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Ch.18

Drug Abuse

termFunctions
Couples/Family Therapy views substance use in terms of a network of influences and aims at intervening on multiple points in the family or couple system
12-step facilitation increasing the likelihood of abstinence through community engagement and adopting certain philosophical principles about addiction
Motivational interviewing/enhancement resolving ambivalence about engaging in treatment (generally used pre-treatment)
Contingency management reinforcing drug-free behavior with low-cost incentives
Cognitive-behavioral therapy learning to identify and correct problematic behaviors through techniques that enhance self-control and coping strategies
13 Principles of Effective Treatment Programs Drug use during treatment must be monitored as lapses during treatment are common. Treatment programs should assess patients for the presence of infectious diseases and provide targeted risk-reduction counseling.
13 Principles of Effective Treatment Programs Medically-assisted detoxification is only the first step in treatment. Treatment does not need to be voluntary to be effective.
13 Principles of Effective Treatment Programs Treatment must be assessed continually and modified as necessary to ensure it meets changing needs. Many individuals with substance use disorders also have other mental disorders. Treatment should address all disorders.
13 Principles of Effective Treatment Programs Counseling – individual and/or group – and other behavioral therapies are the most commonly used form of treatment. Medications are an important element of treatment, especially with combined with behavioral therapies.
13 Principles of Effective Treatment Programs Effective treatment attends to multiple needs of the individual, not just his/her drug abuse. Remaining in treatment for an adequate period of time is critical (with most individuals needs 3+ months).
13 Principles of Effective Treatment Programs Addiction is a complex but treatable disorder that affects brain function and behavior. No single treatment is appropriate for everyone. Treatment needs to be readily available.
Internet addiction/Effects of 6-week bupropion intervention on neural activation Improved adherence to daily routine Improved school attendance Decreased self-report of video game craving
Internet addiction/Relation to cocaine dependence CL1 and CL2 are associated with visuospatial working memory CL3 suggests amygdala and hippocampus functioning Bupropion decreasing craving
Internet addiction/Behavioral markers of addiction Impairment in daily functioning Impairment in school or occupational performance Preoccupation with “substance”
Internet addiction vs substance abuse (particularly cocaine)in brain activation CL1: left occipital lobe CL2: left superior frontal gyrus CL3: left parahippocampal gyrus
Alcohol addiction/Acamprosate (NMDA antagonist) Controls seizures induced by alcohol withdrawal Decreased likelihood of patients to resume drinking Preliminary testing currently being done in UK, not recognized as treatment by USDA
Alcohol addiction/Opiate antagonists, primarily Naltrexone Suggests the reinforcing effects of alcohol are (in part) produced by the secretion of endogenous opioids
Cannabis addiction/Controversial diagnosis/Rimonabant: Pros: Effective in cannabis and nicotine addiction Controls weight gain Cons: anxiety and depression side effects
Trimethaphan Decreases sensory effects of smoking and reduces satisfaction (suggesting addressing nicotine dependence alone is not effective) Blocks nicotine receptors, but does not cross the blood-brain barrier
Nicotine addiction Nicotine replacement maintenance: Pros: works great in combination with psychotherapy Cons: does not address “smoking” component of nicotine addiction
Stimulant addiction mmunotherapy (Cerrera et al., 1995) Deep brain stimulation (particularly the nucleus accumbens) Limited case-study research with regards to addiction treatment I Invasive
Stimulant addiction Blocking dopamine interventions vs. stimulating dopamine interventions Blocking: produce dysphoria and anhedonia; difficulty with treatment integrity Stimulating: reduce dependence gradually; replaces addiction with another
Buprenorphine Pros: Blocks the effects of opiates and produces a weak opiate effect Little value on the illicit drug market
Opiate addiction Methadone maintenance Pro: oral administration Increases opiate levels slowly, not producing high Breaks down slowly, keeping opiate receptors occupied for longer (controlling craving)
Created by: Dalea
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