Post on 07-May-2015
transcript
Management of Addiction
AHMED ALBEHAIRY, M.DPSYCHIATRY
CONSULTANT, MOH
Management of Addiction
Assessment . Bio psycho social
Intervention
bio psycho social
Follow up and maintenance
Implications for Treatment
Must restore– Medical integrity– Personal integrity– Social integrity
Psychopharmacological Treatment of patients
- Symptomatic detox treatment .
Physical, psychological
- Anticraving.
- Antagonist.
- Partial agonist.
- Agonist or replacement.
????? Ideal drug needs
Alcohol
- Benzodiazepine, chlordiazepoxide 5-20 mg three or four times daily.
- Antiepileptic ;carbamezapine .
- vitamin B, thiamine , wernick’s encephalopathy respectively.
Alcohol
-Naltrexone .At night , after meal, liver-Acomprosate. Campral 333mg, 2-1-1, renal , diarrhea, headach-Disulfram.500mg for 1st wk then 250mg, nausea,
metronidazole-Topramate.
opiate
- Alpha 2 agonist, naltrexone.
- symptomatic treatment .
- Naltrxone, xr.
- buperinophin, withdrawel, maintenance.
Cocaine & amphetamine
Antidepressants
Antiepileptic
Cocaine vaccine.
Nicotine
- Symptomatic
- varencelline , chantix. Patial agonist, alpa2 B4. 0,5mg / day and in wk inc to 1mg/day
- wellbutrin. depression, suicidal thoughts, and suicidal
actions
- Nicotine replacement.
BZD, BARBITURATE
Symptomatic.
Taperring.
Vitamine B
antiepileptic.
Cannabinoids, hallucinogen, PCP, inhalent,
- Supportive .
- antidepressants.
- Antipsychotic.
change
The Stages of Change are:
• Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
• Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
• Preparation/Determination (Getting ready to change)
• Action/Willpower (Changing behavior) • Maintenance (Maintaining the behavior change) and • Relapse (Returning to older behaviors and
abandoning the new changes)
Possibility of relapse in addiction therapy
Relapse prevention
Key Themes in Relapse Prevention
1- identify risk relapse factors and develop strategies to deal with.
2- understand relapse as a process and as an event.
3- understand and deal with cues and cravings.
4- understand and deal with social pressures to use substance.
5- develop and enhance a supportive social network.
Key Themes in Relapse Prevention
6- develop methods of coping with negative emotional states.
7- assess the pt. for co morbid psychiatric disorder.
8- help and learn the pt. methods to cope with cognitive distortions.
Relapse warning signs!!!????
- Attitude changes.
- Thoughts changes.
- Mood changes.
- Behavior changes.
Personal integrity
????????????
Self control ---- self efficacy!!!!!!!!
What is self Efficacy????
self-efficacy as our belief in our ability to
succeed in specific situations.
high risk factors internal, external( thoughts, feelings, people, places, events and things )
Factors affecting self-efficacy
• Bandura points to four sources affecting self-efficacy;
• 1. Experience – "Mastery experience" is the most important factor deciding a
person's self-efficacy. Simply put, success raises self-efficacy, failure lowers it.
• 2. Modeling - a.k.a. "Vicarious Experience" – “If they can do it, I can do it as well.” This is a process of
comparison between a person and someone else., modeling
Factors affecting self-efficacy
• 3. Social Persuasions – Social persuasions relate to
encouragements/discouragements. These can have a strong influence – most people remember times where something said to them significantly altered their confidence. Where positive persuasions increase self-efficacy, negative persuasions decrease it. It is generally easier to decrease someone's self-efficacy than it is to increase it.
• 4. Physiological Factors – In unusual, stressful situations, people commonly exhibit signs of
distress; shakes, aches and pains, fatigue, fear, nausea, etc. A person's perceptions of these responses can markedly alter a person's self-efficacy.
Tools of managing self efficacy in addict
- Individual psychotherapy .
- Group .
- Team work.
- Motivational skills.
- Ex addict .
- Family involvement.
- Relapse and lapse investigations.
Self efficacy and solve problem
- Psycho education - Anticipation of risky situations .- Discussion ??????- Training , motivation.- List of problems - Prioritize the problems .- Analysis of the problems.( cognitive errors
and other related psychosocial issues).
Problem solving
- Alternative solutions.
- Choose the suitable solution ( with, against, and key persons).
- Test the solution .
- Approve the solution or choose other alternative.
- Recycle and repeat.
Types of problems to be solved
- cues.
- Craving
- Psychiatric disorders.
- Medical disorders.
- Legal problem.
- Family .
- financial.
Self efficacy and problem solving mean
Continuous motivation for change of - Attitude .
- Thoughts .
- Mood .
- Behavior .
Cognitive behavioral model of the relapse process
High risk situations
Coping response
IncreasedSelf efficacy
Decreased Probability Of relapse
NoCoping
response
Decreased Self efficacy
Initial use Of
substance
AVE
disonance conflicts
Self attribution
Increased Probability
Of relapse
Family intervention in addiction treatment
- F Counseling
- Enabling, coping with relapse and craving.
- F therapy
The aims of counselling
Counselling can help people:
• discuss their problems honestly and openly,
• deal with issues that are preventing them from achieving their goals and ambitions, and
• have a more positive outlook on life
Emphasizing issues in Family Counselling in Addiction
• disease model of addiction.• Motivational skills training.• Signs of enabling.• Main concepts of follow up .• Lapse and relapse.• Role of the family in each therapeutic step.• Role of the key person.• Trust vs. mistrust • How to deal with patients cravings.• More frequent questions from the family.
Emphasizing issues in Family Counselling in Addiction
• disease model of addiction.
disease model
reward system
personality disorders and changes.
Emphasizing issues in Family Counselling in Addiction
• Signs of enabling.• Obsessively thinking or ruminating about what to
do to get others to change behaviors. • Protecting someone from the consequences of
their addiction. • Constantly cleaning up the chaos to keep the
status quo. • Ignoring mood-altering substance abuse
patterns. • Creating lies or excuses for other's drug using or
drinking patterns.
Emphasizing issues in Family Counselling in Addiction
• Signs of enabling.• Nagging or starting arguments then ignoring
drug use and drinking. • Allowing the person in active addiction to live in
the same household when they are abusive or continue with destructive behaviors.
• Tolerating individuals driving under the influence of mood-altering substances
• Ignoring people's self destructive behaviors for fear of starting arguments
Emphasizing issues in Family Counselling in Addiction
Coping with Relapse
• Process.
• Handling crises and emergency situations.
• Indications for referral to family therapy.
Emphasizing issues in Family Counselling in Addiction
Handling craving• Encouraging the individual to express craving• to them• Not panicking, as craving can be handled in
ways• other than using drugs• Understanding that the process of craving is• temporary.
Emphasizing issues in Family Counselling in Addiction
Handling craving
• Giving him/her something to eat or drink. The• craving is often reduced when a person’s hunger• or thirst is quenched• Talking it through when craving occurs• Distracting the individual by playing a game,• reading, going to a movie, listening to music or• going out to visit some relatives, etc
Family Therapy
• confessions and confrontations.• Parenting skills.• Discussions skills.• Solving problem skills.• Anger management in the family.• Family firmness.• Therapeutic alliance ( patient , family and
therapists).
Thank you