Week 12 Chapter 10 Treatment & Prevention of Substance Use Disorders (Caff)

Question 1

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

Answer 1

The user admitting there is a problem

Question 2

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

Answer 2

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

Question 3

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

Answer 3

only 24%

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

• 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

Question 9

What is controlled drinking? &

how effective is it?

Answer 9

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

Question 10

What is guided self-change?

Answer 10

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

Question 11

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

Answer 11

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)

Question 12

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

Answer 12

• 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

Question 13

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

Answer 13

• 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

Question 14

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

Answer 14

• 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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

• 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

Question 18

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

Answer 18

• 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

Question 19

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

Answer 19

• 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

Question 20

What is a downside to both methadone and Naltrexone?

Answer 20

Both involve daily visits to a pharmacy

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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!

Question 23

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

Answer 23

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

Question 24

Why are prevention programs aimed and schools targeting teenagers?

Answer 24

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

Question 25

What do prevention programs focus on?

Answer 25

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

Results are mixed however

Question 26

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

Answer 26

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

Question 27

Which interventions have shown most promise in prevention?

Answer 27

• two family treatment programs

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

Question 28

What are some other treatment interventions?

Answer 28

• 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