Kohlenberg: Treatments for Substance Abuse Disorders and Psychotherapy Techniques

Question 1

People with severe mental illness have a lifetime prevalence rate for substance abuse disorder of (blank)%

Answer 1

50%

Question 2

T/F: Addiction and trauma are highly comorbid

Answer 2

True

Question 3

This is an important first step in treatment of substance abuse disorders

Answer 3

medically assisted detox

Question 4

T/F: Treatment for substance abuse disorders does not have to be voluntary to be effective

Answer 4

True

**court-mandated, for example

Question 5

How effective is treatment?

Answer 5

most people who get into and remain in treatment stop using drugs and improve their lives overall

**relapse rates similar to those with chronic illnesses

Question 6

What are the stages of change in a person giving up addiction?

Answer 6

precontemplation: pts not concerned about their problem, no intention to change
contemplation: pt acknowledges their problem, but pros and cons are equal (action in the next 6 months?)
preparation: pt plans to make changes in the next month or so
action: begins to change
maintenance

Question 7

If a patient slips and uses drugs after a period of abstinence, one of two things can happen. What are they?

Answer 7

1. He/she thinks “I made a mistake, I will now work harder to get sober.”
2. “This is hopeless, I’ll never get better.”

Question 8

What is abstinence violation syndrome?

Answer 8

thinking that your efforts at getting clean are hopeless, so you might as well keep abusing

Question 9

What is the difference b/w a lapse, relapse and prolapse?

Answer 9

lapse: minor setback, no real analysis
relapse: complete reversion to a previous pattern of behavior, spiral downward
prolapse: you work it over and it sends you forward in your recovery

Question 10

What is urge surfing?

Answer 10

learning how to respond differently to your cravings - wait a bit and your craving will subside on its own!

Question 11

What are “seemingly irrelevant decisions?”

Answer 11

the chain of events that lead to a relapse or a poor decision

Question 12

In a study of people who took bupropion (Zyban) for smoking cessation vs a group who took bupropion and did ACT treatment, which group did better?

Answer 12

medicine + ACT (acceptance and commitment therapy)

Question 13

Talk utilized in the service of behavior change, alleviation of emotional symptoms, progress toward a meaningful, value based life.
Focus on thoughts and behavior (CBT), behaviors (BA), Couples therapy (IBCT), family systems (FFT).

Balancing symptom reduction with value driven living.
Feeling sad AND…not wait until I feel better so that I can start….

Creation of a therapeutic relationship in which tools and skills are acquired and practiced.

Answer 13

psychotherapy

Question 14

T/F: Psychotherapy can be individual, group, couples, family. It’s for all ages. For DSM V problems and growth issues. Covered by most insurances. Very confidential.

Answer 14

True

Question 15

What is the active ingredient across psychotherapies?

Answer 15

relationship/alliance - agree on goals, tasks, bond, trust, connect

Question 16

Aims on CHANGING the beliefs central to depression, trauma, whatever

Answer 16

cognitive therapy

Question 17

What are the ABCs?

Answer 17

antecedent
belief
consequence

Question 18

This therapy strategy believes that beliefs are NOT important to change. The harder one tries NOT to think about something, the more they will thing about it!

Answer 18

Acceptance and commitment therapy

Question 19

What is the focus of acceptance and commitment therapy?

Answer 19

focus on changing ones relationships with ones thoughts and feelings, in the service of heading in a cherished, valued life direction

Ex: you can still think about your craving, but make useful choices

Question 20

What type of therapy is this?

Focus on doing what in the past, provided meaning and value and pleasure. Negative thoughts and feelings are not viewed as barriers.
**New relationship with thoughts and feelings, focus on activities.

Answer 20

behavioral activation

**ex: before you were in medical school, what did you like to do? commit to creating small opportunities in time to do what you used to do

Question 21

Based on the idea that the events in your life and how you respond to such events influence how you feel.

Answer 21

behavioral activation

Question 22

When life is less rewarding or stressful, people sometimes (blank) from the world around them and find that basic routines in their lives become disrupted.

Answer 22

pull away

**behavioral activation is about getting people back into their lives that they can enjoy

Question 23

What kind of therapy is this?

Focus on changing ones relationship with conflict and difference
**Not “getting rid” of conflict
Tools:…Acceptance/mindfulness training

Answer 23

integrative behavioral couples therapy

Question 24

Bad signs in couples therapy?

Answer 24

criticism
defensiveness
contempt
stonewalling

Question 25

Good signs in couples therapy?

Answer 25

healthy conflict

respect

Question 26

Is couples therapy about getting rid of conflict?

Answer 26

no!!

Question 27

This is the best ratio of good things to bad things in a healthy/happy couple

Answer 27

5 good things: 1 bad thing

Question 28

When not to treat a couple?

Answer 28

when there’s domestic violence

**can make the problem worst

Question 29

What was the result of the study on rates of major depression relapse after behavioral activation vs cognitive therapy vs antidepressant meds?

Answer 29

people who got well on meds were the worst over time;
people w behavioral activation or cognitive therapy did better!

**the impact of psychotherapy lasts longer

Question 30

What do we know about cumulative costs with anti-depressant meds vs psychotherapy?

Answer 30

initially, meds cost less, but over time, you will save more $$ with psychotherapy