Download Day 15: Substance Use Treatment

Substance Use Disorders:
Treatment
Chapter 10
Biological Treatment of Substance-Related
Disorders
 Agonist Substitution
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Safe drug with a similar chemical composition as the
abused drug
Examples include methadone for heroin addiction, and
nicotine gum or patch
 Antagonistic Treatment
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Drugs that block or counteract the positive effects of
substances
Examples include naltrexone for opiate and alcohol
problems
Biological Treatment of
Substance-Related Disorders (cont.)
 Aversive Treatment
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Drugs that make the use of abused substances extremely
unpleasant
Examples include antabuse for alcoholism and silver nitrate
for nicotine addiction
 Adjunctive Treatment
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Pharmacological treatment of underlying pathology (e.g.,
depression or anxiety)
 Efficacy of Biological Treatment
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Such treatments are generally not effective when used
alone
Psychosocial Treatment of Substance-Related
Disorders
 Inpatient vs. outpatient care
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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
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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
Cognitive-Behavioral Treatment of
Substance-Related Disorders (cont.)
 Coping Skills Training
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Assumes deficit of coping skills as cause of disorder
Behavioral training in social skills, problem-solving,
emotional management, etc.
 Relapse Prevention
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Identify triggers for use and develop skills for avoiding or
coping with triggers
Create plans for coping with lapses to prevent full-blown
relapses
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
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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
Cognitive-Behavioral Treatment of
Substance-Related Disorders (cont.)
 Exposure and Response Prevention
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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
Comprehensive Treatment of
Substance-Related Disorders
 Components of Comprehensive Treatment and
Prevention Programs
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Individual and group therapy
Aversion therapy and covert sensitization
Contingency management
Community reinforcement
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Family involvement
Employment/education
Recreation
Relapse prevention
Preventive efforts via education