Therapy of addiction Flashcards
Alcohol vs other drugs
We know that alcohol impairs the brain and results in addiction with repeated use in the same way as other drugs
however. .
- abuse is a preventable behavior
- addiction is a treatable disease
What is addiction
- A brain disease expressed as a compulsive behavior
- The continued abuse of drugs despite negative consequences
- A chronic, potentially relapsing disorder
Addiction is similar to other chronic illnesses…?
- Recover from it; protracted abstinence and restored functioning. is often a long-term process requiring repeated treatment
- Relapse to drug abuse can occur during or after successful treatment episodes
- participation in self-help support programs during and following treatment can be helpful in sustaining long-term recovery
Why do people take drugs?
TO FEEL GOOD:
- most abused drugs produce intense feelings of pleasure
- the initial sensation of euphoria is followed by other effects which differ with the type of drug used
TO FEEL BETTER
- to lessen: anxiety, worries, fears, depression, hopelessness
Stress and drug abuse
stress can play a major role in:
- beginning drug use
- continuing drug abuse
- relapse in patient recovering from addiction
Coexistance of substance abuse with other psychiatric disorders
- very commong
- individuals with psychiatric disorders are 2,7 times as likely to have alcohol or other drug problems impaired to those without psychiatric disorder
- 37% of individuals with substance abuse disorders had coexisting mental disorders
Most common coexisting mental disorder
- mood disorder
- major depression
- bipolar disorder
- anxiety disorder
- panic disorder
- GAD
- PTSD
- phobias
Screening
several tools may be used to detect loss of control of alcohol and drug use.
These tools are mostly self-reports in questionnaire form
Another common theme is a score or tally that sums up the general severity of alcohol use
CAGE questionnaire
A tool used to assess individuals for potential alcohol problems including: dependence
- 4 simple questions (2 positive answer indicates the individuals to be possible alcohol dependent)
AUDIT
Alcohol Use Disorder Identification Test
a screening questionnaire developed by The Who.
Structural interview
- Reson of asking for help
- method and circumstances of drug use
- Previous use, present use, multiple use
- presence of physical dependence
- presence of health problems
- personal data, life circumstances
- family background, job and financial circumstances
- hobbies, legal problems
- psychiatric disturbances
Steps of screening and brief intervention
- step: questions about alcohol use
- structural intervie
- CAGE - step: evaluation of alcohol-problem
- Risky drinking
- problem driking
- dependence - Step: recommendation to appropriate process
- alcohol dependence
- risky- or problem- drinking - step: follow the development of the patient
Brief intervention
Decrease drinking at risky drinkers
motivation for therapy at addicts
Strategies for changing behavior
Feedback: feedback of state of health, family problems, etc.
Responsibility: emphasize that in change the responsibility of patient plays an important role
Advice: advice to stop drinking or drug use
Menu: recommended different porribilities for help
Empathy: to express that we understand that change is difficult
Self-efficacy: express that we are sure that the client is able to make change.
Why addict brain is not able to stop?
NOT-ADDICTED BRAIN
- control exist
- deliberation of stimuli and response
- inhibitory power functions
ADDICTED BRAIN
- control doesn’t exist
- no deliberation
- inhibitory power doesn’t function
This is why addicts can’t just quit and why treatment is essential.
Phases of motivation
PRECONTEMPLATION
- No thought of change
CONTEMPLATION
- Ambivalence toward change
DETERMINATION
- determined to change
ACTION
- Behavioral change has already started
MAINTENANCE
- Behavioral change is stable
RELAPSE
- Maladaptive behavior occurs
TERMINATION
- Change is very stable
Triggers
PRIMARY TRIGGERS
- Parts of addictive lifestyle
- Living with them is not necessary
SECONDARY TRIGGERS
- Internal stimuli, feelings, craving, stress, sadness, boredom etc.
- Improving coping mechanisms are important
TERTIARY TRIGGERS
- External stimuli, situations related to drug or alcohol, e.g. parties
- learning new behavioral strategies
Cognitive thearpy
Based on the idea that feelings and behaviors are caused by a persons thought, not outside stimuli.
Behavior is determined not by the outside stimuli, but by their interpretation
Cognitive shemes
Determine the meaning giving process
To make clear that not the stimuli lead to drinking or using drugs but the way the individuals think about that situation
Addictive beliefs
Expectation in connection with drug use, e.g. “decreases anxiety”, “causes pleasure”.
- originates from basic schemes; activated in certain situations = lead to craving
- are in connection with pleasure seeking, problem solving, calmness, escape
Influence the persons reaction to feelings in connection with craving. “im incapable to tolerate this feeling” -> attention/sensitivity is increasing to the situation, “I must drink to decrease anxiety”
Development of addictive behavior in the cognitive model
BASIC SCHEME: I’m lonely
EMOTIONS: sadness
ADDICTIVE BELIEFS: I can make friends only if I’m drinking
AUTOMATIC THOUGHTS: a bit of alcohol will help
= ADDICTIVE BEHAVIOR
Cogntitive techniques
- to make understand the underlying thoughts of alcohol or drugs use
- to reveal thoughts in the background of craving, or in all risky situations
- To make clear that not the stimuli lead to drinking or using drugs but the way the individuals think about the situations.
Evidence based interventions
- pharmacotherapy
- psychoeducatinon with families
- assertive communitvy treatment
- skill training
- supported employment
- cognitive therapy
- integrated care for patient with double diagnosis
