Substance Use And Impulse Control PDF

Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 Treatment Biological Treatments Agonist Substitution Chemical makeup of drug similar to addictive drug ◦ Methadone: opioid agonist; may lead to dependence ◦ More effective when combined with couns...

Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 Treatment Biological Treatments Agonist Substitution Chemical makeup of drug similar to addictive drug ◦ Methadone: opioid agonist; may lead to dependence ◦ More effective when combined with counselling ◦ Cross-dependent- act on the same CNS receptors, become a substitute for the original dependency ◦ Buprenorphine: less risk of dependence ◦ Nicotine substitution: gum, patch, inhaler, nasal sprays Copyright © 2024 Cengage Learning 2 Treatment Biological Treatments Antagonist Treatments Block or counteract the effects of psychoactive drugs Naltrexone: opioid-antagonist drugs ◦ Produces immediate withdrawal symptoms ◦ More effective if part of a treatment package ◦ Also given for alcohol dependence – inhibits DA release in the Nucleus Accumbens ◦ Reduces cravings Copyright © 2024 Cengage Learning 3 1  Treatment Biological Treatments Other Biological Treatments Sedatives to minimize discomfort for people withdrawing from other drugs Sedatives dependency - gradually tapered off Desipramine: increases abstinence rates for cocaine Copyright © 2024 Cengage Learning 4 Treatment Inpatient Facilities Detoxification – Withdrawal from alcohol or other drugs For initial withdrawal period Tranquilizers are sometimes given to ease the anxiety and discomfort of withdrawal Expensive Copyright © 2024 Cengage Learning 5 Treatment Psychosocial Treatments Alcoholics Anonymous (1935) and Its Variations Independent from established medical community 12-step philosophy; see Table 12.2 Effective with motivated individuals Cocaine Anonymous, Narcotics Anonymous, Marijuana Anonymous Copyright © 2024 Cengage Learning 6 2  Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Aversion Therapy Prescribed drugs make ingesting abused substances extremely unpleasant ◦ Disulfiram (Antabuse) used for alcohol disorder ◦ Problem of noncompliance ◦ For smoking aversion: silver nitrate in gum, spray Covert sensitization: imagining unpleasant scenes Copyright © 2024 Cengage Learning 7 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Contingency management The clinician and client together select the behaviours that the client needs to change decide on the reinforcers that will reward reaching certain goals. Copyright © 2024 Cengage Learning 8 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Behavioural Self-Control Training for problematic drinking Emphasizes client’s control and includes one or more of the following ◦ Stimulus control ◦ Modification of the topography of drinking ◦ Reinforcing Abstinence (Flett et al, 2017) Copyright © 2017 John Wiley & sons, Inc. 9 3  Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Community reinforcement approach Teaching social skills How to identify antecedents and consequences of their substance use behaviour Assistance with employment, education, finances to reduce stress; teaching job hunting skills Replace substance use with new recreational options Copyright © 2024 Cengage Learning 10 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments CBT Motivational enhancement therapy (MET)- increase motivation to change behaviour ◦ Building trust ◦ Exploring ambivalence ◦ Setting goals ◦ Developing a plan Copyright © 2024 Cengage Learning 11 Treatment Psychosocial Treatments Relapse Prevention Alan Marlatt - Relapse seen as failure of cognitive and behavioural coping skills Helping people remove any ambivalence about stopping their drug ◦ Examining their beliefs about the positive aspects of the drug Copyright © 2024 Cengage Learning 12 4  Treatment Harm Reduction (Alan Marlatt) alternative to an approach that focuses on complete abstinence e.g. AA Controlled use Controlled use of a substance instead of abstinence e.g., controlled drinking ◦ May be an alternative, is not a cure ◦ Not very effective over the long term Safe injection sites (SISs) Copyright © 2024 Cengage Learning 13 Treatment Prevention Education-based programs Harm reduction (Alan Marlatt) vs. “No drugs” messages Skills training to avoid or resist social pressures Community-based interventions ◦ Encouraging responsible beverage services ◦ Local enforcements of drinking and driving laws ◦ Cooperation of governmental, educational, and other social institutions determines success Copyright © 2024 Cengage Learning 14 Gambling Disorder Persistent and recurrent problematic gambling behaviour  significant distress or impairment Job loss, bankruptcy, arrests Similar to substance use disorders ; craving; Tolerance and withdrawal People with gambling disorder: in denial, impulsive, continually optimistic Gambler Anonymous ; CBT Internet gaming disorder (For further study) Copyright © 2024 Cengage Learning 15 5  Impulse-Control Disorders Intermittent Explosive Disorder: Aggressive impulses resulting in serious assaults, destruction of property ◦ Controversial ◦ SE, NE, and testosterone levels ◦ Dysfunction of orbitofrontal cortex in inhibiting amygdala activation Copyright © 2024 Cengage Learning 16 Impulse-Control Disorders Kleptomania: recurrent failure to resist urges to steal things; rare; stigma associated; illegal o Typically starts in adolescence o High comorbidity with mood disorders o “Antidepressant behaviour”- relieving unpleasant feelings with stealing behaviour Pyromania: having an irresistible urge to set fires o Preoccupied with fire and the associated equipment Treatment: Cognitive-behavioural – identify signals that initiate the urges – coping strategies to resist these urges Copyright © 2024 Cengage Learning 17 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2021). Abnormal psychology: An integrative approach (6th Cdn. ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Cdn. ed.). Wiley 18 6