Substance-Related and Addictive Disorders

EPPP

Community Reinforcement Approach (CRA)

A treatment for clients already in SUD treatment that uses operant conditioning to restructure life so sober living becomes more rewarding.

Core Technique of CRA

Operant conditioning applied to redesign a client’s lifestyle, making sobriety more reinforcing than substance use.

Community Reinforcement and Family Training (CRAFT)

An approach that works with a Concerned Significant Other (CSO) when the substance-using person refuses treatment, aiming to guide the user into care.

Main Strategies in CRAFT

Teach the CSO to reinforce sober behavior, avoid enabling, improve communication, and facilitate the user’s entry into treatment.

Twelve-Step Facilitation (TSF)

A method that helps clients engage with Alcoholics Anonymous, emphasizing acceptance of addiction and surrender to a higher power.

Ideal TSF Client

Individuals whose social networks support drinking; Twelve Step Facilitation (TSF) connects them to sober peers and AA supports.

Motivational Enhancement Therapy (MET)

A brief therapy that builds intrinsic motivation, suited for clients with low readiness, ambivalence, or high anger toward change.

Key Techniques in MET

Express empathy, roll with resistance, evoke change talk, and strengthen commitment to change.

Cognitive Behavioral Therapy (CBT) for SUD

A skills-based treatment for cognitively engaged clients, focusing on thoughts, feelings, and behaviors linked to substance use.

Key Strategies in CBT for SUD

Coping-skills training, cognitive restructuring, and planning for high-risk situations to prevent relapse.

What are the key symptoms of opioid intoxication?

• Euphoria followed by apathy

• pupillary constriction

• slurred speech

• drowsiness or coma

• impaired attention or memory.

• May include hallucinations with intact reality testing.

What are the key symptoms of opioid withdrawal?

• Dysphoric mood

• nausea or vomiting

• muscle aches

• diarrhea

• fever

• insomnia

• lacrimation or rhinorrhea

• piloerection

• yawning

  Hint: think flu like sx

What are the key symptoms of alcohol intoxication?

• Slurred speech

• incoordination

• unsteady gait

• nystagmus

• impaired attention or memory

• stupor or coma

• inappropriate behavior

• mood lability

• impaired judgment

What are the key symptoms of alcohol withdrawal?

• Autonomic hyperactivity (e.g., sweating, tachycardia)

• hand tremor

• insomnia

• nausea or vomiting

• transient hallucinations or illusions

• anxiety

• psychomotor agitation

• seizures

What are the key symptoms of stimulant intoxication?

• Euphoria or affective blunting

• hypervigilance

• anxiety

• impaired judgment

• tachycardia or bradycardia

• pupillary dilation

• elevated/lowered BP

• nausea

• weight loss

• psychomotor changes

• seizures or coma

What are the key symptoms of stimulant withdrawal?

• Dysphoric mood

• fatigue

• vivid and unpleasant dreams

• insomnia or hypersomnia

• increased appetite

• psychomotor agitation or retardation

  Hint: think coming down off meth/cocaine

What are the key symptoms of tobacco withdrawal?

• Irritability

• anger

• anxiety

• impaired concentration

• increased appetite

• restlessness

• depressed mood

• insomnia

  Symptoms peak at 48-72 hours.

What are the symptoms of alcohol-induced major neurocognitive disorder (Korsakoff/Amnestic-Confabulatory Type)?

• Anterograde and retrograde amnesia

• confabulation

• linked to thiamine deficiency

• interferes with daily functioning

Amnestic-Confabulatory Type (Korsakoff Syndrome)

• Core features:

  • Severe anterograde amnesia (can’t form new memories)

  • Retrograde amnesia (loss of past memories)

  • Confabulation: making up stories or explanations to fill memory gaps, often without intent to deceive

• Cause: Often linked to thiamine (vitamin B1) deficiency, especially in people with chronic alcohol use

• Impairment: Profound and permanent memory damage that severely affects independence

Nonamnestic-Confabulatory Type

• Less common

• Core features:

  • May involve executive dysfunction, language issues, or other cognitive deficits, but without the severe memory loss and confabulation seen in Korsakoff’s

• Impairment: Still interferes with daily functioning but not centered on amnesia

• Not necessarily linked to thiamine deficiency

What are the key symptoms of hallucinogen persisting perception disorder (HPPD)?

Reexperiencing visual distortions (e.g., halos, color flashes) after LSD or other hallucinogen use, with intact reality testing and significant distress or impairment.

In CRA what is the operant conditioning strategy?

• Core idea:

  Use operant conditioning to make sober living more rewarding than substance use.

• Targets: The person with the substance use disorder (SUD)

• Strategy: Restructure lifestyle so that non-using behaviors are reinforced
  → e.g., job training, social activities, problem-solving skills, positive reinforcement

• Goal: Make a sober life more attractive and rewarding than drug/alcohol use

🧠 Mnemonic:

“CRA = Change Real-life Activities” to reward sobriety