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Psychological interventions in addictive disorders
MRCPsych addiction psychiatry seminar
March 2010
General treatment principles
Addiction is probably best viewed as primarily a psychological (learnt) problem
• Medication is an adjunct to psychosocial treatment• Treatment is a co-operative venture• Medication is useless without some readiness to
change• Treatment requires careful preparation and
aftercare
Treatment aims
• Change substance using behaviour
• Address co-existing mental health disorders:– Anxiety– Depression– PTSD– Childhood sexual abuse
Elements of intervention
• Building motivation
• Cognitive restructuring
• Developing coping skills
Types of psychological intervention
• Psychotherapy
• Drug counselling, including motivational interviewing
• CBT approaches, including contigency management
• Therapeutic communities
• Self-help groups
Mesa Grande top 10 alcohol interventions
• Brief intervention• Motivational
enhancement• Acamprosate• Opiate antagonists• Social skills training
• Community reinforcement
• Behaviour contracting• Behavioural marital
therapy• Case management• Self-monitoring
Review of the effectiveness of treatment for alcohol problems, 2006
• Most people move in and out of problem drinking without treatment
• ‘How’ as much as ‘what’• A range of effective treatments available- from brief
interventions to intensive treatments• Psychiatric co-morbidity common and challenging
to treat• Treatment is cost effective• Therapist need training
Scottish HTA report relapse prevention in alcohol dependence
Effective interventions:
• Behavioural self-control training
• Motivational enhancement therapy
• Marital/family therapy
• Coping social skills training
Scottish HTA report
OR 95% CI
BSCT 1.75 1.02-3.02
MET 1.88 1.28-2.77
M/FT 1.94 1.37-2.73
CCST 2.11 1.53-2.92
Brief interventions
• Reduction vs abstinence
• Delivered by non-specialist
• Non-dependent drinkers
• Addresses motivation to change
• Self –directed
• FRAMES ingredients
‘FRAMES’
• Feedback of risk
• Encouraging responsibility for change
• Advice
• Menu of alternative options
• Empathy
• Enhancing self-efficacy
Motivational interviewing
‘ready, willing and able’
Ready: a matter of priorityWilling: the importance of changeAble: confidence for change
‘yes, but…..’
Ambivalence
Motivational interviewing
• Reflective listening
• Pros/cons of change
• Confidence building
• Feedback
• Self-motivational statements
• Rolling with resistance
NICE guideline 51 Drug misuse: psychosocial
interventions
• Opportunistic brief interventions focussed on motivation should be offered
• Staff should provide information about self-help groups
• Contingency management programmes should be introduced