Substance-Related Disorders PDF

Substance-Related Disorders Intoxication refers to the distinct and recognizable pattern of problematic behavioral or psychological changes associated Important Termin...

Substance-Related Disorders Intoxication refers to the distinct and recognizable pattern of problematic behavioral or psychological changes associated Important Terminologies with the use or abuse of a substance. Substance - refers to chemical compounds that are ingested to alter Substances Associated With the Abuse mood or behavior I. Depressants - They cause the central nervous system to slow down. Psychoactive substances Individuals taking depressants may feel relaxed and sociable - substances that alter moods, thought processes, or due to lowered interpersonal inhibitions. other psychological states—are used excessively. - Decrease CNS activity Substance use refers to ingestion of psychoactive substances. A. Alcohol Intoxication physiological reaction to ingested - Alcohol is produced when certain yeasts react with sugar and substance water and fermentation takes place. Substance use disorder - GABA and glutamate systems Substance dependence/addiction Terminologies Addiction - Moderate drinking refers to lower-risk patterns of drinking, - involves compulsive drug-seeking behavior and a loss generally no more than one drink for women or two drinks for of control over drug use. men. - Drinking involves consumption of more than two drinks per Withdrawal symptoms day or 14 drinks per week for men and more than one drink - negative psychological and physiological effects such per day or 7 drinks per week for women. as shaking, irritability, or emotional distress—that occur - Binge drinking is episodic drinking involving five or more when use is discontinued. drinks on a single occasion for men and four or more drinks for women. Withdrawal occurs when chronic exposure to a substance results in physiological dependence—our bodies adapt and Other Terms: we need the substance to feel normal. Alcohol Poisoning - It is a condition in which large amounts of alcohol Evidence of either withdrawal symptoms or tolerance, which consumed quickly can result in impaired breathing, involves progressive decreases in the effectiveness of the coma, and death. substance, indicates that physiological dependence has - It can be exacerbated by the vomiting and dehydration developed. that occur as the body attempts to rid itself of excess alcohol.  Alcoholic - In contrast to the GABA system, the glutamate system is - A person who has become dependent on alcohol and excitatory, helping neurons fire. It is suspected to involve who exhibits characteristics of an alcohol-use disorder. learning and memory, and it may be the avenue through which Alcoholism alcohol affects our cognitive abilities. Blackouts, the loss of - It is a broad term referring to a condition in which the memory for what happens during intoxication, may result from individual is dependent on alcohol and has difficulty the interaction of alcohol with the glutamate system. These controlling drinking. associations show that the effects of alcohol are more complex Delirium tremens as this substance influences a number of neuroreceptor - It is a life-threatening withdrawal symptoms that can systems. result from chronic alcohol use. Abstinence B. Sedatives, Hypnotics, and Anxiolytics - It refers to refraining from use of alcohol, drugs, or Sedatives, Barbiturates, and Benzodiazepines other addictive substances. - Sedative (calming), hypnotic (sleep-inducing), and anxiolytic (anxiety-reducing) drugs Clinical Descriptions: - GABA systems - Apparent stimulation is the initial effect of alcohol, although it is a depressant. We generally experience a feeling of Sedatives (calming), including hypnotics (sleeping pills) and well-being, our inhibitions are reduced, and we become more anxiolytics (antianxiety medications), have calming effects and outgoing. This is because the inhibitory centers in the brain are are prescribed to reduce muscle tension, insomnia, agitation, initially depressed—or slowed. and anxiety. - With continued drinking, however, alcohol depresses more Hypnotics induce sleep and combat insomnia. areas of the brain, which impedes the ability to function Anxiolytics are used to treat anxiety; they are sometimes properly. Motor coordination is impaired (staggering, slurred referred to as minor tranquilizers, so named to distinguish speech), reaction time is slowed, we become confused, our them from the major tranquilizing medications used with ability to make judgments is reduced, and even vision and psychotic disorders. hearing can be negatively affected, all of which help explain why driving while intoxicated is clearly dangerous. The drug classes of barbiturates, such as Seconal and phenobarbital, and benzodiazepines, such as Valium, Ativan, and - Alcohol influences a number of neuroreceptor systems. For Xanax, provide rapid anxiety-reducing effects when used in moderate example, the gamma-aminobutyric acid (GABA) system, doses; higher doses are prescribed to produce hypnotic, or seems to be particularly sensitive to alcohol. GABA, as you sleep-inducing effects. Individuals who have difficulty dealing with will recall, is an inhibitory neurotransmitter. Its major role is to stress or who experience anxiety or insomnia are particularly prone to interfere with the firing of the neuron it attaches to. Because overusing and becoming dependent on sedatives. the GABA system seems to affect the emotion of anxiety, alcohol’s antianxiety properties may result from its interaction Clinical Descriptions: with the GABA system. - The DSM-5 criteria for sedative-, hypnotic-, and anxiolytic-related disorders do not differ substantially from  those for alcohol disorders. Both include maladaptive - Unwanted physiological effects include heart arrhythmias, behavioral changes such as inappropriate sexual or dizziness, tremors, and sweating. Psychological side effects aggressive behavior, variable moods, impaired judgment, can include anxiety, restlessness, agitation, hostility, and impaired social or occupational functioning, slurred speech, paranoia. motor coordination problems, and unsteady gait. Sedative, hypnotic, and anxiolytic drugs affect the brain by influencing A. Caffeine the GABA neurotransmitter system. - Gentle stimulant - 250 mg II. Opiates - Caffeine is a stimulant found in coffee, chocolate, tea, and soft - The word oplate refers to the natural chemicals in the opium drinks. poppy that have a narcotic effect. - It is the most widely consumed psychoactive substance in the - The major effect of these substances is to produce analgesia world, prized by almost every culture for increasing temporarily (reduce pain) and euphoria. attentiveness. - Induce sleep - Caffeine in small doses can elevate your mood and decrease - These are painkilling agents that depress the central nervous fatigue. system. - In larger doses, it can make you feel jittery and can cause - Heroin and opium, both derived from the opium plant, are insomnia. the best-known illicit opioids. - Because caffeine takes a relatively long time to leave our - All opioids (including the medications morphine, codeine, and bodies (about 6 hours), sleep can be disturbed if the caffeine is oxycodone) are highly addictive and require careful medical ingested in the hours close to bedtime. This effect is especially management when prescribed for pain and anxiety. pronounced among those already suffering from insomnia and - Prescription opioids are considered a gateway drug—a the hallmark feature of caffeine withdrawal is headache. substance leading to the use of more dangerous drugs. - The high or “rush” experienced by users comes from the B. Amphetamines activation of the body’s natural opioid system. - Amphetamines, also known as “uppers,” significantly speed - In other words, the brain already has its own opioids—called up central nervous system activity; makes a person feel up enkephalins and endorphins—that provide narcotic effects. - Amphetamines, such as Ritalin, Adderall, and Dexedrine, Heroin, opium, morphine, and other opiates activate this prescribed to treat attention and sleep disorders, are system. increasingly used illicitly, particularly among young adults. - Amphetamines stimulate the central nervous system by III. Stimulants enhancing the activity of norepinephrine and dopamine. - These substances cause us to be more active and alert and Specifically, amphetamines help the release of these can elevate mood. neurotransmitters and block their reuptake, thereby making - These are substances that speed up central nervous system more of them available throughout the system. activity, are used for a variety of reasons: to produce feelings - Too much amphetamine—and therefore too much dopamine of euphoria and well-being, improve mental and physical and norepinephrine—can lead to hallucinations and delusions. performance, reduce appetite, and prevent sleep. Clinical Descriptions - During these binges, they often become paranoid, - DSM-5 diagnostic criteria for intoxication in amphetamine use experiencing exaggerated fears that they would be caught or disorders include significant behavioral symptoms, such as that someone would steal their cocaine. euphoria or affective blunting (a lack of emotional expression), - Such paranoia—referred to as cocaine-induced paranoia—is changes in sociability, interpersonal sensitivity, anxiety, common among persons with cocaine use disorders, Cocaine tension, anger, stereotyped behaviors, impaired judgment, and also makes the heart beat more rapidly and irregularly, and it impaired social or occupational functioning. can have fatal consequences, depending on a person’s physical condition and the amount of the drug ingested. C. Cocaine - Cocaine, a stimulant extracted from the coca plant, induces D. Nicotine feelings of energy and euphoria. - The nicotine in tobacco is a psychoactive substance that - Crack is a potent form of cocaine produced by heating produces patterns of dependence, tolerance, and cocaine with other substances (“freebasing”); it is sold in small, withdrawal—tobacco-related disorders—comparable to those solid pieces (“rocks”) and is typically smoked. of the other drugs discussed above. - Crack produces immediate but short-lived effects. - Nicotine appears to stimulate specific receptors—nicotinic - Cocaine has a high potential for addiction, sometimes after acetylcholine receptors (nAChRs)—in the midbrain only a short period of use. reticular formation and the limbic system, the site of the - Due to cocaine’s intense effects, cocaine withdrawal causes brain’s pleasure pathway (the dopamine system responsible lethargy and depression; users often take multiple doses in for feelings of euphoria). rapid succession trying to recreate the high. - Cocaine seems to bind to places where dopamine Clinical Descriptions: neurotransmitters reenter their home neuron, blocking their - DSM-5 does not describe an intoxication pattern for reuptake. tobacco-related disorders. Rather, it lists withdrawal - The dopamine that cannot be taken in by the neuron remains symptoms, which include depressed mood, insomnia, in the synapse, causing repeated stimulation of the next irritability, anxiety, difficulty concentrating, restlessness, and neuron. This stimulation of the dopamine neurons in the increased appetite and weight gain. “pleasure pathway” (the site in the brain that seems to be - Nicotine in small doses stimulates the central nervous involved in the experience of pleasure) causes the high system; it can relieve stress and improve mood. But it can also associated with cocaine use. cause high blood pressure and increase the risk of heart disease and cancer. Clinical Descriptions - High doses can blur your vision, cause confusion, lead to - Like amphetamines, in small amounts cocaine increases convulsions, and sometimes even cause death. alertness, produces euphoria, increases blood pressure and - Once smokers are dependent on nicotine, going without it pulse, and causes insomnia and loss of appetite. causes withdrawal symptoms. - The effects of cocaine are short lived; for some people, they - If you doubt the addictive power of nicotine, consider that the lasted less than an hour, and they had to snort repeatedly to rate of relapse among people trying to give up drugs is keep themselves up. equivalent among those using alcohol, heroin, and cigarettes  - Marijuana is derived from the leaves and flowering top of the IV. Hallucinogens cannabis plant, whereas hashish, which contains particularly - These substances alter sensory perception and can produce high levels of THC, comes from the pressed resin of the plant. delusions, paranoia, and hallucinations. - Growing conditions influence the THC content, as well as - Cannabis (Marijuana) and LSD (acid) are included in this other chemicals in cannabis plants. category. - Cannabis produces feelings of euphoria, tranquility, and - No reported withdrawal symptoms passivity combined with mild perceptual and sensory - Hallucinogens are substances that can produce vivid sensory distortions, but can also increase anxiety and depression. experiences, including hallucinations. - People who smoke marijuana often experience altered - Traditional hallucinogens are derived from natural sources: perceptions of the world. lysergic acid diethylamide (LSD) from a grain fungus, - Reactions to cannabis usually include mood swings. psilocybin from mushrooms, mescaline from the peyote - Otherwise, normal experiences seem extremely funny, or the cactus, and salvia from an herb in the mint family. person might enter a dreamlike state in which time seems to - LSD (d-lysergic acid diethylamide), sometimes referred to stand still. as “acid,” is the most common hallucinogenic drug. - Users often report heightened sensory experiences and - The DSM-5 diagnostic criteria for hallucinogen intoxication are seeing vivid colors. The feelings of well-being produced by similar to those for cannabis: perceptual changes such as the small doses can change to paranoia, hallucinations, and subjective intensification of perceptions, depersonalization, dizziness when larger doses are taken. and hallucinations. - Physical symptoms include pupillary dilation, rapid heartbeat, B. Inhalants sweating, and blurred vision. - Inhalant abusers become intoxicated from chemical vapors found in a variety of common household products, including V. Dissociative Anesthetics solvents (paint removers, gasoline, lighter fluid), office supplies - Phencyclidine (known as PCP) and ketamine (sometimes (marker pens, correction fluids), aerosol sprays (spray paints, referred to as Special K), both highly dangerous and hair spray), and compressed air products (computer and potentially addictive substances, are classified as dissociative electronics duster sprays). anesthetics; developed for use as anesthetics in veterinary - Inhalation of these substances (known as “huffing”) is medicine, they produce a dreamlike detachment in humans. accomplished through sniffing fumes from containers, bags, or balloons; directly inhaling aerosol sprays; or using VI. Substances with Mixed Chemical Properties inhalant-soaked rags. A. Cannabis - Cannabis is the botanical name for a plant that contains a VII. Designer Drugs chemical (delta9tetrahydrocannabinol, referred to as THC) - The term “designer drug” refers to substances manufactured that can produce stimulant, depressant, and hallucinogenic as recreational drugs, using a variety of chemicals; these effects. synthetic drugs are created to mimic the effects of hallucinogenic or stimulant drugs while evading legal restrictions.  severe intoxication or taking the medication. This criterion does not A. Ecstasy apply to substance-induced neurocognitive disorders or - Ecstasy (methylenedioxymethamphetamine, or MDMA), hallucinogen-persisting perception disorders, which persist beyond which has both stimulant and hallucinogenic properties, is a the cessation of acute intoxication or withdrawal. designer drug that has gained popularity as a party drug. D. The disorder does not occur exclusively during the course of a delirium. - Short-term effects of ecstasy, including euphoria, mild sensory and cognitive distortion, and feelings of intimacy and E. The disorder causes clinically significant distress or impairment in social, well-being, are often followed by intense depression. occupational, or other important areas of functioning. B. Club Drugs Etiology - Many of the designer drugs, including Ecstasy, and Biological DImension substances such as PCP, ketamine, and Rohypnol are - Biological factors affect the development of substance-use considered “club drugs” because they are often used in a club disorders in various ways. First, substance use alters brain or party context. functioning. Some drugs (such as cannabis) produce - Club drugs are used to induce energy and excitement, reduce changes by mimicking the actions of various inhibitions, and create feelings of well-being and connection neurotransmitters. Other drugs (such as stimulants) flood with others. the brain with dopamine and alter the dopamine reward - Although positive effects may last for hours, they are typically circuit, the neurological pathway associated with pleasure. followed by a crash—lethargy, low motivation, and fatigue. Feelings of euphoria or pleasure ensue. The “high” resulting from excessive dopamine reinforces continued drug use. Common Features of Substance/Medication-Induced Disorders Eventually, substance use crowds out other pleasures and A. The disorder represents a clinically significant symptomatic presentation of turns into an all-consuming, compulsive desire. a relevant mental disorder. B. There is evidence from the history, physical examination, or laboratory - When exposed to excessive dopamine, brain cells adapt to the findings of both of the following: overstimulation by decreasing the number of dopamine 1. The disorder developed during or within 1 month of a substance receptors. The brain goes into this self-protective mode in intoxication or withdrawal or taking a medication; and 2. The involved substance/medication is capable of producing the order to maintain equilibrium. As the brain becomes less mental disorder. sensitive to the effects of dopamine and drug tolerance develops, the brain requires more of the substance to recreate C. The disorder is not better explained by an independent mental disorder the original “high”. This decreased sensitivity to dopamine (i.e., one that is not substance- or medication-induced). Such evidence of an means that drugs and alcohol (as well as other normally independent mental disorder could include the following: enjoyable activities) bring limited pleasure. 1. The disorder preceded the onset of severe intoxication or withdrawal or exposure to the medication; or 2. The full mental disorder persisted for a substantial period of time - Furthermore, substance-induced changes in the prefrontal (e.g., at least 1 month) after the cessation of acute withdrawal or cortex result in impaired judgment and decision making.  These changes also reduce self-control, making it difficult to compared to men, are more reactive to drug-related cues, and resist the cravings associated with substance use. Thus, are more susceptible to relapse. Investigation into the compulsive drug-seeking behavior ensues without neurobiological basis of these sex differences has implicated consideration of negative consequences. Adolescence through the effects of estrogen, which can influence dopamine levels early adulthood is a critical period for nuanced development of and susceptibility to the reinforcing effects of addictive the prefrontal cortex; when drug or alcohol use affects this substances. Other physiological differences may explain the process, disruptions in reasoning, goal setting, and impulse more rapid development of alcoholism that occurs in women: control can lead to a lifelong pattern of neurological Women tend to weigh less, produce fewer enzymes to dysregulation and substance abuse. metabolize alcohol, possess less total body fluid to dilute alcohol in the blood, and are more likely to limit food intake—factors that can increase toxicity and physiological - Genetic factors also play an important role in the changes associated with alcohol dependence. Further, sex development of substance abuse. There is strong evidence differences in physiological reactions to stress (combined with that substance abuse runs in families based on twin studies differential exposure to traumatic life events) may help explain and analyses of family patterns of addiction. Although the more severe course of alcoholism in women. collective findings support the importance of heredity in the etiology of substance use, the manner by which specific genes Psychological Dimension or gene combinations influence addiction is complex. For - Coping with psychological stress and emotional example, genetics influence personality traits such as symptoms appears to be a major motive for substance use. impulsivity, risk taking, and novelty seeking that increase the Individuals with psychiatric symptoms often use drugs and likelihood that someone will experiment with drugs or alcohol, alcohol to self-medicate, an attempt to cope with emotions as well as protective characteristics such as self-control. such as depression and anxiety. - Four categories of life stressors influence substance use and - Genes affect individual responses to specific drugs and risk of the development of substance-use disorders: drug dependence. For example, one person may be a. general life stress (e.g., relationship or work susceptible to alcoholism, whereas another has genetic risk of difficulties), marijuana dependence. And some gene combinations produce b. stress resulting from trauma or catastrophic events risk of addiction to multiple substances. Additionally, genetic c. childhood maltreatment variations can influence the degree of pleasure (or aversion) d. the stress of discrimination based on being a member experienced during initial use of specific substances, as well of a sexual or racial/ethnic minority. as the negative and positive effects of ongoing use. - Internalizing disorders such as depression and anxiety often precede substance use and abuse. Anxiety and depressive - Sex differences in the physiological effects of substances are symptoms that begin in early childhood and persist into also important in understanding addiction. Women who use adulthood appear to increase risk of alcohol abuse, particularly drugs or alcohol show a more rapid progression to addiction when accompanied by social withdrawal.  of impulsive behaviors in response to distress, such as turning - Adolescent girls have an increased risk of using pain to substance use as a means of coping. Not surprisingly, medications to deal with stress and depression. Similarly, adolescents with parents with an alcohol-use disorder reported adolescent girls with eating disorders often use depressants to drinking heavily and drinking alone, with the goal of becoming cope with bulimic urges. Adolescent girls also report using intoxicated in order to forget their problems. substances to help “forget troubles” or “deal with problems at home”. - Adolescence and early adulthood are particularly vulnerable periods concerning social influences on substance use, even - The personality characteristic of behavioral under control, for those without other life stressors. Patterns of alcohol or associated with rebelliousness, novelty seeking, risk-taking, drug abuse often begin in early adolescence. Various social and impulsivity, increases risk of substance use and abuse. factors affect decisions to initiate drinking or drug use, Individuals with these traits are more likely to experiment with including pressure from peers, a wish to fit in socially, substances and continue use because they find the effects attempts to rebel and challenge authority, a desire to rewarding and exciting. An investigation of possible genetic assert independence or escape from societal or parental links between substance abuse and impulsivity revealed pressures for achievement, or interest in having fun or that siblings of individuals with a stimulant-use disorder tended taking risks. Adolescent boys often report that drugs help to be highly impulsive, suggesting that impulsivity may be a them “relax socially” and “have more fun at parties”. behavioral endophenotype that increases the risk for stimulant Association with friends who get drunk increases high-risk dependence. Similarly, researchers have linked the trait of drinking. Friends with a high social status can exert a risk-taking with a pattern of neurological response to reward particularly strong influence with respect to substance use. anticipation that occurs in those with substance-use disorders. - Family attitudes and behaviors toward drinking and drugs - Individuals with high levels of sensation seeking are more (including the use of prescription medication) affect likely to exhibit alcohol or cannabis dependence. Impulsivity adolescents’ likelihood of experimenting with substances. has also a particularly strong association with alcohol abuse When parents uses drugs or alcohol liberally, so do their among individuals who are also risk takers and poor planners. children. Additionally, adolescents who receive less parental monitoring have increased substance use, as do those Social Dimension whose parents feel unable to enforce rules or influence - Victimization and stressful events in childhood, including decisions related to substance use and those whose parents neglect and emotional, physical, and sexual abuse, are believe cultural myths such as “all adolescents experiment” or strongly associated with substance use later in life, especially “it’s okay to have teens drink at home”. for those with multiple victimization experiences. Many individuals receiving residential treatment for substance abuse - Unofficial social events that promote partying and peers report childhood trauma. One variable linking child abuse with who minimize the consequences of drinking also contribute risk for substance-use disorders is the earlier onset of drinking to college drinking. College students and other young adults or drug use among individuals exposed to childhood significantly overestimate the extent of alcohol and marijuana maltreatment. Childhood trauma may increase the likelihood use by their peers, thus inflating the social acceptability of  substance use. Not surprisingly, those who overestimate peer - Rather than specialized treatment, self-help groups provide a use of alcohol and marijuana have an increased likelihood of supportive approach to addiction, emphasizing fellowship and using these substances. spiritual awareness to support abstinence. Self-help groups are often included as a component of ongoing treatment or as Sociocultural Dimension a mechanism to support sustained recovery once abstinence - Although substance use varies according to sociocultural has been achieved. factors such as gender, age, socioeconomic status, ethnicity, religion, and nationality, the use and abuse of alcohol and - Goals of treatment include achieving sustained abstinence, other substances pervades all social classes. Drug use and maintaining a drug-free lifestyle, and functioning productively alcohol use are becoming a normative part of adolescent in family, work, and other environments. This requires culture. Declines in the number of teens who view substance changing habits, minimizing thoughts of drugs or alcohol and use as harmful and increases in peer approval for getting high substance-related social activities, and learning to cope with are associated with increased use of substances in social daily activities and stressors without substance use. situations and party environments. Adolescents whose peer Additionally, because drugs so often disrupt multiple aspects of group lacks school commitment and connectedness are an individual’s life, there is a need to rebuild family, friend, and particularly prone to engaging in substance use with their work relationships. peers. Two Phases of Alcohol and Drug Treatment Programs - It is common to see marketing messages regarding tobacco, Phase 1: detoxification alcohol, and prescription drugs, as well as depictions of these - The user ceases or reduces use of the substance. If products in songs, movies, television, and social media. the person is physiologically dependent on the Exposure to positive drug and alcohol information on the substance, medical supervision may be necessary to Internet is increasing, whereas warnings from parents, help manage withdrawal symptoms. schools, and antidrug advertising are decreasing. The effects Phase 2: preventing relapse of exposure to media images and substance use can be - A return to use of the substance. Support is very very powerful (e.g., exposure to movies depicting alcohol use important at this stage because relapse is common is associated with increased drinking). Similarly, factors such among those attempting to recover from alcohol or as the perceived prevalence of smoking, exposure to smokers, drug addiction. and exposure to tobacco advertising are all associated with Understanding and Preventing Relapse smoking in young adults. Media messages promoting smoking - Relapse prevention considers the physiological and appear to be most powerful when friends are present. psychological withdrawal symptoms a person might be experiencing, as well as neurological changes that occurred Treatment due to substance use; these physiological changes can - Treatment and supportive intervention take place in a variety influence motivation, impulsivity, learning, or memory. of settings, including self-help groups, mental health clinics, - Neuroplasticity, the ability of the brain to change its structure and inpatient or outpatient drug and alcohol treatment centers. and function in response to experience, is an important concept in addiction treatment. - Just as an addict’s brain became conditioned to needing a - Unless this ambivalence is resolved, change is slow and substance, treatment and abstinence can help recondition the short-lived. brain, create new neural pathways, and undo changes caused - Motivational interviewing helps clients consider both the by addiction. advantages and disadvantages of continued substance use; - Sustained abstinence is necessary for permanent once there is a commitment to change, relapse risk is reduced neurological changes to occur and is thus essential for and therapy moves forward with an emphasis on life maximizing treatment results. modifications required for abstinence. - Relapse prevention is a critical component of effective Treatment for Alcohol-Use Disorder treatment because many individuals with substance-use - Participation in AA (Alcoholics Anonymous) is a common disorders discontinue treatment when craving occurs. intervention for alcoholism. AA regards alcoholism as a - A single lapse in abstinence often leads to complete relapse. disease and advocates total abstinence. Many therapists view relapse not as a treatment failure but as - Medications are frequently used to treat alcohol abuse. an indicator that treatment needs to be intensified. Antabuse (disulfiram), a medication that produces an aversion - People in treatment sometimes take medications to help to alcohol by creating highly unpleasant symptoms if alcohol is prevent withdrawal symptoms, cravings, and relapse. consumed, has been used for decades. - Medications prescribed vary depending on the substance - The medication acamprosate can also help maintain abused. It is important to remember that although medication abstinence and reduce relapse rates, especially among those can assist with cravings and withdrawal, medication who have undergone detoxification. alone—given the complexities of addiction—is not sufficient to - A comprehensive analysis of interventions to decrease prevent relapse. college drinking revealed that individual, face-to-face interventions using motivational interviewing and providing - Contingency management procedures in which participants information correcting misperceptions of social norms receive either vouchers or cash incentives for verified regarding drinking yielded the greatest reduction in abstinence, adherence to treatment goals, or compliance with alcohol-related problems. a prescribed medication plan can significantly reduce relapse. - Contingency programs also increase treatment participation and maximize behaviors that are incompatible with substance use, such as exercising, attending school, or learning new job Treatment for Opioid-Use Disorder skills. Verifying abstinence via toxicology screening is an - Early detoxification and treatment are critical with opioid important component of these interventions. dependence, because treatment becomes more difficult for those who have used opioids longer. - An approach that is effective in setting the stage for successful - Physicians often prescribe synthetic opioids such as treatment and preventing relapse is motivational methadone to reduce cravings without producing euphoria. enhancement therapy. - This method addresses a common barrier to effective Treatment for Stimulant-Use Disorder treatment—ambivalence about giving up substance use.  - Teaching people who use cocaine to cope with temptations and high-risk situations was beneficial not only in lowering cocaine use but also in lowering the amount of cocaine used during a relapse. Treatment for Cannabis-Use Disorder - Psychological approaches such as brief therapy, cognitive-behavioral therapy, and motivational enhancement have shown promise with cannabis-use disorder. - Some researchers advocate using short, frequent therapy sessions and focusing on increased self-efficacy. - The use of vouchers to reinforce negative urine toxicology has shown some promise. Treatment for Tobacco-Use Disorder - Three pharmaceutical products are used for smoking cessation—nicotine replacement, bupropion, and varenicline. - Various psychological strategies have been helpful in reducing the urge to smoke, including learning to cope with negative emotions.