Chapter 3Addictions: Theory and Treatment

Drug Addiction

• Behavioral pattern of drug use

• Overwhelming involvement

• Securing of its supply

• Tendency to relapse after withdrawal

Three Basic Processes

1. Tolerance• Repeated exposure results in a lesser effect

2. Physical dependence• Withdrawal syndrome

3. Psychological dependence• Observable behavior of frequently using drugs –

reinforcement plays a role with this

Changing Views ofDrug Addiction

• Early medical models– Early theories based on physical dependencies

as the key

• Positive reinforcement model– Concepts of drugs acting as “positive

reinforcers” in psychological dependence

The Broad Viewsof Addiction

• Is addiction caused by the substance?

• Is addiction biological?

• Is there an addictive personality?

• Is addiction a family disorder?

• Is addiction a disease?

Assessment ofAddictive Disorders

• Psychiatric– Diagnosis for dependence– Diagnosis for substance abuse

Dependence Criteria

1. Tolerance toward substance

2. Withdrawal syndrome

3. Substance taken in large amounts

4. Unsuccessful efforts to cut down

Dependence Criteria, cont’d

5. Activities involved to obtain substance

6. Lifestyle is centered around obtaining substance

7. Use continues after being diagnosed

Substance Abuse Criteria

• Pattern leads to impairment at work, school, etc.

• Increased hazards in daily situations

• Legal problems

• Continued use despite expressing the abuse factors

Addiction Treatment

• Deciding to quit– Stages of change

• precontemplation

• contemplation

• preparation

• action

• maintenance

Addiction Treatment, cont’d

• Deciding to quit, cont’d– Intervention– Motivational interviewing (assessment)

• Defining treatment goals– Abstinence– Controlled use

Addiction Treatment, cont’d

• 3 treatment stages– Detoxification

• removing the offending substance from the body

– Active treatment• treating a variety of substance dependence

– Aftercare (relapse prevention)• avoiding use on a day-to-day basis through self-help

approaches

Treatment Approaches

1. Residential treatment• Medical hospitalization

• Synanon

• Other therapeutic communities

2. Outpatient

3. Chemical dependency residency programs• Private-pay clinics

Treatment Approaches, cont’d

4. Medication-assisted treatments• Antagonism

• Substitution

• Medically incompatible

5. Outpatient drug-free programs• Range from telephone hotlines to emergency room-

associated clinics

• Community mental health centers

Addiction Treatment(The Big Picture in the U.S.)

• Treatment outcome data set– Over 1.5 million admissions each year– Four substances account for 90% of admissions

• alcohol 47%

• opiates 15%

• cocaine 15%

• marijuana 13%

Source: SDM HAS Annual Report

Is Treatment Effective?

• Current belief is that treatment is ineffective

• 1990 report shows effectiveness results (Institute of Medicine)

• 1994 report (CA Department of Alcohol and Drug Programs) shows reduction of users and increased savings

Chapter 3

Addictions: Theory and Treatment