Substance Abuse Flashcards

Question

How effective are community reinforcement approaches?

Answer 1

Another package of treatment is the community reinforcement approach (Higgins et al., 2008). In keeping with multiple influences that affect substance use, several facets of the drug problem are addressed to help identify and correct aspects of the person's life that might contribute to substance use or interfere with efforts to abstain. First, a spouse or a friend who is not a substance user is required to participate in relationship therapy to help the abuser improve relationships with other important people. Second, clients are taught how to identify the antecedents and consequences that influence their drug taking. For example, if they are likely to use cocaine with certain friends, clients are taught to recognize the relationships and encouraged to avoid the associations. Third, clients are given assistance with employment, education, finances, or other social service areas that may help reduce their stress. Fourth, new recreational options help the person replace substance use with new activities. There is now strong empirical support for the effectiveness of this approach with alcohol and cocaine abusers (Higgins et al., 2008).

Answer 2

Cognitive-behavioural therapy (CBT) is an effective treatment approach for many psychological disorders and it is also one of the most well designed and studied approaches for treating substance dependence. This treatment addresses multiple aspects of the disorder, including a person's reactions to cues that lead to substance use (e.g. being among certain friends, and thoughts and behaviours to resist use. Another target for CBT addresses the problem of relapse. Marlatt and Gordon's (1985) relapse prevention treatment model looks at the learned aspects of dependence and sees relapse as a failure of cognitive and behavioural coping skills. Therapy involves helping people remove ambivalence about stopping their drug use by examining their beliefs about positive aspects of the drug (“there's nothing like a cocaine high") and confronting the negative consequences of its use (“I fight with my wife when I'm high”). High-risk situations are identified ("Having extra money in my pocket"), and strategies are developed to deal with potentially problematic situations, as well as with the craving that arises from abstinence. Incidents of relapse are dealt with potentially problematic situations, as well as with the craving that arises from abstinence. Incidents of relapse are dealt with as occurrences from which the person can recover; instead of looking on those episodes as inevitably leading to more drug use, people in treatment stress or a situation that can be changed. Research on this technique suggests that it may be particularly effective for alcohol problems.

Answer 3

Prevention. Many states in the US have implemented education-based programs in schools to try to deter students from using drugs. Unfortunately, several extensive evaluations suggest that this type of program may not have its intended effects (Pentz, 1999). Fortunately, more comprehensive programs that involve skills training to avoid or resist social pressures (such as peers) and environmental pressures (such as a media portrayals of drug use) can be effective in preventing drug abuse among some.

Answer 4

Impulse-control disorders represent a number of related problems that involve the inability to resist acting on a drive or temptation. Controversy surrounds both substance-related and impulse-control disorders because our society sometimes believes that these problems result simply from a lack of "will".

Answer 5

* intermittent explosive disorder * kleptomania * pyromania * pathological gambling * trichotillomania

Answer 6

* Pathological gambling affects an increasing number of people. It is estimated that among pathological gamblers, 14% have lost at least job and 195 have declared bankruptcy, 32% have been arrested, and 21% have been incarcerated (Gerstein et al., 1999). * Brain imaging studies were used to observe brain function in gamblers. A decreased level of activity in impulse regulation when compared to normal controls, suggesting an interaction between the environmental cues to gamble and the brain's response (which may be to decrease the ability to resist these cues). Abnormalities in the dopamine system (which may account for the pleasurable consequences of gambling) and the serotonin system (involved in impulsive behaviour) have been found in some studies of pathological gamblers (Moeller, 2009).

Answer 7

The DSM criteria for pathological gambling are similar to those of other impulse-control disorders, and there are parallels with substance dependence as there is a need to gamble increasingly and there are "withdrawal symptoms” such as restlessness and irritability when attempting to stop. In fact, these parallels to substance abuse have led to the discussion of the DSM-5 to recategorize pathological gambling from “impulse-control disorders” to “substance-related disorders” and that this "substance-related disorders” category should be renamed “addiction and related disorders” (Moeller, 2009).

Answer 8

Treatment of gambling problems is difficult. Those with pathological gambling exhibit a combination of characteristics - including denial, impulsivity, and continuing optimism (“one big win will cover my losses!") – that interfere with effective treatment. Pathological gamblers often experience cravings similar to those who are substance dependent (Wulfert et al., 2008). Treatment is often similar to substance dependence treatment, and there is a parallel Gambler's Anonymous that incorporates the same 12-step program we discussed previously. However, the evidence of effectiveness for Gambler's Anonymous suggests that 70% to 90% drop out of these programs and that the desire to quit must be present before intervention. CBT are also being studied and provide a more optimistic view of potential outcomes.