Week 12 Chapter 10 Treatment & Prevention of Substance Use Disorders (Caff) Flashcards
To provide information from Chapter 10 Substance Use Disorders, specifically on the treatment & Prevention of Substance Abuse
What is deemed by many as the first step towards treatment?
The user admitting there is a problem
What is often seen as a block to treatment and yet, remains a necessary part of acceptance into many treatment programmes?
The user to commit to stopping their alcohol &/or drug use before the beginning of treatment
According to a large epidemiological study what is the percentage of people who are physiologically dependent on alcohol that ever receive treatment?
only 24%
What is often the first step of treatment for substance use disorders?
Detoxification
- Many people need to go through detoxification multiple times.
- Detoxification can happen in hospital or at home
- Short stay detox is as effective as longer stay and outpatient treatment
What is the largest and most widely known self-help group in the world?
Alcoholics Anonymous (AA)
- AA is a 12 step program that asserts that alcohol dependence is a disease that can never be cured & that total abstinence is the only way to treat it
- AA has been found to be useful however, no more useful than other treatments such as motivational enhancement, inpatient treatment, couples therapy, or CBT
What is Marlatt & Gordon’s (1985) approach to relapse prevention?
That people dependent on alcohol (or other substances) are encouraged to believe that a lapse will not inevitably precipitate a total relapse & should be regarded as a learning experience rather than the sign that the battle is lost
*This approach is in marked contrast to the AA model
Why is Marlatt & Gordon’s (1985) non-catastrophising approach to relapse prevention so important to treatment?
since the overwhelming majority of people who are dependent on alcohol who become abstinent experience one or more relapse(s) over a four-year period
Which substances are Marlatt & Gordon’s (1985) approach to relapse prevention most effective in treating?
- The relapse prevention model is most effective in alcohol and drug use disorders and least effective for nicotine users.
- Although self-help relapse prevention programs are effective in reducing smoking relapses
What is controlled drinking? &
how effective is it?
Controlled drinking is a moderate pattern of alcohol consumption - avoiding the extremes of total abstinence & inebriation
*People with less severe alcohol problems can learn to control their drinking & improve other aspects of their lives
What is guided self-change?
Guided self-change is the Sobell’s approach to teaching moderation to people with alcohol use disorder.
- The basic premise is that people have more potential to control their drinking than they believe & that heightened awareness of the costs of drinking to excess & of the benefits of abstaining/cutting down can help
- e.g. getting the person to wait 20 minutes before having a 2nd or 3rd drink can help them to reflect on the costs versus benefits of drinking to excess
Which medications are used for the treatment of alcohol use disorder?
Antabuse - it discourages drinking by causing violent vomiting if alcohol is ingested.
However dropout rates are as high as 80%
*Acamprosate (Campral) reduces cravings associated with withdrawal - it is thought to do this by impacting the glutamate and GABA neurotransmitters
*There are arguments against using drug therapy for substance abuse (dependence on one drug to stop using another)
What are some of the treatments aimed at helping people give up smoking?
- GP’s advice
- GP’s advice plus nicotine replacement therapy (gum, patch, inhaler, electronic cigarette)
- scheduled smoking - a person agrees to smoke via a timed schedule thus the person’s smoking behaviour is controlled by the passage of time rather than on moods, urges or situations
How effective are some of the treatments aimed at helping people give up smoking?
- Gum can be as habit forming as cigarettes, though it is still thought to be less harmful than cigarettes
- Patches have been found to be superior to placebo *however, for all NRT abstinence rates are only 50% at 12 month follow up
- NRT & anti-depressants can be an effective treatment
- Clonidine & silver acetate are pharmacological treatments that show benefit also
What is the first stage of treatment for people with drug use disorders?
- Detoxification is central & the first step to rehabilitation. It may also be the easiest step
- Enabling the drug user to function without drugs after detoxification is extremely difficult as the craving for the substance often remains even after the substance has been removed via detoxification
- Psychological treatments, drug substitution treatments and medications are part of this journey
What are the research findings that illustrate the significance of the psychological aspects of substance use?
In a controlled study anti-depressant & CBT together were somewhat effective in reducing cocaine use & improving a person’s family, social & general psychological functioning
- the antidepressant desiramine was better than placebo for people with low degree of dependence on cocaine
- whereas CBT was better for people with a high degree of dependence on cocaine
What did the findings of this study indicate with regard the usefulness of CBT to treat substance use disorder?
People receiving CBT learnt:
*how to avoid high risk situations. *recognise the lure of the drug for them, *& to develop alternatives to using cocaine & *strategies for coping with craving & resisting urges to use
NB: Regular substance abuse counselling has been found to be as effective as CBT
What are some of the other psychological treatments of drug use disorders?
- Contingency management (with or without food/clothing vouchers) has shown promise for cocaine, heroin and marijuana use disorders
- Motivational interviewing or enhancement therapy which combines CBT to help clients identify their own solutions has also shown great promise
- Self-help residential homes are also effective treatments
What are the principles of self-help residential homes such as Odyssey House & Phoenix House?
- Separation from previous social contacts
- An environment where drugs are not available
- Presence of charismatic role models (ex users)
- Direct & intense confrontation group therapy where people are encouraged to take responsibility for their problems, drug habits and urged to change their lives
- An environment where people are respected as human beings, not stigmatised for their habits
What are some of the drug replacement & medication treatments of drug use disorders?
- Heroin substitutes
- Methadone, levomethadyl acetate, & buprenorphine - chemically similar to heroin to replace body’s craving
- these are cross-dependent with heroin
- Opiate antagonists - Naltrexone - drugs that prevent the user from experiencing the heroin high
- 1st people are gradually weaned from heroin, then increasing doses of naltrexone are administered
- this drug binds to the opiate receptors without stimulating them
What is a downside to both methadone and Naltrexone?
Both involve daily visits to a pharmacy
*Methadone side effects: insomnia, constipation, sweating, diminished sexual functioning, stigma
Buprenorphine is another heroin substitute, introduced in 2003. Tell me about it
Buprenorphine (AKA Suboxone) contains both buprenorphine & naloxone
It is a partial opiate agonist so it does not produce such an intense high as heroin & is only mildly addictive
Suboxone is effective at relieving heroin withdrawal symptoms & it seems relapse is less likely
Is drug replacement an effective treatment for cocaine abuse and dependence?
No, there is very little evidence that it is effective.
*A vaccine has recently been developed aimed at producing antibodies to squelch the cocaine - not promising so far!
Is drug replacement an effective treatment for methamphetamine abuse and dependence?
No, there are very few effective treatments for methamphetamine abuse.
Matrix treatment approaches are most effective (Multiple interventions)
Why are prevention programs aimed and schools targeting teenagers?
Because substance abuse disorders in adulthood often follow experimentation in the teenage years
What do prevention programs focus on?
- Raising self-esteem
- Teaching social skills
- Saying no to peer pressure
Results are mixed however
What has become a top priority among health researchers & Politicians?
Developing ways to discourage young people from experimentation with tobacco as this often starts prior to the age of 15 years
Which interventions have shown most promise in prevention?
- two family treatment programs
* delaying alcohol use as long as possible seems to be an effective preventative intervention also
What are some other treatment interventions?
- Peer-pressure resistance training
i. e. ways to say ‘No’ - Correction of beliefs and expectations
i. e. many young people believe smoking is more prevalent than it is - Inoculation against mass media messages
i. e. counter mass media messages - Peer leadership
