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Addiction treatment models mammoura final

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Addiction treatment models mammoura final

  1. 1. ADDICTION TREATMENT MODELS BY DR. SHERIF DARWISHPSYCHIATRIST & ADDICTION THERAPIST
  2. 2. Thinking about addiction We need when we think about treatment to be thiknking of the etiology of addiction and to have a deep understanding of them
  3. 3. Product, pharmacology, prohibition Hisotry,culture ,politics Disease model Addiction scheme Indvidual,personality, Environment, context,psychiatric comorbidity social acceptance Integration problem
  4. 4. 4
  5. 5.  Not only the predisposing and the pricipitating factors, but also the neurobilogy of addiction
  6. 6. Neuroscience – Drug Addiction Habitual – Complusive model: Everitt and Robins. Switch from initial reward to compulsive use Switch from the Ventral striatum to Dorsal striatum function.
  7. 7. Neuroscience – Drug Addiction Incentive Sensitisation Model: Robinson and Berridge. Increased “wanting” vs “liking” Increased salience of drug related stimuli.
  8. 8. Neuroscience – Drug Addiction Aberrant Allostasis Model: Koob and Le Moal. Dysregulation of brain reward system Ability to reset set point in adversity.
  9. 9. Public expectations of substance abuseinterventions Safe, complete detoxification. Reduce use of medical services. Eliminate crime Return or start employment Eliminate family disruption No relapse.
  10. 10. Components of Comprehensive Drug Addiction Treatment www.drugabuse.gov
  11. 11. This brings us to think about treatment Pharmacotherapy not only for withdrawal symptoms but also for maintainance Maintaince treatment as methadone , brupeonorphine or naltrexone. Or maintainece treament for dual diagnosis or accompanying symptoms
  12. 12.  Are we going to treat the patient in an inpatient facility or an out patient clinic. Practice versus science???!!!
  13. 13. The treatment systems
  14. 14. Criteria for long term inpatienttreatment•The following criteria can help identifyclients who could benefit from longer termtreatment:•Failure of previous shorter treatment•Multiple concurrent problems•Severe substance abuse (i.e., dependence)
  15. 15. •Acute psychoses•Acute intoxication•Acute withdrawal•Cognitive inability to focus•Long-term history of relapse•Many unsuccessful treatment episodes•Low level of social support•Serious consequences related to relapse
  16. 16. Director reports of services providedby their facility Group counseling 100% Indvidual counseling 85% Case management 77% Addiction medications 48% Psychiatric medications 37%
  17. 17. Patients reporting of services providedby their facility Group counseling 100% Indvidual counseling 45% Case management 9% Addiction medications 6% Psychiatric medications 0%
  18. 18. Out Patient Treatment Models
  19. 19. EVIDENCE BASED THERAPIES )EBT‘S(THAT ARE INCORPORATED IN THE MATRIX MODEL Matrix Institute 2006 ©
  20. 20. Matrix Groups Psycho-educational Groups Stabilization Groups Relapse Prevention Groups Social Support Groups
  21. 21. Motivantion enhacementSTAGES OF CHANGE:Prochaska &DiClemente Relapse orreoccurrence can happen at any stage Matrix Institute 2006 ©
  22. 22. Outpatient Recovery Issues RELAPSE FACTORS
  23. 23. Outpatient Recovery Issues Relapse Factors - Time Periods Unstructured time••Transition periods•Protracted abstinence•Holidays•Chronic stress, fatigue, or boredom•Anniversary dates•Periods of emotional turmoil
  24. 24. Outpatient Recovery Issues Relapse Factors - Addict Thinking•Paranoia•Relapse justifications: •“I’m not an addict anymore” •“I’m testing myself” •“I need to work” •“Other drugs/alcohol are OK” •“Catastrophic events” •“Negative emotional states”
  25. 25. Outpatient Recovery IssuesRelapse Factors - Relationships Drug-using friends • •Addict must deal with family’s: •Extreme anger and blaming •Unwillingness to change/trust •Hypervigilance - excessive monitoring •Sexual anxieties •Adjustment to non-victim status •Conflict with recovery activities
  26. 26. Outpatient Recovery IssuesRelapse Factors - Addict Behavior•Lying/stealing•Having extramarital/illicit sex•Using secondary substances•Returning to bars/drug friends•Being unreliable/irresponsible•Behavingcompulsively/impulsively•Isolating
  27. 27. Medication assisted models versusno medication models??!!
  28. 28. Special techinques
  29. 29. Integrated group therapy A new treatment developed for patients with substance use and mood disorders. It appears to be a promising approach for this population
  30. 30. Contingency management Contingency management is an evidenced-based behavioral program that uses positive reinforcement, or rewards, to promote behavior change
  31. 31. Designing a CM intervention Selecting a behavior to reinforce Choosing a reinforce )vouchers or prizes( Determining monitoring schedules Integrating behavioral principles
  32. 32. Selecting a behavior to reinforce Abstinence Attendance Medication adherence Compliance with goal related activities
  33. 33. behavioral principles Objectively quantifying behaviors. Priming. Frequency. Immediacy. Magnitude. Escalating. Consistency.
  34. 34. What population respond to CM Probably everyone; No income effect. No race effect. Effective in dual diagnosis. Can promote retention of those with prior preadmissions.
  35. 35. Family education and familytherapy
  36. 36. Occupational support
  37. 37. conclusions We need to consider the psychopathology and neurobiology of addiction when thinking of designing treatment models. In order to meet the patient and public expectations we need to make a lot of efforts and cover different dimensions.
  38. 38. conclusions Treatment success is not limited to inpatient programs)that themselves are not very perfect(. Special treatment methods and multidisciplinary teams are a very good key for success. What are the barriers of research in Mammoura hospital??

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