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Substance Use Disorder, Intentional Self-Harm, Gun Violence, and HIV/AIDS
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Depending on the methodology used in recovery (e.g. harm reduction, moderation [reduce use], abstinence [eliminate use]), and the acuity and severity of the addiction disease, multiple phases or steps are required in the process. Early recovery generally includes acute detoxification, which may involve brief inpatient medical care for monitoring and management of acute symptoms, and involves the initiation of MAT to combat the cravings for the addicted substance. Following the acute phase, many individuals will progress to 30, 60, or 90-day residential or community-based outpatient programs. Long-term recovery typically includes some form of intensive outpatient care for ongoing peer support, counseling, and medical management for several months to years. Methods for clinicians to address mental health and wellness, and improve resiliency and self-efficacy, include motivational interviewing, cognitive behavioral therapy (CBT), and trauma-informed care. Treatment methods designed to harness individual motivation include motivational enhancement therapy and contingency management. Psychotherapeutic treatment methods include dialectical behavioral therapy, family focused therapy, and 12-step programs.
Alcohol Use Disorders: Diagnosis and Treatment
Published in James M. Rippe, Lifestyle Medicine, 2019
Chwen-Yuen Angie, Sara C. Slatkin
We would like to highlight the results of Project MATCH, which was a five-site study sponsored by the NIAAA; its objective was to determine patient characteristics associated with more successful outcomes with respect to specific behavioral treatments. Three types of treatments were included: cognitive behavioral therapy, motivational enhancement therapy, and 12-step facilitation therapy. At the one- and three-year follow-up, a consistent pattern emerged: patients with high levels of anger had better outcomes in motivational enhancement therapy than in the other two treatment modalities. Patients with low anger did better in 12-step facilitation and cognitive behavioral therapy. Additionally, patients with social networks that tend to drink were more likely to have improved outcomes in 12-step facilitation. Overall, though, the conclusion at the one- and three-year follow-up was that no one treatment modality was superior.46
The Role of the Practice Counsellor in Substance Misuse Treatments
Published in Rosie Winyard, Andrew McBride, Substance Misuse in Primary Care, 2018
The four main approaches considered are as follow: motivational enhancement therapysolution focused therapytwelve step facilitationcommunity reinforcement approach.
New approved and emerging pharmacological approaches to alcohol use disorder: a review of clinical studies
Published in Expert Opinion on Pharmacotherapy, 2021
Kirsten C Morley, Christina J Perry, Joshua Watt, Tristan Hurzeler, Lorenzo Leggio, Andrew J Lawrence, Paul Haber
Another group investigated ketamine during a 5 week regimen of motivational enhancement therapy (MET). They conducted a randomized controlled study of ketamine (52-minute intravenous administration of 0.71 mg/kg) or active control midazolam, to reduce alcohol consumption 21 days later [82]. Medication was provided during the second week of MET. The authors found that ketamine significantly increased the likelihood of abstinence, delayed the time to relapse, and reduced the likelihood of heavy drinking days compared with midazolam. These results are promising and mirror the evolving role for ketamine in treatment of depression [83] and the potential use for comorbid AUD with depression. Principles for safe and ethical treatment are evolving [84] but given potential risks associated with intravenous ketamine at higher doses in a substance using population, the feasibility of intravenous administration and lack of double-blind design of the studies, a cautionary approach at this point is necessary.
Confirming Savoring’s Link to Fewer Cannabis Problems
Published in Journal of Psychoactive Drugs, 2021
Maha N. Mian, Brianna R. Altman, Luna F. Ueno, Mitch Earleywine
While clinical trials for pharmacotherapeutic options are currently underway, no medication is proven to decrease withdrawal symptoms (Copeland and Pokorski 2016). Consequently, clinicians primarily rely on psychotherapy to treat cannabis use disorder. Interventions include motivational enhancement therapy, cognitive behavioral therapy, contingency management, and supportive therapy (Copeland, Clement, and Swift 2014). These treatments exhibit modest success at reducing cannabis use, increasing motivation to change use, and disrupting patterns of use, particularly when used together. Despite the moderate success of such treatments, many individuals have difficulty engaging in treatment and maintaining abstinence (Babor et al., 2004; Budney et al. 2006, 2015; Kadden et al. 2007; Sherman and McRae-Clark 2017).
“God put weed here for us to smoke”: A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders
Published in Substance Abuse, 2018
Julie D. Yeterian, Krisanne Bursik, John F. Kelly
RAYS was a 2-stage treatment development study. All procedures in the present study were conducted in compliance with the Partners Human Research Committee and the Suffolk University Institutional Review Board. In order to participate in the study, participants under age 18 needed to have a parent/guardian who was willing to consent to their participation; these participants separately gave their assent to take part. Participants over age 18 provided their consent to participate in the study. In both cases, study staff thoroughly discussed study procedures, risks, and benefits with potential participants in order to inform their decision about whether to participate. In Stage 1a (2011–2012; n = 42), a new Twelve-Step Facilitation (TSF) treatment manual was developed.43 Participants in this stage received TSF, except for 6 participants who dropped out before receiving treatment. In Stage 1b (2013–2015; n = 59), the randomized pilot study, TSF was tested against motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT).44 Thirty participants were randomized to MET/CBT and 29 to TSF. Two participants in each condition dropped out before receiving treatment. Treatment for all participants consisted of 2 individual and 8 group sessions. In the parent study,45 abstinence from substance use increased equally in both conditions during and following treatment. Participants completed baseline and 2 posttreatment assessments (i.e., 3- and 6-month follow-ups*). Qualitative interviews were completed at the final follow-up (6-month for Stage 1a, 9-month for Stage 1b).