Week 5 412 sud l10 Flashcards
Mst
Intensive intervention for conduct problems and substance abuse.Keeps kids out of jail study showed,Bit complicated intervention though. Need to understand the mechanism of action. Mediators. Associations between treatment and reduction of symptoms. Measured dose of Mst. Higher adherenceFamily functioning, delinquency family and behave. Higher dose of Mst decrese aed delinquency. Gifter direct association: between Mst and family functioning! Family functioning itself associate with decrese asd delinquent peer affiliation, and delinquent behaviour. Mst no direct association behaviour Mst and peer delinquent. Seems like real action is coming from improving family functioning.
Mst mediation of tardent
Family functioning increase, Leas to:Less delinquent behaviourless peer association delinquencyFurther Less delinquent behaviour
Substance Use Disorder definition
Different substances Alcohol, Cannabis, Opiods, Hallucinogens, Inhalants, Sedatives, Hypnotics, Anxiolytics, Tobacco, Other
Example: Alcohol Use DisorderNote other substance may not have well defined withdrawal.Any two of
Problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following occurring within a 12-month period Alcohol is often taken in larger amounts or over a longer period than was intended There is a persistent desire or unsuccessful efforts to cut down or control alcohol use A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects Craving, or a strong desire or urge to use alcohol Recurrent alcohol use resulting failure to fulfill major role obligations atwork, school, or home Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by use Important social, occupational, or recreational activities are given up or reduced because of alcohol use Recurrent use in situations in which it is physically hazardous Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcoholTolerance, defined by: A need for markedly increased amounts of alcohol toachieve same effect A markedly diminished effect with continued use of the same amount of alcohol Withdrawal, as manifested by either of the following: Alcohol withdrawal syndrome Alcohol or a related substance is taken to relieve or avoid withdrawal symptoms
Prevalence of SUD
In community based samples, 12% of adolescents (aged 12 to 17 years) meet criteria for a substance use disorder Prevalence rates increase across adolescence Rates are much higher (about 33%) among youthexperiencing other mental health problems, comorbid Experimentation is very common
Treatment Models for SUDIn-patient treatment
Treatment Models Short duration (4 to 6 weeks) Range of treatment programs Individual counselling, family therapy, treatment for comorbid disorders Often followed by outpatient
Out patient treatment for SUD
Outpatient programs Less intensive than inpatient but longer Group therapy Individual therapy Family therapyMST
Treatment Efficacy
Little research on effectiveness of treatments for substance use in adolescents Historically have been methodological problems in these studies Lack of randomized controlled trials Analyzing only people who complete the treatment Difficulty getting people to follow up Reliance on adolescent self reportWell-designed studies suggest that family therapy may work better than other types of outpatient treatment (e.g., individual counselling, adolescent group therapy, family drug education)
Proactive Treatment of SUD
Relapse prevention Very important Many youth improve when they are away from home, but relapse when they return One half of adolescents receiving treatment for substance use relapse within 3 months Only 20% to 30% are not using at 1 yearFocus on: Identifying high risk situations Developing skills for refusing Developing interests that would help them stay away from high risk Developing a new peer network
Norm-based interventions for SUD for college students
Norms about drinking, normative Injunctive norms: How much others approve or disapprove of drinking Descriptive norms: How much others actually drink Norms share a stronger association with college student drinking behaviorAmerican university students overestimate how much their peers drink (same for sex in hs apparently)
Highlighting di recency of behaviour cognition by Using normative intervention.
Brief Alcohol Screening and Intervention for College Students Individualized feedback about: Actual drinking norms Comparison between individual’s drinking pattern and the norm 1) This is how much you drink 2) This is how much you think others drink 3) This is how much others actually drink 4) Percentile ranking showing where you are relative to others on your campus
252 (148 women) took part Participants and non-participants did not differ onamount of drinking reported Randomly assigned to intervention on normative presentation or control
Procedure:.Baseline Perceived drinking norms Drinking behavior Intervention Received feedback immediately Presented on screen for a minute and given a print out to take home No interpersonal interaction Follow ups at three and six monthsREAULTS,At both 3 and 6 months, amount of drinking in the intervention groups was reduced, relative to the control group At both 3 and 6 months, perceived norms were reduced (intervention groups was reporting that peers drink less than control group) Changes in perceived norms MEDIATED the association between the intervention and reduced drinking Intervention predicted decrease in perceived norms at three months, which predicted decreases in drinking at 6 months
Prevention programs for SUD
Stop the problem before it starts Prevent negative outcomes (e.g., HIV transmission)Information and fear Shortcut to Brain On Drugs.lnkMedia Inconsistent results about effectiveness Hard to study
D A R E
U.S. drug program Drug Abuse Resistance Education Developed in the 1980s during Reagan’s “War on Drugs” Zero-tolerance approach to drug use Happens in schools Police officers deliver substance-use preventioncurriculum to students Teaching students skills needed to recognize and resist pressure to use drugs Decision-making skills Building self-esteem Also includes parent education and summer and after- school programszero tolerance approach (vs harm reduction approach)Dissemination of D.A.R.E Used in 80% of school districts in the United States and in 54 countries In 2009, $5.5 million dollars spent on D. A. R. E.
Evidence for Effectiveness of D.A.R.E
None Meta-analysis (Ennet et al. 1994) Quantitative synthesis of different studies Do we see a significant difference between students who got the intervention and those who did not across studies Found no effect of D.A.R.E. on extent to which participants report using drugs (small effect on tobacco use) Effects are smaller than those seen for other programsOther studyNo difference between students in D.A.R.E. schools and control schools with respect to cigarette, alcohol, or marijuana use immediately following the program, 1 year later, or 5 years laterIn fact, some evidence suggests that programs like D.A.R.E. may be iatrogenic (cause harm) Werch & Owen (2002) found seventeen studies in which programs similar to D.A.R.E. (and, in one case D.A.R.E. itself) resulted in negative effects Most common was increases in use of alcohol among students who got the programFederal funding for D.A.R.E. was cut Currently developing a new program within theoriginal framework Evaluating this new program and following students for 5 years after receiving the programGood intentions like dare need to be looked at and test objectively!
Syringe-Exchange Programs
Developed around the same time as D.A.R.E. In the 1980s, rapid increase in rates of HIV infectionamong intravenous drug users Harm-reduction approach No expectation that use will stop completely Trying to limit the negative effects on the individual and society that are associated with usingSharing of needles contributing to the spread of HIV among IV drug users and their sexual partners Exchanging new, sterile needles and syringes for used ones Most programs also include other services: HIV testing and counseling Condom distribution Referral to drug-abuse treatment
Dissemination of Syringe-Exchange Programs
Evidence for effectiveness played a key role in the dissemination of syringe-exchange programs, unlike dare. Amsterdam, 1984 Large pharmacy stopped selling injection equipment, makingit much more difficult to get clean needles The local health department and a drug-users group set up a syringe-exchange program Found that subsequent to the introduction of this program, rates of HIV among iv drug users decreased Disseminated to other cities in the NetherlandsAmsterdam; United Kingdom 1987; Tacoma, WA;Portland, OR; New Haven, CT All found that syringe-exchange programs were associated with reductions in rates of HIV infections Note that none of these studies were randomized clinical trials Case-control designs, pre- and post-comparisonsNote non of these are rct. Relied on case control design. Precomposed comparisons,
Evidence for Effectiveness of Syringe-Exchange Programs
2001 literature review 42 studies examining syringe-exchange programsand HIV risk behavior and infection 28 showed positive effects of syringe exchange programs, two found negative associations, and 14 found no association or mixed effectsbut does it increase use?
Do Syringe Exchange Programs Increase Use?
RCT (Fisher et al. 2003) addressing the question do people with access to a syringe exchange program use more? Participants randomly assigned to (a) syringe- exchange programs and (b) instructions about how to buy syringes at the pharmacy, only Cn so so on Alaska captive market audience. Showed not using more! Even beyond self report, using urine same ple, not associated to greater drug use,
Syringe-Exchange Programs: Where are they now?
In 1988, US government forbid any federal dollars being spent on these programs until they were shown (a) not to be associated with increased rates of drug use; (b) to be associated with decreased rates of HIV infection 1995 a research summary by the National Academy of Sciences showed that these programs met these requirements Federal government is still not providing funds
