2. Substance Use Disorders: Treatment
Chapter 10

3. Biological Treatment of Substance-Related Disorders
Agonist Substitution
Safe drug with a similar chemical composition as the abused drug
Examples include methadone for heroin addiction, and nicotine gum or patch
Antagonistic Treatment
Drugs that block or counteract the positive effects of substances
Examples include naltrexone for opiate and alcohol problems

4. Biological Treatment of Substance-Related Disorders (cont.)
Aversive Treatment
Drugs that make the use of abused substances extremely unpleasant
Examples include antabuse for alcoholism and silver nitrate for nicotine addiction
Adjunctive Treatment
Pharmacological treatment of underlying pathology (e.g., depression or anxiety)
Efficacy of Biological Treatment
Such treatments are generally not effective when used alone

5. Psychosocial Treatment of Substance-Related Disorders
Inpatient vs. outpatient care
Data suggest little difference in terms of overall effectiveness
For severe dependence, brief inpatient care and intensive outpatient after-care is the current standard of care
Community Support Programs
Alcoholics Anonymous and related groups
Developed by Bill W. as structure for recovering alcoholics to support other alcoholics
Twelve-steps and twelve traditions
Endorses total abstinence as goal
Most successful self-help program ever conceived
Debate over controlled use vs. complete abstinence as treatment goals

6. Cognitive-Behavioral Treatment of Substance-Related Disorders (cont.)
Coping Skills Training
Assumes deficit of coping skills as cause of disorder
Behavioral training in social skills, problem-solving, emotional management, etc.
Relapse Prevention
Identify triggers for use and develop skills for avoiding or coping with triggers
Create plans for coping with lapses to prevent full-blown relapses

7. Relapse Prevention Model by Marlatt
Expect that there will be future stressors which may trigger onset of substance use
Use cognitive principles – how one interprets the onset of substance use will determine how persistent and severe the use will be
Lapse – temporary “slip” that does not predict return of full problem of substance use; use as opportunity to review and implement coping skills as get back on track
Relapse – if interpret as loss of control, then may predict full-blown return of substance use; substance use will reach previous levels and will require comprehensive, long-term treatment

8. Cognitive-Behavioral Treatment of Substance-Related Disorders (cont.)
Exposure and Response Prevention
Reduces conditioned responding to drug-related cues
Incorporates both classically conditioned and operantly conditioned cues
Social situations or specific people (habituate to them rather than avoid entirely)
Experience of stress, anxiety

9. Comprehensive Treatment of Substance-Related Disorders
Components of Comprehensive Treatment and Prevention Programs
Individual and group therapy
Aversion therapy and covert sensitization
Contingency management
Community reinforcement
Family involvement
Employment/education
Recreation
Relapse prevention
Preventive efforts via education