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Transcript
What is it?
What causes it?
What can we do about it?

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

Some substances are more likely to be
associated with addiction than others, but
there are many exceptions both ways.
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Heroin
Cocaine
Methamphetamine
Ecstasy
Alcohol
Psilocybin Mushrooms
Marijuana
PCP

Moral model: Responsibility and guilt

Physical dependence model
◦ Abstinence syndrome
◦ Negative reinforcement for continued drug-taking
◦ Physical or psychological?

The decision
◦ Denial met by intervention or reality
◦ Cognitive changes
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Pre-contemplation: No problem!
Contemplation: Maybe there’s a problem…
Preparation
Action
Maintenance
◦ Cognitive therapy: Motivational interviewing

Abstinence: The 12-step approach

Controlled use

Harm reduction
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Substitute addictions
Methadone
Gum-chewing
Needle exchanges
Water supply

Detoxification (Detox)
◦ “Cold turkey”
◦ Gradual
◦ With pharmacological support

Active treatment

Relapse prevention

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

Self-help groups like AA

Residential treatment
◦ Twelve Steps
◦ Peer identification and support
◦ Sober social relationships
◦ Hospitalization
◦ The therapeutic community
 Milieu therapy
◦ Short-term residential programs
◦ Faith-based programs
 Salvation Army
 Teen Challenge

Medication-assists
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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

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