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Psychological interventions in addictive disorders

Psychological interventions in addictive disorders. MRCPsych addiction psychiatry seminar March 2010. General treatment principles. Addiction is probably best viewed as primarily a psychological (learnt) problem Medication is an adjunct to psychosocial treatment

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Psychological interventions in addictive disorders

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  1. Psychological interventions in addictive disorders MRCPsych addiction psychiatry seminar March 2010

  2. General treatment principles Addiction is probably best viewed as primarily a psychological (learnt) problem • Medication is an adjunct to psychosocial treatment • Treatment is a co-operative venture • Medication is useless without some readiness to change • Treatment requires careful preparation and aftercare

  3. Treatment aims • Change substance using behaviour • Address co-existing mental health disorders: • Anxiety • Depression • PTSD • Childhood sexual abuse

  4. Elements of intervention • Building motivation • Cognitive restructuring • Developing coping skills

  5. Types of psychological intervention • Psychotherapy • Drug counselling, including motivational interviewing • CBT approaches, including contigency management • Therapeutic communities • Self-help groups

  6. Brief intervention Motivational enhancement Acamprosate Opiate antagonists Social skills training Community reinforcement Behaviour contracting Behavioural marital therapy Case management Self-monitoring Mesa Grande top 10 alcoholinterventions

  7. Review of the effectiveness of treatment for alcohol problems, 2006 • Most people move in and out of problem drinking without treatment • ‘How’ as much as ‘what’ • A range of effective treatments available- from brief interventions to intensive treatments • Psychiatric co-morbidity common and challenging to treat • Treatment is cost effective • Therapist need training

  8. Scottish HTA report relapse prevention in alcohol dependence Effective interventions: • Behavioural self-control training • Motivational enhancement therapy • Marital/family therapy • Coping social skills training

  9. Scottish HTA report OR 95% CI BSCT 1.75 1.02-3.02 MET 1.88 1.28-2.77 M/FT 1.94 1.37-2.73 CCST 2.11 1.53-2.92

  10. Brief interventions • Reduction vs abstinence • Delivered by non-specialist • Non-dependent drinkers • Addresses motivation to change • Self –directed • FRAMES ingredients

  11. ‘FRAMES’ • Feedback of risk • Encouraging responsibility for change • Advice • Menu of alternative options • Empathy • Enhancing self-efficacy

  12. Motivational interviewing ‘ready, willing and able’ Ready: a matter of priority Willing: the importance of change Able: confidence for change ‘yes, but…..’ Ambivalence

  13. Motivational interviewing • Reflective listening • Pros/cons of change • Confidence building • Feedback • Self-motivational statements • Rolling with resistance

  14. NICE guideline 51 Drug misuse: psychosocial interventions • Opportunistic brief interventions focussed on motivation should be offered • Staff should provide information about self-help groups • Contingency management programmes should be introduced

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