W5: Diagnosis, assessment and treatment Flashcards
Across the DSM-4 spectrum, they always intermixed across
abuse and dependence
Criteria that should be added
craving
consumption (quantity and frequency)
Set diagnostics for DSM 5 at threshold of
3 criteria or more
Severity scales
criteria count
2-3 mild
4-5 mod
>6 severe
Could biomarkers be used in DSM
no
Which addictions should also be added to the DSM
- cannabis = no in 4, but now there is evidence
- inhalants/hallucingens no evidence
- caffeine yes evidence
- in DSM 5 nicotine is aligned with other SUD
- prenatal yes
- gambling and internet gaming yes
Components of assessment Fong
- current and past patterns of use
- diagnose what SUD is present now
- what effect it has on mental and physical state
- understand readiness to change
- co-occuring psychiatric disorders
- medical history
- lab tests
- family SUD
- social factors
Assessment of consequences Saitz
CAGE_AID
cut down, annoyed, guilty, eye-opener drug
CRAFFT
car, relax, alone, forget, friends, trouble
more than two yes = likely disorder
Effects of brief interventions is to decrease
drinking by 10-12% at 1 year and 3 drinks per week
CB Approach for Alcohol use disorders Rohnsenow
cognitive behavioural coping skills training
cue exposue
Cocaine dependence CB
contigency management
coping skills training
community reinforcement
Marijuana CB
conticency management and coping skills training
Opiate CB
contigency management -> decreased use of other drugs while on methadone
Smoking
aversive conditioning
and coping skill training
Coping skills training
handling emotions or high risk situations for relapse or interpersonal situations more effectively
- alcohol and cocaine
- marijuana
RPT
relapse prevention training
ACT
acceptance and commitment therapy => decreasing escape from key symptoms
- how to reduce negative thoughts
- mindfulness and behavioural change of via CT
- further research needed
Aversive conditioning works for
abstinence initiation
relapse prevention
-BUT avoid positive reinforcement through drug experiences
CET Cue exposue treatment good for
relapse prevention
- reduce respondent conditioning to stimuli associated with drugs
- show cues while patient in safe environment
- long sessions
- no for opiate and cocaine
- no evidence after treatment for smokers
- yes for alcohol
Contigency management good for
abstinence and relapse
Aversive conditioning
-induce nausea via ingestion of agent like apomorphine
=> mod success for drinking
- electrical aversion = less encouraged success
- covert sensitisation: imagining aversive scenes while drinking small amounts = less encouraged success
Basic cognitive model of high risk situation for drug use
- activating stimuli
- automatic thoughts
- urges and cravings
- facilitating beliefs
Cognitive management
- operant conditioning
- requires measure (urine)
- receive reinforcement for positive behaviour
- cocaine, opiate and marijuana
- most useful with CST
- might undermine intrinsic motivation to change
CBT approaches
- relaxation training
- drug refusal skills (social)
- assertive skills (express)
- problem solving skills
- cognitive restructuring (replace thoughts)
- relapse prevention training
Primary prevention strategies
primary - before SUD
secondary - early stage
tertiary - minimise the likelihood of serious consequences
Types of primary prevention
- information dissemination (educate about harms)
- personal growth
- alternative (reduce boredom)
- skills for resisting
- personal and social skills training
- public health (all population)
VR immersion techniques offer
good alternative to conventional cue-provoked treatment
integrate stimulated social interactions
its beneficial effect in assessment and management still needs validation
Opioid
agonists= methadone (analgesia)
antagonist = naltrexone, naloxone
partial agonist = buprenorphine (substitute but without reaching dangerous levels)
