Treatment options and approaches Flashcards
Key to achieving success in treatment
And many different theories that underpin those approaches. Some treatment programmes combine elements from different theoretical perspectives, whilst others adopt a single approach. The key to achieving success in treatment is to FIND THE BEST MATCH FOR THE INDIVIDUAL
four elements of a treatment system
1) public health measures
2) harm reduction strategies
3) pharmacotherapies– which might include
a) withdrawal management
b) substitution treatment
c) relapse prevention
4) psychosocial approaches.
important early stage
detoxification
detoxification
physical tolerance to the effects of a drug, and a substance-specific withdrawal syndrome when the substance is removed.
Medical withdrawal management
involves minimising these unpleasant and potentially dangerous effects by gradually reducing the dose of the substance to nothing over a period of days to weeks. This may require prescription of a medication with an equivalent effect on the brain, which itself is then slowly withdrawn– for example, benzodiazepines for alcohol dependence or buprenorphine for heroin dependence.
third use of pharmacotherapy
relapse prevention
3 different mechanisms of action for alcohol dependence (pharmacology)
1) Disulfiram is a drug that BLOCKS the normal METABOLISM of alcohol, leading to the accumulation of a breakdown product with SEVERE physical SIDE EFFECTS if the individual drinks alcohol.
2) Naltrexone BLOCKS opioid RECEPTORS in the brain, NEGATING the PLEASURABLE effect of naturally released endogenous opioids when alcohol is consumed.
3) Acamprosate ALTERS the BALANCE of excitatory and inhibitory NEUROTRANSMITTERS in the brain, thus REDUCING CRAVING for alcohol and reducing the likelihood of a return to heavy drinking.
four common elements of effective treatment
1) strong working alliance between therapist and client,
2) a degree of structure,
3 goal-orientated process, directed at achieving the individual’s personal objectives
Directly challenging and confronting the addicted individual
is rarely useful and tends to provoke an innate tendency to form counterarguments in favour of persisting with the problem behaviour.
Motivational interviewing
attempts to help the individual RESOLVE the AMBIVALENCE that often exists between continuing the behaviour and stopping.
contingency management,
uses incentives designed to make continued substance use less attractive and abstinence more attractive, often as an adjunct to other treatments. Rewards can be vouchers or prizes, and a variety of behaviours might be rewarded, including compliance with medication or attendance at other forms of treatment. Contingency management has been shown to be extremely effective at encouraging behaviours, such as completing a course of hepatitis B vaccination or stopping use of stimulant drugs, such as crack cocaine.
community reinforcement approach
broader strategy, adopting the same principles,
therapist attempts to rearrange the client’s social environment to provide rewards to compete with substance use, such as pleasurable social activities with people that encourage sobriety or placement in interesting or challenging jobs that allow close monitoring.
Cognitive behavioural approaches
aim to reduce positive expectancies about substance use, increase self-confidence and belief in resisting drugs or alcohol, and improve skills in coping with the stresses of everyday life that might provoke a return to substance use. Patients may be taught to communicate more effectively, to be more assertive, to initiate social interaction, to respond to criticism, or to refuse offers of drugs or alcohol from others.
Abstinence orientate norms & models
a) mutual self-help networks - AA
b) Professional approaches, such as social network and behaviour therapy, aim to build support for behaviour change amongst family and friends.
c) family and network approaches
Risk of relapse high - effective in supporting recovery
strategies that boost self-esteem and self-efficacy, reward positive change, and increase social support for abstinence
Social network support
social environment in which someone lives is important in both developing and recovering from a substance use problem
What does previous research tell us about the influence of the social environment on efforts to overcome alcohol dependence?
In summary, higher levels of social support are associated with less drinking during and after treatment.
Factors on importance of social network
size of the network, the amount of contact they have with others, and the subjective value that the individual places on their network.
Positive outcomes
having a spouse, having more people to go to with problems, and more non-drinking friends.
Poor outcomes
greater disagreement amongst the social network and having and maintaining more friendships with heavy drinkers. From the clinician’s perspective, it’s important to note that alcohol-specific support has been shown to produce better outcomes than general support.
3 broad ways in which social networks can be incorporated into the treatment process.
first is by using family or social network members to help engage people with substance use problems into treatment. The second is engaging family and network members in the process of supporting behaviour change, both during and after treatment. And a third strategy is to support the social network members themselves to cope better.
SBNT
treatment process begins by helping the client draw a diagrammatic representation of their social network. The therapist then goes on to help the individual to build social support for change by utilising the support offered by their naturally occurring network and/or adding new network members. The intervention contains a number of potentially effective strategies that can be used with either the client or the network members or, indeed, both together.
