Disulfiram in treatment, better if abstinent.Acamprosate works on symptomsNaltrexone works if you are working to stay abstinent and you slip and have a drink. Makes it easier to stop and prevent you for relapsing.Topiramate: a medication being tried now…It reduces withdrawal symptoms from alcohol. The nice thing about this drug is that you can take it while you still are drinking.Addictive disorders as chronic medical illnessesAdvantagesDecreasing stigmaMore people may seek treatmentInsurance more likely to reimburse people and pay medical providers for providing these servicesCan inform a research design, if only acute we would only care how people are 6 months later. Now we know we can investigate a new treatment, we can look how people are looking 5 or 10 years later. We should look at disorders across lifetimesDisadvantagesLabelingEconomic burden, why should insurance pay for some of the treatment?Attention focused to most severely affectedBiologic aspects of addiction are emphasizedWhat about social, psychological, economic?Label does not display optimism for changeIncrease health care premiumsCalling substance dependence a chronic medical illness means looking at the top of the pyramid, instead of taking into consideration all of the people who may be at the bottom of the pyramid as well.2nd Article said that if we consider the disorder on chronic medical condition than it means that we are only focusing on the most severely affected people and not on people who do not have as severe of an addiction.It is mostly the word chronic that doesn’t display optimism for change. If we just labeled it medical illness, maybe would be different.But if you remove that chronic label it may take away message that you need to treat things over ones lifetime.FDA-approved medications for alcohol dependenceDisulfiramAccumulates acetaldehyde: Nausea, flushing, vomiting. Begin after abstinence!AcamprosateReduce withdrawal symptoms, including insomnia, anxiety, and other discomfort begin after abstinenceNaltrexoneBlocks receptors involved with craving, decreases “high” from alcohol. Better if started after abstinentHandout Notes Not Yet Covered:There are many things that interfere with adherence to treatment and the outcomes of treatment chronic medical conditions. These things include: No time, money or support. Treatment stops at a certain point, this can be hard for people. There is much relapse potential. There is no lifetime guidance.A relapse or recurrence of symptoms of chronic medical conditions is often seen as a sign of a need for continued treatment. In contrast, relapse or recurrence of substance use disorder symptoms has traditionally been viewed as a sign of failed treatment.Medications that require you to stop drinking before taking them are: Disulfiram and Acamprosate.You can still be drinking on Naltrexone and Topiramate.Lecture 17Motivational ApproachesMotivational Interviewing involves attention to natural language about change with implications for how to have more effective conversations about it. It is about having people talk themselves into change based on their own values and interests. Motivational Interviewing lies between “direction” and “following”. The helper is not trying to force the other person to change or fix that person. People are ambivalent about changing which is the 1st step to change.Change talk: Person’s own statements that favor change.People learn their own attitudes and beliefs. Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.There are four interrelated elements in the spirit of motivational interviewing:Partnership, Acceptance, Compassion, and EvocationPartnership: This is profound respect for the other person. The purpose of this is to understand the life before you.Acceptance: This is acceptance of what the client brings. It is giving inherent worth and potential to every human being. Acceptance also has to do with a basic trust of the other person.Acceptance has 4 key aspects to it: Affirmation: to seek and acknowledge the person’s strengths and efforts Accurate Empathy: an acute interest in and effort to understand the other person’s internal perspective Autonomy: honoring and respecting autonomy Absolute Worth: The idea that every human being has worth and potentialCompassion: This is actively promoting the other’s welfare and giving priority to the other’s needsEvocation: People already have within them much of what is needed to change. The task of the helper is to evoke it out and call it forth. The helper and the client need to find it together like ambivalence inside the person.Change-related speechAn effective motivational interviewer will ask open-ended questions and ask about feelings and thoughts.Motivational interviewer should ask what ways does the client: want to change, need to change, and should change. Also have they been thinking about changing? Have they tried to change and not been successful?The motivational interviewer should not say “just do it!” even though it is human reflex to try to fix what seems wrong in the person this is not the correct way to do motivational interviewing.The motivational interviewer cannot just provide insight, knowledge skills, and hell in order to change the other person. Behavior change is hard often it can be emotional.A motivational interviewer will often bring up change talk. The more change talk someone gives, the more change is likely. Motivational interviewers want to help clients find the change talk. The motivation in people is already there; the helpers just need to draw it out from people.Four Processes of Motivational Interviewing:Engaging, Focusing, Evoking, PlanningEngaging: This is about getting to know one another from a person-centered perspective. It is drawing information about each other.An example of this is when the helper and the client first meet. Every relationship begins with engaging. This is when both parties establish a helpful connection and working relationship. This can take more then just a first time, sometimes it can take weeks.Focusing: This is the strategic focus of conversation. It is very important in this stage to look for change talk. This stage is about dancing not wrestling. The helper should be moving with the client, not against.An example of this is discussing what the person came to talk about. This is the process in which you develop