what is it? what causes it? what can we do about it?
DESCRIPTION
◦ Tolerance ◦ Physiological dependence ◦ Psychological dependence (habituation) ◦ CravingTRANSCRIPT
What is it?What causes it?
What can we do about it?
A chronic, relapsing behavioral disorder.
Pattern: Remissions and relapses
Progression theories:◦ Gateway progression◦ Continuum of drug use◦ “Maturing out”
◦ Tolerance◦ Physiological dependence◦ Psychological dependence (habituation)◦ Craving
Some substances are more likely to be associated with addiction than others, but there are many exceptions both ways.◦ Heroin◦ Cocaine◦ Methamphetamine◦ Ecstasy◦ Alcohol◦ Psilocybin Mushrooms◦ Marijuana◦ PCP
Moral model: Responsibility and guilt
Physical dependence model◦ Abstinence syndrome◦ Negative reinforcement for continued drug-taking◦ Physical or psychological?
The decision
◦ Denial met by intervention or reality◦ Cognitive changes
Pre-contemplation: No problem! Contemplation: Maybe there’s a problem… Preparation Action Maintenance
◦ Cognitive therapy: Motivational interviewing
Abstinence: The 12-step approach
Controlled use
Harm reduction◦ Substitute addictions◦ Methadone◦ Gum-chewing◦ Needle exchanges◦ Water supply
Detoxification (Detox)◦ “Cold turkey”◦ Gradual◦ With pharmacological support
Active treatment
Relapse prevention
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.
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
Self-help groups like AA◦ Twelve Steps◦ Peer identification and support◦ Sober social relationships
Residential treatment◦ Hospitalization◦ The therapeutic community
Milieu therapy◦ Short-term residential programs◦ Faith-based programs
Salvation Army Teen Challenge
Medication-assists◦ Antagonist blockade◦ Treat contributing conditions◦ Substitution◦ Antabuse◦ Craving reduction
Ibogaine
Outpatient drug-free programs
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
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