Self-Management Strategies for substance abuse

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Self-management Strategies

  • Allow the person to take more responsitbility and control over their treatment and recovery
  • Normally involve cognitive, behavioural and humanistic approaches and are commonly used in the UK by many services, including GPs and Drug and Alcohol Action Teams
  • Based on theoretical models of behaviour change with Procheska's stages of change model being a key one--> accepts that relapse may occur and that different stages may have to be repeated before permenant change is achieved.

Usually revolve around a self-help group made up of other people who abuse, or have abused the same substance and include the following activities:

  • Monitering the intake of the substance by keeping a written record
  • Awareness of the reasons for taking the substance and insight into the individual cause
  • Consequences of the substance abuse both for the individual and others

Self-management can be helped through community based programmes- all members of a community are offered a place to go for advice or how to stop taking a substance

Botvin: found binge drinking was 50% lower among teenagers who received a community based programme in NYC--> a helpful and effective method

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Twelve-step Programmes

  • Refer to self-help groups that provide support for substance abusers
  • The most well known is alcoholics anonymous (AA) which has two key principles: 1. People who abuse alcohol are alcoholics for life 2. Taking just one drink after a period of abstinence will cause a return to their origina; state, meaning even one drink must be avoided
  • Operated by the members themsleves, professional help and advice is not available
  • Follows the disease model of addiction- believed that certain people have a biological predisposition to their addiction, which they believe leads to loss of control and a progressive illness that is both irreversible and incurable--> total abstinence is therefore required to be successful
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Twelve-step Programmes Evaluation

  • The disease model is criticised by Miller (1996) who found that the model often leads to a self-fulfilling prophecy, and by doing so significantly increases the risk of relapse--> being told that your condition is due to a disease or genetic influences could make you feel less personally resposible for their condition and as result have low feelings of self efficacy

Marlett and Gordon (1985)- developed the treatment relapse prevention, another self management strategy

  • Addict is not regarded as ill but instead taught that the process of change is their responsibility
  • Rather than relapse being ignored as so not to bring attention to it, individuals are taught to view relapse as a simple mistake that can be learnt from
  • Evaluation- could be argued that this approach would not be effective with all addicts, particularly chronic alcoholics where total abstinence is the only option and so in these circumstances the twelve step programme would be more suitable
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Therapeutic Techniques

Cognitive Behavioural Therapy

  • Often used in combination with self-management strategies
  • A psychotherapy that concentrates on the individual's thoughts, beliefs and attitudes towards their habit
  • Irrational or inaccurate beliefs are challenged and strategies put in place to help the person have the mental strength to abstain from taking the substance, stay off it and, importantly, how to cope with relapse
  • Strategies include: 1.Keeping a written record, 2.Becoming aware of the negative consequences of drug taking for themselves and others, 3.learning how to resist temptation, 3.Learning what to do in the case of relapse
  • Research has shown up to 70% improvement in problem drinkers HOWEVER alcoholics who are physically dependent on alcohol do less well with this treatment--> total abstinence may be the only technique of treatment 
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Therapeutic Techniques

Contingency Contracting

  • The therapist and client draw up a contract about goals for behaviour and substance use for the coming week
  • Progress is reviewed in the next session
  • Token punishments or rewards may be applied
  • E.g. Cutting down on cigarette intake by a certain amount each day with the reward being the return of an amount of money that equals the cost that would have been spent on the cigarettes

Motivational Interviews

  • The client must have the motivation to change
  • The interviews use Procheska's model and the health benefit model
  • A specialist GP and the client discuss the client's goals, their plans to achieve these and the support they will have
  • The client gives a progress report to the GP at a later date and the process can continue, perhaps setting more challenging goals
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Hser et al

  • Aim: To investigate the effectiveness of different therapies in reducing problem drug use in the USA
  • Method: 1,167 adolescents from 4 centres were studies before treatment and one year after. Treatment involves individual/group counselling, 12 step programmes, family therapy and skills training
  • Results: Weekly marajuana use reduced from 80% to 44%, the number of participants with average or better school grades went up from 53% to 80% and the number of illegal acts went down from 76% to 53%. Participants reported higher self esteem and fewer thoughts of suicide. Cocain and hallucinogen use showed little change
  • Conclusion: A variety of treatment styles are effective in reducing adolescent drug use and crime in improving eductional achievement
  • Evaluation: Adolescence is a period during which drug use may be expected  to increase so this research indicates the value of treatments targeted at this age range. The research doesn't show if one treatment is more effective than another as the study doesn't identify between the different treatments. Whilst a multi-modal approach has been found to be the most effective in treating substance abusers, further reasearch is required to identify which specific therapies are the most useful when treating certain patients
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Evaluation

  • Agreement that all the treatments individually lead to reductions in the use of problem drugs
  • Combinations of treatments, a 'multi-modal' approach can be particularly successful
  • Effectiveness is reported to be at its highest when based on a structured approach and combined with other treatments e.g. CBT. This provides both social and emotional support from a self-help group and evidence based therapy from a trained psychologist
  • One issue is that it is difficult to identify exactly why a person has changed their behaviour e.g. the specific treatment, the setting treatment took place in, the quality of care, support or the interest shown by the professional
  • The effectiveness of self-management approaches is difficult to measure scientifically as many groups do not keep the appropriate records or don't disclose who attends the meetings (Alcoholics Anonymous)
  • Hard to measure the effectiveness of treatments when different substances are being abused and individuals have differing levels of addiction and have been addicted to the substance for varying lengths of time, difficult to make comparisons--> A Treatment Outcome Profile (TOP) tackles this issue, looks at the level of drug, education, employment and housing situation, resulting in a broader measure of succes
  • 1/3 relapse at some point often because in the outside world they will come into contact with stimuli and current abusers--> programmes use role play to help people say no and cope with triggers, reducing the level of relapse
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