PSYCH 265 1st Edition Lecture 31Outline of Last Lecture I. Prescription drug abusea. DangersII. Pain relieversIII. Stimulants IV. Anabolic steroids V. OTCVI. DXMVII. Pseudoephedrine VIII. Motion sicknessIX. Inhalants X. Sudden sniffing deathXI. Caffeine XII. Diet pillsXIII. Herbal ecstasy XIV. Other herbalsOutline of Current Lecture I. Addiction II. Change w/o formal treatment These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.III. Motivational concepts IV. Motivation to changeV. Biopsychosocial model VI. Treatment approaches VII. Professional treatment VIII. Treatment of substance use disordersIX. Alcohol & drug treatment X. Special topics/populations XI. Alcohol & drug treatment XII. AACurrent Lecture-Addiction oChronic, often relapsing brain disease that causes "compulsive drug seeking" despite theharmful, obvious negative consequences oPeople who are addicted to substance is unable to resist the impulse to use thanks to the complexity of cravings and the compulsive use is triggered by the over-stimulation of thebrain's reward circuitoDrugs & alcohol re-wire brains natural chem and compel addicted person to use more and more of substance despite negative consequences-Change without formal treatment oSpontaneous remission Prevalence is unknown oMaturing out is common Graduating college & entering into workforce, becoming parents, religion or spiritually influence oMany do not mature out or enter into remission-Motivational concepts oDenial What ever the problem IS it is not meBlaming Rationalization Justification oAcceptance Surface level Bad things are happening Realization that drugs and alcohol are the problemDeeper level acceptance requiring new attitudeoProgram of recovery Disease concept Self-help or 12 step program Daily maintenance-Motivation to change o5 stages of changePre-contemplation Contemplation Preparation Action Maintenance oRelapse-Main purpose of motivational interviewing strategy is behavior change is self-governed -Biopsychosocial model oMoral model Crimj/punishmentoAmerican disease model Jellinek curve Progressive irreversible disease oBiological model Genetic population Physiological processes oSocial learningLearning based on environ & interaction w/ peersoSociocultural Governing bodies enacting laws which limit consumption or limit damage to society as a whole DUI laws, need exchange, and court ordered Tx-Treatment approaches oMotivational enhancement Based on stages of change & self-directed changes oClassical conditioning Based on pavlovian response Cravings & urges a product of learned behavior oConjoint treatment Family wrap around type care Inclusion of significant others into care program oSocial learning based treatment Relapse prevention Social skills training Coping with interpersonal problems in a socially acceptable manner-Professional treatment oAssessment Structured interview method Use history: age of onset/frequency/duration Criminal history: DUI's/assaults/MIPsFamily history Past treatment attempts Mental health issues Goals Client driven Based on specific areas of life improvement Wrap-around services Abstinence or moderation Harm reduction Needle sharing/flop houses/extacy testing at raves-Treatment of substance use disordersoFormal treatment structure Assessment/intake Treatment in recommended level of careInpatient level III.5Outpatient level II.1 Relapse prevention level I.0Weekly level I.0ADIS level .5Aftercare and soberliving houses-Alcohol & Drug treatment oPharmacotherapy Antabuse (disulfiram)Naltrexone Bupinophrin (suboxone)Methadone oNon-pharmacotherapy treatment Group sessions Education, sharing, and support One on one sessions Goal setting Big picture & life story Random urinalysis oEffectiveness About 7% treatment effectiveness Most go through treatment an average of 4 times-Special topics/populations oDual diagnosis or co-occurring patients Person who has substance use disorder and a co-occurring mental health disorder (severe)Severe mood disorder Depression Anxiety PTSDPersonality disorderBorderline personality disorderAntisocial personality disorderOften requires treatment w/ potential drugs of abuse oPolydrug users Most addicts are thisUse revolves around drug of choice Few users stick with one specific drug-Alcohol & drug treatment oWhy??Progressive illness (i.e. diabetes, heart disease)High mortality rateNever gets better only worse Society does a disservice (stigma, aftercare, follow-up)oCosts About $10,000 for 30 day inpatient Tx bed About $6,000 for 6 months outpatient TxCompare to $35,000 to $50,000 for a person to be house for 1 year in state prison oRemember back to stages of change model Denial Acceptance No way to predict when a person will reach the critical level of acceptance -Alcoholics Anonymous oOldest self-help program of recoveryoBased on the 12 steps oNot a religious program oBegain in 1935 by Dr. Bob & Bill Wilson oCore of AA is identification oOne alcoholic helping another to stay sober is key to both remaining soberoMillions of recovering alcoholics. AA is in every city and town in USAoPrinciple of 12-steps have been adapted for other substances tooNarcotics Anonymous Cocaine Anonymous Celebrate recovery