Week 6 - Substance related and addictive disorders Flashcards
What is the evidence that behavioural couples therapy works for substance-use disorders?
- sometimes works better than indivudal BT, but not always
- DOES NOT WORK FOR SMOKING CESSATION
- Small Effect size
What is the evidence that family-based behavioural therapy works for substance-use disorders?
- works better than TAU in reducing substance use but not in improving family functioning
- does not work better than MI or CBT
- small ES
What is the evidence that CBT for substance-use disorders in adolescents?
- works better than psychoeducation for older youth (16+)
- ES not reported
- does not work better than psychoeducation for younger youth and does not work better than family-based therapy
What is the evidence for treatment of substance-use disorders long term?
no evidence that any treatment works long-term
Outcomes better for cannabis but still not great
What is the evidence that CBT + relapse prevention for substance-use disorders in adults?
- works better than doing nothing, but only slightly better than doing something else
- trivial to large ES
- more effective women and cannabis users
What is the evidence for contingency management?
- works better than various controls
- benefits decrease after contingencies are withdrawn
- small to moderate ES
What is the evidence that MI works for adults and adolescents with alcohol use related disorders?
- works better than no treatment for some outcomes
- no consistent evidence that it works better than other active treatments
What is the evidence for smoking cessation and adults?
- works better than TAU and in-person health warnings
- small ES
- does not work better than no treatment or self help
What is the evidence for smoking cession in adolescents?
- works better than placebo, psychoeducation, brief advice, and the nicotine patch
- trivial ES
- keep it short: doing MI for more than an hours is associated with a NS ES
What is the evidence for MI/MET for adults with cannabis use disorders?
- works better than no treatment and pscyhoeducation for most outcomes
- does NOT improve motivation to quit
- not more likely to produce abstinence than doing nothing
- not more effective than CBT
What is the evidence for MI/MET for use of cocaine use in adults?
- DOES NOT WORK BETTER THAN DOING NOTHING
What is the evidence for use of MI in alcohol use in adults
- works better than no treatment for some outcomes
- no consistent evidence that it works better than other active treatments
What is the evidence for smoking cessation and prevention of weight gain?
- works better than smoking cessation alone for abstinence in the very short-term
- effects on preventing weight gain also modest
- small ES
What are the common components for cannabis use treatment?
- assess use and dependence and feedback information
- boost motivation to quit
- psychoeducation about withdrawal
- psychoeducation about cravings
- develop a plan to cope with cravings
- identify and plan for high risk situations
- build up confidence to resist use in multiple situations
- relapse prevention
What are some reasons that may suggest that CBT is not right for substance-use disorders?
- standard CBT teaches avoidance, despite avoidance and control being poor coping strategies
- if clients are asked to focus on their ability to tolerate cravings while being exposed to drug cues: they should learn that they can tolerate cravings in the absence of use; and cue exposure should also render drug cues less able to elicit cravings.
What is the transtheoretical model for substance-use and how does it relate to substance use treatment?
- MI evolved from the Transtheoretical model
- change is a dynamic process (change does happen all at once, it might not occur on the first try)
- motivation for change progresses along a continuum
What are the core components of MI?
- PARTNERSHIP (collaborative, guiding rs)
- ACCEPTANCE (respect the client’s freedom of choice)
- COMPASSION (genuine care and concern; understand and validate the struggle)
- EVOCATION (trust that the client has the wisdom and strength for change)
What are key principles of MI?
- EXPRESS EMPATHY (acceptance, reflective listening and understanding patient’s potential ambivalence)
- DEVELOP DISCREPANCY
- AVOID ARGUMENTATION
- SUPPORT SELF-EFFICACY
What are the 4 overlapping MI processes?
- ENGAGING (establish a working relationship)
- FOCUSING (develop and maintain a specific direction)
- EVOKING (elicit the client’s motivation to change: how might they do it, why might they do it)
- PLANNING (develop a commitment to change and formulate a plan of action)
What are 10 ways to evoke change talk?
- ask evocative questions
- ask for elaboration
- ask for examples
- look back
- look forward
- query extremes
- explore goals and values
- use change rulers
- come alongside
What is another crucial component of MI to elicit change talk?
- open-ended values questions
- reflecting on values
- exploring values in more detail
- follow up with more reflection on values
- importance of values exploration
- discrepancy between goals/values and behaviour
What are some key principles for evoking change in MI?
- express empathy
- develop discrepancy (use linking phrases)
- avoid argumentation
- roll with resistance (simple reflection; amplified reflection; double-sided reflection; shifting focus; agree with a twist; reframing)
- support self-efficacy
