EFFECTIVE Treatment for substance use disorders CARL M. DAWSON , M.S. , MAC , LPC THE FOREST INSTITUTE OF PROFESSIONAL PSYCHOLOGY Springfield , missouri NATIONAL DRUG COURT INSTITUTE ( NDCI ) WASHINGTON , DC - PowerPoint PPT Presentation

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EFFECTIVE Treatment for substance use disorders CARL M. DAWSON , M.S. , MAC , LPC THE FOREST INSTITUTE OF PROFESSIONAL PSYCHOLOGY Springfield , missouri NATIONAL DRUG COURT INSTITUTE ( NDCI ) WASHINGTON , DC

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Title: EFFECTIVE Treatment for substance use disorders CARL M. DAWSON , M.S. , MAC , LPC THE FOREST INSTITUTE OF PROFESSIONAL PSYCHOLOGY Springfield , missouri NATIONAL DRUG COURT INSTITUTE ( NDCI ) WASHINGTON , DC


1
EFFECTIVE Treatment for substance use
disordersCARL M. DAWSON , M.S. , MAC ,
LPCTHE FOREST INSTITUTE OF PROFESSIONAL
PSYCHOLOGY Springfield , missouriNATIONAL
DRUG COURT INSTITUTE ( NDCI )WASHINGTON , DC

2
PRESENTATION OVERVIEW
  • ADOLESCENCE AND ADULT
  • TREATMENT DIFFERENCES .
  • GENDER DIFFERENCES AND
  • SUBSTANCE ABUSE TREATMENT .
  • CLINICAL POINTS OF REFERENCE
  • TREATMENT ISSUES .
  • THIRTEEN ( 13 ) NECESSARY COMPONENTS
  • OF AN EFFECTIVE SUBSTANCE ABUSE
  • TREATMENT PROGRAM .
  • THE FUTURE USE OF MEDICATION
  • ( INTERVENTION ) POSSIBILITIES IN
    TREATMENT .

3
KEEPING PERSPECTIVE
  • Remember Our initial goal during the early
  • months of recovery is not to focus on the
    idea
  • of long term sobriety, but to keep the
    person
  • from relapsing .
  • Relapse is and will always be our enemy .
  • During early recovery, focus on teaching the
  • individual(s) how not to relapse and what it
    will
  • take for them to stay drug free long enough
  • until they feel confident about not using,
    and
  • experienced enough time to reestablish a new
  • life without the use mood altering substances
    .

4
POINTS OF REFERENCEEVERY INDIVIDUAL THAT
ENTERS INTO THE PROCESS OF RECOVERY IS
CURSED WITH KNOWING THAT THEY POSSESS ONE
MORE RELAPSE . . . WHAT THEY DONT KNOW IS
HOW MANY MORE OPPORTUNITES , IF EVER ,
THEY WILL HAVE TO RECOVER !
5
Maslows Needs
  • Individuals in recovery may need to
  • re-experience and redefine each stage
    of emotional development before their healing
    is complete .

6
POINTS OF REFERENCE
  • NINETY ( 90 ) OF SUCCESSFUL RECOVERY
  • OCCURS AFTER THE INDIVIDUAL COMPLETES
  • FORMAL TREATMENT .
  • NETWORK THERAPIES INVOLVING AFTERCARE
  • COUNSELING , SELF - HELP GROUPS ,
    SPONSERSHIP ,
  • AND CONTINUED INVOLVEMENT IN RECOVERY
  • ORIENTED ACTIVITIES FOR A PERIOD OF
  • THREE ( 3 ) TO FIVE ( 5 ) YEARS HAVE
    BEEN
  • FOUND TO BE MOST EFFECTIVE WITH
    REGARDS
  • TO ESTABLISHING A LONG TERM RECOVERY
    AND
  • RELAPSE PREVENTION PROGRAM .
  • MOST RESEARCH ESTIMATES THAT MORE THAN
  • NINETY ( 90 ) RELAPSE ONE TIME BEFORE
  • GAINING SOLID RECOVERY .

7
GENDER DIFFERENCES AND SUBSTANCE ABUSE
TREATMENT
  • WOMEN ( GIRLS ) IN TREATMENT , BLAME
  • STRESS AS THEIR MOST COMMON
  • REASON FOR USING DRUGS .
  • MEN ( BOYS ) IN TREATMENT ROUTINELY
  • STATE THAT PEER PRESSURE WAS
    THEIR
  • INITIAL REASON FOR THEIR USE OF
    DRUGS .

8
GENDER DIFFERENCES
  • WOMEN ( GIRLS ) IN TREATMENT ARE MORE
    FREQUENTLY IDENTIFIED AS HAVING HAD A
  • PRE EXISTING MOOD DISORDER PRIOR
    TO
  • THEIR USE OF DRUGS .
  • MEN ( BOYS ) IN TREATMENT , ARE
  • FREQUENTLY FOUND TO HAVE AQUIRED
  • A MOOD DISORDER AFTER THEIR
    INITIAL INTRODUCTION AND USE OF DRUGS .

9
GENDER DIFFERENCES
  • WOMEN ( GIRLS ) IN GENERAL ARE TWICE ( 2
    Xs )
  • AS LIKELY TO STRUGGLE WITH DEPRESSION
    AND
  • ANXIETY RELATED MOOD DISORDERS THEN
    MEN .
  • AS A CONSEQUENCE . . .
  • THEY ARE ALSO MORE LIKELY TO BE
    ATTRACTED
  • TO ILLICIT DRUGS THAT POSSESS
  • ANTI DEPRESSANT PROPERITIES ,
  • LIKE AMPHETAMINES , METHAMPHETAMINE
  • AND COCAINE AND . . . PERSCRIPTION
    ANTI ANXIETY
  • MEDICATIONS LIKE XANAX OR SEDATIVE
    HYPNOTIC
  • SUBSTANCES SLEEP AIDS .

10
GENDER DIFFERENCES
  • WOMEN SUBSTANCE ABUSERS REPORT STRUGGLING
    MORE WITH SHAME
  • OR . . .
  • WHATS WRONG WITH ME !
  • MEN SUBSTANCE ABUSERS REPORT STRUGGLING
  • MORE WITH FEELINGS OF GUILT
  • OR . . .
  • I KNOW I DID SOMETHING WRONG !







11
GENDER DIFFERENCES
  • WOMEN ( GIRLS ) IN TREATMENT , ARE FOUND
  • TO RESPOND MORE EFFECTIVELY TO A
  • LESS CONFRONTATIONAL THERAPEUTIC
  • COMMUNITY , . . .
  • THAT EMPHASIZES AND REWARDS . . .
  • POSITIVE SELF - GROWTH ,
  • ESTEEM BUILDING AND DEVELOPMENT ,
  • PERSONAL EMPOWERMENT .

12
GENDER DIFFERENCES
  • MEN ( BOYS ) IN TREATMENT , ARE FOUND TO
  • RESPOND MORE POSITIVELY TO TRADITIONAL
  • TREATMENT CONCEPTS INVOLVING A . . .
  • 1. MORE DIRECT CONFRONTATIONAL
  • THERAPEUTIC APPROACH .
  • 2. SELF HELP GROUPS, ( A. A. / N. A. )
    . . .
  • 3. ISSUES SURROUNDING
  • POWERLESSNESS ,
  • LIFE UNMANAGIBILITY .

13
GENDER DIFFERENCES
  • RESEARCH ON WOMEN ( GIRLS ) AND
  • STIMULANT DRUG USAGE , FINDS THE
    FOLLOWING
  • WOMEN ( GIRLS ) ARE LIKELY TO DEVELOP A
  • DEPENDENCY ON METHAMPHETAMINE AND
  • COCAINE SOONER THEN MEN ,
  • THEY ARE PRONE TO USE STIMULANT
  • DRUGS MORE IMPULSIVELY THAN MEN (
    BOYS )
  • AND ,
  • EXPERENCE A HIGHER RATE OF DRUG
  • RELAPSE THAN MEN ( BOYS ) .

14
DAWSONS HYPOTHESIS OF CHANGE
  • A PERSON WILL RARELY SEEK TO
  • CHANGE THEIR BEHAVIOR(S) UNTIL . . .
  • THEY EXPERIENCE THAT MOMENT OF REALITY .
    . .
  • WHEN THEY REALIZE , THEY . . .
  • ARE THE ONLY ONE TRULY RESPONSIBLE FOR
  • THEIR PRESENT SUFFERING ! ! !

15
CLINICAL POINTS OF REFERENCE
TREATMENT ISSUES
  • COMPLETE ABSTINENCE FROM THE USE OF
  • ALL MOOD ALTERING SUBSTANCES ,
  • INCLUDING THE INDIVIDUALS LEAST
  • DRUG OF CHOICE , SHOULD BE THE
  • FUNDAMENTAL PHILOSOPHY AND GOAL OF
  • EVERY EFFECTIVE TREATMENT PROGRAM .

16
REMEMBER CURRENT THERAPEUTIC APPROACHES
ONLY IMPACT APPROXIMATELY 1 BILLION OF THE
100 BILLION NEURONS IN
THE HUMAN BRAIN .
17
TREATMENT ISSUES
  • GROUP DIRECTED TREATMENT HAS BEEN FOUND
  • TO BE MORE EFFECTIVE WHEN TREATING
    ADDICTION
  • DISORDERS THAN INDIVIDUALLY DIRECTED
    TREATMENT .
  • CULTURAL SPECIFIC TREATMENT HAS BEEN
    FOUND
  • TO BE MORE EFFECTIVE THAN GENERIC
    ORIENTED TREATMENT .
  • FAMILY THERAPY AND FAMILY INVOLVEMENT IS
    THE
  • MISSING LINK AND KEY FACTOR IN ALL
    EFFECTIVE
  • SUBSTANCE USE TREATMENT .

18
TREATMENT ISSUES
  • RESIDENTIAL DRUG TREATMENT HAS BEEN
  • FOUND TO BE MORE EFFECTIVE THAN
  • OUTPATIENT DRUG TREATMENT WHEN
  • ADDRESSING ADOLESCENT ADDICTION ISSUES .
  • PERSONALLY AND PROFESSIONALLY ,
  • I WILL NOT REFER TO A TREATMENT
    PROGRAM
  • THAT DOES NOT EMPHASIZE THE PRIMARY
  • PRINCIPLES AND PHILOSOPHIES OF THE
  • ALCOHOLICS ANONMYOUS ( A .A .) PROGRAM .

19
TREATMENT ISSUES
  • WHAT AGE DID THE INDIVIDUAL FIRST BEGAN
  • USING DRUGS ?
  • THAT IS THE EMOTIONAL AGE OF THE
    INDIVIDUAL . . .
  • AND EMOTIONALLY THAT IS WHERE DRUG
  • TREATMENT SHOULD BEGAN .
  • REMEMBER FOR DRUG TREATMENT TO BE
  • EFFECTIVE , YOU MUST BEGAN WHERE THE
  • INDIVIDUAL IS . . . NOT WHERE YOU
    WANT
  • THEM TO BE !!!

20
TREATMENT ISSUES
  • FOR ADDICTION TREATMENT TO BE
  • EFFECTIVE . . .
  • THE INDIVIDUAL MUST BE WILLING OR
  • FORCED TO CHANGE
  • PLAY - GROUNDS , ( Bars , Clubs, Parties )
  • PLAY - MATES , ( Using friends )
  • PLAY - THINGS , ( Drug paraphernalia )

21
THIRTEEN ( 13 ) NECESSARY COMPONENTS
OF AN EFFECTIVE DRUG AND
ALCOHOL TREATMENT PROGRAM
22
( 1 ) NO SINGLE TREATMENT IS APPROPRIATE
FOR ALL INDIVIDUALS
  • PROPER IDENTIFICATION AND PLACEMENT
  • IS CRUCIAL IN DETERMINING
  • CLIENT - TREATMENT COMPLIANCE AND
  • SUCCESS .
  • RESEARCH CONDUCTED BY CSAT AT UCLA
  • CONCLUDED
  • THE MATRIX MODEL APPLIED TO A DRUG
  • COURT PHILOSOPHY WAS MORE EFFECTIVE
  • THAN TREATMENT AS USUAL .

23
( 2 ) TREATMENT NEEDS TO BE
READILY AVAILABLE
  • STRIKE WHILE THE IRON IS HOT !
  • POTENTIAL TREATMENT APPLICANTS
  • CAN BE LOST IF TREATMENT IS NOT
  • IMMEDIATELY AVAILABLE OR IS NOT
  • READILY ACCESSIBLE .

24
( 3 ) EFFECTIVE TREATMENT ATTENDS TO
THE MULTIPLE NEEDS OF THE INDIVIDUAL . . .
NOT JUST THEIR DRUG USE
  • IN ORDER FOR TREATMENT TO BE
  • EFFECTIVE A TREATMENT PROGRAM MUST
  • BE ABLE TO ADDRESS THE INDIVIDUALS
    DRUG
  • USE . . . AND OTHER MEDICAL ,
    PSYCHOLOGICAL ,
  • VOCATIONAL , SOCIAL , AND LEGAL
    PROBLEMS .

25
( 4 ) A CLIENTS TREATMENT PLAN NEEDS TO
BE PERIODICALLY REVIEWED TO ENSURE
THAT THE PLAN IS MEETING THE
CLIENTS CHANGING NEEDS
  • A CLIENT THAT REQUIRES MULTIPLE
  • COMBINATIONS OF ASSISTANCE WILL
  • REQUIRE MORE TIME AND ATTENTION
  • TO ENSURE SUCCESSFUL COMPLIANCE
  • AND PARTICIPATION IN TREATMENT .

26
( 5 ) THE LENGTH OF TIME IN TREATMENT
IS CRITICAL FOR OVERALL TREATMENT
EFFECTIVENES
  • MOST RESEARCH INDICATES THAT A MINIMUM
    OF
  • THREE ( 3 ) MONTHS OF CONTINUOUS
    TREATMENT
  • IS NECESSARY FOR A SUCCESSFUL
    TREATMENT
  • OUTCOME .
  • THE RESEARCH ALSO INDICATES THAT THE
  • LONGER A PERSON REMAINS IN CONTINUOUS
  • TREATMENT ( from 3 T0 14 mo. ) THE
    RELAPSE
  • POTENTIAL RATE DROPS SIGNIFICIANTLY .

27
( 6 ) COGNATIVE BEHAVIORAL THERAPIES ARE
MOST EFFECTIVE IN TREATING ADDICTION
DISORDERS
  • ( MULTI DISCIPLINARY TREATMENT )
    INVOLVING
  • GROUP THERAPIES , INFORMATIONAL
    LECTURES ,
  • DIDACTIC DISCUSSIONS , PEER INTERACTION
  • ( A.A. OR N.A ) , PROBLEM SOLVING AND
    SKILLS
  • BUILDING , MARTIAL COUNSELING AND
    FAMILY
  • INVOLVEMENT IS MOST EFFECTIVE IN
    SUBSTANCE
  • ABUSE TREATMENT .

28
( 7 ) EFFECTIVE TREATMENT PROGRAMS
SHOULD BE CAUTIOUS BUT WILLING TO CONSIDER
THE USE OF APPROPRIATE MEDICATIONS
( PLEASE . . .DONT KILL THE
MESSENGER ! )
  • PSYCHO - PHARMACOLOGICAL INTERVENTION
  • IS PROVING TO BE AN IMPORTANT AND
  • SOMETIMES NECESSARY ADDITION TO
  • TRADITIONAL SUBSTANCE ABUSE TREATMENT .

29
( 8 ) CO EXISTING ( SUBSTANCE ABUSE AND
PSYCHIATRIC DISORDERS ) NEED TO BE
ADDRESSED IN AN EFFECTIVE TREATMENT
PROGRAM
  • SUICIDE FOUR ( 4 ) OUT OF FIVE ( 5 )
    .
  • MOOD DISORDERS
  • Bi Polar ( 20 to 60 ) .
  • Depression ( 98 ) .
  • ANXIETY DISORDERS ( 23 ) .
  • STRESS -TRAUMA DISORDERS
  • ( 60 TO 80) .
  • PERSONALITY DISORDERS ( 40 ) .
  • PSYCHOTIC DISORDERS ( 14 TO 47 ) .

30
( 9 ) MEDICAL DETOXIFICATION AND
INTERVENTION IS ONLY THE FIRST
STAGE OF TREATMENT
  • MEDICAL INTERVENTION ,
  • IDENTIFICATION ,
  • DIAGNOSIS AND
  • DETOXIFICATION ARE
  • CRITICAL FIRST STEPS IN
  • EFFECTIVE SUBSTANCE
  • ABUSE TREATMENT .

31
( 10 ) TREATMENT DOES NOT HAVE TO
BE VOLUNTARY TO BE EFFECTIVE
  • REMEMBER DAWSONS HYPOTHESIS OF CHANGE ! !
    !
  • SANCTIONS AND BEING FORCED TO BE
  • RESPONSIBLE , RELIABLE , DEPENDABLE ,
  • AND CONSISTANT . . . HAS BEEN FOUND
    TO
  • BE A STRONG MOTIVATION TO ATTEND ,
  • PARTICIPATE , AND COMPLETE TREATMENT
    .


32
( 11 ) POSSIBLE DRUG USE DURING TREATMENT
MUST BE MONITORED CONTINUOUSLY
  • DRUG MONITORING HOLDS THE CLIENT
  • RESPONSBILE TO THEIR COMMITMENTS .
  • DRUG MONITORING PERMITS THE
  • TREATMENT TEAM TO ADJUSTED AN
  • INDIVIDUALS TREATMENT PLAN ACCORDING
  • TO THE NEEDS OF THE INDIVIDUAL .

33
( 12 ) EFFECTIVE TREATMENT PROGRAMS
SHOULD HAVE AVAILABLE . . . OR ACCESS
TO . . . ASSESSMENT AND COUNSELING
SERVICES FOR HIV - AIDS , HEPATITIS B
AND C , TUBERCULOSIS AND OTHER
INFECTIOUS DISEASES THAT PLACE THEM
OR OTHERS AT RISK OF INFECTION .
34
( 13 ) TREATMENT AND RECOVERY IS LONG
TERM PROCESS . . . PRONE TO EPISODES
OF RELAPSE AND MULTIPLE TREATMENT
ATTEMPTS
  • REMEMBER
  • TREATMENT AND RECOVERY FROM
  • ALCOHOL AND DRUGS IS A PROCESS . . .
  • NOT AN EVENT !

35
USING MEDICATIONS IN TREATMENT
  • CURRENTLY THERE ARE EFFECTIVE
    MEDICATIONS
  • THAT ASSIST HEALTH CARE PROFESSIONALS
    IN
  • TREATING PSYCHIATRIC DISORDERS , SLEEP
    DISORDERS , NEUROLOGICAL DISORDERS , AND
    PHYSICAL MEDICAL DISEASES . WE ARE IN
    PART AN CHEMICAL ORGANISM .
  • CONSIDER THAT IN THE FUTURE ,
    TREATMENT
  • OF CHEMICAL DEPENDENCY DISORDERS WILL
  • AND SHOULD INCLUDE THE PROPER
    BALANCE
  • OF THERAPEUTIC INTERVENTIONS THAT
    INCLUDE , CONVENTIONAL COUNSELING TECHNIQUES
    ,
  • EDUCATION , PREVENTION , SELF HELP
    GROUPS , PSYCHOLOGY , MEDICINE ,
    SPIRITUALITY AND
  • CHEMISTRY .

36
CURRENT AND FUTURE CRAVING MEDICATIONS
  • ALCOHOL DISULFRAM ANTABUSE .
  • ACAMPROSATE CAMPARAL
    .
  • NALTREXONE VIVITROL
    .
  • GABAPENTIN NEURONTIN
  • IMPACT THE
    GABA SYSTEM .
  • BACLOFEN AN ANTI
    ANXIETY
  • AGENT THAT
    IMPACTS THE
  • GABA
    SYSTEM .
  • TOPIRAMATE TOPAMAX
    IMPACTS
  • THE GABA
    AND THE
  • GLUTAMATE
    SYSTEM .

37
  • COCAINE AND METHAMPHETAMINE ( S )
  • ANTIDEPRESSANTS SSRIS
    ,
  • SNRIS .
  • MEDICATIONS TARGETING THE
  • INSULAR CORTEX OF THE BRAIN
    .
  • A COCAINE VACCINE DEVELOPED
  • DR. THOMAS KOSTEN ,
  • BAYLOR COLLEGE OF MEDICINE .

38
THE INSULAR REGIONS THE BRAIN ALSO
ASSOCIATED WITH CRAVINGS
39
  • MARIJUANA RIMONABANT ACOMPLIA
  • IMPACTS THE
  • ENDOCANNABINOID
    SYSTEM .
  • TOBACCO VARENICLINE CHANTIX .
  • ANTI DEPRESSANTS

    WELLBUTRIN .
  • A NICOTINE VACCINE INVENTED
  • BY NABI BIOPHARM ,
    MARYLAND .
  • OPIATES METHADONE ,
  • NALOXONE ,
    NALTREXONE ,
  • BUPRENORPHINE .

40
CONTACT INFORMATION CARL M. DAWSON , M.S.
MAC , LPC1320 E. KINGSLEY SUITE A
SPRINGFIELD, MO . 65804e mail
cdawson1028_at_YAHOO.COM
41
Recommend Readings
  • U.S. DEPARTMENT OF HEALTH AND HUMAN
    SERVICES
  • Public Health Service
  • Substance Abuse and Mental Health Services
    Administration
  • Center for Substance Abuse Treatment
  • TREATMENT IMPROVEMENT PROTOCOL
  • (TIP) SERIES
  • Rockwall II, 5600 Fishers Lane
  • Rockville, MD 20857

42
References and Recommended Readings
  • American Psychiatric Association (2000). The
    Diagnostic and Statistical Manual of Mental
    Disorders, 4th ed. Washington, DC, The American
    Psychiatric Association.
  • Cooper, J., F. Bloom, and R. Roth. The
    Biochemical Basis of Neuropharmacology, 8th ed.
    Oxford, U.K. Oxford University Press, 2003.
  • Kandel, E.,J.Schwartz, and T. Jessell. The
    Foundations of Neural Science, 4th ed. Boston,
    MA McGraw Hill, 2000.

43
  • Ray, O., Ksir, C. Drugs Society, and Human
    Behavior, 7th ed., Mosby Publishing Co. (1996).
  • Squire, L. Memory and Brain, Oxford, U.K.
    Oxford University Press, (1987).
  • Whishaw. Il, and B. Kolb. Fundmentals of Human
    Neuropsychology, 5th ed. New York Worth Books,
    (2003).
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