Download Substance Use Disorders: Prevalence, Treatment, and Prevention and more Slides Behavioural Science in PDF only on Docsity! Treatment and Prevention of Substance Use Disorders • Lecture Overview – Nature and treatment of alcoholism – Tobacco Treatments and Prevention – Relapse Prevention Docsity.com Prevalence of Substance Disorders Drug Male Female Total Lifetime 12-Mo Lifetime 12-Mo Lifetime 12-Mo Alcohol abuse w/o dependence 12.5 3.4 6.4 1.6 9.4 2.5 Alcohol dependence 20.1 10.7 8.2 3.7 14.1 7.2 Drug abuse w/o dependence 5.4 1.3 3.5 0.3 4.4 0.8 Drug abuse 9.2 3.8 5.9 1.9 7.5 2.8 Any substance abuse/dependence 35.4 16.1 17.9 6.6 26.6 11.3 Docsity.com Lifetime Prevalence of DSM-III-R Drug Use and Dependence 0 10 20 30 40 50 60 Percent use Use 55.8 46.4 51 Dependence 9.2 5.9 7.5 Males Females Total Source: Warner et al (1995). Archives of General Psychiatry, 52, 219-228. Data from National Comorbidity Study Docsity.com Pharmacological Treatment for Alcohol Dependence • Disulfiram • Lithium • Naltrexone • Acamprosate? Docsity.com Effects of Naltrexone in Reducing Relapse 0 10 20 30 40 50 60 % Relapsed Naltrexone Placebo Condition SOURCE: Volpicelli et al (1992). Archives of General Psychiatry, 49, 876-880. Docsity.com Behavioral Approaches to Alcoholism • Aversion Methods – Chemical – Electrical – Imaginal Docsity.com Behavioral Approaches to Alcoholism
* Cue Exposure
— Rationale
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Cue Exposure: Treatment Components • Continuous exposure to an opened alcohol beverage • Focus on the sight and smell of the beverage • Focus on imaginal drinking cues (high risk situations) • Guided practice in specific coping skills to reduce urges to drink during in vivo and imaginal exposures Docsity.com Efficacy Studies: Cued Exposure Sitharthan et al, 1993 Docsity.com Efficacy of Cued Exposure in Moderation Drinking 0 2 4 6 8 10 12 Mean Response Drinking Index CE CBT CE 6.23 3.75 CBT 11.93 5.85 Frequency Amount SOURCE: Sitharthan et al, (1993). JCCP, 65, 878-882. Data presented are for the 6-mo follow-up. Frequency = Drinks per month Docsity.com Behavioral Approaches to Alcoholism • Relapse Prevention Training – Rationale Docsity.com Triggers for Relapse • Intrapersonal – Coping with negative emotional states – Coping with negative physical/physiological states – Enhancement of positive emotional state – Testing personal control – Giving in to urges Docsity.com Triggers for Relapse • Interpersonal triggers – Coping with interpersonal conflict – Social pressure – Enhancement of positive emotional state Docsity.com Most Common High-risk Situations • Coping with negative emotional states (37%) • Coping with social pressures (24%) • Coping with interpersonal conflict (15%) Docsity.com Marlatt’s Relapse Prevention Model • Major components of the model – High-risk situation – Ability to engage in adaptive coping response – Positive outcome expectancies about the substance – Abstinence violation effect (AVE) Docsity.com Major Treatment Components of Relapse Prevention Training • Learning to identify high risk situations via self-monitoring • Specific skill training to build effective coping responses • General lifestyle skill training to increase patients' general coping and sense of personal control • Development of leisure activities that do not involve alcohol • Information to counter positive outcome expectancies • Training in coping with slips and the AVE Docsity.com Controlled Efficacy Data on Relapse Prevention Training • Description of controlled outcome studies – Number of studies – Type of substance – Abstinence initiation vs. Maintenance of abstinence – Types of comparison groups Docsity.com
