Flashcards in Week 12 Substance Abuse Deck (102)
What are some of the issues associated with relapse prevention?
“Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times.” – Mark Twain
*Causes of relapse: stress, physical and social context, substance use (lapse)
*Learning to anticipate risky situations
*Learn from lapses to identify cause and prevent full relapse.
*Effective at reducing use in alcohol dependence, only weak effect for nicotine
What are some of the psychological & behavioural treatments for substance abuse?
*Simply being interviewed about level of use can lead to reductions in use in some.
*Cognitive Behavioural therapy: relapse prevention and replacing drug use with new activities.
-Rewards contingent on abstinence, active avoidance of substance, treatment adherence, adaptive behaviours, etc.
-Effective for alcohol, cannabis, cocaine, heroin
-Alternative to abstinence-focused approach
-Teaching techniques to moderate use, combined with social skills and relaxation training
-Demonstrated effectiveness for alcohol, but would this ever be trialled with other drugs???
What are some of the Mutual Support Fellowship programs available?
*Main ones are Alcoholics Anonymous and Narcotics Anonymous
*Marijuana Anonymous, Cocaine Anonymous, Crystal Meth Anonymous, and Nicotine Anonymous also present in Australia
*Spiritually-based, abstinence-oriented program of frequent meetings, “sponsorship” of newer members by older members
*Based on “permanent disease” model of addiction
Who are the people most likely to recover?
*Personal resources and skills – self-esteem; self-efficacy; positive expectancies; coping skills
*Belonging and embeddedness – bonding and positive support from family, peers, social/community involvement
*Safety and stability
*Pathways and ongoing availability of opportunity
Who are the people least likely to recover?
*Significant history of mental health problems
*Significant history of criminal involvement
*Partner, family and peer group embedded in addiction
*Lack of opportunity and access to support
What medication treatments are available for the treatment of Substance dependence?
-Methadone: full agonist
-Buprenorphine: partial agonist
-Pharmaceutical heroin in some countries
-Nicotine gum, patches, “e-cigarettes”
-Varenicline (“Champix”): partial agonist
What role do medication treatments have in symptom reduction for the treatment of Substance dependence?
*Acamprosate: Mild GABAA receptor agonist and NMDA antagonist (for alcohol craving)
*Baclofen: GABAB receptor agonist (for alcohol and benzodiazepine withdrawal and cravings)
*Clonidine: a2 adrenaline receptor agonist: sedative, lowers blood pressure & heart rate (for physical discomfort associated with alcohol, opioid, or nicotine withdrawal)
*Diazepam: anxiety and agitation associated with cannabis or opioid withdrawal
*Bupropion (“Zyban”, “Wellbutrin”): dopamine reuptake inhibitor, antidepressant (cravings and dysphoria in nicotine withdrawal)
*Various psychiatric medications (antidepressants, antipsychotics, mood stabilisers) used “off-label” for psychological problems associated with withdrawal and post-withdrawal syndrome
What antagonist & allergenic medication treatments are available for the treatment of Substance dependence?
*Opioid receptor antagonist
*Oral pills, long-lasting injections, or implants
*Mildly effective at reducing alcohol cravings and reward
*Blocks effects of opioids, but dangers associated with use in opioid dependence
*Induces “allergy” to alcohol
*Low effectiveness due to low compliance
What 'alternative treatment' medication treatments are available for the treatment of Substance dependence?
*Used experimentally to treat alcoholism in 1950s and 1960s: Bill W (co-founder of AA) was an enthusiast.
*Several trials conducted before banning in late 1960s/early ’70s. Recent meta-analysis showed clear effect of reduced alcohol consumption for 6 months after single dose. Effects not present at 12 months
*Agonist at several serotonin and opioid receptor subtypes, antagonist at NMDA receptor (mixed psychedelic and dissociative effects)
*Blocks opioid withdrawal effects while inducing psychedelic experience. Case reports of lasting reductions of cravings. Also may assist treatment of alcohol, nicotine, methamphetamine dependence.
*Legal in some countries, but absence of controlled trials, safety concerns.
*Evgeny Krupitsky reports successes in alcoholism and opioids in Russian trials
*1-3 administration sessions, in conjunction with ongoing psychotherapy
Tell me about Harm Reduction.
*Accepts that some will continue to use substances, but that associated harms can be reduced.
*Education about potential harms
*Safer routes of administration:
-Needle & syringe programs
*Agonist substitution for opioids
What is being done by way of prevention & how is this problematic?
Supply and opportunity reduction:
Effective in reducing tobacco use and dependence, some evidence for reducing alcohol use (but heavy drinking/dependence?)
*Increased taxes, minimum pricing
*Restrictions on liquor licensing
*Mixed evidence whether it reduces substance use
*Other harms related to criminalisation (criminal activity, less “quality” control)
*Emergence of “legal highs”, some more dangerous than the illegal ones.