substance use

the agent model

the core Belifs: focus is the substance and its powerful effects on nervous system

genetics model

Nature plays a role in development and addiction

learning behavior

social learning

classical conditioning

reflexes and responses

opernat conditioning

is reinforcement and punishment

sociocultural influence

social environment on use and higher levels of use

public health model

relationship between biological, psychological, and social factors

harm reduction model

help reducing harm of persons behavior

cycle of change

pre contemplation, contemplation, preparation, action, maintenance, relapse

precontemplation

no intent to change

contemplation

aware of the problem not yet committed

action

putting in steps to change

maintance

sustained change

relapse

back to recurring of old habits

upward spiral

each time through the cycle many times they learn

how do we know an intervention works?

outcomes, symptoms improvement, subjective experience

evidence matters

must balance evidence with client preference

The five A’s of evidence based Practise

ask, acquire, apprise, apply, assess

1. ask

make clinical question

2. acquire

Search for the best evidence

3. apprise

critically evaluate evidence

4. apply

Integrate evidence with experience

5. asses

evaluate outcomes of change

evidence based practise

practices: 1.clinical experience, 2.best research, 3. patient values

EBP IN SUD

Motivational interviewing, cognitive behavioral therapy, contingency management, family-based intervention.

efficancy

does intervention work under supervistion

effectiveness

does intervention work under in life sinarios

GOLD standard

Research samples may not represent realistic, marginalized groups are underrepresented, need to consider co-occurring, outcomes can vary on training

order of practice

1. Emerging: new interventions, 2. Promising: some evidence, 3. Evidence: strong supportive research.

responsibility when evidence is unclear

transparency, informed consent, clinical judgment, clinical autonomy, cultural humanity, ongoing evaluation

Barriers

Transportation, isolation, stigma, childcare, cost, cultural mistrust

client treatment matching

right intervention+ right person + right context+ right time

Consideration of substance, motivation, disorders, history of treatment, severity, medical needs, supports.

Initation

patient has never received it before. INTIAL

retention

what happened that made participation continuation difficult remaining engagement in the program.

Adjustment disorders

long symptoms 6m + that are heavy

integrated treatment

provide services that treat each condition (SUD and MH) separately to address them

cultural selection

understands cultural beliefs, stigma, historical experience, language, risks

process in action (matching evidence-based intervention)

access, engage, adapt, match, monitor

evidence-based intervention needs

research support, producers, measurable outcomes, appropriate population, consideration

approaches to psychosocial interventions

MI, MET, CBT

MI

motivational interviewing : helps person find strength and motivation by talking

CBT

thoughts, emotions, behaviors. cognitive restructuring

ABC

antecedent, behavior, consequences

contingency management

Behavior followed by meaningful consequences is more likely to happen again (positive reinforcement, behavior control)

family-based interventions

community reinforcement and family training, family function affect

MAT

medically assisted treatment: medications that can support someone with SUD

opioid use disorder medaications

methadone, buprenorphine, naltrexone

Methadone

opioid against, reduce withdrawal, craving and overdose.

Burenorphine

another possibility of opioid against , withdrawal,

Naltrexone

used for OUD and SUD, Opioid Against, NEED TO BE OPOID FREE TO USE

Alcohol use disorder medications

naltrexone, acamprosate, disulfiram

Acamprosate

decreases craving alcohol, maintain absence, restoring of neurotransmitter

Disultfirm

causing vomiting

harm reduction approaches

stimulant use disorders, behavioral interventions, contingency management, CBT, community reinforecement, harm reduction

Benzodiapines

abrupt discontinuation, withdrawal symptoms

OHC

other health concerns

Mental health disorders

depressive, mood, BPD, anxiety, and general anxiety, neurodevelopmental, eating disorders

NOT want medical care

stigma, insurance, previous negative care, lack of transportation