PSYC 210 Chapter Notes - Chapter 10.3-10.4: Relapse Prevention, Relationship Counseling, Contingency Management
30 Apr 2018
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10.3%Treatment%of%Substance%Use%Disorders%
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Substance!use!disorders!are!typically!chronic!and!relapse!occurs!often!
• A!lot!of!treatment!programs!require!people!to!not!only!admit!a!problem,!but!also!to!demonstrate!
their!commitment!to!treatment!by!stopping!their!use!of!alcohol!or!drugs!before!treatment!
o Can!exclude!many!who!desire!and!need!treatment!
• Only!24%!of!people!physiologically!dependent!on!alcohol!ever!receive!treatment!
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Treatment(of(Alcohol(Use(Disorder!
Inpatient!hospital!treatment!
• Often!the!first!step!is!detoxification:!the!initial!stage!in!weaning!an!addicted!person!from!a!drug;!
involves!the!medical!supervision!of!the!sometimes!painful!withdrawal!
o Withdrawal!can!be!difficult!physically!and!psychologically!
o Doesn’t!have!to!happen!in!a!hospital!setting,!but!it!cam!be!less!unpleasant!in!a!supervised!
setting!
• People!used!to!get!more!treatment!than!just!detoxification!
o Now!it's!a!lot!more!expensive!
• Necessary!for!people!with!few!sources!of!social!support!who!are!living!in!environments!that!
encourage!heavy!drinking,!especially!for!those!who!have!other!psychological!disorders!
• Outpatient!is!more!common!(2.5!million)!than!inpatient!(1.8!million)!
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Alcoholics!Anonymous!
• Each!AA!chapter!runs!regular!and!frequency!meetings!where!the!group!supplies!emotional!
support,!understanding,!close!counseling,!and!a!social!network!
• Tries!to!instill!in!each!member!the!belief!that…!!
o Alcohol!dependency!is!a!disease!
o Can!never!be!cured!!
o Continuing!vigilance!is!necessary!to!resist!taking!even!a!single!drink!
• The!person!is!always!considered!an!"alcoholic,"!always!carrying!the!disease,!even!if!it!is!currently!
under!control!!
• Studies!show!little!benefit!of!AA!over!other!types!of!treatment!
• High!dropout!rates!
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Cognitive!and!behavioral!treatments!
• Contingency(management(therapy!is!a!CBT!for!alcohol!and!drug!use!!
o Teaches!people!and!those!close!to!them!to!reinforce!behaviors!inconsistent!with!drinking!or!
drug!use!
o Based!on!belief!that!environmental!contingencies!can!play!an!important!role!in!encouraging!
or!discouraging!drinking!
o Includes!job-hunting!and!social!skills!
o Has!assertiveness!training!for!refusing!drinks!
• Relapse!prevention!
o Goal!is!to!help!people!avoid!relapsing!into!a!drinking!or!drug!use!once!they!have!stopped!
• Couples!therapy!
o Combines!skills!covered!in!individual!CBT!with!a!focus!on!the!couple's!relationship!and!
dealing!with!alcohol!related!stressors!together!as!a!couple!
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Motivational!interventions!
• Aimed!at!helping!the!heavy!drinking!problem!among!college!students!
• Two!part!intervention:!
1. A!comprehensive!assessment!that!included!the!Timeline!Follow!Back!(TLFB)!interview!that!
assess!drinking!in!the!last!3!months!
2. A!brief!motivational!treatment!that!included!
A. Individualized!feedback!about!a!person's!drinking!in!relation!to!community!and!
natural!average!
B. Education!about!the!effects!of!alcohol!
C. Tips!for!reducing!harm!and!moderate!drinking!
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Moderation!in!drinking!
• Drinkers'!beliefs!about!themselves!and!alcohol!may!be!as!important!as!the!addiction!to!the!drug!
itself!
• Differs!from!A!where!the!people!must!abstain!completely!to!be!treated!
• Teach!a!person!who!does!not!use!alcohol!in!an!extreme!fashion!to!drink!with!moderation!
• Controlled(drinking:!a!pattern!of!alcohol!consumption!that!is!moderate,!avoiding!the!extremes!of!
total!abstinence!and!of!inebriation!
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Medications!
• Antabuse:!a!drug!that!makes!the!drinking!of!alcohol!produce!nausea!and!other!unpleasant!effects!
o To!be!effective,!a!person!must!already!be!strongly!committed!to!change!
• Naltrexone:!is!an!opiate!antagonist!that!blocks!the!activity!of!endorphins!stimulated!by!alcohol,!
thus!reducing!the!craving!
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Treatment(for(Smoking!
Psychological!treatments!
• Peer!pressure!to!quit!smoking!appears!as!effective!as!peer!pressure!to!start!smoking!once!was!
o More!likely!to!quit!if!those!around!them!do!too!
• Scheduled!smoking!–!reduce!nicotine!intake!gradually!over!the!period!of!a!few!weeks!by!getting!
smokers!to!agree!to!increase!the!time!between!cigarettes!
• Project!EX!is!a!school!based!program!that!includes!training!!in!coping!skills!and!a!
psychoeducational!component!about!the!harmful!effects!of!smoking!
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Nicotine!replacement!treatments!(NRT)!and!medications!
• Can!be!supplied!in!gum,!patches,!inhalers,!or!e-cigarettes!
• Goal!is!to!reduce!a!smoker's!craving!for!nicotine!by!providing!it!in!a!different!way!
o To!help!smokers!endure!the!nicotine!withdrawal!that!accompanies!any!effort!to!stop!
smoking!
o Long-term!goal!is!for!the!former!smoker!to!be!able!to!cut!back!on!the!use!of!the!gum!and!
eventually!eliminate!reliance!on!nicotine!altogether!
o Also!avoids!the!carcinogens!
• For!the!gum's!doses!available,!the!amount!that!delivers!the!nicotine!equivalent!to!one!cigarette!
and!hour!causes!cardiovascular!changes!that!can!be!dangerous!to!people!with!cardiovascular!
diseases!
