This document discusses various addiction treatment models and approaches. It covers the disease model of addiction and neurobiological factors. It describes different treatment settings like inpatient vs outpatient and criteria for long-term inpatient care. Evidence-based therapies in the Matrix Model are outlined, including groups, motivational enhancement, and addressing relapse factors. Medication-assisted treatment is compared to no-medication models. Special techniques like integrated group therapy and contingency management are explained. The conclusion emphasizes considering psychopathology and neurobiology in design, using multidisciplinary teams, and addressing barriers to research.

1. ADDICTION TREATMENT MODELS
BY
DR. SHERIF DARWISH
PSYCHIATRIST & ADDICTION THERAPIST

2. Thinking about addiction
 We need when we think about treatment to be
thiknking of the etiology of addiction and to have a
deep understanding of them

3. Product, pharmacology,
prohibition
Hisotry,culture ,politics
Disease model
Addiction
scheme
Indvidual,personality,
Environment, context,
psychiatric comorbidity
social acceptance
Integration
problem

4. 4

5.  Not only the predisposing and the pricipitating
factors, but also the neurobilogy of addiction

6. Neuroscience – Drug Addiction
 Habitual – Complusive model:
Everitt and Robins.
 Switch from initial reward to compulsive use
 Switch from the Ventral striatum to Dorsal striatum
function.

7. Neuroscience – Drug Addiction
 Incentive Sensitisation Model:
Robinson and Berridge.
 Increased “wanting” vs “liking”
 Increased salience of drug related stimuli.

8. Neuroscience – Drug Addiction
 Aberrant Allostasis Model:
Koob and Le Moal.
 Dysregulation of brain reward system
 Ability to reset set point in adversity.

9. Public expectations of substance abuse
interventions
 Safe, complete detoxification.
 Reduce use of medical services.
 Eliminate crime
 Return or start employment
 Eliminate family disruption
 No relapse.

11. Components of Comprehensive
Drug Addiction Treatment
www.drugabuse.gov

12. This brings us to think about treatment
 Pharmacotherapy not only for withdrawal
symptoms but also for maintainance
 Maintaince treatment as methadone ,
brupeonorphine or naltrexone.
 Or maintainece treament for dual diagnosis or
accompanying symptoms

13.  Are we going to treat the patient in an inpatient
facility or an out patient clinic.
 Practice versus science???!!!

14. The treatment systems

15. Criteria for long term inpatient
treatment
•The following criteria can help identify
clients who could benefit from longer term
treatment:
•Failure of previous shorter treatment
•Multiple concurrent problems
•Severe substance abuse (i.e., dependence)

16. •Acute psychoses
•Acute intoxication
•Acute withdrawal
•Cognitive inability to focus
•Long-term history of relapse
•Many unsuccessful treatment episodes
•Low level of social support
•Serious consequences related to relapse

17. Director reports of services provided
by their facility
Group counseling 100%
Indvidual counseling 85%
Case management 77%
Addiction medications 48%
Psychiatric medications 37%

18. Patients reporting of services provided
by their facility
Group counseling 100%
Indvidual counseling 45%
Case management 9%
Addiction medications 6%
Psychiatric medications 0%

19. Out Patient Treatment Models

20. EVIDENCE BASED THERAPIES )EBT‘S(
THAT ARE INCORPORATED IN THE MATRIX MODEL
Matrix Institute 2006 ©

21. Matrix Groups
 Psycho-educational Groups
 Stabilization Groups
 Relapse Prevention Groups
 Social Support Groups

22. Motivantion enhacement
STAGES OF CHANGE:Prochaska &DiClemente
Relapse or
reoccurrence
can happen
at any stage
Matrix Institute 2006 ©

23. Outpatient Recovery Issues
RELAPSE FACTORS

24. Outpatient Recovery Issues
Relapse Factors - Time Periods
Unstructured time•
•Transition periods
•Protracted abstinence
•Holidays
•Chronic stress, fatigue, or boredom
•Anniversary dates
•Periods of emotional turmoil

25. Outpatient Recovery Issues
Relapse Factors - Addict Thinking
•Paranoia
•Relapse justifications:
•“I’m not an addict anymore”
•“I’m testing myself”
•“I need to work”
•“Other drugs/alcohol are OK”
•“Catastrophic events”
•“Negative emotional states”

26. Outpatient Recovery Issues
Relapse Factors - Relationships
Drug-using friends •
•Addict must deal with family’s:
•Extreme anger and blaming
•Unwillingness to change/trust
•Hypervigilance - excessive monitoring
•Sexual anxieties
•Adjustment to non-victim status
•Conflict with recovery activities

27. Outpatient Recovery Issues
Relapse Factors - Addict Behavior
•Lying/stealing
•Having extramarital/illicit sex
•Using secondary substances
•Returning to bars/drug friends
•Being unreliable/irresponsible
•Behaving
compulsively/impulsively
•Isolating

28. Medication assisted models versus
no medication models??!!

29. Special techinques

30. Integrated group therapy
 A new treatment developed for patients with
substance use and mood disorders. It appears to be
a promising approach for this population

31. Contingency management
 Contingency management is an evidenced-based
behavioral program that uses positive
reinforcement, or rewards, to promote behavior
change

32. Designing a CM intervention
 Selecting a behavior to reinforce
 Choosing a reinforce )vouchers or prizes(
 Determining monitoring schedules
 Integrating behavioral principles

33. Selecting a behavior to reinforce
 Abstinence
 Attendance
 Medication adherence
 Compliance with goal related activities

34. behavioral principles
 Objectively quantifying behaviors.
 Priming.
 Frequency.
 Immediacy.
 Magnitude.
 Escalating.
 Consistency.

35. What population respond to CM
 Probably everyone;
 No income effect.
 No race effect.
 Effective in dual diagnosis.
 Can promote retention of those with prior
preadmissions.

36. Family education and family
therapy

37. Occupational support

38. conclusions
 We need to consider the psychopathology and
neurobiology of addiction when thinking of
designing treatment models.
 In order to meet the patient and public
expectations we need to make a lot of efforts and
cover different dimensions.

39. conclusions
 Treatment success is not limited to inpatient
programs)that themselves are not very perfect(.
 Special treatment methods and multidisciplinary
teams are a very good key for success.
 What are the barriers of research in Mammoura
hospital??