (or other substances ie cocaine, etc) as a result 🡪 must help individuals to gradually stop using methadone in the final treatment phase
Heroine & Methadone are
cross-tolerant
When two substances are cross tolerant, this means they
act on the same neurotransmitter receptors
- Tolerance / Addiction to one = other
A newer substitution treatment for heroine dependence
Buprenorphine treatment
Buprenorphine treatment May offer some advantages over Methadone such as
Less frequent dosing required
Self-administration at home
**Less risk of dependence **and thus more ideal if the client’s goal is to become completely drug-free (rather than maintaining on medication – i.e., Methadone)
Disadvantages of Bupernorphine treatment
However, the structured support & close monitoring of Methadone treatment may result in better results compared to high rates of drop out from Buprenorphine treatment
Nicotine Replacement therapy
Gums, patches or nasal sprays used in place of the nicotine in cigarettes
Most effective when combined with therapy &/or physical exercise
However, a proportion of people become dependent on the replacements
________ drugs 🡪 block/counteract the effect of drugs
Antagonist
(opioid-antagonist drug)
Naltrexone
Naltrexone
Is given to an individual who is dependent on
opioids 🡪 it reduces the rewarding effects of opioid use
- blocks the alcohol-induced feelings of pleasure by inhibiting dopamine release in the nucleus accumbens
- Blocking the euphoric effect of alcohol helps individuals return to abstinence more quickly if they engage in drinking again
Naltrexone is effective if
Effective if individual is completely withdrawn from opioid before starting Naltrexone (must be opioid-free at least 3 Or More days)
also
Effective if used simultaneously with another treatment program
- use results in quickly developing unpleasant physical effects to punish drinking alcohol
Effective in helping individuals achieve sustained abstinence, particularly for clients who are:
- Older
- More socially stable
- Committed to taking the medication daily
- Effective if consistently taken
Disulfiram
Agonist substitution & antagonist treatments and well as Pharmacotherapies /prescribed medications are known as
Medication-Assisted Treatment (MAT)
Pharmacotherapies or the use of prescribed medications should be combined with behavioural interventions to help clarify & set expectation of:
Benefits, side effects management & potential barriers to compliance with the medication protocol
Medication-Assisted Treatments (MAT) are
Are useful additions to other treatment approaches
However, MAT & “minimal care” can still have substantial impact on individual’s functioning
chemical substances that increase the activity of a neurotransmitter by initiating its effects
Agonists
medications that block or counteract the effects of psychoactive drugs
Antagonist drugs
Help patients get through the initial withdrawal period, & then through supportive therapy
return back to their communities
Extremely effective
Disadvantage 🡪 expensive
& not more effective than outpatient treatments
Inpatient facilities
Extends therapeutic progress by teaching how to cope with future troubling situations
Remove ambivalence about stopping drug use:
Re-examine beliefs about the positive aspects of the drug
Confront the negative consequences of using
Identify high-risk situations & learn strategies to deal with them
Relapse is viewed as a result of stress & can change
Relapse prevention
Helps clients modify their cognitive
processes to develop & implement skills necessary for managing:
- Life stressors (ie; avoiding/coping with high risk situations)
- Cravings (ie; drink refusal skills)
- Mental Health Problems (ie; managing negative moods / depression)
Cognitive Behavioural Therapy/Coping Skills Training (CBCST)
CBCST approaches must be ___________
client-centered & flexible as different clients need different skills
Common needs included in CBCST treatment are
Coping with urges & cravings, social skills, emotional regulation, behavioural self-control & general life skills related to housing & employment
CBCST __________ helps prevent relapse & enhance success in recovery
Skill building
Involving Significant Others in Treatment
The involvement of significant others in treatment 🡪 higher rates of retention, adherence abstinence & maintaining/maitenance after treatment
Numerous approaches have been developed which work with significant others
A technique targeted towards significant others in developing skills related to motivation,
communication, treatment entry & safety
Builds significant other’s confidence to help their partners towards reduced substance use &
entering treatment through positive reinforcement for sobriety
Effective in getting initially unmotivated individuals into treatment & engaging them in care
Significant others also benefit 🡪 increased happiness & reduced depression, anger & family
conflict
CRAFT
Community Reinforcement & Family Training
Engages significant others in treatment to improve the couple’s relationship & support
behaviours that encourage sustained abstinence
Primary components:
Establishing goals related to supporting sobriety
Improving the positivity of the relationship
Strengthening communication skills
Reducing conflicts & negative interactions
Can be combined with psychosocial & medication-assisted services
Successful in treating addictions with an overall better outcome compared to individual
treatments , resulting in increased:
Abstinence
Adherence to medications
Relationship functioning
Behavioural Couples Therapy (BCT)
Important for adolescents as family dynamic & home environment play a major role in
supporting treatment engagement
May use cognitive behavioural family therapy approach
Focus on behaviour change related to improved 🡪 decision making, problem solving,
communication skills & relationship building
Results in reduced adolescent substance use & increased positive family relationships
Effective cross-culturally & long-lasting (into adulthood)
However, not all relationships are suited for couple or family-based approaches (ie;
Relationship violence)
Working with couples & families supports treatment & recovery & may be more effective
than individual treatment in terms of: entry to care, engagement & long-term recovery
success
Family-Involved Treatment
Motivational Enhancement Therapy
Helps individuals increase motivation to change
- Which treatment is most effective is treating SUDs? 2. Which individuals would not benefit from certain treatment
approaches?
GENERALLY, CBCST (formal structured, CBT based) combined with other approaches IS THE BEST
FOR SUDS (AT LEAST ONE OF THE APPROACHES)
Case management _________ behavioural treatment to address such issues which may interfere with recovery
complements (not a replacement!)
Case Management
Failure to address unemployment/financial/other problems may place individuals with SUDs
at increased risk for continuing substance misuse
Case management complements (not a replacement!) behavioural treatment to address
such issues which may interfere with recovery
Establishing a strong case manager-client working relationship is the first (& key) step
The case manager & client clarify needed services & assess client’s levels of commitment
towards seeking & participating in services
A service request form is useful in assessing the need for specific services & determining
which problems need to be addressed first
May enable individuals to assume ownership of goals , increase readiness for steps necessary to
facilitate change & develop a high-quality change plan
NIDA’s Principles of Effective Treatment
- No single treatment is appropriate for all individuals
- Treatment needs to be readily available
- Effective treatment attends to multiple needs of the individual, not just their drug use
- An individual’s treatment & services plan must be assessed continually & modified as necessary ensure that the plan meets the person’s changing needs
- Remaining in treatment for an adequate period of time is critical for treatment effectiveness (i.e., three months / longer)
- Counselling (individual &/or group) & other behavioural therapies are critical components of effective treatment for addiction
- Medications are an important element of treatment for many clients, especially when combined with counselling &/or behavioural therapies
- Addicted or drug-misusing individuals with coexisting mental disorders should have both disorders treated in an integrated way
- Medical detoxificaiton is only the first stage of addiction treatment & by itself does little to change long-term drug use
- Treatment does not need to be voluntary to be effective
- Possible drug use during treatment must be monitored continuously
- treatment programs should provide assessment for HIV/AIDS, Hepatitis B and C, tuberculosis & other infectious diseases, & counseling to help patients modify or change behaviours that place themselves or others at risk of infection
- Recovery from drug addiction can be a long-term process & frequently requires multiple episodes of treatment
