Treatment and Prevention of Substance Use DisordersPrevalence of Substance DisordersLifetime Prevalence of DSM-III-R Substance Abuse DisordersConditional Probabilities of Drug Use Co-occurrenceLifetime Prevalence of DSM-III-R Drug Use and DependencePharmacological Treatment for Alcohol DependenceEffects of Naltrexone in Reducing RelapseSlide 8Slide 9Behavioral Approaches to AlcoholismSlide 11Cue Exposure: Treatment ComponentsEfficacy Studies: Cued ExposureCue Exposure With Coping Skills TrainingSlide 15Efficacy of Cued Exposure in Moderation DrinkingSlide 17Approaches for Preventing RelapseMarlatt's Relapse Prevention ModelTriggers for RelapseSlide 21Most Common High-risk SituationsSlide 23Marlatt’s Relapse Prevention ModelSlide 25Major Treatment Components of Relapse Prevention TrainingControlled Efficacy Data on Relapse Prevention TrainingSlide 28Research on Treatment MatchingTreatment MatchingSlide 31Slide 32Slide 33Project MatchProject MATCHSlide 36Slide 37Slide 38Project MATCH – Study FindingsSlide 40Differential Effects of Psychiatric SeveritySlide 42Prevention of Substance AbuseEpidemiologyPrevalence of Substance Use Among Adolescents 12-17Gender Breakdown of Substance Use Among Adolescents 12-17Racial Breakdown of Substance Use Among Adolescents 12-17Cigarette SmokingPowerPoint PresentationSlide 50Rationale for PreventionChannels of InterventionHistory of Drug Abuse Prevention ProgramsExamples of Drug Abuse Prevention ProgramsLife Skills Training Program (Botvin et al, 1990)Midwestern Prevention Program (Johnson Et Al, 1990)Project D.A.R.E.Meta-analysis of School-based Prevention Studies (Tobler et al, 1997)Program TypesDrug TypeLeader TypeOutcome MeasuresEffect Sizes Broken Down by Group ProcessEffect Sizes of Prevention Programs Broken Down by TypeEffect Sizes Broken Down by Study SizeMeta-analysis-major Findings (Tobler et al, 1997)Evidence Supporting the Role of Cue Reactivity in Alcoholism01/14/19 Substance Abuse 1Treatment and Prevention of Substance Use Disorders•Lecture Overview–Nature and treatment of alcoholism–Tobacco Treatments and Prevention–Relapse Prevention01/14/19 Substance Abuse 2Prevalence of Substance DisordersDrugMale Female TotalLifetime 12-Mo Lifetime 12-Mo Lifetime 12-MoAlcohol abuse w/o dependence12.5 3.4 6.4 1.6 9.4 2.5Alcohol dependence20.1 10.7 8.2 3.7 14.1 7.2Drug abuse w/o dependence5.4 1.3 3.5 0.3 4.4 0.8Drug abuse9.2 3.8 5.9 1.9 7.5 2.8Any substance abuse/dependence35.4 16.1 17.9 6.6 26.6 11.301/14/19 Substance Abuse 3Lifetime Prevalence of DSM-III-R Substance Abuse Disorders02468Percent useAbuse0.60.20.100.1Dependence6.64.21.311Total7.24.41.411.1MarijuanaStimulantsSedativesHeroinPsychedelicsSource: Tsuang et al (1998). Archives of General Psychiatry, 55, 967-972.Data based on 3372 Male Twin Pairs01/14/19 Substance Abuse 4Conditional Probabilities of Drug Use Co-occurrenceIndex DrugProbability of Also AbusingMarijuana Stimulants Sedatives Heroin & OpiatesPsychedelicsMarijuana… .31 .12 .07 .12Stimulants.52 … .17 .11 .18Sedatives.63 .53 … .20 .26Heroin & Opiates.46 .44 .26 … .14Psychedelics.80 .72 .32 .14 …SOURCE: Tsuang et al (1998). Archives of General Psychiatry, 55, 967-972.Data based on 3372 Male Twin Pairs01/14/19 Substance Abuse 5Lifetime Prevalence of DSM-III-R Drug Use and Dependence0102030405060Percent useUse55.846.451Dependence9.25.97.5MalesFemalesTotalSource: Warner et al (1995). Archives of General Psychiatry, 52, 219-228.Data from National Comorbidity Study01/14/19 Substance Abuse 6Pharmacological Treatment for Alcohol Dependence•Disulfiram•Lithium•Naltrexone•Acamprosate?01/14/19 Substance Abuse 7Effects of Naltrexone in Reducing Relapse0102030405060% RelapsedNaltrexone PlaceboConditionSOURCE: Volpicelli et al (1992). Archives of General Psychiatry, 49, 876-880.01/14/19 Substance Abuse 8Effects of Naltrexone in Reducing Relapse0%10%20%30%40%50%60%70%% AbstinenceNaltx+Sup Pla+Sup Naltx+CS Pla+CSConditionSOURCE: O’Malley et al (1992). Archives of General Psychiatry, 49, 881-887.01/14/19 Substance Abuse 9Effects of Naltrexone in Reducing Relapse0123456789Amount of drinkingNaltx+Sup Pla+Sup Naltx+CS Pla+CSConditionSOURCE: O’Malley et al (1992). Archives of General Psychiatry, 49, 881-887.01/14/19 Substance Abuse 10Behavioral Approaches to Alcoholism•Aversion Methods–Chemical–Electrical–Imaginal01/14/19 Substance Abuse 11Behavioral Approaches to Alcoholism•Cue Exposure–Rationale01/14/19 Substance Abuse 12Cue Exposure:Treatment Components•Continuous exposure to an opened alcohol beverage•Focus on the sight and smell of the beverage•Focus on imaginal drinking cues (high risk situations)•Guided practice in specific coping skills to reduce urges to drink during in vivo and imaginal exposures01/14/19 Substance Abuse 13Efficacy Studies: Cued ExposureMonti et al, 199301/14/19 Substance Abuse 14Cue Exposure With Coping Skills Training0102030405060% Abstinent3-mo 6-moCETCCSOURCE: Monti et al (1993). JCCP, 61, 1011-1019.CET = Cue Exposure + Skills TrainingCC = Control Condition01/14/19 Substance Abuse 15Efficacy Studies: Cued ExposureSitharthan et al, 199301/14/19 Substance Abuse 16Efficacy of Cued Exposure in Moderation Drinking024681012Mean ResponseDrinking IndexCECBTCE6.233.75CBT11.935.85FrequencyAmountSOURCE: Sitharthan et al, (1993). JCCP, 65, 878-882.Data presented are for the 6-mo follow-up. Frequency = Drinks per month01/14/19 Substance Abuse 17Behavioral Approaches to Alcoholism•Relapse Prevention Training–Rationale01/14/19 Substance Abuse 18Approaches for Preventing Relapse•Booster session method•Shot gun method•Self-control method•Analyses of relapse process01/14/19 Substance Abuse 19Marlatt's Relapse Prevention Model•Major components of the model–High-risk situation01/14/19 Substance Abuse 20Triggers for Relapse•Intrapersonal–Coping with negative emotional states–Coping with negative physical/physiological states–Enhancement of positive emotional state–Testing personal control–Giving in to urges01/14/19 Substance Abuse 21Triggers for Relapse•Interpersonal triggers–Coping with interpersonal conflict–Social pressure–Enhancement of positive emotional state01/14/19 Substance Abuse 22Most Common High-risk Situations•Coping with negative emotional states (37%) •Coping with social pressures (24%)•Coping with interpersonal conflict (15%)01/14/19 Substance Abuse 23Marlatt's Relapse Prevention Model•Major components of the model–High-risk
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