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Approaches
for
Addiction
Toni
Peters
MSN, RN
Disorders
Objectives
Identify
Prevalence of Substance
Use
In 2013, 4.1 million persons aged 12 or older (1.5
According
The
At Risk Populations
History
of
physical,
emotional,
sexual abuse
Mental illness
Physical,
sensory, or
cognitive
disabilities
Chronic pain
Chronic
pain
Unemployment
Limited education
Low socioeconomic
status
Military experience
Wheeler,
2014
Associated Terms
Tolerance:
Physical
Withdrawal:
Associated Terms
Substance
Addiction:
Abstinence:
substance
voluntary avoidance of a
Dual
Signs of Dependence
Spending a lot of time engaging in activities
related to substance use
Using the substance in greater quantities or for a
longer time than intended
Tolerance (i.e., needing to use the substance more
than before to get desired effects or noticing that
the same amount of substance use had less effect
than before)
Unsuccessful attempts to cut down on use
Continued substance use despite physical health or
emotional problems associated with substance use
Reducing or eliminating participation in other
activities because of substance use
Withdrawal symptoms when substance is
discontinued (Substance Abuse and Mental Health
Services Administration, 2014)
Addiction as a Disease
Recovery requires making major changes to the way you live, deal
with lifes problems, and relate to others.
NCADD, 2014
Relapse
Relapse:
recurrence or return to
substance use or addictive
behaviors after periods of
abstinence
It is estimated that 40-60% of addicts will
relapse at least once
Not a treatment failure
Can be drug or reward triggered, cue
triggered, or stress triggered
SAMHSA, 2014
Recovery
A
Guiding Principles of
Recovery
Recovery is person driven: self-determination and selfdirection. Life goals and future path defined by the individual
Guiding Principles of
Recovery
Integrative Theoretical
Framework
It is a sensation + an associated emotion + an
Feeling-State
Therapy
associated cognition with
a behavior that causes
the urges and cravings for both substance and
behavioral addictions
Feeling
These
Feeling
Evidenced-Based
Psychotherapeutic
Interventions
Goals
of Interventions
Improving impulse control
Reducing craving
Promoting an adaptive social
environment
Wheeler,
2014
Evidenced-Based
Psychotherapeutic
Interventions
Motivational Interviewing (MI)
Integrated
Wheeler, 2014
Motivational Interviewing
Contingency Management
The
Relapse Prevention
Therapy
Coping skills training is the cornerstone of RPT, teaching clients strategies to:
Understand relapse as a process
Identify and cope effectively with high-risk situations such as negative
emotional states, interpersonal conflict, and social pressure
Cope with urges and craving
Implement damage control procedures during a lapse to minimize
negative consequences
Stay engaged in treatment even after a relapse
Learn how to create a more balanced lifestyle
Coping skills training strategies include both cognitive and behavioral
techniques.
SAMHSA, 2014
Brief
Goal
make drinking behavior safe for students and not to try
to coerce abstinence
2012
Blume,
Blume, 2012
Special Populations
Older Adults
High rates of lifetime illegal drug use among the baby boom
generation, people born between 1946 and 1964, suggest that the
number of older adults using illegal drugs will increase in the next two
decades.
It has been predicted that by the year 2020, the number of persons
needing treatment for a drug abuse and addiction will double
among persons aged 50 or older.
Special Populations
Older Adults
Increased
Stevenson, 2005
Special Populations
Older Adults
Brief
Special Populations
Adolescents
9.4%
Third
Important
Delaying
Potential
Special Populations
Adolescents
Family-Focused Interventions
Adolescent focus, parent focused, adolescent-parent focus
Tevyaw, 2007
Special Populations
Co-Occurring Disorders
Dual
Diagnosis Disorders
Addiction occurs simultaneously with a
mental health disorder
Both disorders require treatment
Which came first?
May seek treatment for either one or
both
Always assess substance use history
IV
More severe mental
disorder/ more severe
substance abuse
disorder
Seen in state
hospitals, jails,
prisons, EDs, or
criminal justice
system on
parole/probation
I
Less severe mental
disorder/ less severe
substance abuse
disorder
II
More severe mental
disorder/ less severe
substance abuse
disorder
Trauma-Informed Care
Hx
12 Step Programs
Peer
support groups
Set of 12 guiding principles
Admit you cannot control your addiction
Recognize a higher power
Examine past mistakes with sponsors help
Make amends for past mistakes
Learning to live a new life with new
behaviors
Help others who suffer from addictions
Wheeler, 2014
An international fellowship of men and women who come together to share their experience, strength
and hope with the purpose of staying sober and helping other alcoholics to achieve sobriety. The only
requirement for membership is a desire to stop drinking.
Al-Anon/ALATEEN www.al-anon.alateen.org
Whether the person you are concerned about is still drinking or not, Al-Anon/Alateen offers hope and
recovery to all people affected by the alcoholism of a loved one or friend. Support for friends and families.
Summary
There
Question #1
An individual with a more severe mental
disorder and a less severe substance
abuse disorder will most likely be seen
A. in the primary health care setting
with some counseling with
specialized cars
B.
in the substance abuse
treatment
system
C. in the mental health system
D. State hospitals and prisons
Question # 2
All of these are part of the
Guiding Principles of Recovery
except
A.
B.
C.
D.
E.
Question # 3
Relapse during recovery
A. shows that the individual is not ready
for treatment
B. occurs at least once in approximately
50% of recovering addicts
C. means that the individual should be
terminated from the treatment
program
D. should be considered a treatment
failure
Question # 4
The evidence-based
psychotherapeutic intervention
that is based on a monetary
based reward system is called
A. Contingency Management
B. Motivational Interviewing
C. Cognitive Behavioral Coping Skills and
Relapse Prevention
D. Harm Reduction Therapy
Question # 5
Addiction
A. is a chronic disease
B. is treatable but has no cure
C. impacts the physical, emotional,
and social aspects of individuals
life
D. requires making major changes to
the way you live, deal with lifes
problems, and relate to others
E. all of the above
References
Blume, A.W. (2012). Seeking the middle way: G. Alan Marlatt and harm reduction. Addiction Research
and Theory, 20(3), 218-226. doi: 10.3109/16066359.2012.657281
Chen, W.C., Berger, C.C., Gandhi, D.,Weintraub, & Lejuez, C.W. (2013). Adding integrative meditation
with ear accupressure to outpatient treatment of cocaine addiction: A randomized controlled pilot study.
The Journal of Alternative and Complementary Medicine, 19(3), 204-210. doi: 10.1089/acm.2011.00311
Ciketic, S., Hayatbakhsh, M.R., Doran, C.M., Najman, J.M., & McKetin, R. (2012). A review of
psychological and pharmacological treatment options for methamphetamine dependence. Journal of
Substance Abuse, 17(4), 363-383. doi: 10.3109/14659891.2011.592900
National Counsel on Alcoholism and Drug Dependence, Inc. (2014). NCADD-Home. Retrieved from
http://www.nsadd.org
National Institute of Mental Health (2014). Complementary and alternative medicines. Retrieved from
http://nccam.nih.gov
Recovery.org (2014). About Alcoholics Anonymous 12-Step Recovery Programs. Retrieved from
http://www.recovery.org/topics/alcoholics-anonymous-12-step/
Stevenson, J.S. (2005). Alcohol use, misuse, abuse, and dependence in later adulthood. Annual Review
of Nursing Research, 23, 245-280.
Substance Abuse and Mental Health Services Administration. (2014) SAMHSA-home. Retrieved from
http://www.samhsa.gov
References
Young, K.S. (2011). CBT-IA: The first line treatment model for internet addiction. Journal of
Cognitive Psychotherapy: An International Quarterly, 25(4), 304-312. doi:
http://dx.doi.org/10.1891/0889-8391.25.4.304
Wheeler, K. (2014). Psychotherapy for the advanced practice nurse: A how-to guide for
evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company, LLC.
Winters, K.C., Leitten, W., Wagner, E., & Tevyaw, T.O. (2007). Use of brief interventions for
drug abusing teenagers within a middle and high school setting. Journal of School Health,
77(4), 196-206.
Witkiewitz, K., & Marlatt, A. (2011). Behavioral therapy across the spectrum. Alcohol
Research and Health, 33(4), 313-319.