Substance Use Treatment Overview

Substance Use and Impulse Control - Treatment

• Agonist Substitution: Chemical makeup of drugs similar to addictive drugs (e.g., methadone for opioids, buprenorphine, nicotine substitution). Methadone is an opioid agonist, while buprenorphine has a lower risk of dependence. Nicotine substitution comes in gum, patch, inhaler, and nasal spray forms. Combined with counselling, agonist substitution is more effective. Cross-dependence occurs when drugs act on the same CNS receptors, becoming a substitute.

• Antagonist Treatments: Block or counteract the effects of psychoactive drugs. Naltrexone is an opioid antagonist, producing immediate withdrawal symptoms. More effective when part of a treatment package and can also be used for alcohol dependence to inhibit DA release in the Nucleus Accumbens. Reduces cravings.

Other Biological Treatments

• Sedatives to lessen withdrawal discomfort from other drugs, gradually tapered off. Desipramine increases abstinence rates for cocaine.

Inpatient Facilities

• Detoxification from alcohol or other drugs. Often includes tranquilizers to ease anxiety and discomfort of withdrawal. These facilities are expensive.

Psychosocial Treatments

• Alcoholics Anonymous (AA) and Variations: Independent 12-step philosophy, effective with motivated individuals. This includes variations like Cocaine Anonymous, Narcotics Anonymous, and Marijuana Anonymous.

• Cognitive and Behavioural Treatments:

  • Aversion Therapy: Prescribed drugs make using abused substances unpleasant (e.g., disulfiram for alcohol, silver nitrate for smoking). Covert sensitization involves visualizing unpleasant scenes.
  • Contingency Management: Clinicians and clients select behaviors to change and reward progress with reinforcers.
  • Behavioural Self-Control Training: Empowers clients to control their drinking by teaching stimulus control, modifying drinking behavior, and reinforcing abstinence (through reward).
  • Community Reinforcement Approach: Focuses on equipping individuals with social skills, employment opportunities and replacing substance use with new hobbies and recreational options.
  • Motivational Enhancement Therapy (MET): CBT, aims to increase motivation to change behavior. Building trust, exploring ambivalence, and setting goals are necessary for MET; leading to a developed behavioral plan.

• Relapse Prevention (Alan Marlatt): An alternative approach to complete abstinence. Recognizes substance use as a failure of coping skills and may focus on controlled use for some people.

Harm Reduction:

• Controlled use (vs. total abstinence): an alternative approach to drug and alcohol use. May be an alternative but not effective long-term.

Gambling Disorder:

• Persistent problematic gambling behavior causes significant distress or impairment (e.g., job loss, financial problems, arrests). Similar to substance use, showing cravings and possible tolerance or withdrawal. CBT and Gambler's Anonymous (GA) could help.

Impulse Control Disorders

• Intermittent Explosive Disorder: Sudden aggressive impulses, resulting in violent outbursts and property destruction.
• Kleptomania: Recurrent failure to resist urge to steal things, typically starts in adolescence, often associated with mood disorders.
• Pyromania: Irresistible urge to set fires; preoccupied with fire and related equipment. These are treated with Cognitive-behavioural Therapy where signals associated with urge are identified and coping strategies to avoid the urge are developed.