SlideShare a Scribd company logo
1 of 51
Download to read offline
BEHAVIORAL THERAPY
FOR THE TREATMENT OF
SUBSTANCE ABUSE
Presented By:
Santosh
APP. PSYCHOLOGY
(U.D.S.C)
Contemporary Approaches to
Substance Abuse Treatment
12-Steps Fellowships - AA, Al-Anon, ACOA, NA, CoDA, SLAA
Traditional Minnesota Model Inpatient Treatment - Detox,
medical supervision, disease model, AA, group, drug
education
Intensive Outpatient Minnesota Model Treatment - Medical
supervision, individual sessions, disease model, AA, groups
Therapeutic Communities for Substance Abuse - 24-hour
residential setting, norms, responsibility, encounter groups
Pharmacological Therapy – Antabuse, methadone, LAMM,
buprenorphine, naltrexone, etc
Psychological Therapies – Group, couple, and individual
therapy
Behavior Therapy – Aversion therapy, cue exposure, skills
training, contingency management, community reinforcement
Cognitive-Behavioral Therapy – Relapse Prevention, coping
skills training, cognitive therapy, lifestyle modification
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Brickman’s Model of Helping &
Coping Applied to Addictive
Behaviors
Is the person
responsible
for the
development
of the
addictive
behavior?
Is the person responsible for
changing the addictive behavior?
YES
NO
COMPENSATORY MODEL
(Cognitive-Behavioral)
Relapse = Mistake, Error, or
Temporary Setback
YES NO
MORAL MODEL
(War on Drugs)
Relapse = Crime or Lack of
Willpower
SPIRITUAL MODEL
(AA & 12-Steps)
Relapse = Sin or Loss of
Contact with Higher
Power
DISEASE MODEL
(Heredity &
Physiology)
Relapse = Reactivation
of the Progressive
Disease
Behavioral therapy in post traumatic stress disorder by dr. santosh
Biopsychosocial Factors in Development
and Maintenance of Addictive Behaviors
BIOLOGICAL FACTORS
• Biological vulnerability and genetic predisposition in
interaction with certain facilitating environments create
problems and eventually disease.
• Pharmacological impact of excessive use of alcohol
and other drugs on body chemistry, physiology , and
the organ systems of the body.
• Tolerance – Increased frequency of use and higher
doses over time.
• Withdrawal – Negative effects of cessation of
addictive behaviors.
• Higher risk of developing specific physical disorders
(diseases) associated with the chronic and excessive
use of particular substances.
Biopsychosocial Factors in Development
and Maintenance of Addictive Behaviors
PSYCHOLOGICAL FACTORS
• Motivation – Stages of habit initiation and stages of
habit change.
• Expectancies – Positive outcomes of drug use and
self-efficacy.
• Attributions – Effects of substance use and reasons
for relapse.
• Sensation-Seeking – Excessive need for stimulation
• Impulsivity – Inability to effectively control or restrain
behavior.
• Negative Affect – Dysphoric moods such as anxiety &
depression.
• Poor Coping – Deficits in cognitive and behavioral
skills or inhibitions in the ability to perform behaviors
due to the effects of anxiety.
Biopsychosocial Factors in Development
and Maintenance of Addictive Behaviors
SOCIOCULTURAL FACTORS
• Family History – Dysfunctional family settings
especially parental alcohol and drug problems and
parental abuse or neglect of children.
• Peer Influences – Social pressure to engage in risk-
taking behaviors including substance use especially
when related to gang membership.
• Culture and Ethnic Background – Norms and religious
beliefs that govern the use of alcohol and drugs and
ethnic variations the body’s rate and efficiency of
metabolizing drugs and alcohol.
• Media/Advertising – Societal emphasis on immediate
gratification and glorification of the effects of alcohol
and drug use.
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Analysis of High-Risk Situations for Relapse Alcoholics,
Smokers, and Heroin Addicts
RELAPSE SITUATION
(Risk Factor)
Alcoholics
(N=70)
Smokers
(N=35)
Heroin
Addicts
(N=32)
TOTAL
Sample
(N=137)
Negative Emotional States 38% 43% 28% 37%
Negative Physical States 3% - 9% 4%
Positive Emotional States - 8% 16% 6%
Testing Personal Control 9% - - 4%
Urges and Temptations 11% 6% - 8%
TOTAL 61% 57% 53% 59%
Interpersonal Conflict 18% 12% 13% 15%
Social Pressure 18% 25% 34% 24%
Positive Emotional States 3% 6% - 3%
TOTAL 39% 43% 47% 42%
INTRAPERSONAL DETERMINANTS
INTERPERSONAL DETERMINANTS
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Analysis of High-Risk Situations for Relapse
Alcoholics, Smokers, Heroin Addicts, Compulsive Gamblers, and Overeaters
RELAPSE SITUATION
(Risk Factor)
Alcoholics
(N=70)
Smokers
(N=64)
Heroin
Addicts
(N=129)
Gamblers
(N=29)
Overeaters
(N=29)
TOTAL
Sample
(N=311)
Negative EmotionalStates 38% 37% 19% 47% 33% 35%
Negative PhysicalStates 3% 2% 9% - - 3%
Positive EmotionalStates - 6% 10% - 5% 4%
Testing PersonalControl 9% - 2% 16% - 5%
Urges and Temptations 11% 5% 5% 16% 10% 9%
TOTAL 61% 50% 45% 79% 48% 56%
InterpersonalConflict 18% 15% 14% 16% 14% 16%
SocialPressure 18% 32% 36% 5% 10% 20%
Positive EmotionalStates 3% 3% 5% - 28% 8%
TOTAL 39% 50% 55% 21% 52% 44%
INTRAPERSONAL DETERMINANTS
INTERPERSONAL DETERMINANTS
High-Risk
Situation
Effective coping
response
Increased
self-efficacy
Decreased
probability of
relapse
Ineffective
coping response
Lapse
(initial use of the
substance)
Increased
probability of
relapse
Abstinence
Violation Effect
¤
Perceived effects
of the substance
Decreased
Self-efficacy
¤
Positive outcome
Expectancies
(for initial effects of
the substance)
A Cognitive Behavioral Model of
the Relapse Process
Relapse Prevention: Specific Intervention Strategies
High-Risk
Situation
Abstinence
Violation Effect
Ineffective
Coping
Response
Lapse
Decreased
Self-Efficacy
¤
Positive
Outcome
Expectancies
Self-Monitoring
¤
Inventory of
Drug-Taking Situations
¤
Drug Taking
Confidence
Questionnaire
Mediation,
Relaxation Training,
Stress Management
¤
Efficacy-Enhancing
Imagery
Contract to limit
extent of use
¤
Reminder Card
(what to do if
you have slip)
Description of
Past Relapses
¤
Relapse Fantasies
Situational
Competency Test
¤
Coping-Skill
Training
¤
Education about
immediate vs.
delayed effects
¤
Decision Matrix
Cognitive
Restructuring
(a lapse is a mistake:
coping vs.
BEHAVIORAL THERAPY FOR
THE TREATMENT OF
SUBSTANCE ABUSE
Describe the philosophies, practices, policies, and
outcomes of the most generally accepted and
scientifically supported models of treatment,
recovery, relapse prevention, and continuing care
for addiction and other substance-related problems.
Scientifically Supported Models of Treatment
› Pharmacotherapies
› Behavioral Therapies
› Approaches Used by Substance Abuse Treatment
Facilities
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-27
PHARMACOTHERAPIES
 Opioid Addiction
› Methadone
› Buprenorphine
› Naltrexone
 Tobacco Addiction
› Nicotine Replacement
Therapy (NRT)
 Electronic Cigarettes, gum,
patches
› Bupropion (Zyban®
)
› Varenicline
(Chantix®
)
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-28
 Alcohol Addiction
› Naltrexone
› Acamprosate
(Campral®)
› Disulfiram
(Antabuse®
)
› Topiramate
(Topamax®)
Cognitive Behavioral Therapy
Community Reinforcement Approach Plus
Vouchers
Contingency Management Interventions &
Motivational Incentives
Motivational Enhancement Therapy
The Matrix Model
Stimulants
12-Step Facilitation Therapy
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-29
BEHAVIORAL THERAPIES
Clinical or Therapeutic
Approaches Used by Substance
Abuse Treatment Facilities
In Brief
In 2009, the majority of substance abuse treatment facilities
always or often used substance abuse counseling (96%),
relapse prevention (87%), cognitive-behavioral therapy (66%),
12-step facilitation (56%), and motivational interviewing (55%).
More than one third of facilities always or often used anger
management (39%) or brief intervention (35%). More than one
quarter always or often used contingency
management/motivational incentives (27%). More than one fifth
always or often used trauma-related counseling (21%).
More than half of all facilities either rarely or never used or were
not familiar with community reinforcement plus vouchers (86%),
Matrix Model (63%), or rational emotive behavioral therapy
(51%).
BEHAVIORALTHERAPIES
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-31
 Behavioral Couples Therapy
 Behavioral Treatments for
Adolescents
 Multisystemic Therapy
 Multidimensional Family Therapy
for Adolescents
 Brief Strategic Family Therapy
Competency 6
Recognize the importance of family, social
networks, and community systems in the
treatment and recovery process.
Families often do not understand
substance use disorders or recovery
Family education and opportunities to
express their concerns during the recovery
process are critical
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-32
 Goals
› Present accurate information about addiction, recovery,
treatment, and the resulting interpersonal dynamics.
› Help clients and family members understand how the
recovery process may affect current and future family
relationships.
› Provide a forum for families to discuss recovery issues.
› Present accurate information about the effects of drugs.
› Teach, promote, and encourage clients’ family members to
care for themselves while supporting clients in their
recovery.
› Provide a professional atmosphere in which clients and their
families are treated with dignity and respect.
› Encourage participants to get to know other recovering
people and their families in a comfortable and
nonthreatening environment
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-33
Understand the importance of research and
outcome data and their application in clinical
practice.
Evidence-Based Practice (or Best Practice) Defined
› Approaches to prevention or treatment that are
validated by some form of documented scientific
evidence.
› Evidence often is defined as findings established
through scientific research
› Evidence-based practice stands in contrast to
approaches that are based on tradition,
convention, belief, or anecdotal evidence
(SAMHSA OAS, 2010).
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-34
Competency 7
 Best research evidence: supporting
clinically relevant research, especially
patient-centered research
 Clinician expertise: using clinical skills
and past experience to identify and treat
the individual client
 Patient values: integrating the
preferences, concerns, and expectations
that each client brings to the clinical
encounter into treatment planning (Institute of
Medicine)
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-35
E
v
i
d
e
n
c
e
-
B
a
s
e
d
T
h
i
n
k
i
n
g
Lori L. Phelps
California Association for Alcohol/Drug Educators, 2013
3-36
Figure 3.2: Evidence-Based Thinking
Source: CSAT (2007)
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Empirical Support:
Review of 24 RCTs
Kathleen M. Carroll (1996)
Relapse Prevention:
• Does not usually prevent a lapse better than other active
treatments, but is more effective at “Relapse
Management,” i.e. delaying first lapse and reducing
duration and intensity of lapses
• Particularly effective at maintaining treatment effects over
long term follow-up measurements of 1-2 years or more
• “Delayed emergence effects” in which greater
improvement in coping occurs over time
• May be most effective for “more impaired substance
abusers including those with more severe levels of
substance abuse, greater levels of negative affect, and
greater perceived deficits in coping skills.” (Carroll, 1996,
• Reviewed 17 controlled studies to evaluate overall
effectiveness of the RP model as a substance abuse
treatment
• Statistically identified moderator variables that
may reliably impact the outcome of RP treatment
• “Results indicate that RP is highly effective for
both alcohol-use and substance-use disorders”
Empirical Support: Meta-Analytic
Review
Irvin, Bowers, Dunn & Wang (1999)
Moderator Variables with Significant Impact on RP
Effectiveness:
 Group format more effective than individual therapy
format
 More effective as “stand alone” than as aftercare
 Inpatient settings yielded better outcomes than outpatient
 Stronger treatment effects on self-reported use than on
physiological measures
 While effective across all categories of substance use
disorders, stronger treatment effects found for substance
abuse than alcohol abuse
Empirical Support: Meta-Analytic
Review
Irvin, Bowers, Dunn & Wang (1999)
Behavioral therapy in post traumatic stress disorder by dr. santosh
The Abstinence Violation Effect
Emotional- guilt, blame, failure, etc.
Cognitive- Internal, stable, global,
uncontrollable
Self-awareness increase
Comparison to Internalized
Standards- greater difference, more guilt
Behavioral Reaction- dominant habitual
response
Cognitive Reaction- resolve discrepancy
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Behavioral therapy in post traumatic stress disorder by dr. santosh
Relapse Prevention
Specific Intervention Strategies
What to do if a lapse occurs
• Stop, Look, and Listen
• Keep Calm
• Renew Your Commitment
• Implement your Relapse Prevention
plan
• Ask For Help
• Review the situation leading-up to
the lapse
RELAPSE PREVENTION
Specific Intervention Strategies
Coping with Lapses
(Initial Use of a Substance)
• Relapse Plan with Emergency Procedures
• Relapse Contract to limit extent of use
• Relapse Reminder Card
“What do I do in case of a lapse?”
Precontemplation
Stage
Contemplation
Stage
Preparation
Stage
Action
Stage
Maintenance
Stage
Relapse
Stage
Motivational
Enhancement
Strategies
Assessment
& Treatment
Matching
Relapse
Prevention
& Relapse
Management
Stages of Change in Substance Abuse
& Dependence: Intervention
Strategies
Thank You

More Related Content

What's hot

Psychological dimensions
Psychological dimensionsPsychological dimensions
Psychological dimensionscaяen iz lovǝ
 
Cognitive Therapy Addiction Workshop EABCT2009
 Cognitive Therapy Addiction Workshop EABCT2009 Cognitive Therapy Addiction Workshop EABCT2009
Cognitive Therapy Addiction Workshop EABCT2009drfrankryan
 
Relapse Prevention.pps
Relapse Prevention.ppsRelapse Prevention.pps
Relapse Prevention.ppsOla
 
Risk Reduction Through Family Therapy (RRFT)
Risk Reduction Through Family Therapy (RRFT)Risk Reduction Through Family Therapy (RRFT)
Risk Reduction Through Family Therapy (RRFT)BASPCAN
 
Relapse Prevention Counseling Strategies for SUD Clients
Relapse Prevention Counseling Strategies for SUD ClientsRelapse Prevention Counseling Strategies for SUD Clients
Relapse Prevention Counseling Strategies for SUD ClientsAaron Garner
 
Relapse Prevention - March 2011
Relapse Prevention - March 2011Relapse Prevention - March 2011
Relapse Prevention - March 2011Dawn Farm
 
The Hidden Agenda: Cognitive processes in addiction
The Hidden Agenda: Cognitive processes in addictionThe Hidden Agenda: Cognitive processes in addiction
The Hidden Agenda: Cognitive processes in addictiondrfrankryan
 
Recovery and-beyond-drug-rehab-guide-by-rehab centernet
Recovery and-beyond-drug-rehab-guide-by-rehab centernetRecovery and-beyond-drug-rehab-guide-by-rehab centernet
Recovery and-beyond-drug-rehab-guide-by-rehab centernetRehab Center
 
Relapse Prevention Inservice VA Prescott
Relapse Prevention Inservice VA PrescottRelapse Prevention Inservice VA Prescott
Relapse Prevention Inservice VA PrescottGuy Lamunyon
 
Implicit cognitive processes in the addiction clinic
Implicit cognitive processes in the addiction clinicImplicit cognitive processes in the addiction clinic
Implicit cognitive processes in the addiction clinicdrfrankryan
 
relapse prevention class presentation
relapse prevention class presentationrelapse prevention class presentation
relapse prevention class presentationnaylortittlebaum
 

What's hot (20)

Psychological dimensions
Psychological dimensionsPsychological dimensions
Psychological dimensions
 
Cognitive Therapy Addiction Workshop EABCT2009
 Cognitive Therapy Addiction Workshop EABCT2009 Cognitive Therapy Addiction Workshop EABCT2009
Cognitive Therapy Addiction Workshop EABCT2009
 
Relapse Prevention.pps
Relapse Prevention.ppsRelapse Prevention.pps
Relapse Prevention.pps
 
Relapse prevention: an Overview
Relapse prevention: an OverviewRelapse prevention: an Overview
Relapse prevention: an Overview
 
Relapse prevention (2)
Relapse prevention (2)Relapse prevention (2)
Relapse prevention (2)
 
Risk Reduction Through Family Therapy (RRFT)
Risk Reduction Through Family Therapy (RRFT)Risk Reduction Through Family Therapy (RRFT)
Risk Reduction Through Family Therapy (RRFT)
 
Relapse Prevention Counseling Strategies for SUD Clients
Relapse Prevention Counseling Strategies for SUD ClientsRelapse Prevention Counseling Strategies for SUD Clients
Relapse Prevention Counseling Strategies for SUD Clients
 
Relapse Prevention - March 2011
Relapse Prevention - March 2011Relapse Prevention - March 2011
Relapse Prevention - March 2011
 
The Hidden Agenda: Cognitive processes in addiction
The Hidden Agenda: Cognitive processes in addictionThe Hidden Agenda: Cognitive processes in addiction
The Hidden Agenda: Cognitive processes in addiction
 
Module 2-treatment-slides
Module 2-treatment-slidesModule 2-treatment-slides
Module 2-treatment-slides
 
Recovery and-beyond-drug-rehab-guide-by-rehab centernet
Recovery and-beyond-drug-rehab-guide-by-rehab centernetRecovery and-beyond-drug-rehab-guide-by-rehab centernet
Recovery and-beyond-drug-rehab-guide-by-rehab centernet
 
Relapse Prevention Inservice VA Prescott
Relapse Prevention Inservice VA PrescottRelapse Prevention Inservice VA Prescott
Relapse Prevention Inservice VA Prescott
 
Prevention
PreventionPrevention
Prevention
 
Pd2
Pd2Pd2
Pd2
 
Understanding substance abuse
Understanding substance abuseUnderstanding substance abuse
Understanding substance abuse
 
Implicit cognitive processes in the addiction clinic
Implicit cognitive processes in the addiction clinicImplicit cognitive processes in the addiction clinic
Implicit cognitive processes in the addiction clinic
 
Personality disorders
Personality disordersPersonality disorders
Personality disorders
 
Tip42: Assessment and Treatment of Co-Occurring Disorders
Tip42: Assessment and Treatment of Co-Occurring DisordersTip42: Assessment and Treatment of Co-Occurring Disorders
Tip42: Assessment and Treatment of Co-Occurring Disorders
 
Treatment
TreatmentTreatment
Treatment
 
relapse prevention class presentation
relapse prevention class presentationrelapse prevention class presentation
relapse prevention class presentation
 

Similar to Behavioral therapy in post traumatic stress disorder by dr. santosh

Risk factors for teen drug use (including alcohol, tobacco, prescr.docx
Risk factors for teen drug use (including alcohol, tobacco, prescr.docxRisk factors for teen drug use (including alcohol, tobacco, prescr.docx
Risk factors for teen drug use (including alcohol, tobacco, prescr.docxmalbert5
 
11 chemical dependency
11 chemical dependency11 chemical dependency
11 chemical dependencyDon Thompson
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptxJanetOdhiambo2
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptxThePassenger2
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptxAlexandruBuruc
 
cannabis related disorder.pptx
cannabis related disorder.pptxcannabis related disorder.pptx
cannabis related disorder.pptxSakun Rasaily
 
Region 8 Co-Occurring Disorders (Wk 1)
Region 8 Co-Occurring Disorders (Wk 1)Region 8 Co-Occurring Disorders (Wk 1)
Region 8 Co-Occurring Disorders (Wk 1)CASATmedia
 
Addiction-and-the-Brain-Inova-Template_-002(1).pptx
Addiction-and-the-Brain-Inova-Template_-002(1).pptxAddiction-and-the-Brain-Inova-Template_-002(1).pptx
Addiction-and-the-Brain-Inova-Template_-002(1).pptxmograine
 
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...Smriti Arora
 
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing | Juhin J
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing |  Juhin JHallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing |  Juhin J
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing | Juhin JJuhin J
 
Substance abuse in special population
Substance abuse in special populationSubstance abuse in special population
Substance abuse in special populationmanishkumargoyal7
 
Substance abuse rf order 5
Substance abuse rf order   5Substance abuse rf order   5
Substance abuse rf order 5rfranquiz1
 
Substance abuse rf order 5
Substance abuse rf order   5Substance abuse rf order   5
Substance abuse rf order 5rfranquiz1
 
substance use in children and young adults
substance use in children and young adultssubstance use in children and young adults
substance use in children and young adultsHimanshi Walia
 

Similar to Behavioral therapy in post traumatic stress disorder by dr. santosh (20)

Sud 2014
Sud 2014Sud 2014
Sud 2014
 
Risk factors for teen drug use (including alcohol, tobacco, prescr.docx
Risk factors for teen drug use (including alcohol, tobacco, prescr.docxRisk factors for teen drug use (including alcohol, tobacco, prescr.docx
Risk factors for teen drug use (including alcohol, tobacco, prescr.docx
 
Getting the Low Down on Substance Abuse
Getting the Low Down on Substance Abuse Getting the Low Down on Substance Abuse
Getting the Low Down on Substance Abuse
 
11 chemical dependency
11 chemical dependency11 chemical dependency
11 chemical dependency
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptx
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptx
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptx
 
module-2-treatment-slides.pptx
module-2-treatment-slides.pptxmodule-2-treatment-slides.pptx
module-2-treatment-slides.pptx
 
Substance abuse treatment
Substance abuse treatmentSubstance abuse treatment
Substance abuse treatment
 
Ecstacy
EcstacyEcstacy
Ecstacy
 
cannabis related disorder.pptx
cannabis related disorder.pptxcannabis related disorder.pptx
cannabis related disorder.pptx
 
Region 8 Co-Occurring Disorders (Wk 1)
Region 8 Co-Occurring Disorders (Wk 1)Region 8 Co-Occurring Disorders (Wk 1)
Region 8 Co-Occurring Disorders (Wk 1)
 
Addiction-and-the-Brain-Inova-Template_-002(1).pptx
Addiction-and-the-Brain-Inova-Template_-002(1).pptxAddiction-and-the-Brain-Inova-Template_-002(1).pptx
Addiction-and-the-Brain-Inova-Template_-002(1).pptx
 
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...
Role of Health Care workers against Drug abuse & Illicit Trafficking among Ch...
 
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing | Juhin J
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing |  Juhin JHallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing |  Juhin J
Hallucinogen Use Disorder | Substance Abuse | Psychiatric Nursing | Juhin J
 
Substance abuse in special population
Substance abuse in special populationSubstance abuse in special population
Substance abuse in special population
 
Substance abuse rf order 5
Substance abuse rf order   5Substance abuse rf order   5
Substance abuse rf order 5
 
Substance abuse rf order 5
Substance abuse rf order   5Substance abuse rf order   5
Substance abuse rf order 5
 
Drugs and its impact
Drugs and its impactDrugs and its impact
Drugs and its impact
 
substance use in children and young adults
substance use in children and young adultssubstance use in children and young adults
substance use in children and young adults
 

Recently uploaded

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Employability skills, work experience presentation
Employability skills, work experience presentationEmployability skills, work experience presentation
Employability skills, work experience presentationmarwaahmad357
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfrg0000009
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)1922Jaygohel
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 

Recently uploaded (20)

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Employability skills, work experience presentation
Employability skills, work experience presentationEmployability skills, work experience presentation
Employability skills, work experience presentation
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdf
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 

Behavioral therapy in post traumatic stress disorder by dr. santosh

  • 1. BEHAVIORAL THERAPY FOR THE TREATMENT OF SUBSTANCE ABUSE Presented By: Santosh APP. PSYCHOLOGY (U.D.S.C)
  • 2. Contemporary Approaches to Substance Abuse Treatment 12-Steps Fellowships - AA, Al-Anon, ACOA, NA, CoDA, SLAA Traditional Minnesota Model Inpatient Treatment - Detox, medical supervision, disease model, AA, group, drug education Intensive Outpatient Minnesota Model Treatment - Medical supervision, individual sessions, disease model, AA, groups Therapeutic Communities for Substance Abuse - 24-hour residential setting, norms, responsibility, encounter groups Pharmacological Therapy – Antabuse, methadone, LAMM, buprenorphine, naltrexone, etc Psychological Therapies – Group, couple, and individual therapy Behavior Therapy – Aversion therapy, cue exposure, skills training, contingency management, community reinforcement Cognitive-Behavioral Therapy – Relapse Prevention, coping skills training, cognitive therapy, lifestyle modification
  • 10. Brickman’s Model of Helping & Coping Applied to Addictive Behaviors Is the person responsible for the development of the addictive behavior? Is the person responsible for changing the addictive behavior? YES NO COMPENSATORY MODEL (Cognitive-Behavioral) Relapse = Mistake, Error, or Temporary Setback YES NO MORAL MODEL (War on Drugs) Relapse = Crime or Lack of Willpower SPIRITUAL MODEL (AA & 12-Steps) Relapse = Sin or Loss of Contact with Higher Power DISEASE MODEL (Heredity & Physiology) Relapse = Reactivation of the Progressive Disease
  • 12. Biopsychosocial Factors in Development and Maintenance of Addictive Behaviors BIOLOGICAL FACTORS • Biological vulnerability and genetic predisposition in interaction with certain facilitating environments create problems and eventually disease. • Pharmacological impact of excessive use of alcohol and other drugs on body chemistry, physiology , and the organ systems of the body. • Tolerance – Increased frequency of use and higher doses over time. • Withdrawal – Negative effects of cessation of addictive behaviors. • Higher risk of developing specific physical disorders (diseases) associated with the chronic and excessive use of particular substances.
  • 13. Biopsychosocial Factors in Development and Maintenance of Addictive Behaviors PSYCHOLOGICAL FACTORS • Motivation – Stages of habit initiation and stages of habit change. • Expectancies – Positive outcomes of drug use and self-efficacy. • Attributions – Effects of substance use and reasons for relapse. • Sensation-Seeking – Excessive need for stimulation • Impulsivity – Inability to effectively control or restrain behavior. • Negative Affect – Dysphoric moods such as anxiety & depression. • Poor Coping – Deficits in cognitive and behavioral skills or inhibitions in the ability to perform behaviors due to the effects of anxiety.
  • 14. Biopsychosocial Factors in Development and Maintenance of Addictive Behaviors SOCIOCULTURAL FACTORS • Family History – Dysfunctional family settings especially parental alcohol and drug problems and parental abuse or neglect of children. • Peer Influences – Social pressure to engage in risk- taking behaviors including substance use especially when related to gang membership. • Culture and Ethnic Background – Norms and religious beliefs that govern the use of alcohol and drugs and ethnic variations the body’s rate and efficiency of metabolizing drugs and alcohol. • Media/Advertising – Societal emphasis on immediate gratification and glorification of the effects of alcohol and drug use.
  • 20. Analysis of High-Risk Situations for Relapse Alcoholics, Smokers, and Heroin Addicts RELAPSE SITUATION (Risk Factor) Alcoholics (N=70) Smokers (N=35) Heroin Addicts (N=32) TOTAL Sample (N=137) Negative Emotional States 38% 43% 28% 37% Negative Physical States 3% - 9% 4% Positive Emotional States - 8% 16% 6% Testing Personal Control 9% - - 4% Urges and Temptations 11% 6% - 8% TOTAL 61% 57% 53% 59% Interpersonal Conflict 18% 12% 13% 15% Social Pressure 18% 25% 34% 24% Positive Emotional States 3% 6% - 3% TOTAL 39% 43% 47% 42% INTRAPERSONAL DETERMINANTS INTERPERSONAL DETERMINANTS
  • 23. Analysis of High-Risk Situations for Relapse Alcoholics, Smokers, Heroin Addicts, Compulsive Gamblers, and Overeaters RELAPSE SITUATION (Risk Factor) Alcoholics (N=70) Smokers (N=64) Heroin Addicts (N=129) Gamblers (N=29) Overeaters (N=29) TOTAL Sample (N=311) Negative EmotionalStates 38% 37% 19% 47% 33% 35% Negative PhysicalStates 3% 2% 9% - - 3% Positive EmotionalStates - 6% 10% - 5% 4% Testing PersonalControl 9% - 2% 16% - 5% Urges and Temptations 11% 5% 5% 16% 10% 9% TOTAL 61% 50% 45% 79% 48% 56% InterpersonalConflict 18% 15% 14% 16% 14% 16% SocialPressure 18% 32% 36% 5% 10% 20% Positive EmotionalStates 3% 3% 5% - 28% 8% TOTAL 39% 50% 55% 21% 52% 44% INTRAPERSONAL DETERMINANTS INTERPERSONAL DETERMINANTS
  • 24. High-Risk Situation Effective coping response Increased self-efficacy Decreased probability of relapse Ineffective coping response Lapse (initial use of the substance) Increased probability of relapse Abstinence Violation Effect ¤ Perceived effects of the substance Decreased Self-efficacy ¤ Positive outcome Expectancies (for initial effects of the substance) A Cognitive Behavioral Model of the Relapse Process
  • 25. Relapse Prevention: Specific Intervention Strategies High-Risk Situation Abstinence Violation Effect Ineffective Coping Response Lapse Decreased Self-Efficacy ¤ Positive Outcome Expectancies Self-Monitoring ¤ Inventory of Drug-Taking Situations ¤ Drug Taking Confidence Questionnaire Mediation, Relaxation Training, Stress Management ¤ Efficacy-Enhancing Imagery Contract to limit extent of use ¤ Reminder Card (what to do if you have slip) Description of Past Relapses ¤ Relapse Fantasies Situational Competency Test ¤ Coping-Skill Training ¤ Education about immediate vs. delayed effects ¤ Decision Matrix Cognitive Restructuring (a lapse is a mistake: coping vs.
  • 26. BEHAVIORAL THERAPY FOR THE TREATMENT OF SUBSTANCE ABUSE
  • 27. Describe the philosophies, practices, policies, and outcomes of the most generally accepted and scientifically supported models of treatment, recovery, relapse prevention, and continuing care for addiction and other substance-related problems. Scientifically Supported Models of Treatment › Pharmacotherapies › Behavioral Therapies › Approaches Used by Substance Abuse Treatment Facilities Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-27
  • 28. PHARMACOTHERAPIES  Opioid Addiction › Methadone › Buprenorphine › Naltrexone  Tobacco Addiction › Nicotine Replacement Therapy (NRT)  Electronic Cigarettes, gum, patches › Bupropion (Zyban® ) › Varenicline (Chantix® ) Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-28  Alcohol Addiction › Naltrexone › Acamprosate (Campral®) › Disulfiram (Antabuse® ) › Topiramate (Topamax®)
  • 29. Cognitive Behavioral Therapy Community Reinforcement Approach Plus Vouchers Contingency Management Interventions & Motivational Incentives Motivational Enhancement Therapy The Matrix Model Stimulants 12-Step Facilitation Therapy Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-29 BEHAVIORAL THERAPIES
  • 30. Clinical or Therapeutic Approaches Used by Substance Abuse Treatment Facilities In Brief In 2009, the majority of substance abuse treatment facilities always or often used substance abuse counseling (96%), relapse prevention (87%), cognitive-behavioral therapy (66%), 12-step facilitation (56%), and motivational interviewing (55%). More than one third of facilities always or often used anger management (39%) or brief intervention (35%). More than one quarter always or often used contingency management/motivational incentives (27%). More than one fifth always or often used trauma-related counseling (21%). More than half of all facilities either rarely or never used or were not familiar with community reinforcement plus vouchers (86%), Matrix Model (63%), or rational emotive behavioral therapy (51%).
  • 31. BEHAVIORALTHERAPIES Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-31  Behavioral Couples Therapy  Behavioral Treatments for Adolescents  Multisystemic Therapy  Multidimensional Family Therapy for Adolescents  Brief Strategic Family Therapy
  • 32. Competency 6 Recognize the importance of family, social networks, and community systems in the treatment and recovery process. Families often do not understand substance use disorders or recovery Family education and opportunities to express their concerns during the recovery process are critical Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-32
  • 33.  Goals › Present accurate information about addiction, recovery, treatment, and the resulting interpersonal dynamics. › Help clients and family members understand how the recovery process may affect current and future family relationships. › Provide a forum for families to discuss recovery issues. › Present accurate information about the effects of drugs. › Teach, promote, and encourage clients’ family members to care for themselves while supporting clients in their recovery. › Provide a professional atmosphere in which clients and their families are treated with dignity and respect. › Encourage participants to get to know other recovering people and their families in a comfortable and nonthreatening environment Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-33
  • 34. Understand the importance of research and outcome data and their application in clinical practice. Evidence-Based Practice (or Best Practice) Defined › Approaches to prevention or treatment that are validated by some form of documented scientific evidence. › Evidence often is defined as findings established through scientific research › Evidence-based practice stands in contrast to approaches that are based on tradition, convention, belief, or anecdotal evidence (SAMHSA OAS, 2010). Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-34 Competency 7
  • 35.  Best research evidence: supporting clinically relevant research, especially patient-centered research  Clinician expertise: using clinical skills and past experience to identify and treat the individual client  Patient values: integrating the preferences, concerns, and expectations that each client brings to the clinical encounter into treatment planning (Institute of Medicine) Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-35
  • 36. E v i d e n c e - B a s e d T h i n k i n g Lori L. Phelps California Association for Alcohol/Drug Educators, 2013 3-36 Figure 3.2: Evidence-Based Thinking Source: CSAT (2007)
  • 39. Empirical Support: Review of 24 RCTs Kathleen M. Carroll (1996) Relapse Prevention: • Does not usually prevent a lapse better than other active treatments, but is more effective at “Relapse Management,” i.e. delaying first lapse and reducing duration and intensity of lapses • Particularly effective at maintaining treatment effects over long term follow-up measurements of 1-2 years or more • “Delayed emergence effects” in which greater improvement in coping occurs over time • May be most effective for “more impaired substance abusers including those with more severe levels of substance abuse, greater levels of negative affect, and greater perceived deficits in coping skills.” (Carroll, 1996,
  • 40. • Reviewed 17 controlled studies to evaluate overall effectiveness of the RP model as a substance abuse treatment • Statistically identified moderator variables that may reliably impact the outcome of RP treatment • “Results indicate that RP is highly effective for both alcohol-use and substance-use disorders” Empirical Support: Meta-Analytic Review Irvin, Bowers, Dunn & Wang (1999)
  • 41. Moderator Variables with Significant Impact on RP Effectiveness:  Group format more effective than individual therapy format  More effective as “stand alone” than as aftercare  Inpatient settings yielded better outcomes than outpatient  Stronger treatment effects on self-reported use than on physiological measures  While effective across all categories of substance use disorders, stronger treatment effects found for substance abuse than alcohol abuse Empirical Support: Meta-Analytic Review Irvin, Bowers, Dunn & Wang (1999)
  • 43. The Abstinence Violation Effect Emotional- guilt, blame, failure, etc. Cognitive- Internal, stable, global, uncontrollable Self-awareness increase Comparison to Internalized Standards- greater difference, more guilt Behavioral Reaction- dominant habitual response Cognitive Reaction- resolve discrepancy
  • 48. Relapse Prevention Specific Intervention Strategies What to do if a lapse occurs • Stop, Look, and Listen • Keep Calm • Renew Your Commitment • Implement your Relapse Prevention plan • Ask For Help • Review the situation leading-up to the lapse
  • 49. RELAPSE PREVENTION Specific Intervention Strategies Coping with Lapses (Initial Use of a Substance) • Relapse Plan with Emergency Procedures • Relapse Contract to limit extent of use • Relapse Reminder Card “What do I do in case of a lapse?”

Editor's Notes

  1. For the most recent research on electronic cigarettes or “e-cigs” go to www.casaa.org.