1. What is it? What causes it? What can we do about it?

2.  A chronic, relapsing behavioral disorder.  Pattern: Remissions and relapses  Progression theories: ◦ Gateway progression ◦ Continuum of drug use ◦ “Maturing out”

3. ◦ Tolerance ◦ Physiological dependence ◦ Psychological dependence (habituation) ◦ Craving

4.  Some substances are more likely to be associated with addiction than others, but there are many exceptions both ways. ◦ Heroin ◦ Cocaine ◦ Methamphetamine ◦ Ecstasy ◦ Alcohol ◦ Psilocybin Mushrooms ◦ Marijuana ◦ PCP

5.  Moral model: Responsibility and guilt  Physical dependence model ◦ Abstinence syndrome ◦ Negative reinforcement for continued drug-taking ◦ Physical or psychological?

6.  The decision ◦ Denial met by intervention or reality ◦ Cognitive changes  Pre-contemplation: No problem!  Contemplation: Maybe there’s a problem…  Preparation  Action  Maintenance ◦ Cognitive therapy: Motivational interviewing

7.  Abstinence: The 12-step approach  Controlled use  Harm reduction ◦ Substitute addictions ◦ Methadone ◦ Gum-chewing ◦ Needle exchanges ◦ Water supply

8.  Detoxification (Detox) ◦ “Cold turkey” ◦ Gradual ◦ With pharmacological support  Active treatment  Relapse prevention

9.  Self-treatment (“spontaneous remission”) ◦ Perhaps 20% follow this route. ◦ Self-treatment often requires multiple attempts: Learning to quit. ◦ For 57%, quitting is the result of cost-benefits analysis. ◦ For 29%, the change is immediate.

10.  Sometimes because of “bottoming out”  Positive life changes: marriage, childbearing, religious encounter  Negative life changes: health problems, social or legal consequences of drug use, death of a friend

11.  Self-help groups like AA ◦ Twelve Steps ◦ Peer identification and support ◦ Sober social relationships  Residential treatment ◦ Hospitalization ◦ The therapeutic community  Milieu therapy ◦ Short-term residential programs ◦ Faith-based programs  Salvation Army  Teen Challenge

12.  Medication-assists ◦ Antagonist blockade ◦ Treat contributing conditions ◦ Substitution ◦ Antabuse ◦ Craving reduction  Ibogaine  Outpatient drug-free programs

13.  Provide substances, paraphernalia and injection rooms in ways that reduce crime and disease transmission  Meet other needs of addicts ◦ Health care and nutrition ◦ Social support ◦ Employment or volunteer activities

14.  Risk of relapse is reduced by ◦ Frequent review of the decision ◦ Avoiding drug-related cues by moving and dumping drug-using friends ◦ Social connections with non-users ◦ Getting a job ◦ Learning substitute activities ◦ Developing structure for life