Substance Use Disorder Treatment

By Psych Central Staff

TREATMENT


Cocaine Abuse and Dependence


Medical Treatment

Basic Principles

The principles of cocaine rehabilitation are similar to treatment of alcoholism or sedativism. Detoxification is a prerequisite in the treatment of this disorder.

Antianxiety Drugs

Severe cocaine-induced agitation can be treated with diazepam (Valium) 5 to 10 mg every 3 hours IM or PO. Tachyarrhythmias can be treated with propranolol (Inderol) 10 to 20 mg PO every 4 hours.

Antidepressant Drugs

In preliminary tests, imipramine and desipramine attenuated cocaine euphoria and craving.

Lithium

Lithium has been reported to block cocaine euphoric effects, though recent evidence suggests lithium is effective only in bipolar or cyclothymic patients.

Other Drugs

Vitamin C (0.5 g PO every 6 hours) may increase urinary excretion by acidifying urine.

Methylphenidate has not been found to be useful in those cocaine abusers who do not have preexisting attention deficit disorder.

Hospitalization

Usually cocaine dependent patients are best treated as outpatients. Inpatient hospitalization may be needed for severe crash symptoms, suicide ideation, psychotic symptoms, or failure in outpatient treatment.


Psychosocial Treatment

Basic Principles

If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.

Life-style changes such as avoiding people, places, and things related to cocaine use should be encouraged.

Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of cocaine abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans.

Drug urine tests should be used to ensure compliance.

Treatment outcome is affected more by such factors as employment status, family support, and degree of antisocial features than by initial motivation for treatment.

Psychotherapy

It is likely that some heavy cocaine users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.

Psychotherapy is useful when it focuses on the reasons for the patient’s drug abuse. The drug abuse itself – past, present, and future consequences – must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.

The therapist must be watchful for return of cocaine-related activities, attitudes, friendships, and paraphernalia. Alcohol and other mood-altering drugs should be avoided, since they may disinhibit behavior and lead to relapse. Concurrent Axis I or II psychiatric disorders should be treated with attention to the interaction with cocaine disorder.

Treatment of clearly defined attention deficit disorder or bipolar or unipolar depression should proceed along with attention to the addiction.

Cocaine Anonymous

A new self-help group, Cocaine Anonymous, has started. It is patterned after Alcohol Anonymous and Narcotics Anonymous.


Cannabis Abuse and Dependence

Table of Contents


Medical Treatment

Basic Principles

Usually adverse effects of marijuana intoxication do not lead to professional attention. There is no adequately documented case of a fatality in a human being. Pure marijuana abuse rarely requires inpatient or pharmacological treatment, and detoxification is not necessary.

Since marijuana may be one of many drugs abused, total abstinence from all psychoactive substances should be the goal of therapy.

Periodic urine testing should be used to monitor abstinence.

Cannabinoids can be detected in the urine up to 21 days after abstinence in chronic abusers due to fat redistribution; however, one to five days is the normal urine positive period. Thus, beginning drug monitoring needs to be interpreted accordingly.

Antianxiety Drugs

Antianxiety drugs are occasionally needed to treat severe cannabis-induced anxiety or panic.

If the patient was using cannabis for anxiety reduction, an antianxiety drug should be considered as substitution therapy.

Antipsychotic Drugs

Antipsychotic drugs are occasionally needed to treat protracted, cannabis-induced psychosis.

Antidepressant Drugs

If the patient was using cannabis for alleviation of depression, an antidepressant should be considered as substitution therapy.


Psychosocial Treatment

Basic Principles

If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.

Life-style changes such as avoiding people, places, and things related to cannabis use should be encouraged.

Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of cannabis abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans.

Drug urine tests should be used to ensure compliance.

Educating patients about the amotivational syndrome and other complications of cannabis abuse may dissuade some from using cannabis. Often the patient does not realize the full extent of his amotivational syndrome until he stops using the drug and notices the improvement.

Psychotherapy

It is likely that some heavy cannabis users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.

Psychotherapy is useful when it focuses on the reasons for the patient’s drug abuse. The drug abuse itself – past, present, and future consequences – must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.

In the adolescent, cannabis dependence often hides poor self-esteem, depression, severe family problems, and learning disorders. These issues must be addressed in therapy. Generally, a nonjudgmental, honest, steady, and firm approach is needed with adolescence.

Behavior Therapy

Behavior therapy teaches the cannabis drug user other ways to reduce anxiety. Relaxation training, assertiveness training, self-control skills, and new strategies to master the environment are emphasized.

Symptoms


Reprinted from Internet Mental Health, Copyright © 1995 by Phillip W. Long, M.D.

 

 

APA Reference
Psych Central. (2014). Substance Use Disorder Treatment. Psych Central. Retrieved on July 28, 2014, from http://psychcentral.com/disorders/substance-use-disorder-symptoms/

Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
        or
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 2 Apr 2014
    Published on PsychCentral.com. All rights reserved.