1. GENERAL METHODS OF TREATMENT
SUBSTANCE USE DISORDERS
GENERAL METHODS OF TREATMENT
Inpatient Detoxification and Rehabilitation
Outpatient Individual, Couple, or Family
Counseling
Self-help Groups (Alcoholics Anonymous;
NA, CA, OA, GA, Al-Anon etc.)
Residential Facilities & Therapeutic
Communities
Medications

2. Disease Model - Treatment
Early identification
Education about diagnosis
Acceptance of disease and overcoming “denial”
Abstinence
12-steps essential for real recovery

3. 12 Steps of Alcoholics Anonymous

4. TREATMENT OF SUBSTANCE USE DISORDERS
Addictive Behavior Meds
ETOH: antabuse, naltrexone, acomprosate; benzodiazepines
Opiates:
Methadone; LAAM
narcan/naltrexone; depot naltrexone
buprenophine
Nicotine:
Nicotine Replacement Therapies
Zyban, Wellbutrin (bupropion)
Effexor (venlafaxine)

5. Strength of Evidence of Pharmacotherapies for Alcohol Dependence
Naltrexone –
Acomprosate –
Disulfiram –
Serotonergic drugs –
Lithium –

6. TREATMENT OF SUBSTANCE USE DISORDERS
TX myths
1. Nothing works
2. One approach is superior to all others (“one true light” tradition)
3. All treatment approaches work equally well for everyone
- measuring outcomes
- good studies use:________________________

7. TREATMENT OF SUBSTANCE USE DISORDERS
Outcome Studies
Hazeldon study:
Drug Abuse Treatment Outcome Study (DATOS) –
natural tx in 4 settings: outpt. methadone clinics, outpatient drug-free, short-term inpatient, long-term residential: 1 year f/u data for outpt. methadone group
Pre F/U
N = 727 / 1, %  27.8 heroin use
(60 %) 41.9%  21.7 cocaine use
*weekly or more drug use 17.1%  13.9 marijuana use
14.8%  16.3 alcohol use, 5+ drinks
28.6%  13.7 predatory illegal activity
25.2%  12.9 sexual behavior risk
Pred illegals; burglary, larceny etc.
Sex behavior; not always using condoms

8. Project MATCH Treatment Conditions
4 sessions in 12 weeks
Therapist applies motivational psychology to examine effect of drinking on patient’s life, and develop and implement a plan to stop drinking
Mobilize the person’s own commitment and motivation to change
MET
(Motivational Enhancement Therapy)
12 weekly sessions
Patients introduced by therapist to the first steps of Alcoholics Anonymous and encouraged to attend meetings
Acceptance of the disease of alcoholism and loss of control over drinking
TSF
(Twelve Step Facilitation)
Coping and drink-refusal skills taught by therapist to handle states and situations known to precipitate relapse
Learn skills to achieve and maintain sobriety
CBT
(Cognitive Behavioral Therapy)
Frequency
Description
Goal of Treatment
Type of Treatment

9. Project MATCH Results:
N = 1,726 outpatients (n=952) and aftercare (n=774) at 5 sites (one of largest clinical trials ever)
25% were women; 15% were minority group members
10 client characteristics studied: severity etoh, sociopathy, cognitive impairment, gender, meaning seeking, motivation, psych severity, etc.
90% of the participants were assessed at 1-year follow-up
pre-post differences in drinking days per month (25  6) and drinks per “drinking” day (15  3)
each of the 3 treatments worked about equally well in reducing drinking

10. TSF outpatients more likely to remain sober (24%) at 1 yr
TSF outpatients more likely to remain sober (24%) at 1 yr. than outpatients in CBT or MET (about 15%)
only 1 “matching” prediction supported: outpatients with few or no psychiatric problems had more abstinent days in TSF tx than in CBT
At 3-yr. follow-up: 36% of TSF clients abstinent vs. 27% MET and 24% CBT clients
*** strong correlation between abstinence rates and compliance with aftercare (“recovery” is a PROCESS).

11. Principles of Effective Treatment http://www. nida. nih
No single treatment is appropriate for all individuals.
Treatment needs to be readily available.
Effective treatment attends to multiple needs of the individual, not just his or her drug use. Clients with coexisting mental disorders should have both disorders treated in an integrated way.
In order to meet the changing needs of the client, the treatment plan must be continually assessed and modified.

12. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
Counseling (individual, couple, and/or group) and other behavioral therapies are critical components of effective treatment for addiction...
Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

13. Treatment does not need to be voluntary to be effective
Possible drug use during treatment must be monitored continuously.
Treatment programs should provide assessment and counseling for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases to help patients modify or change behaviors that place themselves or others at risk of infection.
Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.

14. ALCOHOL & DRUG RECOVERY CENTER PROGRAM
OUTLINE OF SERVICES
Chemical Dependence Treatment Program
Adolescent (ages 13-18)
Adults
Additional Specialty Areas
Specialized Chronic Pain Tract
Native American Program
Treatment Options
Detoxification 7 Medical Stabilization
In-Patient Rehabilitiation
Residential
Partial Residential
Intensive Out-Patient
Chronic Pain Stabilization

15. ALCOHOL & DRUG RECOVERY CENTER PROGRAM
OUTLINE OF SERVICES
General Services
Free, Confidential Assessments
Emergency Consultation Services
24 Hour Crisis Line
Intervention Services
Referrals
Educational Programs
Counseling Services
Individualized Treatment Plans
Group Therapy
Individual Therapy
Family Program
Art Therapy
Spiritual Counseling
Recreational Therapy
ROPES Course
Relapse Prevention Program

16. FAMILY PROGRAM GOALS Learn the Neurobiology of Addiction and Relapse
Change old behaviors that the family has employed in responding to the alcoholic/chemically dependent family member; develop new adaptive strategies
Learn about co-dependency and enabling
Improve family communication by learning how to express emotions in an effective and appropriate way
Share with and draw support from other family members experiencing similar feelings, thoughts, and fears
Learn how to become open and honest in communicating emotions
Enjoy relationships free from chemical dependency

17. ROPES COURSE Reality Oriented Physical Experiential Services
Provides a therapeutic outlet that does not solely rely on verbal ability
Teaches skills and lends insights which have beneficial application to daily life to include:
A more positive self-image and enhance self-esteem
Effective teamwork and cooperative abilities
Improved communication and listening skills
Willingness to take appropriate risks
An ability to set and achieve goals
Improved problem-solving skills
Feelings of accomplishment and success