What is it?What causes it?

What can we do about it?

A chronic, relapsing behavioral disorder.

Pattern: Remissions and relapses

Progression theories:◦ Gateway progression◦ Continuum of drug use◦ “Maturing out”

◦ Tolerance◦ Physiological dependence◦ Psychological dependence (habituation)◦ Craving

Some substances are more likely to be associated with addiction than others, but there are many exceptions both ways.◦ Heroin◦ Cocaine◦ Methamphetamine◦ Ecstasy◦ Alcohol◦ Psilocybin Mushrooms◦ Marijuana◦ PCP

Moral model: Responsibility and guilt

Physical dependence model◦ Abstinence syndrome◦ Negative reinforcement for continued drug-taking◦ Physical or psychological?

The decision

◦ Denial met by intervention or reality◦ Cognitive changes

Pre-contemplation: No problem! Contemplation: Maybe there’s a problem… Preparation Action Maintenance

◦ Cognitive therapy: Motivational interviewing

Abstinence: The 12-step approach

Controlled use

Harm reduction◦ Substitute addictions◦ Methadone◦ Gum-chewing◦ Needle exchanges◦ Water supply

Detoxification (Detox)◦ “Cold turkey”◦ Gradual◦ With pharmacological support

Active treatment

Relapse prevention

Self-treatment (“spontaneous remission”)◦ Perhaps 20% follow this route.◦ Self-treatment often requires multiple attempts:

Learning to quit.◦ For 57%, quitting is the result of cost-benefits

analysis.◦ For 29%, the change is immediate.

Sometimes because of “bottoming out” Positive life changes: marriage, childbearing,

religious encounter Negative life changes: health problems, social

or legal consequences of drug use, death of a friend

Self-help groups like AA◦ Twelve Steps◦ Peer identification and support◦ Sober social relationships

Residential treatment◦ Hospitalization◦ The therapeutic community

Milieu therapy◦ Short-term residential programs◦ Faith-based programs

Salvation Army Teen Challenge

Medication-assists◦ Antagonist blockade◦ Treat contributing conditions◦ Substitution◦ Antabuse◦ Craving reduction

Ibogaine

Outpatient drug-free programs

Provide substances, paraphernalia and injection rooms in ways that reduce crime and disease transmission

Meet other needs of addicts◦ Health care and nutrition◦ Social support◦ Employment or volunteer activities

Risk of relapse is reduced by◦ Frequent review of the decision◦ Avoiding drug-related cues by moving and

dumping drug-using friends◦ Social connections with non-users◦ Getting a job◦ Learning substitute activities◦ Developing structure for life