1 Addiction: Treatment and Prevention James Colvin Manuel Oropeza Stephanie Pavone Jennifer Peterson Kyle Steinke
2 Introduction Defining Addiction Continued involvement with a substance or activity despite ongoing negative consequences Physiological dependence Psychological dependence
3 To Be Addictive A behavior must have the potential to produce a positive mood change Responsibility of Chemicals
4 Diagnosis of Addiction Based on 3 criteria 1. The presence of an abstinence syndrome, or withdrawal A series of temporary physical and psychological symptoms that occurs when the addicted person abruptly stops using the drug 2. An associated pattern of pathological behavior 3. Relapse The tendency to return to the addictive behavior after a period of abstinence
5 Habit vs. Addiction Habit A repeated behavior in which the repetition may be unconscious Can be annoying Compulsion Obsessive preoccupation with a behavior and an overwhelming need to perform it Understanding addiction
6 Signs of Addiction 4 Common Symptoms: Compulsion Loss of control Negative consequences Denial
8 Scientific Process of Addiction Built in reward system in the brain Evolutionary designed for motivation Rewards evolutionary productive actions Learning Memory Sex Food
9 Mesolimbic System The reward Circuit aka Mesolimbic system Dopamine Nucleus accumbens Nac Primary target for addicting drugs through Dopamine Ventral Tagmental Area Contains Dopamine transmitters that bathes forebrain Hippocampus Learning and memory
10 Mesolimbic System
11 How Addictions Affect the Brain Two kinds of Addiction Substance and Process Addictions Process addictions operate through normal dopamine channels Substance addictions hijack normal dopamine channels Generally more dangerous then process addictions
12 How Addictions Affect the Brain Substance addictions create abnormal amounts of dopamine in the brain. Various ways
13 Prolonged Effects Homeostasis More Dopamine = less dopamine receptors available
14 Behavioral Effects Normal rewarding behaviors replaced by drug seeking behaviors. Decrease in pleasure in all other rewards. Decrease in learning and logic centers.
15 HBO: Brain Imaging
16 A Model of Addiction
17 Biological or Disease Influences Unusual early response to the substance or experience Easy development of tolerance to alcohol Attention deficit/hyperactivity disorder and other learning disabilities Biologically based mood disorders Depression and bipolar disorders Addiction among biological family members
18 Environmental Influences Ready access to the substance or experience Abusive or neglectful home environment Peer norms Misperception of peer norms Membership in an alienated, oppressed, or marginalized group Life events, including chronic or acute stressors
19 Psychological Factors Low self-esteem esteem External locus of control Looking outside oneself for solutions Passivity Post-traumatic traumatic stress disorders Victims of abuse or other trauma
20 Treatment for Addiction
21 What is Addiction Treatment? Behavioral Therapy Counseling Cognitive Therapy Psychotherapy Medications Antidepressants Mood stabilizers Methadone Combination of Therapy and Medication
22 Treatment in the U.S. More than 11,000 specialized addiction treatment facilities Provide counseling, behavioral therapy, medication, rehabilitation, and many other services Large portion is funded by local, State, and Federal Governments
23 Types of Treatment Programs 12-Step and Self-Help Groups Medical Detoxification Outpatient Drug-Free Treatment Short-Term Residential Treatment Long-Term Residential Treatment Prison-Based Treatment Programs Therapeutic communities (TCs)
24 12-Step and Self-Help Groups Groups such as AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and CA (Cocaine Anonymous) complement and extend the effects of professional treatment 12-steps are controversial due to the religious aspects
25 Medical Detoxification Precursor of treatment Medications are available for detoxification Typically under the care of a physician Untreated withdrawal may be medically dangerous and even fatal Not designed to address the psychological, behavioral, and social problems associated with addiction.
26 Outpatient Drug-Free Treatment Varies per state on intensity of services offered Costs less than residential or inpatient Group counseling is emphasized Random Urine Analyses and Drug-Test are administered
27 Short-Term Residential Treatment Treatment typically lasts from days Provides 24-hours per day treatment Focuses on psychological, behavioral, social problems Often times individual, group and family counseling offered Aftercare and Sober Living is often suggested
28 Long-Term Residential Treatment Provides care 24-hours per day Planned lengths of stay (6-12 months) Often times individual, group and family counseling offered Treatment is highly structured and at times be confrontational. Typical patient has more severe problems with Co-occurring occurring mental health problems
29 Goals and Objectives of Treatment Help client admit that he or she suffers from the disease of addiction Point out signs and symptoms of addiction Teach addict to recognize triggers and rechannel urges
30 Process of Treatment and Counseling Initial Screening Intake Psychosocial Assessment Treatment Planning Individual Counseling Group Counseling Graduation Aftercare and Relapse Prevention
31 Interventions Definition: a structured process in which the delusional system of an individual is confronted in caring, objective, and nonjudgmental manner so that the individual receives help for his/her problem. Goals: To break through the conspiracy of silence To understand and share information about substance abuse and its effects on everyone Understand owns enabling behaviors Interrupt the individual s s usage To offer help
32 Interventions continued Monitor and encourage abstinence Help to develop new, more effective problem- solving skills Help the addict to recognize and change problematic attitudes that may stimulate a relapse
33 Principles of Treatment 1. No single treatment is appropriate for all individuals 2. Treatment needs to be readily available. 3. Effective treatment attends to multiple needs of the individual, not just his or her addiction 4. An individual s s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person s s changing needs.
34 Principles of Treatment Continued 5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness 6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. 8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way
35 Principles of Treatment Continued 9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. 10.Treatment does not need to be voluntary to be effective. 11.Possible drug use during treatment must be monitored continuously. 12.Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.
36 How Effective is Addiction Treatment? Several studies show drug addiction treatment reduces drug use by 40 to 60 percent. Drug addiction treatment also significantly decreases criminal activity during and after treatment. Overall, treatment for addiction is as successful as treating other chronic diseases such as hypertension, asthma, and diabetes.
37 Drug Addiction: Punishment and Drug Related Treatment
38 Punishment-Incarceration Rates Half of State inmates and a third of Federal Inmates report committing current offense under the influence of alcohol or drugs. In 1997, 80% of State and 70% of Federal prisoners reported past drug use; 1 in 6 report committing current offense to obtain money for drugs.
39 Punishment-Incarceration Rates In the month before an offense 57% of State and 45% of Federal prisoners report using drugs. 33% of State and 22% of Federal prisoners report using drugs at the time of their offense.
40 Punishment-Incarceration Rates A third of State and a quarter of Federal prisoners said they participated in drug or alcohol treatment substance abuse programs since admission. Of the drug offenses in State prisons possession accounted for 27%, trafficking 70%, and other 3%. Of the drug offenses in Federal prisons possession accounted for 5%, trafficking 86% and other 9%.
41 Punishment-Incarceration Rates Cocaine/Crack is the type of drug used during current offense for 72% of State and 66% of Federal prisoners. Marijuana is the type of drug used during current offense in 13% of State and 19% of Federal prisoners. Violent offenders have the highest percentage of drug use (40%).
42 Punishment-Does it work? Compulsive drug seeking by rats under punishment: effects of drug taking history (2006) Four groups of rats trained with cocaine or sucrose as their reinforcer: moderate- cocaine group, moderate-sucrose group, extended-cocaine group, and extended sucrose group.
43 Punishment-Does it work? Training consisted of a seeking-taking chained schedule with sucrose or cocaine as a reinforcer. Regular training occurred for sessions. Extended training occurred for 14 more sessions after regular training. The rat must press a seeking lever which gives access to a taking lever which delivered the reinforcer.
44 Punishment-Does it work? Between the cycles there was a time out period (TO) long enough to be sure that short-term term satiety effects have been minimized and the rat is showing seeking behavior that is positively related to the cocaine dose.
45 Punishment-Does it work? During the punishment sessions half of the cycles had no punishment and in the other half the seeking response was punished. The half who received punishment had a small foot shock and were then led to a TO period without access to the taking link.
46 Punishment-Does it work? The reinforced and punished cycles were presented randomly within 8 daily sessions.
47 Punishment-Does it work?
48 Punishment-Does it work?
49 Punishment-Does it work? For the rats with a moderate history of reinforcement punishment suppressed both sucrose and cocaine seeking responses. The rats with an extended cocaine history were more resistant to punishment than those with a moderate cocaine history.
50 Punishment-Does it work? No difference in suppression of sucrose seeking were found in animals with moderate vs. extended sucrose histories. There were some rats who did not suppress responding with punishment. These rats had extended cocaine self- administration experience.
51 Drug Related Treatment Drug treatment often includes the use of replacement drugs. The treatment of opiate addiction may use other opiates that are also classified as highly addictive.
52 Drug Related Treatment Some drugs often prescribed are Methadone and Buprenorphine. These drugs are used in order to stabilize levels of opioid needed and a way to gradually reduce the levels of opioid needed.
53 Drug Related Treatment- Methadone Methadone Maintenance Treatment (MMT) Methadone is thought to occupy the receptor sites affected by opiates. It relieves the craving for opiates, relieves symptoms from withdrawls and is not said to cause euphoria or intoxication (with stable dosing).
54 Drug Related Treatment- Methadone Most patients require mgs a day to receive optimum therapeutic effects. Patients on higher doses are more likely to stay in treatment and less likely to use other drugs.
55 Drug Related Treatment- Methadone Methadone addiction became a problem in the 1990s. As overdoses of the drug rose, the FDA approved the use of a substitute of Methadone: Buprenorphine.
56 Drug Related Treatment- Methadone 20% of 810,000 heroin addicts in the U.S. receive MMT. If taken correctly and under a physician s supervision it is considered medically safe.
57 Drug Related Treatment- Methadone
58 Drug Related Treatment- Methadone Patients on MMT have weekly heroin use decrease by 69%. Criminal activity decreased by 52% among patients. Full-time employment increased by 24%.
59 Drug Addiction: Prevention
60 Laws Do They Work? Raising tobacco taxes Philip Morris: A high cigarette price, more than any other cigarette attribute, has the most dramatic impact on the share of the quitting population price, not tar level, is the main driving force for quitting.
61 Laws Do They Work? Ignition interlock device for DUI prevention - Comparing the recidivism rates of two groups of Illinois drivers - Drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device.
62 Laws Do They Work? However Once the ignition interlock was removed, drivers in this [the interlock] group rapidly returned to DUI arrest rates similar to those in the comparison group.
63 Laws Do They Work? Prison sentence - Rat study indicates that punishment is not an effective solution for severe addicts Other options more viable
64 Laws Do They Work? RSAT Residential Substance Abuse Treatment Program - Formulated from successful Delaware program in late 80 s - Provides funding for substance abuse treatment in a correctional setting - The rationale for RSAT is that, although there is a need to punish offenders, it is important they not return to prison. Hence, the RSAT initiative is an attempt to break the cycle of drug use and crime, and simultaneously make the inmate s prison time more productive.
65 Laws Do They Work? Therapeutic Community (TC) - Based upon the idea that drug abuse is a disorder of the person, and that addiction is thus a symptom of this disorder - Goal is to change negative psychological and behavioral patterns that incline toward drug use - Especially good for drug-involved offenders who are incarcerated: the TC is a total treatment environment isolated from the rest of the prison population separated from the drugs, violence, and other aspects of prison life that militate against rehabilitation
66 Education - D.A.R.E. School-based drug-prevention program 1983 Originated in LA through coordination between school district and LAPD Unique because uniformed officers teaching curriculum rather than teachers Based upon social influence approach to prevention of drug use Quickly implemented nationwide
67 Education D.A.R.E. Growth has exceeded evaluation Most evaluations assess immediate results of program rather than long-term effects Longitudinal studies: DARE exposure had no statistically significant effect on subjects initiation of alcohol use, cigarette smoking, or heavy drinking immediately after DARE, or 1 year or 2 years later.
68 Education D.A.R.E. Increase in self-esteem reported at immediate post-test, but study showed no immediate or long-term effects on participants social skills or attitudes toward drugs 2003 United States General Accounting Office concluded that D.A.R.E. was ineffective in preventing the use of drugs among youth.
69 Education D.A.R.E. Highly visible Substantial federal and corporate funding Portrays a favorable image of police and politicians who support it
70 Education Anti-Drug Campaign National Youth Anti-Drug Media Campaign launched by ONDCP, Partnership for a Drug-Free America, and Ad Council Variety of media targeting adolescents Variety of media targeting adolescents 2003 study showed little evidence of direct favorable effects on youth. Moreover, for some youth cohorts, those with the highest exposure to the media ads appeared more likely to initiate marijuana use.
71 Education Targeting Certain Groups Elementary, middle school-aged children - problems Family interventions - Long-term effects of 2 brief family interventions with general population families of 6 th graders in Iowa - Data collected 4 years later showed subjects of both interventions to have lower rates of initiation and current use of alcohol, tobacco, and marijuana than control group - Brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use and thus have important public health implications
72 Aftercare and Continued Care Treatment Shift of addiction Consequences or treatment for addiction can actually become a substitute dependence - Parole and Alcoholics Anonymous
73 Relapse Prevention Study following hospital-treated treated heroin and alcohol addicts for 20 and 12 years Post-morbid factors found to be correlated with freedom from relapse for both groups - Community compulsory supervision - Substitute dependence - New relationships - Inspirational group membership
74 Relapse Prevention
75 Works Cited Donatelle, R. J. (2006). Access to Health. In Addictions and Addictive Behavior (p ). 336). San Francisco, CA: Pearson. Gabe Msw, Mac, Janice E. NAADAC Desk Reference and Study Guide on Addiction Counseling. 6th ed Inciardi, James A., Ph.D. The Irrational Politics of American Drug Policy: Implications for Criminal Law and the Management of Drug-Involved Offenders. Ohio State Journal of Criminal Law Vol. 1: iardi.pdf Jones S, Bonci A (2005). "Synaptic plasticity and drug addiction". Curr Opin Pharmacol 5 (1): doi: /j.coph Kalivas PW, Volkow ND (2005). "The neural basis of addiction: a pathology of motivation and choice". Am J Psychiatry 162 (8): doi: /appi.ajp Lindblom, Eric. "Raising Cigarette Taxes Reduces Smoking, Especially Among Kids (and the Cigarette Companies Know It). Campaign for Tobacco-Free Kids.. 11 June Mumola, Christopher J. Substance Abuse and Treatment. State and Federal Prisoners, Bureau of Justice Statistics. Jan
76 Works Cited Continued Pelloux, Yann, et.al. Compulsive drug seeking by rats under punishment: effects of drug taking history. Psychopharmacology.. 21 May sp?accesstoken=23a3a3 M8SEFYMBMWLYWWBWWXXWEW8AML1&Show=Object Principles of Drug Addiction Treatment: a Research Based Guide.. National Institute on Drug Abuse No , Raub RA, Lucke RE, Wark RI. Breath alcohol ignition interlock devices: controlling the recidivist. Traffic Inj Prev Sep Vol 4(3): ?ordinalpos= 12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum _RVDocSum Spoth, Richard L.; Redmond, Cleve; Shin, Chungyeol. Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline. Journal of Consulting and Clinical Psychology Aug Vol 69(4): Therapy Manuals for Drug Abuse:.. Vol. 3. National Institute of Drug Abuse, Vaillant, George E., M.D. What Can Long-Term Follow-up Teach us About Relapse and Prevention of Relapse in Addiction? British Joumal of Addiction. October : synergy.com/doi/abs/ /j tb03021.x tb03021.x Walters, John P. Methadone. Methadone. Drug Policy Information Clearinghouse. 25 July ne/index.html Wikipedia. Drug Addiction. 1 March
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