Treatment

  • Mindfullness treatment for craving and as coping

    • Thought suppression is a conscious process whereby an individual attemts to not thing about something

      • may be counter productive (dont think about elefant, hah you thought about an elefant)

    • Mindfulness may help here

      • breathing exterisize- how your mind react to thoughts, count your breaths (odd number inhales, even number exhales)

      • Brain training

  • treatment'

    • never simple

    • never the same

      • all the factors that affect withdrawl and craving'

      • disrupts so many aspects of life

    • goals

      • stop using drugs

      • maintain a drug free life

      • repair and maintain social functioning

    • timing

      • staying in treatment longer seems to help

    • standardization

      • the use of manuals

      • aim is to guide

  • Abstinance vs harm reduction

    • for people who repeatedly fail to achive drug free life is it reasonble to aim for

      • reduction in use

      • reduction in harm

      • improvement in socail functioning

      • Ex: methadone

    • minimize damage done by addiction

  • Voluntary vs involuntary

    • Evidence suggests involuntary treatment is effective

    • Jails & the justace system are playing major role in detox

      • Maybe less so than acctual treatment

    • Family coercion

    • Monitoring sobriety

      • parole

      • incentivizes sobriety

    • Incentives

      • money, work, family

  • Combined treatment

    • Pharmacologic

      • noxicone

      • psychpathology treatment

    • Psychsocial

      • coping skills

      • CBT for psychopathology

      • fam/comunity support

    • Physical

      • HIV/Hep C/TB

    • Need to match treatments to the individuals based on what will have biggest impact

  • Putting it together

    • care of individuals with substance abuse disorder

      • assessing needs

      • providing treatment for intox and withdrawl

      • develop a treatment plan including referals to psychosocial care

      • the treat plan sould adress

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  • Settings

    • lots of varaibity

      • prisons

      • priveate and expenseive care

      • hosptial/socail work-often just detox and referal

    • this can end up in a health insurence nightmare

      • networks

      • underinsurance

      • lifetime caps

    • 4 levels of care

      1. gen outpaitent

      2. intensive outpaitent/day hosptial

      3. medical monitoring in inpatient residental setting

      4. medically managed inpatient care

  • Hospitialization

    • patient who will not be safe in outpatient

      • acute intoxication

      • medically complicated withdrawl

      • psychatric condition-threat to self and other

      • relapse/failure @ less restritive settings

      • life threat condition (ampuations, or infections)

      • any threat to self or other

  • Partial hospitialization

    • need intensive care but has a good chance to make progress on treatment holds

    • can maintain abstenance

    • still need/benifit from reg monitoring durring treatmement

    • often folks who prevously relapsed

    • efective for

      • pregnant

      • psych compromized

  • residentail/day clinic

    • sleeping at home but otherwise at clinic

    • nonhospital settings

  • outpaitent

    • lots of variables

  • Halfway houses/sober living

    • envormemtal risk is great

    • not as good for younger folks

  • case mangament

    • meet each person where they are

      • planning

    • hard to acess how well it works quantitavity

      • Seems to help with alcholol

    • helps folks stay in a treatment plan

  • Criminal justace

    • tends to be assocaited with longer treatments

  • Treatment approaches

    • clinical

      • dextox

      • drug testing

    • behave thearpy

      • idenitify

    • cognitive behave therapy

      • idenitify

    • 12 steps