CM: Treatment of Addiction Flashcards
What are six reasons for drug use?
hedonistic, instrumental, self-medication
positive reinforcement, negative reinforcement (withdrawal), incentivize to use (sensitivity of dopa reward system to cues from prior alcohol or drug use) –> urges even if want to quit
When is no substance disorder, mild, moderate, or severe substance use disorder present?
zero or 1 symptom = no diagnosis
2 or 3 symptoms = mild disorder
4 or 5 symptoms = moderate disorder
6 or more symptoms = severe disorder
What is substance use disorder?
2 of the symptoms occurring w/i 12 month period
What are the 11 possible symptoms of substance use disorder?
impaired control: substance taken in increase amounts or over longer period than intended, inability to control/modify use, great deal of time spent trying to obtain, using or recovering from use, craving or strong desire for substance
social impairment: use impacts fxning ability, continued use despite personal problems surrounding use, other activities stopped because of use
risky use: use in situations where physically hazardous, use continued despite physical or psychological problem it causes
pharm criteria: tolerance, withdrawal
What are the four factors that contribute to onset of alcohol/drug abuse?
genetics - 50% is genetically determined
temperament/personality - but no “addictive personality”
stress
availability
What are the traits associated w Type I alcoholics?
timid, anxious, dependent on approval, likely to avoid risky situations
What are the learned behavior aspects of addiction?
operant conditioning: action-outcome, drug effect reinforcing and likely to be repeated
classical conditioning: stimuli associated w drug effect likely to trigger desire for drug when re-exposed
over time operant becomes less sensitive and classical dominates
What is the main neural pathway associated with drugs of abuse?
dopamine rich mesolimbic system - activation impairs capacity to control impulses and increases importance of seeking pleasurable effects of substance
How can denial of alcohol abuse be explained?
alcoholism as a psychological trauma: effects of alcohol addiction (blackouts, losses, etc) become traumatic experiences –> regression –> immature defenses
What is the idea behind regression in alcoholism?
repetitive immediate gratification makes someone “spoiled” and they behave less maturely
What are the cognitive changes that develop as a consequence of pathological use of drugs or alcohol?
psychological primacy - drug becomes priority
self-doubt: believe can’t fxn without drug
sense of loss: could fxn w/o it but would be unfair, life boring w/o it
belief that one cannot abstain
What is the progression of treatment from focusing on dynamics of dz to focusing on individual psychodynamics?
initially focus on educating pt about substance use as a dz
initial therapy = achieving abstinence and strengthening the ego
as abstinence is achieved, pt can gain more perspective on their addiction and the etiology of it
What is “stinking thinking”?
things going better so ppl think “I can handle one drink” - if in recovery, ppl realize this is a rationalization
What are the two synchronous goals in the later stage of psychotherapy?
spiritual development
insight
What are the classes of pharmacotherapy used for addiction treatment?
maintenance with cross-tolerant agent blocking drug high aversive therapy agent to suppress craving agents to block withdrawal symptoms therapy of comorbid psychiatric disorders
