Transcript Addiction Powerpoint

What is it?
What causes it?
What can we do about it?
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A chronic, relapsing behavioral disorder.
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Pattern: Remissions and relapses
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Progression theories:
◦ Gateway progression
◦ Continuum of drug use
◦ “Maturing out”
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Tolerance
Physiological dependence
Psychological dependence (habituation)
Craving
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Some substances are more likely to be
associated with addiction than others, but
there are many exceptions both ways.
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Heroin
Cocaine
Methamphetamine
Ecstasy
Alcohol
Psilocybin Mushrooms
Marijuana
PCP
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Moral model: Responsibility and guilt
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Physical dependence model
◦ Abstinence syndrome
◦ Negative reinforcement for continued drug-taking
◦ Physical or psychological?
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The decision
◦ Denial met by intervention or reality
◦ Cognitive changes
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Pre-contemplation: No problem!
Contemplation: Maybe there’s a problem…
Preparation
Action
Maintenance
◦ Cognitive therapy: Motivational interviewing
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Abstinence: The 12-step approach
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Controlled use
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Harm reduction
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Substitute addictions
Methadone
Gum-chewing
Needle exchanges
Water supply
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Detoxification (Detox)
◦ “Cold turkey”
◦ Gradual
◦ With pharmacological support
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Active treatment
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Relapse prevention
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Self-treatment (“spontaneous remission”)
◦ Perhaps 20% follow this route.
◦ Self-treatment often requires multiple attempts:
Learning to quit.
◦ For 57%, quitting is the result of cost-benefits
analysis.
◦ For 29%, the change is immediate.
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Sometimes because of “bottoming out”
Positive life changes: marriage, childbearing,
religious encounter
Negative life changes: health problems, social or
legal consequences of drug use, death of a
friend
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Self-help groups like AA
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Residential treatment
◦ Twelve Steps
◦ Peer identification and support
◦ Sober social relationships
◦ Hospitalization
◦ The therapeutic community
 Milieu therapy
◦ Short-term residential programs
◦ Faith-based programs
 Salvation Army
 Teen Challenge
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Medication-assists
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Antagonist blockade
Treat contributing conditions
Substitution
Antabuse
Craving reduction
 Ibogaine
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Outpatient drug-free programs
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Provide substances, paraphernalia and
injection rooms in ways that reduce crime
and disease transmission
Meet other needs of addicts
◦ Health care and nutrition
◦ Social support
◦ Employment or volunteer activities
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Risk of relapse is reduced by
◦ Frequent review of the decision
◦ Avoiding drug-related cues by moving and
dumping drug-using friends
◦ Social connections with non-users
◦ Getting a job
◦ Learning substitute activities
◦ Developing structure for life