Chapter 3 Addictions: Theory and Treatment

Drug Addiction Behavioral pattern of drug use Overwhelming involvement Securing of its supply Tendency to relapse after withdrawal

Three Basic Processes 1.Tolerance Repeated exposure results in a lesser effect 2.Physical dependence Withdrawal syndrome 3.Psychological dependence Observable behavior of frequently using drugs – reinforcement plays a role with this

Changing Views of Drug Addiction Early medical models –Early theories based on physical dependencies as the key Positive reinforcement model –Concepts of drugs acting as “positive reinforcers” in psychological dependence

The Broad Views of Addiction Is addiction caused by the substance? Is addiction biological? Is there an addictive personality? Is addiction a family disorder? Is addiction a disease?

Assessment of Addictive Disorders Psychiatric –Diagnosis for dependence –Diagnosis for substance abuse

Dependence Criteria 1.Tolerance toward substance 2.Withdrawal syndrome 3.Substance taken in large amounts 4.Unsuccessful efforts to cut down

Dependence Criteria, cont’d 5.Activities involved to obtain substance 6.Lifestyle is centered around obtaining substance 7.Use continues after being diagnosed

Substance Abuse Criteria Pattern leads to impairment at work, school, etc. Increased hazards in daily situations Legal problems Continued use despite expressing the abuse factors

Addiction Treatment Deciding to quit –Stages of change precontemplation contemplation preparation action maintenance

Addiction Treatment, cont’d Deciding to quit, cont’d –Intervention –Motivational interviewing (assessment) Defining treatment goals –Abstinence –Controlled use

Addiction Treatment, cont’d 3 treatment stages –Detoxification removing the offending substance from the body –Active treatment treating a variety of substance dependence –Aftercare (relapse prevention) avoiding use on a day-to-day basis through self-help approaches

Treatment Approaches 1.Residential treatment Medical hospitalization Synanon Other therapeutic communities 2.Outpatient 3.Chemical dependency residency programs Private-pay clinics

Treatment Approaches, cont’d 4.Medication-assisted treatments Antagonism Substitution Medically incompatible 5.Outpatient drug-free programs Range from telephone hotlines to emergency room- associated clinics Community mental health centers

Addiction Treatment (The Big Picture in the U.S.) Treatment outcome data set –Over 1.5 million admissions each year –Four substances account for 90% of admissions alcohol47% opiates15% cocaine15% marijuana13% Source: SDM HAS Annual Report

Is Treatment Effective? Current belief is that treatment is ineffective 1990 report shows effectiveness results (Institute of Medicine) 1994 report (CA Department of Alcohol and Drug Programs) shows reduction of users and increased savings

Chapter 3 Addictions: Theory and Treatment