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Published byEustace Bradford Modified over 9 years ago
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What is it? What causes it? What can we do about it?
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A chronic, relapsing behavioral disorder. Pattern: Remissions and relapses Progression theories: ◦ Gateway progression ◦ Continuum of drug use ◦ “Maturing out”
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◦ Tolerance ◦ Physiological dependence ◦ Psychological dependence (habituation) ◦ Craving
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Some substances are more likely to be associated with addiction than others, but there are many exceptions both ways. ◦ Heroin ◦ Cocaine ◦ Methamphetamine ◦ Ecstasy ◦ Alcohol ◦ Psilocybin Mushrooms ◦ Marijuana ◦ PCP
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Moral model: Responsibility and guilt Physical dependence model ◦ Abstinence syndrome ◦ Negative reinforcement for continued drug-taking ◦ Physical or psychological?
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The decision ◦ Denial met by intervention or reality ◦ Cognitive changes Pre-contemplation: No problem! Contemplation: Maybe there’s a problem… Preparation Action Maintenance ◦ Cognitive therapy: Motivational interviewing
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Abstinence: The 12-step approach Controlled use Harm reduction ◦ Substitute addictions ◦ Methadone ◦ Gum-chewing ◦ Needle exchanges ◦ Water supply
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Detoxification (Detox) ◦ “Cold turkey” ◦ Gradual ◦ With pharmacological support Active treatment Relapse prevention
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Self-treatment (“spontaneous remission”) ◦ Perhaps 20% follow this route. ◦ Self-treatment often requires multiple attempts: Learning to quit. ◦ For 57%, quitting is the result of cost-benefits analysis. ◦ For 29%, the change is immediate.
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Sometimes because of “bottoming out” Positive life changes: marriage, childbearing, religious encounter Negative life changes: health problems, social or legal consequences of drug use, death of a friend
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Self-help groups like AA ◦ Twelve Steps ◦ Peer identification and support ◦ Sober social relationships Residential treatment ◦ Hospitalization ◦ The therapeutic community Milieu therapy ◦ Short-term residential programs ◦ Faith-based programs Salvation Army Teen Challenge
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Medication-assists ◦ Antagonist blockade ◦ Treat contributing conditions ◦ Substitution ◦ Antabuse ◦ Craving reduction Ibogaine Outpatient drug-free programs
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Provide substances, paraphernalia and injection rooms in ways that reduce crime and disease transmission Meet other needs of addicts ◦ Health care and nutrition ◦ Social support ◦ Employment or volunteer activities
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Risk of relapse is reduced by ◦ Frequent review of the decision ◦ Avoiding drug-related cues by moving and dumping drug-using friends ◦ Social connections with non-users ◦ Getting a job ◦ Learning substitute activities ◦ Developing structure for life
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