L5 - Background info

Question 1

Comorbidity

Answer 1

• very comorbid with other psychological symptoms (50%)
• mood disorders, anxiety disorders, personality disorders and ADHD
  > crucial to identify comorbid complaints in time (for case conceptualization)
• some psychological complaints can be caused or exacerbated by substance abuse
  1. adress substance abuse first
  2. possible treatment of comorbid disorders

Question 2

‘It takes a village’: the role of close relatives
- what is the focus of the lecture?
- how do close people differ in reaction to person’s SUD?

Answer 2

• focus on role of patient’s community in CRA/CRAFT treatment
  > some want to detach/be harsh, some want to support and be close
  > some blame themselves / the other person
  > have to deal with lots of emotions (sadness, anger, frustration, …
  > conflicts, domestic violence, financial problems and a disrupted relation with their children
  > more relationship problems, low relationship satisfaction, sexual issues, and divorce is 4x as prevalent than in nonproblematic users
  ! relatives also need help to cope with the negative consequences for their own well-being and mental health

Question 3

what roles can close people play in the recovery of patient?

Answer 3

• contribute to positive change
  > getting patient to treatment
  > in CBT itself
• play negative role by facilitating substance abuse

Question 4

what treatments take those roles into account?

Answer 4

1. Al-Anon (based on the twelve steps of the AA)
2. Johnson intervention (also known as “confrontational intervention”)
3. CRAFT (Community Reinforcement and Family Training)
4. BCT (Behavioral Couple Therapy)

Question 5

Al-Anon

Answer 5

• based on 12 steps of alcoholics anonymous
  > help close relatives to accept that they are powerless
  > help them “detach with love” from the addict
  (they should not try to influence the addict’s behavior)

Question 6

what are some readings in Al-anon?

Answer 6

• “Do not reprimand the alcoholic, do not moralize, do not swear, do not accuse, do not threaten, do not beg, do not argue, don’t throw away any drink, don’t lose your temper, and don’t stand for the consequences of his / her drinking. You may feel better, but the condition is getting worse.
• Do not get angry, because then you will hurt yourself and with it the opportunity to help.
• Don’t let your fear tempt you to do things that the alcoholic needs to fix himself.
• Don’t accept promises, because that’s only a way to delay pain. Don’t change anything you agreed upon. If something has been agreed upon, stick to it.
• Don’t believe everything the alcoholic tells you, it could be a lie.
• Do not let the alcoholic exploit or abuse you, because that way you are participating in his game: avoiding responsibilities.
• Keep recognizing that alcoholism is an ever-worsening disease that grows in severity if the drinking continues. ”

Question 7

Johnson intervention

Answer 7

• addict is unexpectedly confronted by relatives/friends
• radical, direct and very confronting with regard to negative consequences of S.A.
• “breaking through resistance” → seen as last chance to reach out (life-or-death)
  X not much empirical support

Question 8

CRAFT

Answer 8

• by John Meyers
• close relatives are supported by the practitioner to adjust their behavior in order to motivate the patient to start treatment
  > important goal → improve life of close relatives
• based on cognitive behavioral therapy and motivational interviewing
• convincing scientific evidence

Question 9

what are two central principles in CRAFT?

Answer 9

• positive reinforcement of desired behavior by close relatives
  > the close relative rewards a clean and sober lifestyle, or other forms of good behavior of their loved one
  > e.g. desirable activities and verbal positive reinforcement
• not rewarding unwanted behavior (positive reinforcing)
  > not try to protect their loved one from the natural negative consequences of abuse
  > e.g. not intervene when person oversleeps and misses important meeting

Question 10

BCT (behavioral couple therapy)

Answer 10

(1) teach the couple effective ways to cope with substance ‐ related situations
(2) teach the partner to support/reinforce behavior change and sobriety
(3) improve relationship satisfaction and reduce stress (in order to prevent relapse), by enhancing positive, rewarding exchanges between partners, and boosting healthy communication patterns and problem-solving skills

• Relationship satisfaction appears to be a protective factor for relapse
• BCT is expensive and intensive
  → recommended only when individual therapy is ineffective
  → when there are severe triggering relationship issues
  → only when the partner is willing to be involved in treatment