TREATMENT OF SUBSTANCE USE DISORDERSTREATMENT OF SUBSTANCE USE DISORDERS

TX myths

1. Nothing works

2. One approach is superior to all others (“one true light” tradition)

3. All treatment approaches work equally well for everyone

- measuring outcomes

- good studies use:________________________

TREATMENT OF SUBSTANCE USE DISORDERS

TREATMENT OF SUBSTANCE USE DISORDERS

MOTIVATION AND STAGES OF CHANGE

• Pre-Contemplation (Denial?)

• Contemplation(Ambivalence)

• Preparation (Commitment & Goal-setting)

• Action (explicit change activities)

• Maintenance (Relapse) **

TREATMENT OF SUBSTANCE USE DISORDERSTREATMENT OF SUBSTANCE USE DISORDERS

• Outcome Studies

• Hazeldon study: • N = 1,083 (71%)…53% abstinent at 1 yr. f/u

• Drug Abuse Treatment Outcome Study (DATOS) – natural tx in 4 settings:

• methadone clinics: N = 727 / 1,203 89.4% 27.8 heroin

use at 1 yr. f/u

41.9% 21.7 cocaine use *weekly or more drug use 17.1% 13.9 marijuana use

14.8% 16.3 alcohol use, 5+ drinks

• Project MATCH

4 sessions in 12 weeks

Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking

Mobilize the person’s own commitment and motivation to change

MET

(Motivational Enhancement Therapy)

12 weekly sessions

Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings

Acceptance of the disease of alcoholism and loss of control over drinking

TSF

(Twelve Step Facilitation)

12 weekly sessions

Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse

Learn skills to achieve and maintain sobriety

CBT

(Cognitive Behavioral Therapy)

FrequencyDescriptionGoal of

TreatmentType of

Treatment

Project MATCH Treatment Conditions

Results:• N = 1,726 outpatients (n=952) and aftercare (n=774) at 5 sites (one of largest clinical trials

ever)

• 25% were women; 15% were minority group members

• 10 client characteristics studied: severity etoh, sociopathy, cognitive impairment, gender, meaning seeking, motivation, psych severity, etc.

• 90% of the participants were assessed at 1-year follow-up

• pre-post differences in drinking days per month (25 6) and drinks per “drinking” day (15 3)

• each of the 3 treatments worked about equally well in reducing drinking

• TSF outpatients more likely to remain sober (24%) at 1 yr. than outpatients in CBT or MET (about 15%)

• only 1 “matching” prediction supported: outpatients with few or no psychiatric problems had more abstinent days in TSF tx than in CBT

• At 3-yr. follow-up: 36% of TSF clients abstinent vs. 27% MET and 24% CBT clients

• *** strong correlation between abstinence rates and compliance with aftercare (“recovery” is a PROCESS).

Principles of Effective Treatment http://www.nida.nih.gov/PODAT/PODAT1.html

• No single treatment is appropriate for all individuals.

• Treatment needs to be readily available.

• Effective treatment attends to multiple needs of the individual, not just his or her drug use. Clients with coexisting mental disorders should have both disorders treated in an integrated way.

• In order to meet the changing needs of the client, the treatment plan must be continually assessed and modified.

• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

• Counseling (individual, couple, and/or group) and other behavioral therapies are critical components of effective treatment for addiction...

Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.

• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

• Treatment does not need to be voluntary to be effective

• Possible drug use during treatment must be monitored continuously.

• Treatment programs should provide assessment and counseling for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases to help patients modify or change behaviors that place themselves or others at risk of infection.

• Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.