1. ADDICTION TREATMENT MODELSBYDR. SHERIF DARWISHPSYCHIATRIST & ADDICTION THERAPIST

2. Thinking about addiction We need when we think about treatment to bethiknking of the etiology of addiction and to have adeep understanding of them 3. Product, pharmacology, prohibitionHisotry,culture ,politics Disease modelAddiction scheme Indvidual,personality, Environment, context,psychiatric comorbiditysocial acceptanceIntegrationproblem 4. 4 5. Not only the predisposing and the pricipitatingfactors, but also the neurobilogy of addiction 6. Neuroscience Drug Addiction Habitual Complusive model:Everitt and Robins. Switch from initial reward to compulsive use Switch from the Ventral striatum to Dorsal striatumfunction. 7. Neuroscience Drug Addiction Incentive Sensitisation Model:Robinson and Berridge. Increased wanting vs liking Increased salience of drug related stimuli. 8. Neuroscience Drug Addiction Aberrant Allostasis Model:Koob and Le Moal. Dysregulation of brain reward system Ability to reset set point in adversity. 9. Public expectations of substance abuseinterventions Safe, complete detoxification. Reduce use of medical services. Eliminate crime Return or start employment Eliminate family disruption No relapse. 10. Components of ComprehensiveDrug Addiction Treatmentwww.drugabuse.gov 11. This brings us to think about treatment Pharmacotherapy not only for withdrawalsymptoms but also for maintainance Maintaince treatment as methadone ,brupeonorphine or naltrexone. Or maintainece treament for dual diagnosis oraccompanying symptoms 12. Are we going to treat the patient in an inpatientfacility or an out patient clinic. Practice versus science???!!! 13. The treatment systems 14. Criteria for long term inpatienttreatmentThe following criteria can help identifyclients who could benefit from longer termtreatment:Failure of previous shorter treatmentMultiple concurrent problemsSevere substance abuse (i.e., dependence) 15. Acute psychosesAcute intoxicationAcute withdrawalCognitive inability to focusLong-term history of relapseMany unsuccessful treatment episodesLow level of social supportSerious consequences related to relapse 16. Director reports of services providedby their facility Group counseling100%Indvidual counseling 85% Case management 77%Addiction medications48% Psychiatric medications 37% 17. Patients reporting of services providedby their facilityGroup counseling100% Indvidual counseling 45%Case management 9%Addiction medications 6%Psychiatric medications 0% 18. Out Patient Treatment Models 19. EVIDENCE BASED THERAPIES )EBTS(THAT ARE INCORPORATED IN THE MATRIX MODEL Matrix Institute 2006 20. Matrix Groups Psycho-educational Groups Stabilization Groups Relapse Prevention Groups Social Support Groups 21. Motivantion enhacementSTAGES OF CHANGE:Prochaska &DiClemente Relapse orreoccurrencecan happen at any stageMatrix Institute 2006 22. Outpatient Recovery Issues RELAPSE FACTORS 23. Outpatient Recovery Issues Relapse Factors - Time Periods Unstructured timeTransition periodsProtracted abstinenceHolidaysChronic stress, fatigue, or boredomAnniversary datesPeriods of emotional turmoil 24. Outpatient Recovery Issues Relapse Factors - Addict ThinkingParanoiaRelapse justifications:Im not an addict anymoreIm testing myselfI need to workOther drugs/alcohol are OKCatastrophic eventsNegative emotional states 25. Outpatient Recovery IssuesRelapse Factors - Relationships Drug-using friends Addict must deal with familys:Extreme anger and blamingUnwillingness to change/trustHypervigilance - excessive monitoringSexual anxietiesAdjustment to non-victim statusConflict with recovery activities 26. Outpatient Recovery IssuesRelapse Factors - Addict BehaviorLying/stealingHaving extramarital/illicit sexUsing secondary substancesReturning to bars/drug friendsBeing unreliable/irresponsibleBehavingcompulsively/impulsivelyIsolating 27. Medication assisted models versusno medication models??!! 28. Special techinques 29. Integrated group therapy A new treatment developed for patients withsubstance use and mood disorders. It appears to bea promising approach for this population 30. Contingency management Contingency management is an evidenced-basedbehavioral program that uses positivereinforcement, or rewards, to promote behaviorchange 31. Designing a CM intervention Selecting a behavior to reinforce Choosing a reinforce )vouchers or prizes( Determining monitoring schedules Integrating behavioral principles 32. Selecting a behavior to reinforce Abstinence Attendance Medication adherence Compliance with goal related activities 33. behavioral principles Objectively quantifying behaviors. Priming. Frequency. Immediacy. Magnitude. Escalating. Consistency. 34. What population respond to CM Probably everyone; No income effect. No race effect. Effective in dual diagnosis. Can promote retention of those with priorpreadmissions. 35. Family education and familytherapy 36. Occupational support 37. conclusions We need to consider the psychopathology andneurobiology of addiction when thinking ofdesigning treatment models. In order to meet the patient and publicexpectations we need to make a lot of efforts andcover different dimensions. 38. conclusions Treatment success is not limited to inpatientprograms)that themselves are not very perfect(. Special treatment methods and multidisciplinaryteams are a very good key for success. What are the barriers of research in Mammourahospital??