藥物濫用Drug Abuse Prevention and Treatment

賴滄海 教授01-11-2008

Learning Objectives

Learn the 10 most prominent factors influencing drug use

List the 5 types of drug users Learn the 4 levels of drug abuse prevention

program Learn the 4 prevention program found in higher

education Learn the alternatives to drug use

Treatment

Principles that characterize effective drug treatment

Advantages and disadvantages of several strategies to treat addiction

Pharmacological strategies to treat addiction

Factors affecting an individual’s use of drugs

Individual Influences Genetics personality traits Attitudes and beliefs Interpersonal and peer resistance skills

Factors affecting an individual’s use of drugs

Interpersonal and societal influences Parents, peers Community, School policy personal situation

Factors affecting an individual’s use of drugs

Environmental influences Cost of alcohol and other drugs Marketing of alcohol Federal laws concerning alcohol and illegal drugs Minimum purchase age for alcohol Portrayal of alcohol, tobacco, and other drugs on

TV and in movies

Major types of drug users

Early experimenters Non problem drug users Non detected, committed, or secret

users Problem users Former users

Primary drug prevention programs

The very broad range of activities aimed at reducing the risk of drug among nonusers and assuring continued nonuse

Secondary drug prevention programs

Targeting at-risk groups, experimenters, and early-abuse populations to reverse the progression of abusive behaviors, similar to “early intervention”

Tertiary drug prevention program

Intervention at an advanced state of drug abuse; basically the same as drug abuse treatment

Primary Prevention (Risk reduction before abuse) 1.Intra personal factors Affective education Resilience training Value clarification Personal and social skill development Assertiveness skills training Refusal skills Drug information and education

Primary Prevention (Risk reduction before abuse)

2. Small Group factors peer mentoring, counseling, outreach, modeling conflict resolution curriculum infusion activities demonstrating misperception of peer norms

alternatives to drug use: recreational, cultural, athletic,

strengthening families

Primary Prevention (Risk reduction before abuse)

3. System Level Strengthening school-family links Strengthening school-community group

links Strengthening community support systems Media advocacy efforts, reducing alcohol Marketing

Secondary prevention Assesment strategies: identification of abuse s

ubgroups Early intervention coupled with sanctions Teacher-counselor-parent team approach Developing healthy alternative youth culture Recovering role models

Tertiary prevention

Assesment and diagnoss Referral into treatment Case management Reentry

Comprehensive prevention programs for drug use and abuse

Harm reduction model Community-based drug prevention School-based drug prevention Family-based prevention

Summary of common school-based Drug Prevention Approaches

Approach Cognitive Premise If youths understand the dangers of

AOD,they will not use them

Strategies Teach pharmacology of AOD, how

they are used, long-range onsequences

of use -usually through scare tactics

Summary of common school-based Drug Prevention Approaches

Approach Affective Premise High self-esteem, values consistent with nonuse, good problem-solving and decision-making skills help youth avoid AOD Strategies Raise self-esteem, teach values and life

skills Typically do not include AOD information

Summary of common school-based Drug Prevention Approaches

Approach Combined cognitive and affective Premise Student need both information and life

skill to avoid AOD Strategies Teach problem-solving, decision-

making peer pressure resistance skills;

provide information about AOD to

connect life skill and AOD use and

consequences.

Summary of common school-based Drug Prevention Approaches

Approach Social learning/cognitive-behavioral approach

Premise AOD use begins with peers, youth need skills for resisting peer pressures.

Strategies Teach how to identify pressure from peers media, advertising, families. Teach resistance skills model counterarguments

Summary of common school-based Drug Prevention Approaches

Approach Normative education approach Premise youth overestimate the extent of AOD

use among peers and thus may use

AOD to feel part of the group Strategies correct misconceptions demonstrate

actual norms through discussion,

develop nonuse norms

Drug Prevention Programs in Higher Education

Information-Only or Awareness model Attitude change model or Affective

Education model Social Influence model Person-in- Environment Model

DARE

Drug Abuse Resistance Education Drug Courts Meditation

Treatment of Addiction

Addicted person come from different walks of life

Severity of addictions varies widely There are many types of addictive

drugs Abuse of multi drug is common

Goal of Treatment

Total abstinence (Disease model) Responsible drug use

Measures of effectiveness

Family functioning-employability Criminal behavior and medical con

dition

NIDA’S principles to achieve effective treatment

1.No single treatment is appropriate for all individuals

2.Treatment needs to be readily available

3.Effective treatment attends to multiple needs of the individual

4.Treatment and service plan must be assessed and modified as necessary

NIDA’S principles to achieve effective treatment

5. Remaining in treatment for an adequate period of time

6. Counseling and other behavioral therapies are critical components of treatment plan

7. Medications are important element of treatment

8. Addicted individuals with coexisting mental disorders should have both disorders treated in an integrated way

NIDA’S principles to achieve effective treatment

9. Medical detoxification is only the first stage of addiction treatment

10.Treatment does not need to be voluntary

11. Possible drug use during treatment must be monitored continuously

12. Treatment programs should provide assessment for infectious diseases

13. Recovery can be a long-term process and frequently requires multiple episodes of treatment

Drug Addiction Treatment Historical Approaches AA, Rehabilitation Facilities General Therapeutic Strategies 1. medical detoxification 2. Outpatient Drug-Free Treatment 3. Short-Term Residential programs 4. Long-Term Residential Programs 5. Treating Criminal Justice-Involved Drug Abusers and Addicts

Specific Therapeutic Strategies

Relapse Prevention The Matrix Model Supportive-Expressive Psychotherapy Individualized Drug Counseling Motivation Enhancement Therapy Community Reinforcement Approach

plus Vouchers

Pharmacological Strategies

Opioid Agonist maintenance therapy Nicotine Replacement : Therapy Antagonist Therapy Naltrexone, cycla

zpcine, nalocone Other pharmacological Therapies clonidine-to treat opiate withdrawl disulfiram-to treat alcoholics