1. Substance-Use Disorders Lori Ridgeway PSYC 3650

2. What is abuse? Criteria Failure to meet responsibilities Use despite potential dangers Legal problems Problems aggravated by use At least one of these in past _____________ No dependence

3. What is dependence? Criteria ______________ Withdrawal Use more than intended Failed attempts to stop or cut down Time spent getting, using, recovering Given up important activities Use despite problems At least 3 criteria met in past 12 months

4. Drug Classes Depressants Alcohol, sedative-hypnotics, opiates Stimulants Cocaine, amphetamines, caffeine, nicotine Hallucinogens LSD, mescaline, MDMA Cannabis Polysubstance use

5. Depressants Slow down activity of the ________ Act on GABA receptor sites Alcohol, barbiturates, benzodiazapines Attach to endorphine receptor sites Opiates (e.g., morphine, heroine) Withdrawal symptoms dangerous

6. Stimulants Increase activity of _______ Affect neurotransmitter activity Increase supply of ________________ Increase supply of norepinephrine and serotonin Amphetamines, caffeine Withdrawal Depression, fatigue, headaches, “crashing”

7. Hallucinogens & Cannabis Hallucinogens ________________________ Bind to serotonin receptors and alter effects MDMA – rapid release of ALL serotonin Cannabis Combination of hallucinogenic, depressant, and stimulant effects Physical dependence possible

8. What “causes” substance disorders? Sociocultural Socioeconomic conditions Acceptance and use in environment Problems ___________________________________ Some people in “good” environments do

9. Psychodynamic Dependency needs Failed to ______________________ as children Substance abuse personality Problems Drug use or personality – which came first? Wide range of personality traits

10. Behavioral & Cognitive Operant conditioning and expectancy Opponent-process theory Negative reinforcement Avoid aftereffects Classical conditioning Objects present during _______________________ Each may explain a piece of the puzzle

11. Biological Genetic predisposition Twin studies Adoption studies Dopamine-2 receptor gene Biochemical processes Prolonged use of substance ____________________ Lower production of certain NT’s Reward center – dopamine

12. How do we treat substance disorders? Biological treatments _________________ Medications Cognitive behavioral models Coping strategies Relapse-prevention Behavioral therapies Classical conditioning models Contingency management Alternative behaviors

13. Motivational Enhancement Therapy (MET) Based in motivational psychology & stages of change Goal is to move client through stages of change Effective with low motivation Responsibility and capacity for change are _______ Therapist creates _________ to increase motivation

14. Five Motivational Principles _________________ Respect client’s freedom of choice and self- direction Develop Discrepancy Must see a discrepancy between where they are and where they want to be Avoid Argumentation Client should voice arguments for change

15. Roll with Resistance Ambivalence seen as __________ Support Self-Efficacy Hope and belief that things can change

16. How is MET different? MET vs. confrontational approaches Don’t argue with the client Don’t tell the client what he or she "must" do No direct confrontation to combat denial MET vs. _______________________ Client not seen as powerless Don’t impose a diagnostic label on the client MET vs. CBT No direct skill training Motivation enhancement seen as first step

17. Phases of Treatment Phase I: Building Motivation for Change Elicit statements of self-motivation for change Reflective listening and empathy Presenting personal feedback Personal Feedback Report (PFR) Compare _____________________ Approach to resistance Reflect ambivalence Shift focus / roll with it reframe

18. Phase II: Strengthening Commitment to Change Shift from reasons to change to a _______ for change Decisional balance Consequences of change and of not changing Emphasize free choice Abstinence vs. harm reduction Change Plan Worksheet What, why, how, who, and trouble-shooting Verbal commitment to change

19. Phase III: Follow-Through Strategies Maintenance Review progress Renew motivation Redo ______________

20. Additional Notes on MET Encourage inclusion of _________________ in treatment Can be done in relatively few sessions MUSC study comparing CBT and MET CBT = 12 weekly session MET = 5 sessions over 12 weeks Comparable outcomes More effective if combined with medications Ex: Naltrexone