Second exam is ThursdaySimilar as first examExam not cumulativeWill public study guide by Friday nightTopicsEmpirically supported treatmentsCulturally-specific treatmentsMidterm feedbackGoalsThink about ways to balance the need for structured and proscriptive treatments with culturally specific treatmentsHow we identify effective treatmentsPatients-> Random assignment -> treatment group and control group, then follow up for both, and then compare results-Treatment group receives new treatment-Control group receives no treatment or the old treatmentShould be able to make interference that 2 groups are equalSince randomized any difference between the group should be due to if they had treatment or old treatment.Usually the people doing experiment want to look at results 1 year later.Usually a few follow-ups but 1 year is standard. Will investigate how many people using cocaine or any drug anymore.-Gold standard determined whether a new drug worksEmpirically supported treatments“What works” when it comes to pharmacological, behavioral, and public health interventions for addictionWhy should we care about empirical support?Shows treatment has a good chance of working definitely in comparison to something else we are doing.Some treatments are harmful, those are ones we want to avoidWe don’t want to put time and money into something that isn’t effectiveWho should care about empirical support?Pharmaceutical companies care because they make moneyPeople who do drugs should care about thisAnyone really because anyone could become addicted to substances, some of us more than others, but it still could be anyonePeople running agencies that deliver these treatmentsResearchers care because they could make new treatments and apply it to other populations if the other treatment they made worksA few examples of empirically supported treatmentsEmpirically supportedMotivational interviewingMany cognitive and behavioral therapiesCertain medications12-step programs such as AA (alcoholics anonymous)Certain family training approachesScreening and brief interventionNot empirically supportedDetoxification without follow-upSupportive therapy without any specific goalUsing medications below recommended doseEducation without treatmentHarmfulConfrontationShamingMaking someone go to treatment is better then doing nothing at all, because we do nothing at all for addicted people do not go to treatment.What reaction do we normally have when a friend is over the toilet puking?Hold their hairRub their backHelp themLaugh get them some waterRemind them they aren’t an idiot but maybe should not have drank so muchThat is something that is positively reinforcingPositive attention giving someone just for getting drunk and out of controlSomething to teach family members with someone with addiction, positive attention may worsen the attention. Some people feel like when they are acting drunk like that, they get a lot of attention. And those people tend to like that attention so they continue to act the same way. Through teaching family members other ways to interact with individuals that gets way more people into treatment.Other treatments work way better then confrontation.Empirically supported treatments: Cultural considerationsLargely developed by U.S. and European researchersLargely tested in European, Western, industrialized countriesLargely tested in white populationsVery few high-quality trials examine treatments in racial/ethnic or cultural minority populationsCultural and racial/ethnic differences in effectiveness largely unknownA lot of evidence of treatments based on majority populations. Culture influences reasons for addiction also different cultural needs people have to address in treatment.In what ways might empirically supported treatments:Not meet the specific needs of racial/ethnic or cultural minorities?Be culturally incompatible with diverse populations?If we know who comes into treatment system from policing especially where African Americans and other minorities are arrested more often then whites that can affect culture because it just makes people go to treatment even though they may not want to.Trials are mostly among whites, which may not work for every culture…Families are not all the same, trying to change how people interact with each other may be difficultGovernment funded study that lasted a long time. There was a natural course study of syphilis study. It was all African American men who were studied.Eventually we came to learn that antibiotics would treat it.The antibiotics were withheld which was extremely harmful to African Americans. So now there are a lot of trust issues between the government and African Americans.Movie:Everyone in this treatment program has to be a quarter Native American. Cultural teachings are a big part of this treatment program.Spirituality is important for these kids because they see everything they do as a ceremony.Still many children go to boarding schools that Native American children had to do in the 19th centurySome of the children have been abandoned, feel alone, have had some sort of sexual abuse issue, drugs, alcohol, etc.Lecture 14 Outline of Last Lecture I. Overarching issues addressed by addiction treatmentII. Cognitive-behavior therapyIII. Environmental triggersIV. Biological evidence of triggers V. Cognitive-behavioral interventionsa. Example treatment program that uses cognitive-behavioral therapyVI. Behavioral strategies VII. Identifying the intensity of cravings VIII. Cognitive strategiesIX. Eliciting automatic thoughtsa. Correcting automatic thoughtsX. Self monitoring: craving, high-risk situations, and triggers Outline of Current Lecture II. AnnouncementsIII. How we identify effective treatmentsIV. Empirically supported treatmentsa. Few examples of empirically supported treatmentsb. Cultural considerationsV. Movie notesCurrent LectureAnnouncements Second exam is Thursday Similar as first exam Exam not cumulative Will public study guide by Friday night Soc Work 453 1nd Edition Topics Empirically supported treatments Culturally-specific treatments Midterm feedback Goals Think about ways to balance the need for structured and proscriptive treatments with culturally specifictreatments How we identify effective treatments Patients-> Random assignment -> treatment group and control group, then follow up for both, and then compare results -Treatment group receives new treatment