Week 12 Substance Abuse Flashcards Preview

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Flashcards in Week 12 Substance Abuse Deck (102)
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91

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

92

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.

*Contingency management:
-Rewards contingent on abstinence, active avoidance of substance, treatment adherence, adaptive behaviours, etc.
-Effective for alcohol, cannabis, cocaine, heroin

*“Controlled drinking”:
-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???

93

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

94

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

95

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

96

What medication treatments are available for the treatment of Substance dependence?

Agonist substitution:

*Opioids:
-Methadone: full agonist
-Buprenorphine: partial agonist
-Pharmaceutical heroin in some countries

*Alcohol, benzodiazepines:
-Diazepam

*Tobacco:
-Nicotine gum, patches, “e-cigarettes”
-Varenicline (“Champix”): partial agonist

97

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

98

What antagonist & allergenic medication treatments are available for the treatment of Substance dependence?

Naltrexone:
*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

Disulfram
*Induces “allergy” to alcohol
*Low effectiveness due to low compliance

99

What 'alternative treatment' medication treatments are available for the treatment of Substance dependence?

LSD
*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

Ibogaine
*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.

Ketamine:
*Evgeny Krupitsky reports successes in alcoholism and opioids in Russian trials
*1-3 administration sessions, in conjunction with ongoing psychotherapy

100

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
-“E-cigarettes”

*Pill testing
*Agonist substitution for opioids

*Overdose prevention:
-Naloxone
-ducation

101

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
*No-smoking areas
*Restrictions on liquor licensing
*Age restrictions

Prohibition, criminalisation:
*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.

102

What prevention programs are in place?

Social and educational measures:
*Restrictions on advertising
*Public education campaigns
*Regarding harms of use
*Peer pressure resistance
*Correcting false beliefs regarding use
*Self esteem training

Family interventions: Delaying onset of use reduces likelihood of dependence

Social change (employment opportunities, alternative recreational activities)