???????????????????/??????????? (Addiction Treatment)

1
???????????????????/??????????? (Addiction
Treatment)

• ??. ????? ??????
• Bsc. Nursing, MS (Mental Health), MN (Mental
  Health),
• PhD (Addiction Studies)
• ???????????????????????????????????????
  ????????????????
• ??????????????????????????????????????
• dphukao_at_hotmail.com

2
???????????????????

• 1. ?????????????????? (15 min)
• 2. ??????????? / ?????????? /??????????
  /?????????? / Hang Over (15 min)
• 3. ???????????????????????????????????????????
  (15 min)
• 4. ???????????????????????????????????????????????
  ??????? / ???????????????????????? (15 min)
• 5. ?????????????/???????????????????????????????
  (45 min)
• 6. ????????????????? ?????????????????? (45
  min)
• 7. ????? ??????? (20 min)

3
???????????????

• ?????????????????? (Burden of Disease)
  ??????????????????????? (Disability-Adjusted Life
  years, DALYs) ????????????????????????????????????
  ??????????????????????????????????????????,
  ???????, ?????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?? 3 ?????????????????????????????????????????????
  ?????????????????????????????????????????? (Year
  of lost due to disability, YLDs) (????????????,
  ????????????????, 2546)
• 1. ???????????????
• 2. ?????????
• 3. ?????????????????????????????????

4
??????????????????

• 1. ?????????????????????????
• ?????, ????, ??????, ???????, ??????? (????, ??,
  ?????????, ??????????????????), ??????? (??????)
• 2. ????????????????????
• ?????, ?????????????????????????, ??????? ????
  ??????? (?????)
• 3. ????
• ?????, ????????, ?????????, ?? PCP, ????, ??????
• 4. ????????
• ???, ????????, ??

5
??????????????? / ?????????? ?????????? ??????????
6
???????????????????????

• ?????- ????????????, ????????, ???????,
  ??????????, ???????????????, ?????????????,
  ????????????, ???????????????????, ??????????,
  ??????????????????, ??????????????????????????????
  ????????, ??????
• ????? ??????, ????, ?????????????,
  ??????????????????, ?????????????????????????????
  (??????????) ????????????????????, ?????????
• ????- ?????????? ????????, ???????,
  ??????????????????????????????????, ?????????????
  (?????????, ???) ????????????????????????????,
  ?????

7
???????? (Intoxication)

• ????????- ?????, ???????, ?????
• ?????????????????- ???????????????????????????????
  ?????
• ???????????????????, ?????????????, ??????????
  ???????
• ???????? ?????????????, ???????, ?????????????
  (Psychosis) ?????????, ????????????????????,
  ??????, ??????????, ???, ??????, ?????????????,
  ???????????????, ?????????????????????????????????
  ???, ?????????????, ???????????????????

8
???????? (Intoxication)

• ????????- ????????????????????????????????????????
  ????????, ??????????????????????, ??????????, P,
  BP,T ??????????, ????????????????????????????,
  ????????????????????????, ???????????????????,
  ????????
• ???????, ?????? - ????????, ?????????,
  ?????????????????, P, BP,T , ?????????????????????
  ??????????????, ????????????, ?????

9
??????????????? (Intoxication)

• 30 mg ????????, ???????, ??????????????
• 50 mg
• ??????????????????????????????????????????????????
  ?????????
• ???????????????????????????
• ????????? ??????????????
• ??????????????????????????????????????????????????
  ???????????? 2 ????
• 100 mg ??????????????????????????????????????????
  ?????????????????????????? 7 ????
• 150 BAC ??????????????????????????????????????????
  ?????????????????????????? 25 ????

10
Hang over

• ???????????????????????????????????? 0
  ??????????????? 24 ???????
• ???????, ????????, ??????????????, ????????,
  ???????????????????, ????????? ???????????????????
  ???, ?????????????, ????????, ????????, ????????,
  ?????, ?????????

11
?????????? (Withdrawal)

• ???????? ?????????, ????????, ??????? ????????,
  ?????????????? ???????????????????????????
  ??????? ????? ?????????????
• ?????????? ???? ??????? ??? ??????????????
  ????? ????????? ????????????????
• ?????????? ???? ????????? ???????????
  ?????????? ???????? ???????? ???? ??????????
  ????????????? ?????????? ????? ???????????????

12
?????????????

• 1. Alcohol withdrawal (5-7 ???)
• ?????????, ????, ?????????, ?????????????, ?????,
  ?????????????????????, ????????????? ???????
  ????? ????????
• 2. Alcohol withdrawal delirium- BP ??? ?????
  ?????, ?????????? (??????????? 5-7 ???)
• 3. Protracted symptoms of withdrawal
  ??????????????????????, ????????? ??????????
  ????? ??????????????? ?????????
  ?????????????????????, ?????????????????,
  ???????, ??????????????????????

13
??????????????????????????????????????????????????
?

• ??????
• 1. ???????????
• (Substance Abuse)
• ?????????????
• ????? (Intoxication)
• 2. ????????????
• (Substance Dependence)
• ?????????????
• ????? (Intoxication)
• ??????????, ?????????? (Withdrawal)

• ??????
• ??????????????????????????????????????
• ????????

14
???????????????
???????????????
?????????
??????????
??????????????? Moderate drinking
?????????????????????????????????????????????????
??????
?????????????? Social drinking ??????????????????
???????????????
Moderate / safe-limit drinking lt1 drink / day for
most woman lt2 drinks / day for most
men ???????????????????????????????
????????????????? ?????????????????? ?????????????
??? ????????????????? 21 ?? ??????????????????????
U.S. Department of Agriculture and the U.S.
Department of Health and Human Services
15
????????????????????????????????????
?????????
??????????
?????
?????????? ??????????? ??????????? ??? ???????
? 2 STD ???????? 4 STD ??????? 2-4 STD
4-6 STD ??? ??????? 4 STD ??????? 6 STD
National Institute on Alcohol Abuse and
Alcoholism (1995) The physicians' guide to
helping patients with alcohol problems
16
?????????
?????????????????????????????????
??????????
?????? (4.5-5 ?????????) 3/4 ???????
??????????? ???????? ???????? 40 ????? 1??
???? 1/2 ???? (?????? 25 ??.)
???? (10-12 ?????????) 1 ???????? (?????? 100
??.)
17
??????????????????????????????????????????????????
????
18
??????????????????????????????????????????????????
?

• ???????
• ?????????????? ????????
• ?????????? ????????? CAGE, ???????????????????
  ?? MAST, ?????????????? (AUDIT/Alcohol Use
  Disorders Identification Test)
• ????????
• ??????????????? DSM-IV, ICD 10
• ??????????
• ?????????
• ???? ????? (CIDI-AUTO), ???? (SCID)
• ?????????????? ????????????, ?????, ?????????????
• ???????????????????????? (?????, ???????,
  ???????, ??????, ??????)

19
??????????????????????????????????????????????????
? ???????????????????????? (?????)

• ????????????? ?????
• MCV (Mean corpuscular volume)- CBC
• Blood chemistry
• CDT (Carbohydrate deficient transferrin)
• GGT (Gamma-glutamyl transferase)
• Liver function test/ LFT
• SGOT, SGPT

20
??????????????????????????????????????????????????
? ???????????????????????? (???????)

• ????? tetrabromo ??????
• ????????????????????????????????????
• ???????????????? 2-3 ???
• ????? 2-3 ???
• ??????????? 2-7 ???
• ??????? 2 ???

• ??????? 3-4 ???
• ?????
• ???????? 3 ???
• ???????????? 7-10 ???
• ??????????? 21 ???
• ???? 8 ???
• ?? benzodiazepine 3 ???

21
??????????????????????????????????????????
(Substance Abuse)

• ???????? ???????????????????????????? 12
  ??????????????
• ????? ??????????????????????????? 1 ?????
• ??????????
• ??????????????????????????????????????????? ????
  ?????????????
• ????????????????????????????????????
• ???????????????? ?????????????????????????????????
  ??????????

22
?????????????????????????????????????? (Substance
Dependence)

• ???????? ???????????????????????????? 12
  ??????????????
• ????? ??????????????????????????? 3 ?? 7 ?????
• 1. ?????????????????????(2 ?????)
• 1.1 ??????
• 1.2 ?????

23
?????????????????????????????????????? (Substance
Dependence)

• 2. ???????????????????????? (3 ?????)
• 2.1 ???????????????????????????????????
• 2.2 ????????????????????????????????????????????
• 2.3 ??????????????????????????????????????????????
  ???????
• 3. ??????????????(2 ?????)
• 3.1 ????????????????????????????
  ????????????????????????????????
• 3.1 ?????? ?????????? ????????????????????????????
  ??????????????????????

24
?????????????/???????????????????????????????

• ????????-???-??????(Bio-Psyco-Neurobiological
  theories)
• ????????????????
• ?????????????????????????? (Social cognitive
  theory)
• ?????????????????????????????????????????
• ?????????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ??????
• ??????????????????????????????????????????????????
  ?????

25
????????????????????/ ????????-???-??????(Bio-Psy
co-Neurobiological theories)

• ???????????? (Craving symptoms causing from
  existing vulnerability)
• Alcohol Withdrawal Symptoms
• The reinforcing properties of alcohol
• ?????? (Impulsive Control)
• ?????????????????????? ???????????????????????????
  ???????????????????????

26
????????????????????/ ????????????????

• ?????????????????????????????? (Behavioral
  skills) ????????????????
• Learning theory Classical Conditioning
• ????????????????????????????????????? (Craving
  symptom conditioned with cues)
• ????????????????????????????????? (Withdrawal
  symptom) ?????????????????????????????????????????
  ???????????
• Instrument or operant conditioning
• ??????????????? (Reinforcement)

27
????????????????????/ ??????????????????????????
(Social cognitive theory)

• 1. ??????????????????????????????? ??????
  ???????? ???????????
• 2. ????????????????????? ???????????????????
  ????????????????????????????????????? ???????
• ??????????????????? (?. ??????????????????????????
  ????????????????????????? ?. ?????????????????????
  ?????????????????????????????????????)
• ????????????????????????? (?. ????????????????????
  ?????????????????????????????? ?.
  ??????????????????????????????????????????????????
  ????????????? ?. ?????????????????????????????????
  ????????????????)

28
Abandonment
Social Exclusion
????????????
Mistrust
Defectiveness
???????????? ?????????????
Failure
Inhibition
Dependence
Unrelenting Standard
Vulnerabilities
Subjugation
??????????????????????????????/ ???????????
(Lifetraps)
29
????????????????????/ ??????????????????????????
(Social cognitive theory)

• 3. ???????? (?????????????????????????????????
  ?????????????????????? ?????????????????????????
  ????????????????????????????????)
• 4. ???????????????????????????????????????????????
  ?????????
• (Deficits in cognitive restructuring skills)
  (?????????? ??????????????????????????? -
  ??????????? ???????????????????? (Intellectual
  abuse) ???????????????????????????????????????????
  ????????)
• 5. ????????????????????????????????????
  (Cognitive and behavioral skills)?????????????????
  ????????????????????? ????????????????????????????
  ???????(Deficits in problem solving)

30
??????????????????????????
???????
??????????????????????
????????????1-2 ?????
?????
???????????????????
????????/ ???????????
??????????
???????????????????????
Transtheoretical Model
31
????????????????????/ ????????????????????????????
?????????????

• ??????????????????????? ????????
  ???????????????????? ??????????????????????
  (Resistance)
• ??????????? (Negative emotional states)
  ????????????????????????????? ????????????????????
  ? (Intensed emotion lead to ineffective in
  thinking critically)
• ??????????????????????????????????????????????????
  ??????????? (Physical abuse/ Sexual abuse/
  Emotional abuse/ Verbally abuse/ Intellectual
  abuse
• ?????????????????????????????????
• ????????????????? ????????????????????
• ?????????????????????????? ???????????????????????
  

32
????????????????????/?????????????????????????????
????????????????????

• ??????????????????????
• ????????
• Cross cultural theory / trans-cultural model,
  Empowerment theory,
• Communication theory
• ????????, ???????
• System theory, Interpersonal theory
• ?????????????? / ?????? (Peer domain)
• ?????
• Socio-Cultural perspective, Ecology setting and
  availability, Norm, The Social context model

33
Cross cultural theory / Trans-cultural model

• ??????
• ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?????
• Cultural imposition
• Cultural shock
• Resistance

• ??????????????????????????
• Develop awareness or sensitivity to the overt
  and covert cultural cues
• ?????????????????????????? MI

34
Communication theory

• ??????
• ??????????????????????????????????????????????????
  ??????????????????????????????????????????????
  (Judging, Sending solution, Avoiding others
  concerns)

• ??????????????????????????
• ????????????????????
• ?????????????????????????? MI, Client centered
  counseling

35
Empowerment theory

• ??????
• ??????????????????????????????????????????????????
  ????????????????????
• ????????
• One sided commitment to intervention ???????????
  Patronizing programs, Paternalistic programs,
  Treatment based on shame or guilty.

• ??????????????????????????
• ??????????????????????????????????
• ??????????????????????????? ??????????????????????
  ??????????

36
??????????????????????????????????????????????????
?????????? / ?????? (Peer domain)

• ??????????????????????????????????????????????????
  ????????????????????? (Antisocial Peers)
• ??????????????????????????????????????????????????
  ????????????????????????????????????????????????

37
???????????????????????????????????????????????
????????????/????????

• System theory
• ??????
• Poor Boundary
• ??????????????????????????????????????????????????
  ??? ?????????????????, ??????????,
  ???????????????????????

• Interpersonal theory
• ??????
• ???????????????????????

38
??????????????????????????????????????????????????
?????????/ ????? ????????

• Norm
• ??????
• ??????????????????????????????????????????????????
  ???????????, ????????????

• Ecology setting and availability
• ??????
• ??????? ?????????????

39
??????????????????????????????????????????????????
?????????/ ????? ????????

• Environmental approach / Empowerment theory
• ??????
• ????????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ???? ????????

• Sociology
• ??????
• ???????????????????????? ?????????????????????????
  ?????????????????????????????????????????????????
  

40
????? The Social context model

• ??????
• P
• B E
• P Belief, emotion, neurophysiology
• BBehavior
• E Environment
• ??????????????????????????????????????????????????
  ??????????????????????????????????????????????

41
????????????????????/ ????????????????????????????
????????????????????????????

• ??????????????????????????
• ??????????????????????????
• High working memory load
• Cognitive psychology

42
????????????????????/ ????????????????????????????
???????????????????????????

• ???????????????????????????
• ?????????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ????????????
• ??????????????????????????????????????????????????
  ??????????????????????????????????????????????
• Elkin et al, 1988.

• ??????????????????????????
• AA, Existential group
• ???????????????????????????????????????????????
  Spiritual

43
?????????????????????????????????????
44
??????????????????????????????????????????(Substan
ce Dependence)

• ????????????????? 3 ???????
• ?????????????????????????
• ?????????????????????????????? (?????, ?????)
  ????? (????????????????), ???????????
• ??????????????????????????????????????????????????
  ?
• ???????????????????????????????????????
• ????????????????????????? (??????????????? (Rx.
  of Intoxication) ???????? (Detoxification)
• ???????????????? (Maintenance of abstinence)
• ??????????????????
• ??????????????????????

45
???????????????????????????????????????????????

• ????
• ???????????????????????????
• ????????????????????
• ????????, ?????????????????????????????????????
• ???????????????????????????????
• Disulfiram, Acamprosate, Naltrexone
• ????????????????????????????????

46
??????????????????????????????????????????????
(??????????)

• ????
• ????????????????????????????????????
• ????????????????
• ????????????????????
• ????????????????
• ???????????????? (Motivational Interviewing)

• ???????????????? (???)
• ???????????????????? (Cognitive behavioural
  therapy) , ????????????????????????? (Relapse
  prevention) ??????????????????
• ?????????????
• ?????????????????
• ??????????
• Matrix program

47
??????????????????????????????????????????????????
?

• ?????????? (Therapeutic Community)
• ?????????????????????????????????????????? (FAST
  MODEL)
• ??? ??? ????? ????? (FRESH MODEL)
• ??? ??? ????? ????? (Matrix Program)
• ???????????
• Narcotic Anonymous (NA)
• ???????????????????? Harm Reduction
• ???????????????? (Motivational Interviewing)

48
Matrix

• ??? ??? ????? ????? ???? 3 ????? (Modified
  Matrix) ????????????????, 2546
• ??? ??? ????? ????? ???? 4 ????? (Matrix
  Program) ????????????????, 2544
• ???????????????????????????????????????????????
  ????????????, 2544 (5 ????)
• 3.1 ??????????????????????? 3.2
  ????????????????????????????????????? 3.3
  ?????????????????????????????????????? 3.4
  ???????????????????????? 3.5 ????????????????????

49
??????????

• ??????????????????????????? ???????????? ???????
  20 ???????????????????????????????????????????????
  ??????????????????????????? ?????
• a group of researchers at the Matrix Center in
  Southern California
• Matrix ???????????????????????????????????????????
  ???????????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????????????????????????????
  (Relapse prevention skill group)

50
Relapse Prevention

• ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????????????????????????,
  ??????????????? (Coping skills)???????????????????
  ????????? (Cognitive skill) ??????????????????????
  ??? (Problem solving) ???????????????????(Behaviou
  ral coping skill) ????????????? 2
  ??????????????????????????????????????????????????
  ????????????????????????

51
The content of Matrix treatment manual

• Relapse prevention
• family and group therapies
• drug education and drug abuse monitoring.
• The program format is composed of strategies to
• a) cease drug use
• b) remain in a treatment process
• c) learn about issues critical to addiction and
  relapse
• d) receive direction and support from therapists
• e) receive education for family members affected
  by addiction
• f) become familiar with the self-help programs

52
??????????
53
Therapeutic Community Program

• The assumption is that addictive disorders are
  viewed as deviant behaviour reflecting impeded
  personality development or chronic deficits in
  (a) behaviour, (b) emotional and psychological,
  (c) intellectual and spiritual and (d) vocational
  domains.
• The principal aim of the therapeutic community is
  facilitating or maximizing such aspects of life
  functioning. Facilitating change or maximizing
  four aspects of life functioning is offered
  through various kinds of overlapping activities
  composed of group therapy, group activities and
  job assignment activities.

54
???? ?????????????????

• ??????????????????????? (15 ???)
• ???????????????????????????????? (1 ??)
• ?????????? (????????????? ???? Transactional
  analysis/ Gestal therapy) ????????????????????
  (Encounter group) ?????????????? (Confrontation)
  ???????????????
• ????????????????????? (Work therapy)
  ?????????????????????????
• ????????????????????? ?????? /????????????????/
  ?????????????????/???????????? (??????????????????
  ???? (Communication Roadblock/ Verbally abuse)
  ?????????????????? ???????? Borderline /
  Psychotic
• ?????????????????????? (6 ?????)
• ?????????????????????????? (Follow up and after
  care phase) (3-5 ??)

55
?????????????????????????????????????????? (FAST
MODEL) 4-6 mths.

• ??????????
• F Family ???????? family walk rally
  ?????????????????????????
• A Alternative treatment activity
  ??????????????? ?????????? ????????? ??????
  ?????????? ??????? ???? ???????
• S Self help ???????????????????????????
  ???????????????????????? ???????????? ??????
  ?????????? ?????????????????? ??????????????????
  NA
• T Therapeutic Community ???????????????????
  (Peer pressure, Behaviour modification, social
  learning EQ ???????????????????
  ?????????????????? ?????????????
  ???????????????????? ???????????????????????? ,
  Morality, - Maturity)

56
??? ??? ????? ????? (FRESH MODEL)

• F Family education group ?????????? 12 ?????
• R Relapse prevention group ????????? 2 ????? ???
  32 ?????
• E Early recovery group ??????????????????????????
  ?????????????? 2 ????? ??? 8 ?????
• SH Self help group ???????????????????????????
  NA/ Socia support ?????????? 17-52
• ????????????????????????????????????????????????
  10 ?????

57
????

• ?????????????
• 1. ????????????????????? ??????????? 18 ??
  (?????? 40 ??)
• 2. ?????????????????????????????
• ???????? 9-14 ???

58
??????????

• ????????? ????????????????????????????????????????
  ???
• ??????????????????????????????????
  (???????????????????? (Self awareness)
  ?????????????????? (Managing emotional)
  ?????????????????????????? (Motivation oneself)
  ?????????????????????? (Empathy)
  ????????????????????? (Social skills)
• ????????????????????????????? (???????????????????
  ????? ????????????? ????????????????? ??????????
  ??????????????????? ??????????
• ?????????????????????????????????????????
  (????????????? ??????????????????)
• ??????????????????????????
• ??????????????????? ???????????? ?????????????

59
Thanks for your attention

• Any comments?