Summary
4.1 Addiction week 4 summary
- Course
- Institution
Summary for the course 4.1 Addiction at eur in depth notes
[Show more]
Seller
Follow
ebru1365
Reviews received
Content preview
ADDICTION WEEK 4COMORBIDITY
Horsfall 2009 – Psychosocial treatments for people with co-occurring severe mental
illnesses and SUDs
Intro
- mainly focused on those with serious and persistent mental illnesses including: SCZ,
psychotic illness, BP, major depression and most common co-occurring substances
alcohol and cannabis
- people with SCZ are 3x more likely to be alcohol abusers and 6x more likely to abuse
other substances
- cannabis use with comorbid psychiatric conditions is estimated around 50%
- cigarette smoking among SCZ patients is between 70-80%, 40% smoking more than
40 cigs a day
Correlates and consequences of living with dual diagnoses
- people with psychosis and SUDs are more likely to be male and have a family history
of SUD
- consequences include: inc. rates of treatment noncompliance, relapse, distorted
perception and cognition, suicidal ideation, social exclusion, homelessness,
aggression, injury, HIV, hepatitis, cardiovascular, liver and gastrointestinal disease
- common factor of refusal and avoidance of treatment: low motivation to reduce
substance use
- SUD destabilizes their illness, exacerbates social alienation and inc. potential for
violent lashing out
- friends and family also experience distress, tension, and conflict
Reasons for substance use among people with psychosis
four main explanations:
- 1. substance abuse causes SCZ
o cannabis is the only substance to show a strong association between early
heavy use and development of SCZ (not causal)
- 2. substance abuse is an attempt, by self-medication, to improve the experiences of
SCZ
o study: people with SCZ use alcohol and cannabis to relieve depression,
anxiety, boredom or to relax, next most common reason is socializing
such use is not self-medication though
o substance abuse among psychotic patients is associated with the
demographic correlates of the general population rather than patients’
symptomology
o people with psychosis diagnosis may also have poor problem-solving skills,
and limited resources to improve well-being
- 3. SCZ and substance abuse have etiological factors in common
o no evidence that the two have common genetic basis
, o emotional, social and biological conditions of early childhood may increase
vulnerability for both conditions (e.g. physical or sexual abuse in childhood,
sexual or physical assault, PTSD,
- 4. SCZ and substance abuse maintain each other
o vulnerability might be especially great during puberty
Treatment issues regarding people with dual diagnoses
- people with co-occurring SUDs and psychosis have less motivation to change, are
harder to engage, drop out of long-term programs more easily, and make slow
progress
- housing and rehabilitation by employment need to be addressed
- relationships may be key difficulty
- features of psychosis might inhibit progress
o positive symptoms like delusions, auditory hallucinations, concrete thinking,
inferential thinking create barriers
o negative symptoms like flat affect, low energy levels, decreased goal-directed
activity and limited emotional expressivity
- people with SCZ have low tolerance of stressors
- SUDs populations have poor coping skills, avoidance methods to avoid positive
symptoms
- model for motivation: 5 stages for readiness of change
o precontemplation, contemplation, preparation, action, maintenance
- 3 specific aspects of SCZ as barriers:
o lack of motivation
may arise from medication, illness, or constrained life circumstances
o impaired cognition
deficits in attention, concentration, abstract thinking block
information processing, problem solving and realistic planning
o social-skills limitations
absence of healthy social support system, difficulties resisting pressure
from peers
PSYHOSOCIAL INTERVENITONS FOR DUAL DIAGNOSES
Individual approaches
motivational interviewing (MI):
- essential in early stages
- acknowledges that people may not be aware that their substance use is causing
problems
- emphasizes personal choice, responsibility, and awareness of risks and benefits of
continued substance use
- a written treatment plan with individual’s strengths and links between life goals and
problems
- active management around client concerns
- informational components and constructive feedback
- support for forces within patients that encourage their interest in change
, - MI sessions can include developing coping strategies to avoid specific situations at
high risk substance use and build on alternative constructive, non-substance related
activities
- in-depth reality-oriented interventions are more likely to be effective
CBT:
- 6 issues that people must address:
o recognizing escalations symptoms and warning signs
o coping with cravings
o coming up with health alternative activities
o normalizing substance use lapses
o developing plans for lapse or relapse
o cognitive restricting to counteract positive beliefs
- sometimes combined with contingency management (payment and employment
related)
- family support may enhance both individual and group treatment approaches
Group interventions
- advantages of using group interactions:
o potential to change social attitudes and behavior
o cost effective
- groups offer social support from those who fully understand the difficulties of staying
sober and provide structure for daily living
- traditional 12-step programs are unhelpful for people with dual diagnoses
o limitations of social and emotional expression among people with SCZ don’t
fit with AA custom of talking
assertive community treatment (ACT):
- adapting a conventional model of case management to the need of this client cohort
- develop a working alliance with clients, link them to relevant other services, function
as their advocate
- keeping contact and providing ongoing assessment, case managers are central to
engagement, treatment and retention
- ACT clients get better outcomes in substance use and quality of life
- ACT is superior to standard case management in preventing hospitalization, only
when the base rate of hospital use is high
residential programs
- residential programs offer intense, integrated treatments during the live-in stage but
short term (3-months) programs don’t do better than outpatient services
- long-term programs (a year or more) show better abstinence, accommodation and
other positive outcomes
- low intensity residential programs might be better due to inc. flexibility and freedom,
and dec. therapeutic intensity might be experienced as more supportive and less
demanding/overwhelming
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ebru1365. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for CA$9.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
79789 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now