Substance Use Disorders Treatment Chapter 10 Biological Treatment

Substance Use Disorders: Treatment Chapter 10

Biological Treatment of Substance-Related Disorders n Agonist Substitution n n Safe drug with a similar chemical composition as the abused drug Examples include methadone for heroin addiction, and nicotine gum or patch n Antagonistic Treatment n n 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. ) n Aversive Treatment n n Drugs that make the use of abused substances extremely unpleasant Examples include antabuse for alcoholism and silver nitrate for nicotine addiction n Adjunctive Treatment n Pharmacological treatment of underlying pathology (e. g. , depression or anxiety) n Efficacy of Biological Treatment n Such treatments are generally not effective when used alone

Psychosocial Treatment of Substance-Related Disorders n Inpatient vs. outpatient care n n 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 n Community Support Programs n n n 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 n Debate over controlled use vs. complete abstinence as treatment goals

Cognitive-Behavioral Treatment of Substance-Related Disorders (cont. ) n Coping Skills Training n n Assumes deficit of coping skills as cause of disorder Behavioral training in social skills, problem-solving, emotional management, etc. n Relapse Prevention n n 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 n Expect that there will be future stressors which may trigger onset of substance use n Use cognitive principles – how one interprets the onset of substance use will determine how persistent and severe the use will be n n 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. ) n Exposure and Response Prevention n n 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 n Components of Comprehensive Treatment and Prevention Programs n n Individual and group therapy Aversion therapy and covert sensitization Contingency management Community reinforcement n n n Family involvement Employment/education Recreation Relapse prevention Preventive efforts via education