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Risk Behavior and Addiction in Adolescence > 8 - Resolving the problem of addiction: Behavioural interventions and clinical treatment (L8, Sussman CH13, Michie (in 7)) > Flashcards

8 - Resolving the problem of addiction: Behavioural interventions and clinical treatment (L8, Sussman CH13, Michie (in 7)) Flashcards

1
Q

Which behavioral change model is frequently used by addiction care and what does this model assume? (Q)

A

Transtheoretical model: Stages of change. The transtheoretical model is a way to understand how people change their habits and behaviors related to their health. It breaks down this process into different stages and looks at the thoughts and actions people have during each stage of change. It helps researchers and professionals understand how individuals go from not thinking about a change to actually making and maintaining that change in their behavior.

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2
Q

Which psychological mechanism plays an important role in the continuation of risky and addictive behaviors, despite knowledge about harmful effects? (Q)

A

Cognitive dissonance: Refers to the inner state of having conflicting cognitions. E.g. happy smoker who does not want to quit but knows that smoking is unhealthy.

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3
Q

What is the goal of motivational interviewing? (Q)

A

Achieving cognitive consonance in the client (cognitions being in harmony with each other).

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4
Q

What are important characteristics of motivational interviewing? (Q)

A
  • Respecting clients’ choices
  • Asking questions without any judgement
  • Asking questions that may raise awareness about existing cognitive dissonance
  • Strengthening the clients’ self-efficacy (their perceived ability to change behavior)
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5
Q

How can the Behavior Change Wheel be used for the development of prevention and policy measures? (Q)

A

The model is not fixed, its a wheel that can rotate.
E.g. prevention: education, persuasion, incentivisation, coercion, training, enablement, modelling, environemental restructuring, restrictions
E.g. policy: guidelines, environmental/social planning, communication/marketing, legislation, service provision, regulation, fiscal measures

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6
Q

For which primary addiction problems young people mainly seek help at Dutch addiction services? (Q)

A

Cannabis use (45%)

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7
Q

What does the term ‘comorbidity’ mean? (Q)

A

Comorbidity occurs when a person has more than one disease or condition at the same time. Conditions described as comorbidities are often chronic or long-term conditions.

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8
Q

What are the different visions on the goals of addiction treatment? (Q)

A
  • Complete abstinence
  • Controlled use
  • Damage control
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9
Q

Which forms of treatment are used in case of addiction problems? (Q)

A
  • Detox
  • Pharmacotherapy
  • Outpatient treatment
  • Day treatment / Part-time
  • Inpatient Treatment
  • Outreaching
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10
Q

What are important differences between the Cognitive Behavioral Therapy (CBT) and the 12-step approach? (Q)

A

One of the biggest differences is CBT’s focus on empowering a person to change his or her own life where as 12step disempowers an individual in order to empower the group as a whole. 12step places a strong emphasis on leaning on each other versus CBT’s goal of learning to depend on yourself.

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11
Q

What are the stages of change in the transtheoretical model? (HC)

A

(Pre)contemplation.
Contemplation.
Preparation.
Action.
Maintenance.
(Relapse.)

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12
Q

Where do interventions aimed at in the pre-contemplation stage? (HC)

A

Motivation

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13
Q

Where do interventions aimed at in the preparation stage? (HC)

A

Self-efficacy

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14
Q

What criticism is given to the transtheoretical model? (HC)

A
  • Individuals do not systematically move from one stage to the next
  • ‘Stages of change’ is an unstable construct: the motivation to change behavior can fluctuate heavily (even in one day)
  • ‘Processes of change’ are quite non-theoretical
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15
Q

What about the motivation to quit smoking among adolescent smokers when you look at pre-contemplation, contemplation and preparation? (HC)

A

Pre-contemplation 70%
Contemplation 12%
Preparation 18%

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16
Q

What does the Cognitive dissonance theory say? (HC)

A

Cognitive dissonance raises uncomfortable feelings (e.g. tension). People have a strong inner drive to reduce cognitive dissonance.

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17
Q

In what ways can cognitive dissonance can be eliminated? (HC)

A
  1. Changing the cognition ‘i am a (happy) smoker and do not want to quit’ by quitting smoking OR
  2. Changing the cognition that ‘smoking is extermely unhealthy’ by adopting comoforting thoughts (e.g. excuses to smoke).
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18
Q

What role do excuses to smoke play in quitting smoking? (HC)

A

Excuses to smoke are more important in motivation quitting smoking attemps than nicotine dependence.

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19
Q

Definition Cognitive consonance (HC)

A

Cognitions are being in harmony with each other.

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20
Q

Definition Change talk (HC)

A

Talk about the costs of risk behavior and the benefits of behavior change. Is used in motivational interviewing.

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21
Q

For a certain behaviours to occur, which three conditions have to be met (Behavior change wheel; HC)

A
  1. Motivation: all the brain processes that energize certain actions/behaviors
  2. Capability: the individual capability to engage in certain behavior
  3. Opportunity: environmental factors that promote or hamper behavior
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22
Q

Which two kinds of motivation do we have in the Behavior change wheel? (HC)

A
  • Automatic motivation: impulses, urges, drives, emotions, and habits (emotional brain)
  • Reflective motivation: self-aware, conscious decisionmaking processes (rational brain)
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23
Q

Which two kinds of capability do we have in the Behavior change wheel? (HC)

A
  • Physical and mental (cognitive) capability: executive funcitoning, self-control, impulsivity (rational brain)
  • Psychological capability: self-efficacy
24
Q

Which two kinds of opportunity do we have in the Behavior change wheel? (HC)

A
  • Physical opportunity: availability of substance, costs of substance (and financial resources)
  • Social opportunity: social norms
25
Q

What are different settings in treatment? (HC)

A
  1. Forensic: verdict - judge - sentence - treatment
  2. Chronic: relapse, after relapse - problems in life
  3. Regular: doctor
  4. Step vision: i need abstinence, sobriety and a fellowship
26
Q

Where does SORR stand for in cognitive behavioral therapy? (HC)

A

Stimulus, Organism, Response, Reinforcement control

27
Q

What are the three aspects of the triade of CBT? (HC)

A
  • Thought: what we think affects how we act and feel
  • Behavior: what we do affects how we think and feel
  • Emotion: what we feel affects what we think and do
28
Q

What are examples of CGT tools? (HC)

A
  • Setting treatment goals
  • Identifying risk situations
  • Avoiding high-risk situations
  • Self-registration
  • Self control practices (increasing social & coping skills, practicing alternatives)
  • Cognitive restructuring
  • Relapse prevention plan
29
Q

What are the 12 steps of the 12 steps minnesota model? (HC)

A
  1. We admitted we were powerless over our addiction – that our lives had become unmanageable. I have a problem…
  2. Came to trust that resources outside of ourselves could restore us to rational thinking and behavior. I maybe tried, but cannot handle this problem alone…
  3. Made a decision to turn our direction and actions over to the guidance of those resources. I accept help
  4. Made an honest and thorough list of the issues in our lives. I reflect on myself
  5. Admitted to ourselves and another person our specific role in those issues. I admit my wrongdoings
  6. Became entirely ready to make changes in our character. I am ready to work on myself/my problems
  7. Began making changes in our thinking and behavior with humility and honesty. CBT; thoughts, behavior… and maybe also emotions
  8. Made a list of all persons we had harmed and became willing to make amends to them all.
  9. Made direct amends to those people wherever possible, except when to do so would injure them or others.
  10. Continued to be aware of our thoughts and actions and when we were wrong promptly admitted it.
  11. Pursued a program of ongoing self-improvement and empowerment through meditation, reflection, and study.
  12. Having experienced a personal transformation as a result of these steps, we tried to carry this program to other addicts and to practice these principles in all aspects of our lives
30
Q

Definition Detoxification (Sussman)

A

Removing the toxins from drugs from a person’s body. This can cause you to experience symptoms (sweating, heart palpitations, sleep problems, irritability, difficulty concentrating etc).

31
Q

Vul in (Sussman). In behavioral addictions, withdrawal is more …(1) and …(2). There are also …(3) (by reducing production of certain hormones).

A

1: psychological
2: mood-related
3: neurotransmission adaptations

32
Q

What are two arguments that make it seem that the idea of withdrawal for addiction is not directly and clearly physiologically addictive? (Sussman)

A
  1. All addictions are accompanied by withdrawal symptoms, especially difficulty concentrating, irritability/anxiety and the desire to engage in the addiction.
  2. Individuals may be unable to stop the behavior of addiction for longer than very short periods of time.
33
Q

What are the mail goals of Pharmacotherapy (Sussman)

A

o Reducing intoxication or overdose
o Assistance in beginning abstinence
o Relapse prevention
o Assistance with associated symptomatology (e.g., agitation and depression)
Weinig empirische ondersteuning.

34
Q

What are examples of drugs/medicine whose work against drugs? (Sussman)

A
  1. Agonists - which mimic the effects of endogenous (naturally occurring) neurotransmitters
  2. Antagonists - which counteract the effects of endogenous neurotransmitters. Give similar effects to drugsm, but are relatively safe or have less psychotropic (disabling) effects.
  3. Cause aversive-negative reinforcement: these cause subjectively aversive effects when the preferred drug is used.
35
Q

What is the effect of Antagonists? (Sussman)

A

Give similar effects to drugs, but are relatively safe or have less psychotropic (disabling) effects. They block the effect of the preferred drug so that the person taking them does not experience pleasant effects when using the preferred drug.

36
Q

What would be a detoxfication of pharmacotherapy for drug addictions? (Sussman)

A

Long-term involvement in various addictions can lead to long-term changes in brain function, indicating changes in gene activity and amino acid deficiency. An example would be NAAT (neuronutrient amino acid therapy), which is a means to restore mesolimbic genes, reduce dopamine in the reward system.

37
Q

What would be a detoxfication of pharmacotherapy for tabak? (Sussman)

A

Different medications, e.g.
- Buproprion SR (this blocks reuptake of dopamine, norepinephrine or nicotinic acetycholiergic receptors)
- Varenicline (partial nicotinic inhibitor; drug that is part agonist and part antagonist)
- 5 nicotine-containing products (which may have both agonistic and reduce withdrawal symptoms)

38
Q

What would be a detoxfication of pharmacotherapy for food addiction? (Sussman)

A

E.g. Lorcaserin (induce verzadiging;satiety) and agonist that targets specific serotonin receptor.

39
Q

What would be a detoxfication of pharmacotherapy for gamble addiction? (Sussman)

A

Tot 18wk opioïde antagonisten.

40
Q

What would be a detoxfication of pharmacotherapy for sex addiction? (Sussman)

A

Citalopram and other SSRIs that have been shown to reduce masturbation and pornography use.

41
Q

What would be a detoxfication of pharmacotherapy for Compulsive buying disorder? (Sussman)

A

Use of mood stabilizers and antidepressants, the combination of which reduce CBD.

42
Q

What do behavior modification interventions focus on? (Sussman)

A

Focus on observable antecedens and consequences of a behavior without acknowledging cognitive mediation of behavior.

43
Q

Where do cognitive interventions focus on? (Sussman)

A

Include strategies to directly change thinking to improve executive control or other cognitive processes to facilitate cessation of addictive behavior.

44
Q

What does the technique SORR mean? (Sussman)

A
  • Stimuluscontrol: veranderen van effecten van stimuli waarmee de persoon wordt geconfronteerd
  • Organismcontrol: de manier waarop de persoon deze stimuli interpreteert
  • Responsecontrol: reacties die de persoon uit
  • Ratificationcontrol (bekrachtigings): introduceren nieuwe voorwaarden van bekrachtiging
45
Q

Definition Cognitive herstructuring (Sussman)

A

Involves recognizing and exploring self-defeating cognitions and replacing them with self-fulfilling thoughts that can lead to a better, more rational direction of thought and behavior.

46
Q

Definition Self-instructional training (Sussman)

A

When elements of one’s inner voice are missing (eg someone is impulsive), this can help guide the individual to regulate their behavior.

47
Q

Is (and when is) CGT effective with tabacco, alcohol and other drug addictions? (Sussman)

A

Tabacco: Effects are maximal when CGT gets combined with pharmalogical treatment
Alcohol and other: Effects are minimal for CGT and pharmalogical

48
Q

What is Motivational Interviewing? (Sussman)

A

Includes a set of procedures for therapists to help clients clarify their goals and follow through with their behavior change efforts.

49
Q

What are 8 strategies for Motivational interviewing? (Sussman)

A

o Providing advice to elicit and reinforce change goals
o Remove barriers to change through the use of problem solving and other techniques
o Providing positive choices as elicited by the client
o Reducing the desirability of not changing
o Showing empathy (warmth, caring, understanding)
o Giving accurate feedback on client behavior
o Clarify goals by confronting the client with discrepancies between future goals and current situation
o Supporting the development of self-efficacy through active help

50
Q

Did Motivational interviewing help with tobacco, alcohol and other drug addictions? (Sussman)

A

From 39 studies, 67% rapported significant improving outcomes.

51
Q

Definition Cue-exposure treatment protocols (Sussman)

A

Consist of extinguishing conditioned responses through unreinforced exposure to conditioned stimuli. E.g. someone using cocaine gets exposed to white powder (cocaine related stimuli) while working on reducing cravings. Protocol can help reduce craving and prepare to cope with these cues outside of treatment.

52
Q

Definition Postacute withdrawal (Sussman)

A

Period up to about 28 months after acute withdrawal from drug use and perhaps other addictions. Variety of symptoms will apear indicating ysfunctiong during abstinence.

53
Q

What are symptoms of postacute withdrawal? (Sussman)

A

o Inability to think clearly
o Emotional overreactivity, numbness or artificial affect
o Memory disorders or problems
o Stress sensitivity
o Sleep disorders
o Physical coordination problems

54
Q

What are ways to cope with Postacute withdrawal? (Sussman)

A

o Becoming aware of and responding to PAW-related relapse signals (e.g., dealing with them through meditation practices or seeking social support)
o Mood management

55
Q

Definition Abstinence effect (Sussman)

A

Sense of loss of control over addictive behavior and perceived inability to engage in health behaviors (cognitive herstructuring can help).

56
Q

What do memory-enhancing components focus on? (Sussman)

A

Reinforcing new associations in the memory. May help minimize influence of pre-existing associations and promote influence of more protective associative cognitive structures.

57
Q

What are 11 sequential phases of relapse? (Sussman)

A
  1. Internal changes
  2. Denial
  3. Avoidance and defensiveness
  4. Crisis building
  5. Immobilization
  6. Confusion and overreaction
  7. Depression
  8. Behavioral loss of control
  9. Recognition loss of control
  10. Option reduction
  11. Engagement in addiction

Risk Behavior and Addiction in Adolescence (10 decks)

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