Substance Abuse and Dependence and tx.docx

Substance Abuse and Dependence Abuse Problems with: Relationships Work Fulfilling responsibilities The law Dependence Tolerance Withdrawal Taking too much Inability to cut-down on intake Preoccupation with the drug Continue even though know it?s bad Sociocultural Addictive personality? Certain personality traits correlate with drug abuse/dependence Learning and Expectation Tension Reduction Hypothesis People consume drugs to relieve anxiety Avoid withdrawal effects Genetics Treatment Approaches Psychotherapy designed to help people resolve emotional, behavioral, and interpersonal problems and improve the quality of life many different brands/types patients commonly delayed in treatment-seeking (up to 2 years after problems start?) Clinical psychologists Who seeks treatment? Women are more likely than men Caucasian Americans are more likely than Asian Americans and Hispanic Americans Who benefits from treatment? Patients with some anxiety often do better Patients who are better adjusted to begin with and those that are willing to work on their difficulties Patients with more severe and chronic problems do the poorest Approaches to Treatment Insight Therapies Humanistic Therapies Behavioral & Cognitive Approaches Biological Treatments Psychoanalysis: The 1st Therapy invented by Freud Goal: bring unconscious to the conscious motivations of unconscious forces are key, as are early childhood experiences insight and re-experiencing significant past events may lead to symptom reduction Primary Approaches (6) Free association say the first thing that comes to your mind? Interpretation therapist?s explanation of the patient?s emotions & behavior Dream analysis reveal unconscious themes Resistance difficulty patients experience in coming face to face with their own problems Transference projecting intense, unrealistic feelings and expectations from past onto the therapist Working through helping to process the problems (after insight is gained) Neo-Freudian Psychoanalysis concerned with conscious aspects of the patient?s functioning recognized the importance of cultural and interpersonal influences on behavior acknowledge needs other than sexuality and aggression (e.g. love, status, power) Jungian Analytic Psychology recall: Jung ? ex-Freud student, collective unconscious treatment focused on individuation, the integration of opposing aspects of the patients personality Amplification ? patients and therapists expand on dream associations Prognostic dreams ? dreams that foretell the future Object Relations Therapy emphasize patients mental representations of themselves and others focus on difficulties with trust, attachment, separation, and identity formation therapist as participant observer interpersonal therapy focused on strengthening social skills and assisting with coping with life transitions and conflicts Critical Analysis of Psychodynamic Therapies Many are not scientifically sound: poor external validity: limited population of wealthy, intelligent, successful people not replicable: clinical sessions were never systematically examined relied heavily on memories from the patient?s past which we now know may be wrong not falsifiable: - unable to disprove rival hypotheses insight may not be necessary may be more important to learn new behaviors many problems with repressed memories actually more memorable? can?t be falsified short-term therapy better than nothing but less effective on some disorders Humanistic-Existential Psychotherapy Emphasis on the development of potential Humanistic ? self-actualization occurs naturally, unless roadblocks hamper it Existential ? struggle, pain, and self-discipline inevitably occur along the road to personal fulfillment Humanistic-Existential Therapy therapies utilize a phenomenological approach ? deals with the subjective phenomena (thoughts, feelings) patients experience in the present Person-centered Therapy (Rogers)* centered on the patient?s goals and ways of solving problems DON?T tell the patient how to solve their problems, structure session for patient DO show unconditional positive regard to elicit a more positive self-concept lead to motivational interviewing Logotherapy (Frankl)* therapeutic approach that helps people find meaning in their lives creator?s experience in Nazi camp can preserve freedom of mind through even the worst conditions imaginable discourages patients from blaming past circumstances, other people, and adverse situations for their difficulties Gestalt Therapy (Perls)* aims to integrate different, and sometimes opposing aspects of personality, into a unified sense of self Gestalt = organized whole two-chair technique experiential therapy recognizes the importance of awareness, acceptance, and expression of feelings Behavioral & Cognitive Treatments Behavior Therapy focus on specific problem behaviors, and current variables that maintain problematic thoughts, feelings, and behaviors identify and assess the problem (behavioral assessment) then design and implement a strategy for behavior change uses a learning framework and functional analysis to determine these factors Exposure Therapy confronts patients with their fears, with the goal of reducing that fear very effective treatment for phobias systematic desensitization ? taught to relax as gradually exposed to feared object/situation in a stepwise manner flooding ? patients immediately experience their greatest fear, with no aversive consequences Flooding based on the idea that fears are maintained by avoidance (negative reinforcement) provokes anxiety in the absence of negative consequences extinction response prevention is key - therapists prevent patients from performing their typical avoidance behaviors can be done with virtual reality Systematic Desensitization Dismantling research procedure for examining the effectiveness of isolated components of a larger treatment studies like this show that each component of desensitization (relaxation, imagery, anxiety hierarchy) can be eliminated without affecting the outcome ?so how does it work? placebo effect or extinction of fear? also used to debunk fad approaches like Thought Field Therapy Participant Modeling therapist first models a problematic situation, and then guides the patient through steps to cope with it unassisted assertiveness training being able to ask for what you need in a direct and responsible manner behavioral rehearsal role-playing different responses to situations, often from different perspectives Working With Consequences Operant procedures ? using reward and punishment to shape behavior Token economy ? desirable behaviors are rewarded with tokens that patients can exchange for tangible rewards Aversion therapy ? uses punishment to decrease the frequency of undesirable behaviors e.g. alcohol abuse & Antabuse Cognitive-Behavior Therapy attempts to replace maladaptive or irrational thoughts (cognitions) with more adaptive, rational ones Core assumptions: thoughts can be identified and evaluated thoughts are the key player in both healthy and unhealthy psychological functioning irrational beliefs can be replaced by more rational and adaptive cognitions doing this may help alleviate symptoms Cognitive-Behavior Therapy treatments for depression, anxiety, substance abuse, personality disorders, eating disorders, schizophrenia?. cognitive approaches are as good as or better than psychodynamic, person-centered, or drug therapies appear to have lasting effects beyond other treatments (preventative) can be effectively combined with drug therapies treatments for depression, anxiety, substance abuse, personality disorders, eating disorders, schizophrenia?. cognitive approaches are as good as or better than psychodynamic, person-centered, or drug therapies appear to have lasting effects beyond other treatments (preventative) can be effectively combined with drug therapies Types of Cognitive Therapy Rational Emotive Behavior Therapy (Ellis) we respond to an (A) activating event with a range of emotional and behavioral (C) consequences and our responses vary because of our (B) beliefs about the world and ourselves promote rational, flexible, logical beliefs; realistic expectations of self and others therapists (D)ebate negative beliefs and help build more (E)ffective ones Rational Emotive Behavior Therapy (Ellis) we respond to an (A) activating event with a range of emotional and behavioral (C) consequences and our responses vary because of our (B) beliefs about the world and ourselves promote rational, flexible, logical beliefs; realistic expectations of self and others therapists (D)ebate negative beliefs and help build more (E)ffective ones Beck?s Cognitive Therapy emphasizes identification and modification of automatic, negative thoughts and long-held negative core beliefs also prioritizes behavioral activities stress-inoculation training: preparing for future stressful events Other approaches Eclecticism sampling bits and pieces from other approaches Dialectical Behavior Therapy (Linehan) treatment for suicide risk patients emphasizes two sides, integration Acceptance and Commitment Therapy coming to accept emotions / circumstances Biological Treatments pharmacotherapy electrical stimulation psychosurgery Pharmacotherapy use of medications to treat psychological problems many different classes of drugs to treat different problems; operate on different parts of the brain mood disorders: selective serotonin reuptake inhibitors (SSRIs), MAO inhibitors, lithium (bipolar) anxiety: benzodiazepines schizophrenia: antipsychotics, neuroleptics drug companies claim these drugs fix a ?chemical imbalance? in the brain, but how they actually work is unclear probably complex mechanisms Dosage & Side Effects side effects are common problem with psychopharmaceutical drugs usually reversible when the drug is discontinued, but some are not tardive dyskinesia (TD) ? irreversible side effect of some antipsychotic drugs; involuntary movements of facial muscles and twitching of the neck, arms & legs different patients require different doses sex, ethnicity, body weight alter response Electrical Stimulation of Brain Electroconvulsive therapy (ECT) brief electrical pulses to the brain which produce a seizure and treat serious psychological problems (last resort) highly effective: 80-90% improvement rates not as uncomfortable as it sounds 98% of patients said they would repeat it adverse side effects: memory and attention problems can persist 6 months after treatment highly controversial still not clear how it works (like drugs) Electrical Stimulation of Brain Vagus nerve stimulation: electrical pulses to treat major depression stimulates vagus nerve, may increase serotonin & blood flow large scale study has not been done (may be placebo effect) Psychosurgery brain surgery to treat psychological problems 1950s - researchers claimed that prefrontal lobotomies were effective treatments for a range of disorders heavy criticism of this practice surgeries became more targeted to decrease side effects today psychosurgery is used as an absolute last resort few well-controlled studies have been performed