Substance Abuse Treatment

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Substance AbuseTreatment

• Self-Help Psychosocial and Medication
  Interventions

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Using Too Much

• When is treatment necessary?
• ABUSE
• DEPENDENCE

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Popular Conceptions

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

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DSM-IV CriteriaSubstance 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

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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

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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

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The Process of Change
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Substance Abuse Treatment

• Self-Help (AA NA CA Rational Recovery)
• Psychosocial Interventions
• Medications

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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

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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.

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• 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.

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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.

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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

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Pharmacotherapy

• Alcohol Dependence
• Antabuse
• Naltrexone
• Drug Dependence
• Methadone Naltrexone (Heroin)
• Antidepressants (Cocaine)
• Cocaine vaccine?????

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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

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Prevention

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

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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