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

1
Q

What is deemed by many as the first step towards treatment?

A

The user admitting there is a problem

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2
Q

What is often seen as a block to treatment and yet, remains a necessary part of acceptance into many treatment programmes?

A

The user to commit to stopping their alcohol &/or drug use before the beginning of treatment

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3
Q

According to a large epidemiological study what is the percentage of people who are physiologically dependent on alcohol that ever receive treatment?

A

only 24%

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4
Q

What is often the first step of treatment for substance use disorders?

A

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
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5
Q

What is the largest and most widely known self-help group in the world?

A

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
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6
Q

What is Marlatt & Gordon’s (1985) approach to relapse prevention?

A

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

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7
Q

Why is Marlatt & Gordon’s (1985) non-catastrophising approach to relapse prevention so important to treatment?

A

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

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8
Q

Which substances are Marlatt & Gordon’s (1985) approach to relapse prevention most effective in treating?

A
  • 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
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9
Q

What is controlled drinking? &

how effective is it?

A

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

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10
Q

What is guided self-change?

A

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
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11
Q

Which medications are used for the treatment of alcohol use disorder?

A

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)

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12
Q

What are some of the treatments aimed at helping people give up smoking?

A
  • 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
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13
Q

How effective are some of the treatments aimed at helping people give up smoking?

A
  • 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
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14
Q

What is the first stage of treatment for people with drug use disorders?

A
  • 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
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15
Q

What are the research findings that illustrate the significance of the psychological aspects of substance use?

A

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
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16
Q

What did the findings of this study indicate with regard the usefulness of CBT to treat substance use disorder?

A

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

17
Q

What are some of the other psychological treatments of drug use disorders?

A
  • 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
18
Q

What are the principles of self-help residential homes such as Odyssey House & Phoenix House?

A
  • 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
19
Q

What are some of the drug replacement & medication treatments of drug use disorders?

A
  • 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
20
Q

What is a downside to both methadone and Naltrexone?

A

Both involve daily visits to a pharmacy

*Methadone side effects: insomnia, constipation, sweating, diminished sexual functioning, stigma

21
Q

Buprenorphine is another heroin substitute, introduced in 2003. Tell me about it

A

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

22
Q

Is drug replacement an effective treatment for cocaine abuse and dependence?

A

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!

23
Q

Is drug replacement an effective treatment for methamphetamine abuse and dependence?

A

No, there are very few effective treatments for methamphetamine abuse.
Matrix treatment approaches are most effective (Multiple interventions)

24
Q

Why are prevention programs aimed and schools targeting teenagers?

A

Because substance abuse disorders in adulthood often follow experimentation in the teenage years

25
Q

What do prevention programs focus on?

A
  • Raising self-esteem
  • Teaching social skills
  • Saying no to peer pressure

Results are mixed however

26
Q

What has become a top priority among health researchers & Politicians?

A

Developing ways to discourage young people from experimentation with tobacco as this often starts prior to the age of 15 years

27
Q

Which interventions have shown most promise in prevention?

A
  • two family treatment programs

* delaying alcohol use as long as possible seems to be an effective preventative intervention also

28
Q

What are some other treatment interventions?

A
  • 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