Psychotherapy for drug addiction

1. Muhammad Musawar Ali
MPHIL, ICAP
Psychmmusawarali@gmail.com
Psychotherapies for Addiction

3. Meaning of Addiction
Addiction is the
habitual,
psychological and
physiological
dependence on a
substance or practice.
Which is beyond
voluntary control.

4. What is drug addiction?
 Drug addiction is a chronic disease characterized by compulsive, or
uncontrollable, drug seeking and use despite harmful
consequences and changes in the brain, which can be long lasting.
 Drug addiction is also a relapsing disease. Relapse is the return to
drug use after an attempt to stop.

5. What are drugs?
 A drug is something that affects your body. Drugs must be able to
pass through the body and into the brain; interferes with brain’s
neurotransmitters
 Not all drugs are illegal.

6. Types of drugs
 Stimulants
 Depressants
 Opioids
 Hallucinogens
 Cannabis

7. Stimulants
 Increase the activity of CNS.
 They tend to increase heart rate , breathing and offer a sense of
excited euphoria.
 Cocaine, caffeine, amphetamine, nicotine are some stimulants.

8. Depressants
 A depressant, or central depressant, is a drug that lowers neurotransmission
levels, which is to depress or reduce arousal or stimulation, in various areas of
the brain.
 Alcohol, benzodiazepines,
barbiturates are some
depressants.

9. Opioids (opiates)
 Opioids are drugs that act on nervous system to relieve pain.
 Heroin
 Morphine.
 Oxycodone

10. Hallucinogens
 A hallucinogen is a psychoactive agent which can cause hallucinations,
perceptual anomalies, and other substantial subjective changes in thoughts,
emotion, and consciousness
 LSD
 Half Moon
 Ketamine

11. Cannabis
 Cannabis is often used for its mental and physical effects, such as a "high" or
"stoned" feeling, a general change in perception, euphoria (heightened mood),
and an increase in appetite.
 Marijuana
 Weed
 Hash

12. Why Do People Use Drugs?

13. Signs and Symptoms
 lose interest in school
 change friends (to hang out with kids who use drugs)
 become moody, negative, cranky or worried all the time
 ask to be left alone a lot
 have trouble concentrating
 sleep a lot (maybe even in class)
 get in fights
 have red or puffy eyes
 lose or gain weight
 cough a lot
 have a runny nose all of the time

14. Can drug addiction be treated?
 Yes, but it’s not simple. Because addiction is a chronic disease
 Addiction treatment must help the person do the following:
 stop using drugs
 stay drug-free
 be productive in the family, at work, and in society

15. How is drug addiction treated?
 Successful treatment has several steps:
 detoxification (the process by which the body rids itself of a drug)
 behavioral counseling
 medication (for opioid, tobacco, or alcohol addiction)
 evaluation and treatment for co-occurring mental health issues such as
depression and anxiety
 long-term follow-up to prevent relapse

16. Three types of treatment programs
 SUD treatment –only program
 COD-Capable program
 COD –Enhanced program

17. SUD treatment only program
 Only for SUD’s
 Can not be done on people with mental disorders

18. COD Capable programs
 Deals with SUD’s having mild level of mental problems.
 Use the referral system to deal with mental problems of client.

19. COD Enhanced programs
 Deals with those people having both SUD and other co occurring
mental disorder.
 It makes strong plan of treatment considering both disorders.

20. Models of treatment
 Sequential treatment model
 Parallel treatment model
 Integrated treatment model

21. Sequential treatment model
 It deals with one problem at one time and then other.
 Severity level of disorder determines what to be treated first

22. Parallel treatment model
 Both disorders are treated at same time but at different settings

23. Integrated treatment model
 This is most effective model for treatment
 All the problems are dealt under one roof and supervised by one
person.

24. I
SUD
1ST Model
BI, IDP,ODP
RC (Strong)
IV
SUD
MD
3RD Model
IPD
RC (Strong)
II
SUD
MD
3RD Model
BI, IDP, ODP
RC(Weak)
III
SUD
MD
2ND Model
IPD,OPD
RC(Weak)
May or not

25. Treatment plan
 Pretreatment components
 outreach
 Screening and brief interventions
 Assessment and treatment planning
 Detoxification

26. Primary treatment
 Individual counseling
 is a process through which clients work one-on-one with a trained
therapist—in a safe, caring, and confidential environment—to explore
their feelings, beliefs, or behaviors, better understand themselves and
others, set personal goals, and work toward desired change.
 A client and therapist may work together for as few as five or six
sessions or as long as several years, depending on the client’s unique
needs and personal goals for therapy.

27. Group counseling
 Group counseling is a highly effective form of therapeutic
treatment. The small and intimate nature of a group provides a
safe and supportive space for addicts to explore a range of issues
as they interact with others.

28. Psychotherapies for addiction
 Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine,
Methamphetamine, Nicotine)
 Contingency Management Interventions (Alcohol, Stimulants,
Opioids, Marijuana, Nicotine)
 Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine)
 The Matrix Model (Stimulants)
 12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates)
 Family Behavior Therapy
 Behavioral Therapies Primarily for Adolescents

29. Cognitive behavioral therapies
 Individuals in CBT learn to identify and correct problematic
behaviors by applying a range of different skills that can be used to
stop drug abuse and to address a range of other problems that
often co-occur with it.
 Research indicates that the skills individuals learn through cognitive-
behavioral approaches remain after the completion of treatment
(Carroll, K.M.; and Onken, L.S. Behavioral therapies for drug
abuse. The American Journal of Psychiatry 168(8):1452–
1460, 2005.)

30. Motivational Enhancement
Therapy
(Alcohol, Marijuana, Nicotine)
Motivational Enhancement Therapy (MET) is a
counseling approach that helps individuals resolve
their ambivalence about engaging in treatment
and stopping their drug use.
MET has also been used successfully with marijuana-
dependent adults when combined with cognitive-
behavioral therapy

31. Motivational enhancement therapy
 MET seeks to
 Help client create their own motivation for change
 Consolidate client decision and plan for change
Approach is client centered but counseling sessions are planned and
directed by counselors.

32. MET and Goal Settings
 Counselors impose no absolute goal
 Counselors may advise about specific goals
 A broader range of “life” goals may be explored as well

33. MET Summary
 Based on principles of cognitive and social psychology, where the
counselor
 Assume that internal motivation is necassory and often the only factor
needed to create change.
 Helps client percieve discrepencies between current behavior and
personal goals.
 Emphasizes client self motivational statements of both desire for and
commitment to change

34. MET Effectiveness
 Researchers have found MET to be effective for addressing the
following addictions
 Alcohol
 Marijuana
 Nicotine
Source: U.S. National Institute on Drug Abuse. (2009). Principles of
drug addiction treatment: A research-based guide, 2nd Ed. NIH
Publication No. 09-4180. Bethesds, Maryland: Author.

35. TWELVE STEP FACILITATION
THERAPY
 Twelve-step facilitation therapy is an active engagement strategy
designed to increase the likelihood of a substance abuser becoming
affiliated with and actively involved in 12-step self-help group
 Three keys
 (1) acceptance
 (2) surrender
 (3) active involvement

36. Acceptance
which includes the realization that drug addiction is a chronic,
progressive disease over which one has no control
Surrender
which involves giving oneself over to a higher power, accepting the
fellowship and support structure of other recovering addicted
individuals
Active involvement
in 12-step meetings and related activities. While the efficacy of 12-
step programs (and 12-step facilitation) in treating alcohol
dependence has been established
 (Donovan D.M., and Wells E.A. "Tweaking 12-step": The potential role of 12-Step self-help group
involvement in methamphetamine recovery. Addiction 102(Suppl. 1):121-129, 2007.)

37. Multisystemic therapy(MST)
 This therapy is for child and adolescents suffering from addiction
problem
 Intensive in home and in-community approach
 Focuses on changing thinking and behavior of
 Adolescents
 Their parents

38. MST (Cont)
 Uses cognitive-behavioral and social developmental strategies
 Concentrates on family strengths

39. MST Interventions
 Occur in home to overcome high drop-out rates and focus on
 Promoting responsible behavior
 Decreasing irresponsible actions by family members
 Addressing what is currently occurring in adolescents life
 Taking immediate actions targeting specific problem

40. MST Interventions(cont)
 MST focuses on
 Building adolescents peer relationships
 Acquiring academic and vocational skills
Focus on
 not gaining insights into past
 Not on blaming family or labeling parents
but on
 Empowering caregivers as key to long term success
 Holding MST counselors solely responsible for treatment success.

41. MST Effectiveness
 MST found to
 Significantly reduce adolescents drug use during and for at least six
months after treatment
 Reduce the number of incarcerations and out of home juvenile
placements.
Source: U.S. National Institute on Drug Abuse. (2009). Principles of
drug addiction treatment: A research-based guide, 2nd Ed. NIH
Publication No. 09-4180. Bethesds, Maryland: Author.

42. More psychotherapies or
techniques
 Relapse Prevention Therapy
 Decisional balancing technique
 Behavioral couple therapies
 Multidimensional family therapy
 Reward motivation
 Community reinforcements

44. 1.Seek Guidance Of Religion

46. 2.Try To Be Part Of Good Company

47. 3.Do Not Copy Others

48. 4.Express Yourself

49. 5.Do Some Exercises

50. 6.Set Life Goals

51. 7.Dare To Say ‘NO’

52. Helpful sources
 SAMHSA – www.samhsa.gov
 Substance Abuse and Mental Health Services
Administration
 NIDA – www.drugabuse.gov
 National Institute on Drug Abuse
 AAAP – www.aaap.org
 American Academy of Addiction Psychiatry
 ASAM – www.asam.org
 American Society of Addiction Medicine