Substance Abuse Treatment

1. Substance Abuse Treatment Kara Barretine

2. Before Beginning Treatment • The clinician should assess whether the individual is sober or reducing the potential harm that could occur due to substance abuse (i.e. using clean needles, not drinking and driving) before beginning treatment. • Coercive (i.e. family pressure, court ordered) VS Voluntary • Detox- some substance abusers need this before treatment in order to manage unpleasant physical symptoms associated with cessation of use

3. Intervention • Intervention-important members of addicts life preferably with professional assistance-family members give descriptive accounts of addicts behaviors-organized and planned thoroughly –if person refuses treatment could incur consequences such as loss of job, divorce, not including individual in family activities etc. • Daly and Raskin concluded four steps are imperative for successful interventions (1.) Gather the team, (2.) Gather the data, (3.) Rehearse the intervention, and (4.) Finalize the details (1991).

4. Individual Treatment(Stevens and Smith, 2009) 1. Direct Effect Strategies-primary goal is cessation of use • Aversion therapy-research points to reducing cravings in those addicted to crack-cocaine (Bordnick et al., 2004). • Behavioral self-control training-includes such techniques as covert sensitization which is a technique designed to help the client think about the averse consequences of their use (Stevens and Smith, 2009). • Medication-disulfiram (Antabuse), research shows it is effective for treating both cocaine and alcohol dependent individuals (Stevens and Smith, 2009). Other medications proven effective for alcoholism include acamprosate (Campral), and naltrexone. Buprenorphine has shown to be effective for opiate addiction.

5. Individual Treatment(Stevens and Smith, 2009) 2. Broad Spectrum Strategies-focus on issues and situations. Cessation of use is the secondary goal • Harm reduction-needle exchange programs, designated driver programs, smoking instead of injecting etc. • Social skills training-assertiveness training and refusal skills. Common techniques used are modeling, role-play and demonstration. • Support groups-According to Stevens and Smith, research has associated membership in AA with decreases in substance abuse and lower rates of depression and other mental illnesses (2009). Also offers peer support. • Solution-focused brief counseling-focus on client strengths and resources working towards solutions

6. Group Treatment(Stevens and Smith, 2009) • Treatment modalities • Pschoeducational groups-provide information in lecture format including homework, discussion, exercises etc. • Psychotherapy groups-focus on interactions and the “here and now” and must be ran by a professional • Cognitive behavioral groups-like psychoeducational but includes coping-skills training and problem-solving. Often prescribed for those with comorbid disorders and/or to facilitate relapse prevention. • Self-help groups-Al-Anon, AA, NA, CA, Rational recovery, etc.

7. Family Therapy(Tanner-Smith et al., 2011) • Recent research points to the possible beneficial effects of family therapy. • Tanner-Smith et al. conducted a study measuring reduction of substance use among adolescents receiving various types of treatments. • The most significant correlations were shown between adolescents receiving family therapy and positive treatment outcomes. • The study also pointed out that behavioral therapy, cognitive-behavioral therapy and motivational interviewing were also effective in reducing substance use among adolescents.

8. Other treatments • Contingency management- studies with patients meeting the criteria for cocaine dependence. The study also did not show a significant relationship between treatment outcomes and SES (Secades-Villa et al., 2012) • Motivational interviewing-studies with depressive patients (Satre et al., 2011). The studied showed a significant relationship between depressed patients receiving motivational interviewing as a therapeutic treatment and reduction of heavy drinking. However, MI did not have an effect on reducing cannabis use.

9. Discrimination, prejudice, counseling and psychology issues, and barriers to service delivery • Lack of agency funding • Low SES of consumers • No health insurance-which leads to higher costs in healthcare because those using substances do not seek help until they need emergency treatment (Schildhaus, 2011).

10. Physical health issues • Intoxication • Withdrawal • Neurological issues • Cardiac issues • Gastrointestinal issues (Gastritis, diarrhea, and gastric ulcers from drinking) • Metabolic/Endochrine issues (alcoholics who have poor diets and vitamin deficiencies) • Reproductive issues (Marijuana) • Hepatitus B and C (liver-damaging virus spread through contact with contaminated blood and body fluids from dirty needles) • HBC is most common cause of liver disease in the world • HCV a virus that destroys liver cells • HIV/AIDS (sharing needles)

11. Mental health issues • Depression-Population studies have found a link between depressive symptoms and alcohol abuse (Satre et al., 2011) • Bipolar Disorder • Anxiety Disorders • Adult ADHD • Cognitive disorders (delirium and dementia)-Wernicke-Korsakoff Syndrome which usually presents as short term memory deficiencies as well as confabulation or “honest lying” to fill in the gaps from lost memories • Schizophrenia and schizoaffective disorders • Personality disorders • Eating disorders

12. Mental Health Issues • Are substance abusers more likely to have mental health issues as well? (mixed results) • According to one study Helzerand Pryzbeckconcluded that around one-third of the substance abusing population have a co-occuring mental disorder (1998). Almost half of the alcoholics in the study met the criteria for a mental health diagnosis.

13. Mental Health Issues(Helzer and Pryzbeck, 1988) • Most common disorders for alcoholic males • Phobias • depression, • Schizophrenia • panic • Mania • Most common disorders for alcoholic females • Phobias and depression • Antisocial personality disorder • Panic • Schizophrenia • Mania

14. Support Groups • Al-Anon www.tallyalanon.org/ (850)222-2294 • AA intergroup5.org/ (850) 224-1818 • Disc Village www.discvillage.com/ (850) 561-0717

15. References • Derek D. Satre, K. D. (2011). Motivational interviewing to reduce hazardous drinking and drug use among depression patients. Journal of Substance Abuse Treatment, 44, 323-329. • Emily E. Tanner-Smith, S. J. (2011). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44, 145-158. • Roberto Secades-Villa, G. G.-F.-S.-R.-H.-H. (2012). Contingency management is effective across cocaine-dependent outpatients with different economic status. Journal of Substance Abuse, 44, 349-354. • Sam Schildhaus, C. S. (2011). Community hospital admission from the emergency department by persons with substnace use disorders. Journal of Substance Abuse, 44, 201-207. • Smith, P. S. (2009). Substance Abuse Counseling Theory and Practice. Upper Saddle River, New Jersey: Pearson.