Substance Abuse Treatment Self-Help Psychosocial and Medication Interventions

Using Too Much When is treatment necessary? ABUSE DEPENDENCE

Popular Conceptions Lying Cheating Denial Criminal Life-long What are your conceptions?

DSM-IV Criteria Substance Abuse A maladaptive pattern of substance use occurring within a 12 month period –Impairment/Distress –One of the following Failure to fulfill major role obligation Use in physically hazardous situations Recurrent legal problems Continued use despite recurrent psychosocial problems

DSM-IV Substance Dependence A maladaptive pattern of substance use occurring within a 12 month period Three of the following: –Tolerance (increased drinking to achieve same effect) –Withdrawal –Drinking more than intended –Unsuccessful attempts to cut down on use –Excessive time related to obtaining, using and/or recovering from –Impaired social or work activities due to alcohol –Use despite physical or psychological consequences

From A Psychological Standpoint Drug abuse/dependence is a disorder of behavior Not only does it have health implications, abuse and dependence have extreme psychosocial implications People make changes in their alcohol/drug abuse behavior in the same way they make changes in all other behaviors Much alcohol and drug abuse/dependence is related to psychopathology Most people stop on their own

The Process of Change Precontemplation Preparation Contemplation Maintenance Action Relapse

Substance Abuse Treatment “Self-Help” (AA NA CA Rational Recovery) Psychosocial Interventions Medications

Self-Help 12 Step Fellowships Alcoholics Anonymous/Narcotics Anonymous –View of Problem: Spiritual disease –Tools: 12 steps to recovery –Mechanism: Powerful social support –Issues: Effective for those who stick. Can be difficult to stick

We admitted we were powerless over alcohol--that our lives had become unmanageable. Came to believe that a Power greater than ourselves could restore us to sanity. Made a decision to turn our will and our lives over to the care of God as we understood Him. Made a searching and fearless moral inventory of ourselves. Admitted to God, to ourselves and to another human being the exact nature of our wrongs. Were entirely ready to have God remove all these defects of character. Humbly asked Him to remove our shortcomings.

Made a list of all persons we had harmed, and became willing to make amends to them all. Made direct amends to such people wherever possible, except when to do so would injure them or others. Continued to take personal inventory and when we were wrong, promptly admitted it. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Psychosocial Interventions Behavioral and Cognitive Behavioral –View of Problem: Behavioral disorder. –Tools: Functional analysis, contingency management and cognitive interventions as well as relapse prevention –Mechanisms: Skills improvement, attitude change, coping with psychopathology –Issues: Highly researched treatments. Very effective. Not sure how they work actually.

Psychosocial Interventions Motivational Interviewing –Alternative to confrontational approach –Designed to move individual through stages of change –Brief (1 to 4 sessions) –Effective as stand-alone and as a booster to treatment

Pharmacotherapy Alcohol Dependence –Antabuse –Naltrexone Drug Dependence –Methadone & Naltrexone (Heroin) –Antidepressants (Cocaine) –Cocaine vaccine?????

Outcome Abstinence vs. Harm Reduction AA/NA, CBT, MI are all effective Meds can be effective as well Stage-matched interventions The longer people stick, the better they do Most often takes multiple treatments Social support after treatment is critical Treatment works better than jail in the short and long run

Prevention Primary – Prevention targeted to everyone Secondary – Prevention in at-risk groups Tertiary – Prevention in people who have the problem. Treatment.

Ways to Prevent Use Legality – War on drugs –A failure as it currently is Taxation – Cigarettes and alcohol –Reduces consumption in many Education – D.A.R.E., Education Programs –No effects on behavior. Maybe a sleeper effect for D.A.R.E. Intervention – Self-esteem boosting, refusal skills training –Peer counseling and refusal skills work –Parental monitoring works –Media debunking works