Transcript Psychological interventions - Welcome to the Peninsula

Psychological interventions in
addictive disorders
MRCPsych addiction psychiatry
seminar
March 2010
General treatment principles
Addiction is probably best viewed as primarily a
psychological (learnt) problem
• Medication is an adjunct to psychosocial treatment
• Treatment is a co-operative venture
• Medication is useless without some readiness to
change
• Treatment requires careful preparation and
aftercare
Treatment aims
• Change substance using behaviour
• Address co-existing mental health
disorders:
–
–
–
–
Anxiety
Depression
PTSD
Childhood sexual abuse
Elements of intervention
• Building motivation
• Cognitive restructuring
• Developing coping skills
Types of psychological
intervention
• Psychotherapy
• Drug counselling, including motivational
interviewing
• CBT approaches, including contigency
management
• Therapeutic communities
• Self-help groups
Mesa Grande top 10 alcohol
interventions
• Brief intervention
• Motivational
enhancement
• Acamprosate
• Opiate antagonists
• Social skills training
• Community
reinforcement
• Behaviour contracting
• Behavioural marital
therapy
• Case management
• Self-monitoring
Review of the effectiveness of treatment
for alcohol problems, 2006
• Most people move in and out of problem drinking
without treatment
• ‘How’ as much as ‘what’
• A range of effective treatments available- from
brief interventions to intensive treatments
• Psychiatric co-morbidity common and challenging
to treat
• Treatment is cost effective
• Therapist need training
Scottish HTA report relapse
prevention in alcohol dependence
Effective interventions:
• Behavioural self-control training
• Motivational enhancement therapy
• Marital/family therapy
• Coping social skills training
Scottish HTA report
BSCT
MET
M/FT
CCST
OR
1.75
1.88
1.94
2.11
95% CI
1.02-3.02
1.28-2.77
1.37-2.73
1.53-2.92
Brief interventions
•
•
•
•
•
•
Reduction vs abstinence
Delivered by non-specialist
Non-dependent drinkers
Addresses motivation to change
Self –directed
FRAMES ingredients
‘FRAMES’
•
•
•
•
•
•
Feedback of risk
Encouraging responsibility for change
Advice
Menu of alternative options
Empathy
Enhancing self-efficacy
Motivational interviewing
‘ready, willing and able’
Ready: a matter of priority
Willing: the importance of change
Able: confidence for change
‘yes, but…..’
Ambivalence
Motivational interviewing
•
•
•
•
•
•
Reflective listening
Pros/cons of change
Confidence building
Feedback
Self-motivational statements
Rolling with resistance
NICE guideline 51
Drug misuse: psychosocial
interventions
• Opportunistic brief interventions focussed
on motivation should be offered
• Staff should provide information about selfhelp groups
• Contingency management programmes
should be introduced