Substance Use Disorders: Treatment

Chapter 10

Biological Treatment of Substance-Related Disorders

Agonist Substitution Safe drug with a similar chemical composition as the

abused drug Examples include methadone for heroin addiction,

and nicotine gum or patch

Antagonistic Treatment Drugs that block or counteract the positive effects of

substances Examples include naltrexone for opiate and alcohol

problems

Biological Treatment ofSubstance-Related Disorders (cont.)

Aversive Treatment Drugs that make the use of abused substances

extremely unpleasant Examples include antabuse for alcoholism and silver

nitrate for nicotine addiction

Adjunctive Treatment Pharmacological treatment of underlying pathology

(e.g., depression or anxiety)

Efficacy of Biological Treatment Such treatments are generally not effective when

used alone

Psychosocial Treatment of Substance-Related Disorders

Inpatient vs. outpatient care Data suggest little difference in terms of overall

effectiveness For severe dependence, brief inpatient care and

intensive outpatient after-care is the current standard of care

Community Support Programs Alcoholics Anonymous and related groups Developed by Bill W. as structure for recovering

alcoholics to support other alcoholics Twelve-steps and twelve traditions Endorses total abstinence as goal Most successful self-help program ever conceived

Debate over controlled use vs. complete abstinence as treatment goals

Cognitive-Behavioral Treatment ofSubstance-Related Disorders (cont.)

Coping Skills Training Assumes deficit of coping skills as cause of disorder Behavioral training in social skills, problem-solving,

emotional management, etc.

Relapse Prevention Identify triggers for use and develop skills for

avoiding or coping with triggers Create plans for coping with lapses to prevent full-

blown relapses

Relapse Prevention Model by Marlatt

Expect that there will be future stressors which may trigger onset of substance use

Use cognitive principles – how one interprets the onset of substance use will determine how persistent and severe the use will be Lapse – temporary “slip” that does not predict return

of full problem of substance use; use as opportunity to review and implement coping skills as get back on track

Relapse – if interpret as loss of control, then may predict full-blown return of substance use; substance use will reach previous levels and will require comprehensive, long-term treatment

Cognitive-Behavioral Treatment ofSubstance-Related Disorders (cont.)

Exposure and Response Prevention Reduces conditioned responding to drug-related cues Incorporates both classically conditioned and

operantly conditioned cues Social situations or specific people (habituate to

them rather than avoid entirely) Experience of stress, anxiety

Comprehensive Treatment ofSubstance-Related Disorders

Components of Comprehensive Treatment and Prevention Programs Individual and group therapy Aversion therapy and covert sensitization Contingency management Community reinforcement

Family involvement Employment/education Recreation

Relapse prevention Preventive efforts via education