Substance Use Disorders: Treatment

2. Substance Use Disorders: Treatment Chapter 10

3. Biological Treatment of Substance-Related Disorders • Agonist Substitution • Safe drug with a similar chemical composition as the abused drug • Examples include methadone for heroin addiction, and nicotine gum or patch • Antagonistic Treatment • Drugs that block or counteract the positive effects of substances • Examples include naltrexone for opiate and alcohol problems

4. Biological Treatment ofSubstance-Related Disorders (cont.) • Aversive Treatment • Drugs that make the use of abused substances extremely unpleasant • Examples include antabuse for alcoholism and silver nitrate for nicotine addiction • Adjunctive Treatment • Pharmacological treatment of underlying pathology (e.g., depression or anxiety) • Efficacy of Biological Treatment • Such treatments are generally not effective when used alone

5. Psychosocial Treatment of Substance-Related Disorders • Inpatient vs. outpatient care • 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 • 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

6. Cognitive-Behavioral Treatment ofSubstance-Related Disorders (cont.) • Coping Skills Training • Assumes deficit of coping skills as cause of disorder • Behavioral training in social skills, problem-solving, emotional management, etc. • Relapse Prevention • Identify triggers for use and develop skills for avoiding or coping with triggers • Create plans for coping with lapses to prevent full-blown relapses

7. 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 • 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

8. Cognitive-Behavioral Treatment ofSubstance-Related Disorders (cont.) • Exposure and Response Prevention • 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

9. Comprehensive Treatment ofSubstance-Related Disorders • Components of Comprehensive Treatment and Prevention Programs • Individual and group therapy • Aversion therapy and covert sensitization • Contingency management • Community reinforcement • Family involvement • Employment/education • Recreation • Relapse prevention • Preventive efforts via education