This document discusses substance abuse treatment. It covers various treatment programs like inpatient, outpatient, counseling, pharmacotherapies, and 12-step models. The key goals of treatment include defining treatment goals and helping users move through stages of change like pre-contemplation and contemplation. Treatment is most effective when the program matches the individual's needs. Relapse is common due to negative emotions, conflicts, and social pressures. Overall, treatment is beneficial by reducing drug use, criminal behavior, and health risks.
Tailoring programs and services to methamphetamine (Nov 15)Uniting ReGen
Presentation by Laurence Alvis & Rose McCrohan on ReGen's work developing a range of treatment responses to people seeking treatment for methamphetamine dependence.
Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
Tailoring programs and services to methamphetamine (Nov 15)Uniting ReGen
Presentation by Laurence Alvis & Rose McCrohan on ReGen's work developing a range of treatment responses to people seeking treatment for methamphetamine dependence.
Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
Delivered by Dr. Gabe Kuperminc from Georgia State University, the presentation details the results of the Georgia BASICS initiative where SBIRT was implemented in emergency rooms in Georgia.
Star Ratings are increasingly challenging to maintain and improve upon each year. It is incredibly important to improve upon programs each year. What you were doing last year may not earn you the same Star Rating due to increasing cut points. Focusing on pharmacy measures and the patients with diabetes may be a great way to improve upon those ratings.
Georgia Basics: Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments
Presented by:
Gabriel P. Kuperminc, Ph.D
Professor of Psychology
Georgia State University
Tackling the Top 5 Barriers to Medication AdherenceHealth Dialog
A lack of medication adherence can lead to poor clinical outcomes, higher hospital admissions and rising spend for your organization. On top of that, CMS Star point rates are also increasing year after year, making it increasingly difficult to obtain a 5 Star rating. It can be tough thinking about how to start building an effective strategy to increase adherence in your population.
We will overview the top struggles with medication adherence in populations and how to use predictive analytics, tailored outreach and patient engagement, and behavior change programs to overcome them.
Health Consumers' Council's Manager of Advocacy and Research and Murdoch's Dr Norman Stomski co-presented on a recent project where 60 de-identified advocacy cases were analysed for themes and to explore how advocacy supported the mental health consumer patient journey.
Unnecesary Medication Use in Long Term Care FacilitesDebbie Ohl
Meds are a key component in the clinical process.
The guidelines are intended to insure medication use is of value and necessary. T
Significant emphasis is placed on preventing and recognizing adverse drug reactions ASAP.
Consequently, surveyors will expect to see:
Rationale for use, Parameters for monitoring
Prompt recognition and evaluation of new onset problems and conditions worsening
Consideration for dose reduction and discontinuance as appropriate.
Course Director Peter A. Lio, MD, and Robert Sidbury, MD, MPH, prepared useful Practice Aids pertaining to atopic dermatitis for this CME activity titled "Advances in the Management of Moderate to Severe Atopic Dermatitis: How Can We Address Unmet Medical Needs in Individual Patients to Optimize Long-Term Outcomes?" For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2VJqSFq. CME credit will be available until June 19, 2020.
The path to medication adherence is filled with road blocks. In order to overcome what is stopping your population from taking their medication as prescribed understanding the barriers is key.
Innovative Steps That Increase Medication Adherence Health Dialog
Learn how to improve your medication adherence strategy with help from our analytics exports. Identifying the right patients with AI machine-learning and predictive analytics are a solid foundation.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Delivered by Dr. Gabe Kuperminc from Georgia State University, the presentation details the results of the Georgia BASICS initiative where SBIRT was implemented in emergency rooms in Georgia.
Star Ratings are increasingly challenging to maintain and improve upon each year. It is incredibly important to improve upon programs each year. What you were doing last year may not earn you the same Star Rating due to increasing cut points. Focusing on pharmacy measures and the patients with diabetes may be a great way to improve upon those ratings.
Georgia Basics: Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments
Presented by:
Gabriel P. Kuperminc, Ph.D
Professor of Psychology
Georgia State University
Tackling the Top 5 Barriers to Medication AdherenceHealth Dialog
A lack of medication adherence can lead to poor clinical outcomes, higher hospital admissions and rising spend for your organization. On top of that, CMS Star point rates are also increasing year after year, making it increasingly difficult to obtain a 5 Star rating. It can be tough thinking about how to start building an effective strategy to increase adherence in your population.
We will overview the top struggles with medication adherence in populations and how to use predictive analytics, tailored outreach and patient engagement, and behavior change programs to overcome them.
Health Consumers' Council's Manager of Advocacy and Research and Murdoch's Dr Norman Stomski co-presented on a recent project where 60 de-identified advocacy cases were analysed for themes and to explore how advocacy supported the mental health consumer patient journey.
Unnecesary Medication Use in Long Term Care FacilitesDebbie Ohl
Meds are a key component in the clinical process.
The guidelines are intended to insure medication use is of value and necessary. T
Significant emphasis is placed on preventing and recognizing adverse drug reactions ASAP.
Consequently, surveyors will expect to see:
Rationale for use, Parameters for monitoring
Prompt recognition and evaluation of new onset problems and conditions worsening
Consideration for dose reduction and discontinuance as appropriate.
Course Director Peter A. Lio, MD, and Robert Sidbury, MD, MPH, prepared useful Practice Aids pertaining to atopic dermatitis for this CME activity titled "Advances in the Management of Moderate to Severe Atopic Dermatitis: How Can We Address Unmet Medical Needs in Individual Patients to Optimize Long-Term Outcomes?" For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2VJqSFq. CME credit will be available until June 19, 2020.
The path to medication adherence is filled with road blocks. In order to overcome what is stopping your population from taking their medication as prescribed understanding the barriers is key.
Innovative Steps That Increase Medication Adherence Health Dialog
Learn how to improve your medication adherence strategy with help from our analytics exports. Identifying the right patients with AI machine-learning and predictive analytics are a solid foundation.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Goals: The goal of this training is to help participants develop their knowledge, skills and abilities as Substance Use Screenng, Brief Intervention, and Referral to Treatment (SBIRT) Trainers.
At the end of this training participants will be able to understand the information screening does and does not provide,define brief intervention, describe the goals of conducting a BI, understand the counselor's role in providing BI, describe referral to treatment, identify SBIRT as a system change initiative, introduce the public health approach, and understand the continuum of substance use.
Audience: Social Workers, counselors and other behavioral health providers from all settings can benefit from understanding substance use across a continuum and its impact on clients behavioral health and other psychosocial interactions.
Goals: The goal of this training is to help participants develop their knowledge, skills and abilities as Substance Use Screenng, Brief Intervention, and Referral to Treatment (SBIRT) Trainers.
At the end of this training participants will be able to understand the information screening does and does not provide,define brief intervention, describe the goals of conducting a BI, understand the counselor's role in providing BI, describe referral to treatment, identify SBIRT as a system change initiative, introduce the public health approach, and understand the continuum of substance use.
Audience: Social Workers, counselors and other behavioral health providers from all settings can benefit from understanding substance use across a continuum and its impact on clients behavioral health and other psychosocial interactions.
Dave Atkinson
Lead on Department of Health’s Positive and Safe Guidance
Independent Consultant Nurse working who led on Department of Health's ' 'Positive and Proactive Care'
Sensible Specialist Service Responses to the Methamphetamine “Crisis”Uniting ReGen
APSAD 2014 presentation by Trevor King on current community concerns about methamphetamines and ReGen's experience in developing targetted treatment models for people affected by methamphetamine use.
Presentation Objectives:
1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs
2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app
3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.
Presented by Stephen Cha, MD, MHS of the Centers for Medicare and Medicaid Services at the annual meeting of the Asthma Regional Council of New England, June 13, 2013, Shrewsbury, MA.
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
For more detailed information on delivering micro-credentials in TVET, visit this https://tvettrainer.com/delivering-micro-credentials-in-tvet/
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
4. Treatment & Recovery
• Defining treatment goals
• Programs:
• Inpatient
• Outpatient
• Counseling
• Individual
• Group
• Family
• Pharmacotherapies
• AA and other 12-step models
5. Before we can evaluate the success of a drug
treatment program, we have to understand the
program’s
A. Administrative structure.
B. Training requirements.
C. Goals.
D. Theoretical approach.
Adm
inistrative
structure.
Trainingrequirem
ents.
Goals.
Theoreticalapproach.
0% 0%
96%
4%
6. Opinion: What do you think the
goal of treatment should be?
A. Complete
abstinence
B. Controlled
substance use
C. Helping the user
make better
decisions
D. Other
Com
plete
abstinence
Controlled
substance
use
Helpingthe
userm
ake
be...
Other
29%
0%
71%
0%
7. Stages of Change
• Motivational Enhancement Interview
• Resistance
• Client
• Community
8.
9. The goal of motivational
enhancement is
1. To confront the
user with his/her
negative behavior
2. Find alternatives to
substance use
3. Encourage the user
to move to another
stage of change
To
confrontthe
userw
ith...
Find
alternativesto
subs...
Encourage
the
userto
m
...
14%
81%
5%
10. Drug Courts
• Drug treatment courts combine the power of the
justice system with effective treatment services
• First drug court was established in 1989 for nonviolent
drug offenders whose underlying problem is
substance use
• Offenders who complete substance abuse programs
may have their sentences dismissed or reduced
13. The most widely used treatment for
substance abuse is:
A. Motivational
enhancement
B. Pharmacotherapy
C. Cognitive-
behavioral therapy
D. Detoxification M
otivationalenhancem
entPharm
acotherapy
Cognitive-behavioralthe...
Detoxification
0% 0%
91%
9%
14. The goal of the maintenance
phase of treatment is
A. Preventing seizures
B. Preventing cross
tolerance
C. Preventing relapse
Preventingseizures
Preventingcrosstolerance
Preventingrelapse
0%
100%
0%
17. Is Treatment Effective?
• Relapse
• Factors:
• Negative emotional states
• Interpersonal conflicts
• Social pressure
18. Benefits of Treatment
•Less expensive than incarceration
•Reduced use of illicit drugs
•Decline in criminal activity
•More stable employment
•Reduced transmission of AIDS
19. Treatment Issues
• Four pertinent issues in treating drug abuse:
1. Voluntary or compulsory treatment
2. Matching patients to the best treatment
3. Effectiveness of treatment programs
designed for adults for adolescent substance
abusers
4. Programs to address female addicts
21. Barriers
• Client Resistance to Treatment:
• Many treatment facilities are not readily available or
accessible
• A large percentage of clients lack insurance and
cannot afford the cost of treatment
• Policies and philosophies of some facilities deter
drug abusers from pursuing help
• Benefits of using drugs outweigh the disadvantages
• Clients think that legal authorities will be made
aware of their drug-taking behavior if they enter
treatment
22. Barriers
• Community Resistance:
• People do not want drug treatment centers in
their neighborhoods
• Concerned about more crime, more traffic,
exposure of children to bad influences, and
lower property values
• NIMBY (not in my backyard) syndrome
23. Barriers
• Continuing Drug Use:
• The goal of abstinence is often not realized
• Treatment of at least six months seems to be
necessary to reduce drug use significantly
• One study of adolescents in treatment reported
that drug usage declined somewhat, but
remained high
24. Barriers
• Factors that contribute to relapse among
alcoholics:
1. Negative emotional states such as frustration,
anxiety, depression, anger, or boredom
2. Interpersonal conflicts with a spouse, family
member, friend, or employer
3. Social pressure from a person or group of
people
25. Barriers
• Factors in Personnel Recruitment and
Retention:
• Reluctance to work with drug abusers
• Undesirable locations of facilities
• Inadequate supply of applicants with
professional experiences and qualifications
• Fear of contracting AIDS
Editor's Notes
23.5 million persons aged 12 and older need treatment for either an illicit drug or alcohol
Only 11.2% of those individuals receive treatment from a specialized facility
The federal government allocates more than two-thirds of its drug-control budget to law enforcement and interdiction efforts, rather than treatment
People in treatment for substance abuse:
Disadvantaged in education and employment
More likely to be male, Caucasian, aged 25 to 45
Increasing trend toward veterans and the elderly
Most people in drug treatment :
Caucasian males
Average age at admission is 34
Less than one-fourth are employed
One third completed high school or a GED
Many have mental health problems
30-40% of homeless population are drug abusers
Most use more than one drug
The goals of a treatment program differ, depending on whether drug abuse is seen as a medical problem, as a breakdown in society, or as a personality weakness
Hundreds of thousands of Americans undergo treatment for substance abuse and dependence each year
A variety of treatment approaches are used, often in combination
Behavioral/psychosocial treatments
Pharmacotherapies
Different approaches reflect
Different substance abuse problems
Different theories about substance abuse
Treatment goals are influenced by the underlying theoretical view of substance abuse
Alcohol
View that substance dependence is a biological disease that someone either has or does not have
Only acceptable treatment goal is complete abstinence
View that substance dependence represents one end of a continuum of drinking
A possible treatment goal is controlled social use
Opioids
View that substance dependence undermines the physical and mental health of its victims
Only acceptable treatment goal is abstinence (traditional view)
View that dependence on legal methadone is preferable to dependence on illegal heroin
Goal of treatment has changed from eliminating opioid use to eliminating heroin use
Tobacco
Complete abstinence (most common goal) vs. cutting down on smoking or switching to cigarettes lower in tar and nicotine
How to evaluate treatment outcomes of reduced use as opposed to abstinence?
Researchers are beginning to develop cost/benefit analyses
Cost of treatment
vs.
Cost savings from increased employment and decreased crime after treatment
Alcoholics Anonymous
Founded in 1935: A loose affiliation of local groups that adhere to common methods
Based on the disease model of dependence
An alcoholic is biologically different from others, so abstinence is the only appropriate goal
The disease takes away a person’s control over his or her own drinking behavior
It removes the blame for the problem from the alcoholic but not the responsibility for dealing with it
Major approaches are group support and a buddy system
Formal evaluations of AA have not been very positive
However, studying people who have court-ordered referrals to AA might not be an appropriate evaluation method
A more appropriate evaluation might be to determine which types of drinkers are most likely to benefit from AA’s programs
Evaluation is important because many treatment programs follow the 12-step model of AA
Betty Ford Center, Hazelden, Phoenix House
Motivational interviewing
Used to boost the motivation to change of an ambivalent or less ready substance abuser
A nonconfrontational process of determining the abuser’s current stage of change and then helping the individual move forward
Motivational Enhancement Therapy
Conventional wisdom about people with substance abuse problems:
Most substance abusers use the defense mechanism of denial and are unwilling to admit they have a problem
Only when a user suffers serious consequences (“hits bottom”) will he or she be ready to seek help
Problem with this perspective is that very serious consequences may occur before the abuser is ready for treatment
Motivational enhancement therapy attempts to shift the focus away from denial and toward motivation to change
Client Resistance to Treatment:
Many treatment facilities are not readily available or accessible
A large percentage of clients lack insurance and cannot afford the cost of treatment
Policies and philosophies of some facilities deter drug abusers from pursuing help
Benefits of using drugs outweigh the disadvantages
Clients think that legal authorities will be made aware of their drug-taking behavior if they enter treatment
Community Resistance:
People do not want drug treatment centers in their neighborhoods
Concerned about more crime, more traffic, exposure of children to bad influences, and lower property values
NIMBY (not in my backyard) syndrome
VOLUNTARY or INVOLUNTARY
Some studies show that volunteers fare better than those required to be in treatment
Other studies show that those required to receive treatment make as much progress, as those who enter voluntarily
The key issue could be how long the person stays in treatment
Stages of change
Precontemplation: Individual doesn’t recognize that a problem exists
Contemplation: Individual recognizes there is a problem and begins to consider the possibility of changing her or his behavior
Preparation: Individual decides to change and makes plans to change
Action: Individual takes active steps toward change
Maintenance: Individual engages in activities intended to maintain the change
Goals of motivational interviews
Help the client focus on problem behaviors
Help the client move forward to the next stage of change
Motivational enhancement therapy is probably best conceptualized as preparation for other therapies rather than as a stand-alone treatment
Methadone Maintenance
Treatment that involves the dispensing of methadone for opiate addiction for more than 30 days
Eliminates withdrawal symptoms and prevents euphoria
Given orally, every 24 hours
Effective only for heroin addiction
Psychotherapy in conjunction with methadone yields the best results
Crime reduction and relapse rates improve with duration of treatment
Alternatives to Methadone:
Extended-release form of naltrexone allows patients to be treated on a monthly rather daily basis
Levo-alpha-acetylmethadol (LAAM) works for three days, but has side effects
Other drugs that block the effects of opiates are naltrexone, naloxone, clonidine, and buprenorphine
Some narcotic addicts say that methadone withdrawal is worse than going cold turkey
Therapeutic communities (TCs)
Drug-free residential settings where abusers reside for one or two years
Philosophy is that drug abuse is incurable, but can benefit from behavioral intervention
Stress group intervention techniques, especially encounter groups
Provide vocational and educational assistance and improve the self-esteem of residents
Outpatient Treatment:
Most common form of drug abuse treatment
Less disruptive and stigmatizing than inpatient treatment
Ranges from counseling centers to halfway houses to community centers
Frequently is used after a client leaves methadone maintenance
Clients often go back to the environments that contributed to their drug abuse initially
Inpatient Treatment:
Typically hospital based
Expensive
No more effective than intensive outpatient treatment
Tend to be highly structured
Group therapy and drug education are stressed
Self-Help Groups:
Members are bound by a common denominator such as alcohol, gambling, food, shopping, or sex
Largest self-help group is Alcoholics Anonymous (AA), based on a 12-step model
Offer fellowship and support
Used in lieu of traditional therapies or after a person stops other therapies
Cost-effective for maintaining changes and preventing relapse
Using drugs to treat drug abuse was common in early treatment programs
US Public Health Service established two hospitals to serve the growing number of addicts in federal prisons
The relapse rate of people released in the 1940s through early 1960s ranged between 87% and 96%
Therapeutic community – a residential facility staffed by former drug addicts
Methadone maintenance programs – outpatient programs in which opiate addicts receive methadone daily
Methadone Maintenance
Treatment that involves the dispensing of methadone for opiate addiction for more than 30 days
Eliminates withdrawal symptoms and prevents euphoria
Given orally, every 24 hours
Effective only for heroin addiction
Psychotherapy in conjunction with methadone yields the best results
Crime reduction and relapse rates improve with duration of treatment
Alternatives to Methadone:
Extended-release form of naltrexone allows patients to be treated on a monthly rather daily basis
Levo-alpha-acetylmethadol (LAAM) works for three days, but has side effects
Other drugs that block the effects of opiates are naltrexone, naloxone, clonidine, and buprenorphine
Some narcotic addicts say that methadone withdrawal is worse than going cold turkey
Therapeutic communities (TCs)
Drug-free residential settings where abusers reside for one or two years
Philosophy is that drug abuse is incurable, but can benefit from behavioral intervention
Stress group intervention techniques, especially encounter groups
Provide vocational and educational assistance and improve the self-esteem of residents
Outpatient Treatment:
Most common form of drug abuse treatment
Less disruptive and stigmatizing than inpatient treatment
Ranges from counseling centers to halfway houses to community centers
Frequently is used after a client leaves methadone maintenance
Clients often go back to the environments that contributed to their drug abuse initially
Inpatient Treatment:
Typically hospital based
Expensive
No more effective than intensive outpatient treatment
Tend to be highly structured
Group therapy and drug education are stressed
Self-Help Groups:
Members are bound by a common denominator such as alcohol, gambling, food, shopping, or sex
Largest self-help group is Alcoholics Anonymous (AA), based on a 12-step model
Offer fellowship and support
Used in lieu of traditional therapies or after a person stops other therapies
Cost-effective for maintaining changes and preventing relapse
Narcotics Anonymous (NA)
Emanated from Alcoholics Anonymous
Open to all drug addicts
Principles of the NA recovery program:
Admitting there is a problem
Seeking help
Engaging in a thorough self-examination;
Confidential self-disclosure;
Making amends for harm done
Helping other drug addicts who want to recover
AA advocates total abstinence, a view that is not universally accepted
Some treatments advocate a controlled drinking approach in which the patient learns to drink in a nonabusive manner
Drug therapy in the form of Antabuse (disulfiram) has been used as well
Alcoholics Anonymous
Started in 1935 by an alcoholic surgeon (Dr. Bob) and an alcoholic stockbroker (Bill W.)
Goals are sobriety and spiritual renewal
Based on the premise that alcoholism is a disease over which the person has no control
Based on a 12-step plan
1. We admitted we were powerless over alcohol—that our lives had become unmanageable
2. Came to believe that a Power greater than ourselves could restore us to sanity
3. Made a decision to turn our will and our lives over to the care of God as we understood Him
4. Made a searching and fearless moral inventory of ourselves
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings
8. Made a list of all persons we had harmed, and became willing to make amends to them all
9. Made direct amends to such people wherever possible, except when to do so would injure them or others
10. Continued to take personal inventory and when we were wrong promptly admitted it
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him
12. We tried to carry this message to alcoholics and to practice these principles in all our affairs
Moderation Management (MM) is a controlled drinking model of behavioral self-management
Drinkers are taught to cope with peer pressure and situations that tempt them to drink excessively
The longer a person has been an alcoholic, the less likely it is that he or she can return to social drinking
The controlled drinking model is contrary to the disease model
Disulfiram (Antabuse)
Acts as an aversive agent by interacting with alcohol in such a way that the drinker becomes violently ill
Naltrexone
Reduces alcohol craving among heavy drinkers, but has not been shown to result in abstinence
Acamprosate
Inhibits the craving for alcohol and food
Detoxification – a medically supervised program to withdraw from drugs on which they are physically dependent
Three immediate goals of detoxification:
To provide safe withdrawal from drugs
To provide withdrawal that is humane and protects the person’s dignity
To prepare the person for ongoing treatment
Self-help programs based on the principles of Alcoholics Anonymous are growing in popularity
Contingency Management
An approach in which individuals receive immediate rewards for providing drug-free urine samples
Value of the rewards increases with consecutive drug-free samples
Clients also participate in weekly skill-building counseling sessions
Has produced consistent reduction in use
Downside of approach is the cost of rewards
Cognitive Behavioral Therapy (CBT)
An approach that combines cognitive therapy techniques with behavioral skills training
Individuals learn to identify and change behaviors that could lead to relapse, such as associating with drug users
Evaluation
Shown to be more effective than most therapies
Considered challenging because it places significant demands on patients
Despite this, it remains one of the most widely used substance abuse treatment strategy
Study of dependence as a brain disease has focused research efforts on developing medications for treatment
Many experts believe that pharmacotherapies alone will not cure a chronic, relapsing, behavioral disorder like substance abuse
Pharmacotherapies can provide a window of opportunity for behavioral/psychosocial treatments by relieving withdrawal symptoms
Detoxification
Detoxification is an initial and immediate phase of treatment
Medications are administered to alleviate unpleasant and/or dangerous withdrawal symptoms that may appear following abrupt cessation of drug use
Some of these medications may also be used during maintenance stage
Maintenance
Maintenance is a longer-term strategy used to help a dependent individual avoid relapse
Three general categories of pharmacotherapy for maintenance
Agonist or substitution therapy
Antagonist therapy
Punishment therapy
Agonist or substitution therapy is used to induce cross-tolerance to the abused drug
Examples: methadone for heroin dependence, nicotine replacement for tobacco dependence
Agonists typically have safer routes of administration and/or diminished psychoactive effects compared to the original drug
Substituting a longer-acting, pharmacologically equivalent drug allows the user to be stabilized on the agonist and then slowly tapered off it, avoiding withdrawal symptoms
Antagonist therapy is used to prevent the user from experiencing the reinforcing effects of the abused drug
Example: naltrexone, which blocks opioid effects
Punishment therapy is used to produce an aversive reaction following ingestion of the abused drug
Example: disulfiram for alcohol dependence
ALCOHOL
Detoxification phase
Pharmacological therapies are important because acute alcohol withdrawal syndrome has serious effects
Medical risks often require an inpatient medical setting for alcohol detoxification
Benzodiazepines are typically used
Reduce autonomic hyperactivity and prevent seizures
Best choices are those with a slow onset of action Chlordiazepoxide (Librium) or diazepam (Valium)
Maintenance therapy
Usually given for weeks or months rather than indefinitely
Three approved medications
Disulfiram (Antabuse)
Naltrexone (Revia)
Acamprosate (Campral)
Disulfiram (Antabuse) causes unpleasant symptoms (headache, vomiting, and breathing difficulties) if alcohol is consumed
Inhibits aldehyde dehydrogenase, thereby increasing acetaldehyde
Not very effective because most people don’t take the medication
Naltrexone (Revia)
Reduces alcohol craving, days per week of drinking, and rate of relapse—but hasn’t had a large impact on overall treatment success
Unclear how it works; it may block opioid receptors and the reinforcing effects of alcohol
Acamprosate (Campral) a compound structurally similar to GABA
Normalizes basal GABA concentrations
Blocks the glutamate increases observed during alcohol withdrawal
Recently approved, so effectiveness hasn’t been determined
NICOTINE
Nicotine withdrawal symptoms (anxiety, depression, insomnia, cigarette cravings) occur in most smokers who stop smoking
Five nicotine replacement products are approved by the FDA
Transdermal nicotine patch
Nicotine gum
Nicotine nasal spray
Nicotine vapor inhaler
Nicotine lozenge
Smokers should stop smoking before using any of them to avoid nicotine toxicity
Use of nicotine replacement products has been shown to increase quit rates in controlled clinical studies
Success rates are probably lower in a real world setting
Bupropion (Zyban), a non-nicotine pharmacotherapy for smoking cessation
Approved by the FDA in 1997
Also used in the treatment of depression
Mechanisms of action haven’t been definitively determined
May inhibit reuptake of dopamine and norepinephrine and, to a lesser extent, block acetylcholine receptors
Has been shown to gradually decrease cigarette craving and use
OPIOIDS’
Traditionally, anticholinergic drugs like belladonna were used to treat opioid dependence
Goal: To produce a state of delirium for several days so that the dependent person would avoid experiencing withdrawal
More recent version is “rapid opioid detoxification,” in which a dependent person is anesthetized and given an opioid antagonist that causes immediate withdrawal
Person is released after 24 hours and enters a period of counseling while continuing to take an opioid antagonist
Criticisms of approach
Medical risks of rapid withdrawal process
Behavioral/psychosocial aftercare is often deemphasized
Detoxification
Medications given to reduce withdrawal symptoms (nausea, vomiting, diarrhea, aches, pain)
Methadone, a long-acting opioid
Buprenorphine, a partial opioid agonist with a long duration of action
Maintenance
Methadone maintenance is the most common form of treatment for opioid dependence
May continue for months or years
Less data available on more recently approved buprenorphine (Subutex) maintenance
Buprenorphine + naloxone (Suboxone)
Naloxone (Narcan), a short-acting opioid antagonist, is used to treat opioid overdose
Naltrexone (Revia), a long-acting opioid antagonist, is approved for treating opioid dependence
Has been shown to be effective, but it is appropriate only for highly motivated individuals
A once-per-month form is being studied; initial findings are promising
COCAINE
Withdrawal symptoms
Can include depression, nervousness, anhedonia (lack of emotional response), fatigue, irritability, sleep and activity disturbances, craving for cocaine
Risk of relapse may be greatest during withdrawal period
Reduced monoamine neurotransmitter activity may underlie withdrawal symptoms
Medications that increase monoamine neurotransmitter activity have been tested but have not been found useful in treating withdrawal symptoms or dependence
Currently no approved pharmacotherapy for cocaine dependence
CANNABIS
Withdrawal from cannabis
People seeking treatment for cannabis dependence often report withdrawal symptoms that make it more difficult to maintain abstinence
Symptoms may include irritability, anxiety, sleep disruption, aches
Many medications have been tested for relief of cannabis withdrawal symptoms
One drug has been found effective: oral ∆9-THC (Marinol)
Currently no approved pharmacotherapy for cannabis dependence
Most frequently reported drugs for substance abuse treatment admissions
Alcohol (40 percent)
Opioids (19 percent)
Marijuana/hashish (16 percent)
Cocaine (13 percent)
Stimulants (8 percent, primarily methamphetamine)
Abusers admitted for treatment
Average age of those admitted with marijuana as the primary drug of abuse is 24
Sites of treatment
47 percent treated as outpatients
13 percent treated as hospital inpatients (detoxification)
18 percent treated in a residential setting
23.5 million persons aged 12 and older need treatment for either an illicit drug or alcohol
Only 11.2% of those individuals receive treatment from a specialized facility
The federal government allocates more than two-thirds of its drug-control budget to law enforcement and interdiction efforts, rather than treatment
People in treatment for substance abuse:
Disadvantaged in education and employment
More likely to be male, Caucasian, aged 25 to 45
Increasing trend toward veterans and the elderly
Most people in drug treatment :
Caucasian males
Average age at admission is 34
Less than one-fourth are employed
One third completed high school or a GED
Many have mental health problems
30-40% of homeless population are drug abusers
Most use more than one drug
Substance abuse treatment development should focus on
More effective interventions for commonly abused drugs
Alcohol
Opioids
Marijuana
Cocaine
Treatment delivery on an outpatient basis
Effective outpatient behavioral/psychosocial interventions are needed to improve the overall success of treatment
Outpatient Treatment:
Most common form of drug abuse treatment
Less disruptive and stigmatizing than inpatient treatment
Ranges from counseling centers to halfway houses to community centers
Frequently is used after a client leaves methadone maintenance
Clients often go back to the environments that contributed to their drug abuse initially
Inpatient Treatment:
Typically hospital based
Expensive
No more effective than intensive outpatient treatment
Tend to be highly structured
Group therapy and drug education are stressed
Self-Help Groups:
Members are bound by a common denominator such as alcohol, gambling, food, shopping, or sex
Largest self-help group is Alcoholics Anonymous (AA), based on a 12-step model
Offer fellowship and support
Used in lieu of traditional therapies or after a person stops other therapies
Cost-effective for maintaining changes and preventing relapse
Benefits of drug treatment:
Less expensive than incarceration
Reduced use of illicit drugs
Decline in criminal activity
More stable employment
Reduced transmission of AIDS
Reported benefits:
Drug use declined from 73% before treatment to 38% one year after treatment
Increase in employment from 51% to 60%
Decline in clients receiving welfare from 40% to 35%
Drop in homelessness from 19% to 11%
53% decline in substance-related medical visits
56% reduction in people exchanging sex for drugs
51% drop in people having sex with an IV drug user
Continuing Drug Use:
The goal of abstinence is often not realized
Treatment of at least six months seems to be necessary to reduce drug use significantly
One study of adolescents in treatment reported that drug usage declined somewhat ,but remained high
Substance dependence is a chronic illness
Treatment doesn’t work for every individual every time
Condition may require continuing care throughout life
Factors that contribute to relapse among alcoholics:
Negative emotional states such as frustration, anxiety, depression, anger, or boredom
Interpersonal conflicts with a spouse, family member, friend, or employer
Social pressure from a person or group of people
Continuing Drug Use:
The goal of abstinence is often not realized
Treatment of at least six months seems to be necessary to reduce drug use significantly
One study of adolescents in treatment reported that drug usage declined somewhat, but remained high
Studies show that treatment is cost-effective by reducing crime and increasing employment
Treatment also saves lives in the long term
Benefits of drug treatment:
Less expensive than incarceration
Reduced use of illicit drugs
Decline in criminal activity
More stable employment
Reduced transmission of AIDS
Reported benefits:
Drug use declined from 73% before treatment to 38% one year after treatment
Increase in employment from 51% to 60%
Decline in clients receiving welfare from 40% to 35%
Drop in homelessness from 19% to 11%
53% decline in substance-related medical visits
56% reduction in people exchanging sex for drugs
51% drop in people having sex with an IV drug user
Questions to be addressed:
Which treatment produces the best outcomes for a specific group or person?
Do members of certain ethnic or socioeconomic groups respond similarly to certain types of treatment?
Is the effectiveness of a specific program linked to age of participants?
Do females and males differ in their responses to treatment?
ADOLESCENTS
In 2009, in the US, 149,277 individuals aged 12 to 17 were admitted to a drug treatment facility
The primary drug of abuse was marijuana
More intensive, longer programs (three months) are more effective than short (two session) programs
Teens who enter treatment do better academically than teens who do not receive treatment
WOMEN
Treatment programs for women are scarce
Women substance abusers are more likely to have poor family relationships and psychological health than men
Even when treatment is available, many women are reluctant to enter a program
Women in female-only drug abuse treatment centers are more likely to benefit from treatment
Some studies show that volunteers fare better than those required to be in treatment
Other studies show that those required to receive treatment make as much progress, as those who enter voluntarily
The key issue could be how long the person stays in treatment
Questions to be addressed:
Which treatment produces the best outcomes for a specific group or person?
Do members of certain ethnic or socioeconomic groups respond similarly to certain types of treatment?
Is the effectiveness of a specific program linked to age of participants?
Do females and males differ in their responses to treatment?
In 2009, in the US, 149,277 individuals aged 12 to 17 were admitted to a drug treatment facility
The primary drug of abuse was marijuana
More intensive, longer programs (three months) are more effective than short (two session) programs
Teens who enter treatment do better academically than teens who do not receive treatment
Treatment programs for women are scarce
Women substance abusers are more likely to have poor family relationships and psychological health than men
Even when treatment is available, many women are reluctant to enter a program
Women in female-only drug abuse treatment centers are more likely to benefit from treatment
Figure 15.1 Percentages of Reasons* for Not Receiving Substance Use Treatment in the Past Year among Women Aged 18 to 49 Who Needed Treatment and Who Perceived a Need for It: 2004–2006