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SUBSTANCE USE DISORDERS

SUBSTANCE USE DISORDERS. GENERAL METHODS OF TREATMENT Inpatient Detoxification and Rehabilitation Outpatient Individual, Couple, or Family Counseling Self-help Groups (Alcoholics Anonymous; NA, CA, OA, GA, Al-Anon etc.) Residential Facilities & Therapeutic Communities Medications.

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SUBSTANCE USE DISORDERS

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  1. SUBSTANCE USE DISORDERS • GENERAL METHODS OF TREATMENT • Inpatient Detoxification and Rehabilitation • Outpatient Individual, Couple, or Family • Counseling • Self-help Groups (Alcoholics Anonymous; • NA, CA, OA, GA, Al-Anon etc.) • Residential Facilities & Therapeutic • Communities • Medications

  2. Disease Model - Treatment • Early identification • Education about diagnosis • Acceptance of disease and overcoming “denial” • Abstinence • 12-steps essential for real recovery

  3. 12 Steps of Alcoholics Anonymous

  4. TREATMENT OF SUBSTANCE USE DISORDERS • Addictive Behavior Meds • ETOH: antabuse, naltrexone, acomprosate; benzodiazepines • Opiates: • Methadone; LAAM • narcan/naltrexone; depot naltrexone • buprenophine • Nicotine: • Nicotine Replacement Therapies • Zyban, Wellbutrin (bupropion) • Effexor (venlafaxine)

  5. Strength of Evidence of Pharmacotherapies for Alcohol Dependence • Naltrexone – • Acomprosate – • Disulfiram – • Serotonergic drugs – • Lithium –

  6. TREATMENT OF SUBSTANCE USE DISORDERS TX myths 1. Nothing works 2. One approach is superior to all others (“one true light” tradition) 3. All treatment approaches work equally well for everyone - measuring outcomes - good studies use:________________________

  7. TREATMENT OF SUBSTANCE USE DISORDERS • Outcome Studies • Hazeldon study: • Drug Abuse Treatment Outcome Study (DATOS) – • natural tx in 4 settings: outpt. methadone clinics, outpatient drug-free, short-term inpatient, long-term residential: 1 year f/u data for outpt. methadone group • Pre F/U • N = 727 / 1,203 89.4%  27.8 heroin use • (60 %) 41.9%  21.7 cocaine use • *weekly or more drug use17.1%  13.9marijuana use • 14.8%  16.3 alcohol use, 5+ drinks • 28.6%  13.7 predatory illegal activity • 25.2%  12.9 sexual behavior risk

  8. Type of Treatment Goal of Treatment Description Frequency CBT (Cognitive Behavioral Therapy) Learn skills to achieve and maintain sobriety Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse 12 weekly sessions TSF (Twelve Step Facilitation) Acceptance of the disease of alcoholism and loss of control over drinking Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings 12 weekly sessions MET (Motivational Enhancement Therapy) Mobilize the person’s own commitment and motivation to change Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking 4 sessions in 12 weeks Project MATCH Treatment Conditions

  9. Project MATCH Results: N = 1,726 outpatients (n=952) and aftercare (n=774) at 5 sites (one of largest clinical trials ever) 25% were women; 15% were minority group members 10 client characteristics studied: severity etoh, sociopathy, cognitive impairment, gender, meaning seeking, motivation, psych severity, etc. 90% of the participants were assessed at 1-year follow-up pre-post differences in drinking days per month (25  6) and drinks per “drinking” day (15  3) each of the 3 treatments worked about equally well in reducing drinking

  10. TSF outpatients more likely to remain sober (24%) at 1 yr. than outpatients in CBT or MET (about 15%) only 1 “matching” prediction supported: outpatients with few or no psychiatric problems had more abstinent days in TSF tx than in CBT At 3-yr. follow-up: 36% of TSF clients abstinent vs. 27% MET and 24% CBT clients *** strong correlation between abstinence rates and compliance with aftercare (“recovery” is a PROCESS).

  11. Principles of Effective Treatmenthttp://www.nida.nih.gov/PODAT/PODAT1.html • No single treatment is appropriate for all individuals. • Treatment needs to be readily available. • Effective treatment attends to multiple needs of the individual, not just his or her drug use. Clients with coexisting mental disorders should have both disorders treated in an integrated way. • In order to meet the changing needs of the client, the treatment plan must be continually assessed and modified.

  12. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. Counseling (individual, couple, and/or group) and other behavioral therapies are critical components of effective treatment for addiction... Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

  13. Treatment does not need to be voluntary to be effective Possible drug use during treatment must be monitored continuously. Treatment programs should provide assessment and counseling for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases to help patients modify or change behaviors that place themselves or others at risk of infection. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.

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