SubstanceUse Disorders

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Substance-Use Disorders

• Lori Ridgeway
• PSYC 3650

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What is abuse?

• Criteria
• Failure to meet responsibilities
• Use despite potential dangers
• Legal problems
• Problems aggravated by use
• At least one of these in past _____________
• No dependence

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What is dependence?

• Criteria
• ______________
• Withdrawal
• Use more than intended
• Failed attempts to stop or cut down
• Time spent getting, using, recovering
• Given up important activities
• Use despite problems
• At least 3 criteria met in past 12 months

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Drug Classes

• Depressants
• Alcohol, sedative-hypnotics, opiates
• Stimulants
• Cocaine, amphetamines, caffeine, nicotine
• Hallucinogens
• LSD, mescaline, MDMA
• Cannabis
• Polysubstance use

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Depressants

• Slow down activity of the ________
• Act on GABA receptor sites
• Alcohol, barbiturates, benzodiazapines
• Attach to endorphine receptor sites
• Opiates (e.g., morphine, heroine)
• Withdrawal symptoms dangerous

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Stimulants

• Increase activity of _______
• Affect neurotransmitter activity
• Increase supply of ________________
• Increase supply of norepinephrine and serotonin
• Amphetamines, caffeine
• Withdrawal
• Depression, fatigue, headaches, crashing

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Hallucinogens Cannabis

• Hallucinogens
• ________________________
• Bind to serotonin receptors and alter effects
• MDMA rapid release of ALL serotonin
• Cannabis
• Combination of hallucinogenic, depressant, and
  stimulant effects
• Physical dependence possible

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What causes substance disorders?

• Sociocultural
• Socioeconomic conditions
• Acceptance and use in environment
• Problems
• ___________________________________
• Some people in good environments do

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• Psychodynamic
• Dependency needs
• Failed to ______________________ as children
• Substance abuse personality
• Problems
• Drug use or personality which came first?
• Wide range of personality traits

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• Behavioral Cognitive
• Operant conditioning and expectancy
• Opponent-process theory
• Negative reinforcement
• Avoid aftereffects
• Classical conditioning
• Objects present during _______________________
• Each may explain a piece of the puzzle

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• Biological
• Genetic predisposition
• Twin studies
• Adoption studies
• Dopamine-2 receptor gene
• Biochemical processes
• Prolonged use of substance ____________________
• Lower production of certain NTs
• Reward center dopamine

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How do we treat substance disorders?

• Biological treatments
• _________________
• Medications
• Cognitive behavioral models
• Coping strategies
• Relapse-prevention
• Behavioral therapies
• Classical conditioning models
• Contingency management
• Alternative behaviors

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Motivational Enhancement Therapy (MET)

• Based in motivational psychology stages of
  change
• Goal is to move client through stages of change
• Effective with low motivation
• Responsibility and capacity for change are
  _______
• Therapist creates _________ to increase motivation

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Five Motivational Principles

• _________________
• Respect clients freedom of choice and
  self-direction
• Develop Discrepancy
• Must see a discrepancy between where they are and
  where they want to be
• Avoid Argumentation
• Client should voice arguments for change

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• Roll with Resistance
• Ambivalence seen as __________
• Support Self-Efficacy
• Hope and belief that things can change

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How is MET different?

• MET vs. confrontational approaches
• Dont argue with the client
• Dont tell the client what he or she "must" do
• No direct confrontation to combat denial
• MET vs. _______________________
• Client not seen as powerless
• Dont impose a diagnostic label on the client
• MET vs. CBT
• No direct skill training
• Motivation enhancement seen as first step

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Phases of Treatment

• Phase I Building Motivation for Change
• Elicit statements of self-motivation for change
• Reflective listening and empathy
• Presenting personal feedback
• Personal Feedback Report (PFR)
• Compare _____________________
• Approach to resistance
• Reflect ambivalence
• Shift focus / roll with it
• reframe

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• Phase II Strengthening Commitment to Change
• Shift from reasons to change to a _______ for
  change
• Decisional balance
• Consequences of change and of not changing
• Emphasize free choice
• Abstinence vs. harm reduction
• Change Plan Worksheet
• What, why, how, who, and trouble-shooting
• Verbal commitment to change

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• Phase III Follow-Through Strategies
• Maintenance
• Review progress
• Renew motivation
• Redo ______________

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Additional Notes on MET

• Encourage inclusion of _________________ in
  treatment
• Can be done in relatively few sessions
• MUSC study comparing CBT and MET
• CBT 12 weekly session
• MET 5 sessions over 12 weeks
• Comparable outcomes
• More effective if combined with medications
• Ex Naltrexone