Chapter 18 - Addiction Treatment

various reasons for comorbidity and drug abuse

-Self-medicating a mental illness -Mental illness supports impulsive behavior, poor decision making or impairs judgment -Common neurological mechanisms that lead to illness and drug-seeking -Drug use exacerbates illness and/or illness exacerbates drug use

5 nicotine replacement products approved by FDA?

-Transdermal nicotine patch -Nicotine gum -Nicotine nasal spray -Nicotine vapor inhaler -Nicotine lozenge

withdrawal symptoms of cocaine?

-depression -nervousness -anhedonia (lack of emotional response) -fatigue -irritability -sleep and activity disturbances -craving for cocaine

goals of motivational interviewing? (2)

-help client focus on problem behaviors -move to next stage of change

2 examples of agonist/substitution therapy?

-methadone for heroin dependence -nicotine replacement for tobacco dependence

AA has over _______ members

1 million

_______ percent treated as hospital inpatients (detoxification)

13

how frequently is cocaine reported for substance abuse treatment?

13%

how frequently is marijuana reported for substance abuse treatment

16%

____ percent treated in a residential setting

18

how frequently are opioids reported for substance abuse treatment

19%

alcoholics anonymous was founded in

1935

buproprion was approved by the FDA in

1997

Average age of those admitted with marijuana as the primary drug of abuse is

24

how frequently is alcohol reported for substance abuse treatment

40%

____ percent treated as outpatients

47

how frequently are other stimulants reported for substance abuse treatment

8%

two types of treatment approaches?

Behavioral/psychosocial treatments Pharmacotherapies

two things different approaches reflect?

Different substance abuse problems Different theories about substance abuse

acamprosate normalizes basal __________

GABA concentrations

______________ attempts to shift the focus away from denial and toward motivation to change

Motivational enhancement therapy

why are benzodiazepines used during detox?

Reduce autonomic hyperactivity prevent seizures

which stage of change of MET? Individual takes active steps toward change

action

_____________ is used to induce cross-tolerance to the abused drug

agonist or substitution therapy

Substituting a longer-acting, pharmacologically equivalent drug allows the user to be stabilized on the ________ and then slowly tapered off it, avoiding _____________

agonist, withdrawal symptoms

View that substance dependence is a biological disease that someone either has or doesn't have this is a theoretical view of __________; the only acceptable treatment goal according to this view is

alcohol; complete abstinence

disulfiram inhibits ___________, thereby increasing acetylhyde

aldehyde dehydrogenase

for opioids, naltrexone is an

antagonist

naltrexone is an example of _______ therapy

antagonist

_________ is used to prevent the user from experiencing the reinforcing effects of the abused drug

antagonist therapy

nicotine withdrawal symptoms? (4)

anxiety depression insomnia cig cravings

Outpatient daily programs (i.e. methadone, therapy approaches) (are, are not) very effective

are

contingency management uses principles of _____ and ______

behavior, economics

____________ are typically used during the detoxification stage of alcohol use

benzodiazepines

more treatment =

better

according to the disease model, an alcoholic is __________ different from others, so ___________ is the only goal

biologically; abstinence

the disease model It removes the ________ for the problem from the alcoholic but not _________ for dealing with it

blame; responsibility

what does naltrexone do ?

blocks opioid effects

Study of dependence as a ___________ has focused research efforts on developing __________ for treatment

brain disease; medications

Increasing evidence for efficacy

bupronorphine

a non-nicotine pharmacotherapy for smoking cessation (2)

buproprion, chantix

Medications are administered to alleviate unpleasant and/or dangerous withdrawal symptoms that may appear following abrupt _________ of drug use

cessation

cognitive behavioral therapy is considered _________ because it places significant _________ on patients

challenging; demands

substance dependence is a

chronic illness

Currently no approved pharmacotherapy for

cocaine dependence

An approach that combines cognitive therapy techniques with behavioral skills training

cognitive behavioral therapy

_______ when two conditions/illnesses present themselves together in the same individual; Often implies that there is some common link between or that one affects the other

comorbidity

in contingency management, Value of the rewards may increase with ___________ drug-free samples

consecutive

which stage of change of MET? Individual recognizes there is a problem and begins to consider the possibility of changing her or his behavior

contemplation

An approach in which individuals receive immediate rewards for providing drug-free urine samples

contingency management

one of the most effective means to reduce use is

contingency management

View that substance dependence represents one end of a continuum of drinking; a possible treatment goal is

controlled use

downside of contingency management?

cost of rewards

Researchers are beginning to develop ___________ analyses

cost/benefit

there is ___________ AA as well as ________

court-mandated; voluntary

Studies show that treatment is cost-effective by reducing ______ and __________costs, and increasing ____

crime, healthcare; employment

However, high incidence of two together (dual diagnosis) does not imply that one caused the other and that curing one will

cure both

Most substance abusers use the ____________of denial and are unwilling to admit they have a problem

defense mechanism

buproprion is also used in the treatment of

depression

_______ is an initial and immediate phase of treatment

detoxification

alcoholics anonymous is based on the _______ of dependence

disease model

causes unpleasant symptoms (headache, vomiting, and breathing difficulties) if alcohol is consumed

disulfiram

example of punishment therapy?

disulfiram for alcohol dependence

buproprion may inhibit reuptake of _________ and ________, and, to a lower extent, block __________ receptors

dopamine, norepinephrine; acetylcholine

A more appropriate evaluation might be to determine which types of ______________ are most likely to benefit from AA's programs

drinkers

according to the disease model, the disease takes over a person's control over his or her

drinking

High levels of comorbidity between _____________ and ___________

drug addiction; mental illness

____________ is one of the biggest risk factors for developing schizophrenia

drug use

true or false: CBT is not one of the most widely used treatment strategies.

false

true or false: chantix (varenicline) has been shown to be less effective than placebo

false

true or false: treatment works for every individual, every time.

false

acamprosate blocks the ________ observed during alcohol withdrawal

glutamate increases

major approaches of AA consist of _________ and _________

group support; buddy systems

Medications that increase monoamine neurotransmitter activity have been tested and (have, have not) been found useful in treating withdrawal symptoms or dependence

have not

5 side effects of chantix

hostility agitation depression suicide ideation suicide attempts

who benefits the most from cognitive behavioral therapy (CBT)?

individuals with high intelligence those who reject 12 step programs

Short or long-term Focuses on social rehabilitation to change major aspects of a persons life Can be expensive

inpatient facilities

Medical risks often require an ____________ for alcohol detoxification

inpatient medical setting

___________ which have daily routines have been shown to be most effective

inpatient programs

Effectiveness drops off quickly as level of __________ declines

interaction

symptoms of cannabis withdrawal

irritability anxiety sleep disruption aches

People seeking treatment for cannabis dependence often report withdrawal symptoms that make it more difficult to

maintain abstinence

Some of these medications used to alleviate symptoms may also be used during _______stage

maintenance

for opioids, buprenorphine is

maintenance

for opioids, methadone is

maintenance

which stage of change of MET? Individual engages in activities intended to maintain the change

maintenance

why is evaluation of AA important?

many treatment programs follow the 12 step model of AA

coma induced and opioid antagonist introduced

medical rapid detox

Most common form of treatment for opioid dependence May continue for months or years

methadone

formal evaluations of AA have been

mixed

acamprosate is _________ effective

moderately

Emphasizes reduced alcohol intake and awareness over effects of drinking behaviors

moderation management

Opposing view to AA that alcoholism is a continuum

moderation management

Reduced ___________ neurotransmitter activity may underlie withdrawal symptoms of cocaine

monoamine

_________ is very important in treatment

motivation

motivation interviewing is used to boost the __________ of an ambivalent or less ready substance abuser

motivation to change

Problem with the _________________ perspective is that very serious consequences may occur before the abuser is ready for treatment

motivational enhancement therapy

A nonconfrontational process of determining the abuser's current stage of change and then helping the individual move forward

motivational interviewing

Typically requires a _______ approach as no one doctor can be specialized in all that is required

multi-disciplinary

Has been shown to be effective, but it is appropriate only for highly motivated individuals A once-per-month form is being studied; initial findings are promising

naltrexone

Reduces alcohol craving, days per week of drinking, and rate of relapse—but hasn't had a large impact on overall treatment success

naltrexone

example of antagonist therapy?

naltrexone

example of 1 treatment program that follows the 12 step of AA

narcotics anonymous

________ (anxiety, depression, insomnia, cigarette cravings) occur in most smokers who stop smoking

nicotine withdrawal symptoms

chantix (varenicline) is a partial agonist for _____________ receptors

nicotonic acetylcholine

is disulfiram effective? why or why not?

no, most people don't take it

Multiple therapies are often more successful than

one type alone

naltrexone may block ___________ and reinforcing effects of alcohol

opioid receptors

View that dependence on legal methadone is preferable to dependence on illegal heroin; the goal of treatment has changed from eliminating ____ to eliminating ______

opioid use; heroin

View that substance dependence undermines the physical and mental health of its victims ; this is a view of _______, and the only acceptable treatment goal is

opioids, abstinence

drug that has been effective for relieving cannabis withdrawal symptoms?

oral delta 9 THC

ocus on many frequent meetings Good alternative for those with job/family commitments Generally less expensive than in-patient

out-patient facilities

Many experts believe that _________alone will not cure a chronic, relapsing, behavioral disorder like __________

pharmacotherapies; substance abuse

_________ can provide a window of opportunity for behavioral/psychosocial treatments by relieving _________

pharmacotherapies; withdrawal symptoms

which stage of change of MET? Individual doesn't recognize that a problem exists

precontemplation

motivational enhancement therapy stages of change? (5)

precontemplation contemplation preparation action maintenance

which stage of change of MET? Individual decides to change and makes plans to change

preparation

Motivational enhancement therapy is probably best conceptualized as ___________ for other therapies rather than as a ______________ treatment

preparation; stand-alone

disulfiram is an example of ______ therapy

punishment

_____ is used to produce an aversive reaction following ingestion of the abused drug

punishment therapy

Use of nicotine replacement products has been shown to increase _______in controlled clinical studies

quit rates

in the cognitive behavioral therapy approach, Individuals learn to identify and change behaviors that could lead to _________, such as associating with _________

relapse; drug users

classic example of comorbidity

schizophrenia

Only when a user suffers __________ ("hits bottom") will he or she be ready to seek help

serious consequences

Pharmacological therapies are important during the detoxification stage because acute alcohol withdrawal syndrome has

serious effects

contingency management clients also participate in weekly ___________ sessions

skill-building counseling

best benzodiazepine choices during detox are those with

slow onset of action

Legal regulations Reducing likelihood of harm from person these are examples of goals of

society

goals of ______, goals of ________, and goals of ______ are all factors to be considered during treatment

society, the person, the family

Hundreds of thousands of Americans undergo treatment for __________ and __________ each year

substance abuse, dependence

in many cases ______ are the ones paying for treatment

the family

What the person wants from their treatment this is a goal of

the person

Treatment goals are influenced by underlying ____________ of substance abuse

theoretical views

Complete abstinence vs. cutting down on smoking or switching to "healthier" cigarettes; this is a view of

tobacco

Cost of __________ vs. cost savings from increased employment and decreased _______ after treatment

treatment, crime

Both mental illness and drug addiction require their own types of

treatments

true or false: AA is extremely successful to individuals who make it past the early stages.

true

true or false: Agonists typically have safer routes of administration and/or diminished psychoactive effects compared to the original drug

true

true or false: CBT has been shown to be more effective than most therapies

true

true or false: Many treatment programs take portions from many different approaches to treat a person

true

true or false: buproprion has been shown to gradually decrease cig. craving and use

true

true or false: contingency management has produced consistent reduction in use

true

true or false: success rates of nicotine replacement products are probably lower in a real world setting.

true

true or false: there is currently no approved pharmacotherapy for cannabis dependence

true

true or false: treatment saves lives in the long term

true

Some types of detox/rehab facilities may be against any pharmaceutical use, which can be detrimental to ______________ such as depression

underlying conditions

AA is relatively _________ when viewed through all attempts

unsuccessful

A ___________ of treatment approaches are used, often in combination

variety

Most programs are most successful when the individual

wants to participate

risk of relapse of cocaine may be highest during

withdrawal period