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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” ◦ ◦ ◦ ◦ 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. ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ 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 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 ◦ ◦ ◦ ◦ ◦ 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. 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 ◦ ◦ ◦ ◦ ◦ Antagonist blockade Treat contributing conditions Substitution Antabuse Craving reduction Ibogaine Outpatient drug-free programs 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
