Mechanisms, Evaluation, and Treatments in Addiction Psychology

What are the primary mechanisms of pharmacological treatments?

1. Reduce withdrawal symptoms 2. Reduce cravings 3. Make drug effects less reinforcing 4. Produce aversive effects when drug is used

What is the primary method for evaluating medications?

Randomized controlled trials

What are common features of clinical trials?

Random assignment to medication or placebo, double-blind design, combination with psycho-social treatment

What is the goal of detoxification in alcohol treatment?

To manage withdrawal symptoms, not necessarily to treat addiction

What is Naltrexone (Revia) used for?

It is an opioid antagonist that reduces pleasure from alcohol and cravings.

What does Acamprosate (Campral) do?

It acts on GABA and glutamate receptors, used for long-term maintenance and may lessen withdrawal and relapse risk.

What was the Project COMBINE study focused on?

It studied the effectiveness of naltrexone and acamprosate alone and in combination with behavioral treatment.

What is Disulfiram (Antabuse) and how does it work?

It causes physical illness when alcohol is consumed by inhibiting aldehyde dehydrogenase, leading to unpleasant symptoms.

What are the drawbacks of Disulfiram?

Compliance issues and ethical concerns due to making patients sick.

What is Nicotine Replacement Therapy (NRT)?

A treatment that manages withdrawal symptoms through various forms like patches, gum, and inhalers.

What are some drawbacks of Nicotine Replacement Therapy?

Compliance issues, potential overdose, and side effects like rashes and irritation.

What is Bupropion (Zyban) and its role in smoking cessation?

An antidepressant that helps decrease cravings and may block the rewarding effects of nicotine.

What is Varenicline (Champix)?

A partial nicotinic-receptor agonist that helps manage withdrawal and craving while blocking reinforcement during relapse.

What is Opioid Agonist Therapy?

A common treatment for opioid addiction that includes short-term withdrawal management and long-term maintenance.

What is Methadone and its benefits?

A full opioid agonist that is longer acting, less frequently administered, and blocks euphoric action of other opioids.

What is Buprenorphine and how does it work?

A partial opioid agonist that reduces craving and withdrawal, with a low overdose risk.

What is the Stepped Care Approach in addiction treatment?

Matching treatment intensity and resources to the severity of the problem.

What is the Transtheoretical Model?

A model of addiction treatment with stages: Pre-contemplation, Contemplation, Preparation, Action, Maintenance.

What are Brief Interventions in addiction treatment?

Designed to be delivered with minimal effort and time, often in primary care settings.

What is the goal of many addiction treatments?

To move individuals through the stages of the Transtheoretical Model and maintain recovery.

What is the significance of the Hendershot et al. 2017 meta-analysis?

It supports the efficacy of Naltrexone in both animal and human studies.

What are the potential side effects of medications like Bupropion and Varenicline?

Side effects may include dry mouth, physical discomfort, and rare severe effects like depression or suicide.

What is the role of compliance in pharmacological treatments?

Compliance is crucial for the effectiveness of treatments, as many medications are not effective alone.

What is the impact of combining pharmacological treatments with behavioral interventions?

It generally leads to better outcomes in addiction treatment.

What are the limitations of pharmacological treatments for addiction?

They do not address underlying social and psychological factors contributing to addiction.

What is Motivational Enhancement Therapy (MET)?

A type of brief intervention aimed at helping ambivalent individuals move to a higher stage of change.

How can MET be delivered?

In a single session or over multiple sessions.

What treatment model is MET based on?

The client-centered treatment model developed by Carl Rogers.

Who formalized Motivational Interviewing, which MET is based on?

Miller and Rollnick.

What is the primary goal of MET?

To help individuals explore their substance use and its consequences in a supportive environment.

What is the misconception about interventions in pre-contemplation?

The classic intervention approach is often seen as ineffective; confrontation can lead to resistance.

What is the strategy of 'Rolling with Resistance' in MET?

Instead of opposing denial, explore resistance to help clients move through it.

What type of questions does MET encourage?

Open-ended questions, such as 'Tell me more about...'

What is a key takeaway from the bad example of patient counseling?

Accusatory openings and lecturing can put patients on the defensive and hinder effective communication.

What approach does the good example of patient counseling demonstrate?

Empathetic engagement and exploring ambivalence to help patients articulate their own reasons for change.

What are the cognitive components of Cognitive-Behavioral Approaches?

Maladaptive thoughts that underlie substance use.

What does the behavioral component of Cognitive-Behavioral Approaches focus on?

Operant conditioning processes and replacing substance reinforcement with non-substance reinforcement.

What is Contingency Management?

A behavioral approach based on operant conditioning that provides immediate rewards for positive behavior.

What is a concern regarding Contingency Management?

The potential for 'cheating' and the question of intrinsic versus extrinsic motivation.

What is the Community Reinforcement Approach?

A comprehensive cognitive-behavioral intervention that focuses on building a client's support system.

What is the rationale behind the Community Reinforcement Approach?

To rearrange environmental contingencies so that sober behavior is more rewarding than substance use.

What was the purpose of the Project MATCH study?

To determine if matching clients to alcohol use disorder treatment based on personal characteristics improves outcomes.

What treatments were compared in Project MATCH?

Twelve-Step Facilitation (TSF), Motivational Enhancement Therapy (MET), and Cognitive Behavioral Therapy (CBT).

What was a significant finding from Project MATCH after one year?

Significant drinking improvements across all three treatments with no discernible difference in outcomes.

What was a supported hypothesis from Project MATCH?

Lower psychopathology is better matched to Twelve-Step Facilitation (TSF).

What are the final thoughts on treatment approaches?

There is increasing recognition of social structures and broader socio-cultural contexts in treatment effectiveness.

What is a key issue in the treatment system for substance use?

Inequities in treatment access and the need for participatory-action approaches for marginalized communities.

What role does stigma play in substance use treatment?

Stigma complicates treatment and the debate over 'who is to blame' continues.