Task 5 Flashcards

Question

Relapse prevention

Answer 1

Relapse prevention – requires abstinence for treatment entry, so that all their treatment is geared toward keeping the clients abstinent

Answer 2

— Common conceptualization  Client lacks important coping skills, including skills for handling: — Internal states (mood, cravings, stress, etc.) — Interpersonal situations (e.g., family conflicts) — Employment situations — Some of these states/ situations have developed learned associated with substance use  higher relapse risk for those situations

Answer 3

Social learning theory – identifying situations which trigger substance use (via operant/ respondent conditioning principles), cognitions that are elicited by these situations, and probable consequences

Answer 4

Functional Analysis – using those aspects of social learning theory to analyze situations that pose a high risk for relapse

Answer 5

Social learning principles (also called Skills training) guiding the intervention methods include: — People learn through direct instruction – Modeling of alternatives – Learning to counter automatic thoughts/ beliefs with adaptive alternative thoughts – Changing the environment to reduce triggering situations – Increased contact with positive reinforcement for not using substances – Changing social and/ or employment or living environment

Answer 6

— Nausea based approaches – induction of nausea, then the client is exposed to or ingests the addictive substance — Most common but modestly positive success — For tobacco dependence  rapid smoking or rapid puffing procedures – nausea occurs from toxic levels of nicotine BUT only under medical supervision — Electrical aversion – pairing electrical shocks with tasting the substance — Less encouraging success — Covert sensitization – imagining aversive scenes while drinking small amounts of alcohol — Less encouraging success

Answer 7

Cognitive Therapy — Approach to modify both the core and drug-related beliefs and the automatic thoughts elicited by high-risk situations

Answer 8

— To help the client learn new behaviors to replace the maladaptive ones 1. Start with analyzing the client’s personal situational – antecedents of substance use – thoughts and emotions that are triggered by these situations – the core dysfunctional beliefs they have about themselves, other people, and the substance use – and the patterns of behavior that the client uses in response to these beliefs 2. Through Socratic questioning and modelling, the therapist helps the client learn to develop alternative more adaptive thoughts to replace the maladaptive ones with — Used to deal with situations that trigger drug use — Also used to help person learn more effective ways to handle anger, depression, anxiety, and other emotions without using drugs — Used as an aspect of CBT  not on its own

Answer 9

— Interpersonal skills for building better relationships — Cognitive and behavioral emotion-coping skills for regulation moods more effectively — Skills for coping sudden stressful events without using substances — Coping with substance use cues without using — Helps to increase clients’ sense of self-efficacy about handling situations without using substances — Conducted in individual or group sessions  depends on client — CST session topics are structured as skill-focused or situation-focused

Answer 10

— Communication Skills Training – developing social skills designed to promote a lifestyle that encourages sobriety — Cognitive-behavioral mood management training – designed to slow down the process of reacting to risky events — Behavioral self-control training – teach moderation in alcohol consumption for problem drinkers who had not sought abstinence-oriented treatment — CST has excellent support for use with alcohol and cocaine dependence — Good support for marijuana dependence — Persistent long after treatment has ended

Answer 11

Contingency Management — Based on operant conditioning principles — Patients who abstain from drugs are provided with financial incentives  immediate reinforcement — Timing of reinforcement (immediately) — Choosing an incentive that is personally valued by the target individual and is large enough to promote the targeted change — Larger events generally produce more abstinence abstinence during first 2 weeks of treatment predicts longer term abstinence most effective treatment approach for cocaine dependence, with efficacy also shown for opiate and marijuana dependence, particularly when combined with CST or community reinforcement that includes CST reducing value of voucher over time/ using fewer valuable incentives (e.g., lottery tickets) maintain abstinence while lowering the costs of the program

Answer 12

— Long-term efficacy  mixed results — Concerns: — High financial costs — Differing results on whether people stay abstinent after finishing the program — CM might undermine intrinsic motivation to change — The success of CM could be affected by the findings of a recent fMRI study — Sensitivity to monetary rewards was compromised in light of cocaine addiction

Answer 13

— Attempts to reduce, eliminate, or decrease the likelihood of negative thoughts and emotions (“Experiential avoidance”) may worsen potential outcome in the long term — Focus on helping clients realize the breadth of their psychological difficulties and to overcome the cognitive and emotional barriers to stopping destructive drug use patterns — 5 main treatment phases: 1. Creative Hopelessness – Making contact with the scope of the problem and the effort expended to solve it 2. Values Assessment – Exploration of the client’s personal values to direct and dignify the treatment 3. Control as the Problem – Identifying ineffective control strategies 4. Defusing Language – Making room for acceptance 5. Applied Willingness – Putting values into action.

Answer 14

— Designed to reduce respondent condition to stimuli that have been repeatedly associated with the drug in the past — Repeated presentation of sight, sounds, and/or smells associated with drug use (“cues”) while the person is in a safe environment with no access to the drug  unreinforcement of drug

Answer 15

— 3 mechanisms by which cues are believed to pose a risk for relapse: — by classical conditioned responses that elicit urge to use substance — these reactions then interfere with a client’s ability to use coping skills effectively — cues and internal responses to cues lead to operant behavior (substance use) that reinforce the behavior by reducing the aversive aspects of the response

Answer 16

CET is believed to work through one or both of 2 mechanisms: — Breaking the conditioned association between cues and substance use behavior  cues no longer elicit conditioned reactions — Providing the opportunity to practice coping with urges to use so that urges will be less likely to disrupt the client’s ability to apply coping skills when in the presence of cues after treatment

Answer 17

— Exposure should occur long enough for responses to habituate within-session — Wide variety of different cues should be used in exposure sessions — Urge coping practices should occur early in exposure when elicited reactions are at a peak

Answer 18

— CET has not been successful for opiate- or cocaine-dependent clients — No effect after treatment ends for smokers — Beneficial effect for people with alcohol use disorders

Answer 19

Coping skills with best support — Telling themselves that they can wait out the urge and it will go down — Thinking about the negative and positive consequences — Imagining eating or drinking something else — Imagining engaging in an alternative activity

Answer 20

— Might be beneficial, as cues may trigger relapse or urges involve interpersonal or emotional situation — But personal cues are far more effective — Sets of photographs and VR programs are likely weaker methods

Answer 21

Categories of treatment 1. Making contact with drug users 2. Detoxification 3. Drug substitution treatment 4. Use of Blocking or aversive drugs 5. Psychosocial treatment options

Answer 22

Initial assessment – interview designed to understand the nature of the drug problem(s) and associated harm — Often there will be a medical examination and an assessment of psychological problems — Good treatment program  identifies all areas where help is needed and designs a treatment plan that addresses each of these needs — Assessment of these factors at beginning of treatment and at regular intervals during course of treatment

Answer 23

Making contact with drug users — designed to provide factual info about drug use, assist in the safer use of drugs to minimize harms and facilitate access to the available treatment options — can help people move to a higher stage of change (see above: “5 stages of change”) — incl. peer outreach services, primary healthcare providers, social welfare workers, police, etc.

Answer 24

Detoxification — Focused on directly assisting a person cease drug taking — E.g., prescribed medication to prevent relapse due to life threatening complications assoc. with the withdrawal symptoms — Can help to attract the person into more comprehensive forms of treatment — Blocking medication – stops the drug of dependence from having an effect — Aversive medication – produces an unpleasant reaction when it is used in combination with drug but is safe when used by itself

Answer 25

Drug substitution treatment — Involves the medical and pharmacological treatment of drug dependence — Prescription of drugs with a similar action to the drug of dependence but with lower degree of risk — Not available for all drugs — Will stabilize the physical condition of the user — This helps the person to focus on other aspects of health and psychosocial functioning and to develop a new drug-free lifestyle and social network — Often provided over long period of time and in combination with additional forms of treatment — Removes the need for the individual to seek and use the harmful or illicit drug — By providing the drug in a safer form, individual can focus on other areas of life — Individual has the opportunity to separate from their drug-using peers

Answer 26

Use of Blocking or aversive drugs — Use of blocking/ aversive agents to remove the positive reinforcement of drug use — When in period of abstinence

Answer 27

Psychosocial treatment options — Approaches incl. counselling, support groups, social and welfare support, and skills training — Designed to address the psychological reasons for using drugs, support positive life changes, minimize the likelihood of relapse, and build skills to assist with the attempt to quit the drug and cope with other aspects of life — Different reasons for treatment entry (voluntary basis, referral from GP, criminal court, etc.)

Answer 28

— consequences of acute intoxication — management of the physical withdrawal syndrome — management of drug dependence — withdrawal symptoms often have an effect opposite to that of the drug and can be life-threatening — principles of cross-tolerance and the role of half-life on intensity and duration of the

Answer 29

— Withdrawal symptoms can be life-threatening  require medical assistance — Hydration, balancing of electrolyte abnormalities and dealing with the consequences of inadequate nutrition — Benzodiazepines to alleviate withdrawal symptoms and to minimize likelihood of a seizure — Gradually decreased over the course of a few weeks — Antabuse is used to prevent relapse — When taken and alcohol is taken  very unpleasant reactions — For that first need to detoxify!

Answer 30

— Substitution of heroine with a longer acting opioid (e.g., methadone), or detoxification followed by the use of a blocking agent — Withdrawal symptoms are not life threatening but very unpleasant — Methadone does not produce euphoria, but will still alleviate withdrawal symptoms for 24 h — Blocking agent  e.g., naltrexone, long-acting opioid antagonist — Very important that the person has completely stopped using heroine  otherwise withdrawal symptoms might occur

Answer 31

Counselling — Particular useful for people who need assistance to get some order back into their lives — Counsellor builds trusting, non-judgmental relationship to help the person develop a sense of responsibility and self-confidence, and assist the person to develop their own solutions to their drug problem — Individual or group basis — Rarely sufficient by itself — Vital addition to other treatment forms Motivational Interviewing — Involves specialized program designed to help people move through the stages of change — Helps the person making decisions to change their drug use — Exploring the consequences of drug use Behaviorist approaches to treatment — Major principle: drug-use is learned and can be “un-learned” — One approach is to examine antecedent events for drug use and teach to avoid them or handle them without drug-use — Alternatively, medication can be used to alter the reinforcing properties of the drug — Contingency management – provides positive reinforcement contingent upon the person not taking the drug, abstinence is rewarded with vouchers

Answer 32

— CBT – recognize the triggers for craving or using drug, and to modify any dysfunctional cognitions underlying drug-using behavior — Involves skills training and practice to deal with craving — Relaxation training — Teaching techniques to release stress and tension — Drug refusal skills — Teaching skills to refuse offers confidently — Assertiveness skills — Helps individual to express needs and emotions to others — Role play is an essential part here — Problem solving skills — To help the individual deal with problems in everyday life — Teaches people not to ignore problems or to let the pressure build up — Cognitive restructuring — Teaching individuals to identify and challenge the thoughts and feelings that may lead to drug use — To help the person become aware of negative thinking and reframe it into something more positive — Relapse prevention training — Marlatt and Gordon – most relapse happens in high-risk situations — People who are more optimistic and confident are less likely to follow the urge to use the drug — Designed to reduce the impact of a failure by emphasizing the behavior change is not an all or nothing event — Lifestyle factors (positive and negative) are examined and reasons for stopping drugs abuse are explores — To help identify high-risk situations and providing skills to cope with them

Answer 33

— offer social support — offered by people who have experienced drug problems themselves and may be assisted by medical or psychological staff — Therapeutic communities – Principle  a structured, drug-free residential setting provides the best context to address the underlying causes of drug dependence — Assist individuals to develop skills and attitudes to make positive changes — Emphasize the acceptance of personal responsibility for decisions and actions — Assign residents tasks of everyday living — Drug users can leave usual environment and escape many high-risk situations for example — 12 Step Programs: Alcoholics Anonymous — key steps to maintaining abstinence: admit one’s own powerlessness over the drug and develop a strong spiritual belief system — opportunity to develop alternative social networks

Answer 34

Primary Prevention — designed to reach individuals before they have developed an addictive behavior — target individuals who haven’t begun using alcohol and other drugs — Goal: — challenge individual/ environmental factors that promote unhealthy behavior

Answer 35

Secondary Prevention — screening and detecting drug use and other addictive behaviors at an early stage — in order to intervene before significant problems have developed

Answer 36

Tertiary Prevention — designed to prevent addictive behavior — developing further and minimize the likelihood of serious medical and psychosocial consequences associated with drug

Answer 37

Supply reduction efforts: — are based on the assumption that drug use and other addictive behaviors can be managed by controlling how easily can be obtained — approach of drug law enforcement agencies

Answer 38

Drug reduction efforts: — attempt to discourage individuals from using and abusing drugs or engaging in other unhealthy behaviors — including prevention, education, and treatment strategies

Answer 39

Six general strategies: 1. Information dissemination approaches 2. Personal growth 3. Alternative approaches 4. Skills for resisting 5. Personal and social skills training 6. Public health approaches

Answer 40

Information dissemination approaches — aim to educate people of the harms assoc. with addictive behaviors — may include messages designed to promote fear or moral behavior — assumes that insufficient knowledge is cause of addictive behavior — evidence suggests that this is not effective and may even lead to increase in addictive behavior

Answer 41

Personal growth — Incl. programs that are designed to promote self-esteem and develop social skills — Focus on personal and social development — No reliable effectiveness shown

Answer 42

Alternative approaches — Including providing activities in the community to reduce boredom and provide alternatives to addictive behavior — No reliable effectiveness shown

Answer 43

Skills for resisting — Increase awareness of social influences and develop resistance skills — Some effect on limiting drug use

Answer 44

Personal and social skills training — Including programs that are designed to improve self-esteem without necessarily focusing on addictive behaviors — Significant Effects on reducing harms associated with alcohol and drug use

Answer 45

Public health approaches — Directed at general population — Including legislative controls on the availability and price of drugs coupled with educational campaigns delivered through mass media — Including fear arousal massages will not be effective in reducing the harms associated with addictive behavior

Answer 46

Terror management theory – focus on mortality-related risks may even lead to increase in that behavior if it’s important to a person’s self esteems — To be effective campaigns that promote the adverse consequences of addictive behavior must also present info that can assist the person in changing their behavior

Answer 47

— Behind capacity to resist craving and make adaptive decisions stands the reflective system (dependent on cognitive inhibitory control and delayed gratification) — Reflexive processes – Automatic motivational and emotional responses to reward  yield faster approach action tendencies — Impulsivity  subdivided into impulsive choice and impulsive action  both due to reward-seeking or poor inhibitory control Ú compulsive substance seeking combined with a neglect of controlled decision-making in patients with AUDs are explained by deficits and perturbations within both reflective and reflexive systems

Answer 48

Socio-environmental approach: — Implicates a number of social and environmental cues and certain individual sensitivity to them as involved not only in the very development of AUDs, but also processes of recovery and maintenance of abstinence — Substance-related settings and social interactions  first trigger craving and ultimately relapse in even abstinent individuals (reward-pathway activation)

Answer 49

Mind potential risks of VRs application: — Cybersickness — Superrealism, experience intensification, and information overload — Depersonalization, derealization, and dysfunctional re-entry into the real world — Unintended outcomes in vulnerable populations — Misconceptions concerning the true benefits of VR exposure in vulnerable cohorts Challenges: — Questions of limited methodological quality — Piecemeal evidence — Potentially constricted reporting of negative outcomes — General gaps in reporting

Answer 50

1. Precontemplation stage – Individuals may not believe there is a problem with their behavior and may not see a need to change 2. Contemplation stage – As awareness of a problem increases, individuals may begin to weigh the pros and cons of engaging in a specific behavior, a state often described as “ambivalence” 3. Preparation stage – When a state of ambivalence is resolved in the direction of making a change, individuals may then begin to develop a change plan 4. Action stage – Individuals then embark on successive efforts to change the behavior 5. Maintenance stage – characterizes the ongoing efforts to keep momentum and reduce the likelihood of reengaging in previous behavioral patterns (e.g., relapse) — model conceptualizes change as a nonlinear process — characterized by a dynamic back and forth of motivational states as individuals move toward long-term shifts in their behavior — unidirectional shift from being “unmotivated” to being “motivated” — suggests that helping strategies should be sensitive to an individual’s position in the change process

Answer 51

Agonists — E.g., methadone — activate opioid receptors, thereby mimicking the action of the endogenous neurotransmitter

Answer 52

Antagonists — e.g., naltrexone, naloxone, Methadone — occupy the opioid receptors, thereby blocking an agonist from exerting its effects

Answer 53

Partial Agonists — e.g., buprenorphine — have agonists and antagonist action — occupy the opioid receptors but produce only a partial response — full effects of an opioid agonist will be partially blocked and can’t exceed those of the partial agonist — can act as substitute without reaching a dangerous level of respiratory depression, as well as reducing euphoric effects

Answer 54

Time course of opioid effect — medication should have longer half-life and duration of action than the drug — avoids the altering of “highs” and “lows” that occurs several times a day with short-acting drugs — e.g., buprenorphine — longer duration of effect when higher dose, due to higher levels of plasma — but no difference in magnitude of opioid effect because it’s a partial agonist

Answer 55

— described as an alternative substitute to methadone in maintenance and detoxification treatment — produces less euphoria, sedation, positive reinforcement, and respiratory depression than full agonists  because k opioid receptor — high affinity for opioid receptors — prevents opioids from binding to receptors  attenuates their effects as “Blocker” — as partial agonist it activates receptors less than full agonist — resulting in relative drop in receptor activation and therefore a degree of “precipitated opioid withdrawal” — prevented by starting treatment when patient is already in withdrawal

Answer 56

— used as part of relapse prevention — used once patient has completed detoxification

Answer 57

— alternative to Buprenorphine that exhibits less risk of diversion and abuse — if taken intravenously, naloxone will precipitate withdrawal from opioids and block the effect of the buprenorphine

Answer 58

— agonists at the α2-adrenergic auto-receptors — used in opioid detoxification because they manage symptoms of withdrawal

Answer 59

Buproprion Varenicline -agonist Mecamylamine -antagonist

Answer 60

GABA — chronic alcohol use leads to reduced GABA function — as well as changes in specific receptor subunits that render it less sensitive to alcohol, resulting in tolerance Glutamate — major CNS excitatory neurotransmitter — alcohol acts as antagonist at NMDA receptors — alcohol withdrawal  over-activity of the NMDA system, leading to increased brain excitation

Answer 61

— exposes both reduction (tolerance) in GABA system and hyperactivity in the glutamate one — changes result in excitation in the brain, which probably explains increased risk of seizures and neurotoxicity

Answer 62

Benzodiazepines Acamprosate Disulfiram Naltrexone

Answer 63

Rimonabant — CB1 cannabinoid receptor antagonist — Prescribed as an anti-obesity drug — Potential role in treatment for cannabis abuse and dependence

Answer 64

— maintaining abstinence and reducing lapse and relapse — opioid antagonist — reduces pleasure associated with consuming alcohol

Answer 65

Acamprosate — doubles rate of abstinence from alcohol compared to those without medication — reduces the quantity and frequency of drinking in not achieving abstinence patients — reduces craving and urge to drink — enhances GABA-ergic function — reduces the increase in glutamate function during withdrawal — appears to antagonize NMDA receptors

Answer 66

Disulfiram — relapse prevention — inhibits aldehyde dehydrogenase (key enzyme involved in metabolism of alcohol) — accumulation of aldehyde after drinking causes unpleasant effects, such as nausea and vomiting etc., when drinking alcohol — also, increases DA levels acutely

Answer 67

Benzodiazepines — most widely used for alcohol withdrawal — act at the GABA-BDZ receptor complex to increase GABA function — inhibits rates of delirium tremens and seizures

Answer 68

— reasons include limited health care coverage, cost concerns, fear that doing so may impact employment, and stigma — approximately 40% of individuals with a current SUD report not being ready to stop using ( problem becazse Motivation is a key construct in behavioral medicine and is a particularly salient issue in the treatment of SUDs)

Answer 69

1. Precontemplation stage 2. Contemplation stage 3. Preparation stage 4. Action stage 5. Maintenance stage — model conceptualizes change as a nonlinear process — characterized by a dynamic back and forth of motivational states as individuals move toward long-term shifts in their behavior — unidirectional shift from being “unmotivated” to being “motivated” — suggests that helping strategies should be sensitive to an individual’s position in the change process

Answer 70

Precontemplation stage – Individuals may not believe there is a problem with their behavior and may not see a need to change

Answer 71

Contemplation stage – As awareness of a problem increases, individuals may begin to weigh the pros and cons of engaging in a specific behavior, a state often described as “ambivalence”

Answer 72

Preparation stage – When a state of ambivalence is resolved in the direction of making a change, individuals may then begin to develop a change plan

Answer 73

Action stage – Individuals then embark on successive efforts to change the behavior

Answer 74

Maintenance stage – characterizes the ongoing efforts to keep momentum and reduce the likelihood of re-engaging in previous behavioral patterns (e.g., relapse)

Answer 75

Recently: — motivational barriers to recovery have been viewed as coming not from the absence of pain but rather from the absence of hope, and empowering relationships developed during the treatment process are seen as important factors for enhancing motivation — strategies to influence an individual’s motivation, particularly during the earlier stages of recovery have been developed and implemented

Answer 76

the baseline view was that recovery was not possible unless an individual was ready to change and that the motivation to change was derived from the pain of the person’s behavior, thus necessitating the need to “hit bottom” — actions of loved ones, who could protect an individual from the painful consequences of his or her substance use and delay the need to change — _therefore, teaching loved ones to refrain from rescuing (i.e., “enabling”) the individual was seen as an important way to accelerate the pace of change — raising an individual from the “bottom” could be facilitated by a caring confrontation, although pain and threat remained the active ingredients for increasing motivation

Answer 77

— use of certain clinician-guided, -planned, and -scripted family interventions shows demonstrated some efficacy in increasing treatment enrollment — these types of interventions indicate that a significant proportion of family members do not go through with the intervention meeting, thereby reducing its overall clinical impact Ú evidence indicates that the use of confrontation in individual, group, and family-focused interventions does not improve outcomes compared with other treatment strategies and may negatively affect treatment response and engagement — certain counseling styles, such as those striving to convey accurate empathy and to minimize confrontational interactions, have been associated with significantly better treatment response

Answer 78

MI framework – goal is to rely most heavily on open-ended questions — Open-ended questions cannot be answered with a simple “yes” or “no” — designed to elicit from the client additional information, context, and room for further exploration of ambivalence Affirmations — with information from questions clinician highlights the client’s strengths, efforts, abilities, and what has been going well — meant to linguistically reinforce desires or efforts to change that are consistent with the client’s goals Reflections — strategic efforts by the clinician to guess at the client’s meaning in a way that further focuses the conversation toward change — can be either simple or complex Summary statements — Summary statements by the clinician allow further focusing of the session — highlight the prospect of change

Answer 79

Engaging: Building a Working Relationship Focusing: Identifying a Specific Set of Changes to Address Evoking: Inviting Clients to State Their Own Reasons for Change Planning: Developing an Action Plan

Answer 80

— underpins any possibility of helping a client move toward change, because a collaborative, autonomy-reinforcing relationship helps clients build awareness of potential areas of change and open up about ways they may be contemplating changes — precontemplation and contemplation stages can be particularly helped by a clinician’s engaging stance, which encourages openness, discussion of the issues surrounding their behaviors, and reasons for seeking a talk with the counselor

Answer 81

Focusing: Identifying a Specific Set of Changes to Address — encompasses the clinician’s process of strategically narrowing the conversation and helping the client to target an area for potential movement — align with the contemplation stage of change, because clients may require focused thought and discussion before being more actively ready to change — may also align with earlier or later stages of change — in precontemplation stage can benefit from conversations eliciting discussion of ways that particular behaviors are or are not serving their needs or values — in the preparation or action stage can benefit from focused discussions on ways they might move toward the changes they have committed themselves to making

Answer 82

Evoking: Inviting Clients to State Their Own Reasons for Change — clinician strategically “invites in” a client’s change talk and differentially responds to it — tends to align with the preparation stage of change  stage in which most of the clinician’s directional effort occurs

Answer 83

Planning: Developing an Action Plan — clinician offers guidance, with the client’s permission, on how a plan might be put in place for making changes — request for permission before providing advice ensures that the action stage of change aligns with the client’s own values — can be used in action implementation

Answer 84

— MI is preferable to many other behavioral interventions because it requires relatively fewer sessions to demonstrate its effects — MI is more effective than no treatment but comparable in efficacy to other psychosocial interventions — BUT failed to find any long-term effect of MI on substance abuse outcomes

Task 5 Flashcards

(108 cards)