This web page was produced as an assignment for an undergraduate course at Davidson College.

 

Other Substance Abuse Problems

 

Similar to alcohol abuse treatments, many of the substance abuse treatments focus on increasing abstinence rates and decreasing relapse rates.  Many different methods, from drug treatments to therapeutic treatments, have been used to obtain these goals.

 

                                                                                                                                                                                                                       

Drug Treatments

Most substance abuse treatments are aimed at the actions of the specific drug abused, not to the general addictive process. Some of the specific drug treatments are as follows (information from Bisaga  & Popik, 2000):

Though many of these treatments help in alleviating symptoms for only one type of drug abuse, some scientists, such as Bisaga  & Popik, feel as though general treatments should be created that could “cure” more than one substance abuse problem.  In 2000, Bisaga and Popik examine the NMDA receptor as a possible target for substance abuse treatment.  Examples of NMDA receptors are found below:

 

Destromethorphan

Dextromethorphan (DXM) is a dextrorotatory opioid that acts as an NMDA antagonist (Bisaga  & Popik, 2000).  This medication has been proven to be so safe and effective that it is an over-the-counter medication.  In 1991 and again in 1995, Koyuncuoglu (Biosaga & Popik, 2000)found that DXM was successful in treating opiate abusers.  They found that similar results were observed when DXM was used alone, with chlorpromazine or with tizanidine. 

Bisaga et al, in 1997 found similar results.  He tested six patients diagnosed with opioid addictions.  Two persons dropped out of the study due to physical discomfort, but the remaining four showed signs of remarkable improvements.  For these four, destromethorphan showed minimal side effects, and caused a decrease of withdrawal symptoms.

Despite these positive finds, others, such as Rosen et al (1996) found that there was no correlation between dextromethorphan and a decrease in withdrawal symptoms. Thus, the findings have been inconclusive, though this drug does hold some promise.

 

Amantadine

These drugs are NMDA receptor antagonists and have been used in the treatment of Parkinson’s disease and dementia.  In 1992, Thompson  (Bisaga & Popik, 2000)  found that amantadine was effective in controlling a patient’s use of cocaine.  In addition, Thompson found that this drug helped to alleviate withdrawal symptoms.  On the other hand, in 1992, Kolar et al  (Bisaga & Popik, 2000), found that treatment with amantadine did not produce significantly better results than a placebo. 

Other NMDA receptors cited by Bisaga  & Popik (2000) were Memantine, Ibogaine, Cycloserine, and Iamotrigine.  They are not discussed in detail in this summary because there have been few studies regarding their effectiveness to treat substance abuse disorders.

Thus NMDA antagonists hold some promise in the treatments of substance abuse problems, though more studies need to be completed before conclusions can be drawn.

                                                                                                                                                                       

 

Therapuetic Treatments:

Although some drug regimes have shown positive effects in the treatment of substance abuse disorders, there are many therapuetic treatments that also offer promising results.

 

Tobacco:

In 1984, Killen et al, analyzed the percent abstinence in three different conditions:

  1.  Prevention Skills Training Program
  2. Skills Training Program and Nicotine gum
  3. Only nicotine gum

They found that the abstinence rates in treatment two (86%) was not significantly different from treatment 3 (64%), though was significantly higher than the treatment number one (55%).  The combined treatment continued to have the highest abstinence rates after the study, at the 15 week and 10.5 month follow-up. 

 

Then, in 1989, Stevens and Hollis (Carroll, 1996)  tested for abstinence rates in a different set of three conditions:

  1. Relapse Prevention Skills Training
  2. Discussion Control
  3. No-Treatment Control

After three weeks, this study found that treatment one produced significantly higher rates of abstinence than the other two treatments.

 

In 1992, Zelman et al (Carroll, 1996), tested abstinence rates in a 2x2 study, patients were in one of two counseling groups:

  1. Coping Skills Counseling
  2. Supportive Counseling

The coping skills counseling was associated with significantly higher rates of abstinence (98%) when compared to treatment 2 (88%). 

 

Thus, many studies have found that skills training programs are associated with higher abstinence rates.  Perhaps a greater focus should be placed on these programs when treating substance abuse patients. 

 

Cocaine

In 1991, Carroll et al (Carroll, 1996), evaluated abstinence rates in relapse prevention programs versus interpersonal psychotherapy (IPT).   They assigned 42 outpatient cocaine abusers to one of the two treatments.  Although no significant results were shown when analyzing the group as a whole, it was determined that the more severe cocaine users needed at least three weeks of continued abstinence, as opposed to the high severity patients that received IPT.  In other words, patients that were considered “more severe” showed better results when they were treated with the relapse prevention program.  Thus, the relapse program proved to be more effective in treating severe cocaine addicts. 

                                                                                                                                                                                                                                 

Overall

Both drug treatments and therapeutic treatments have shown to be effective in lowering relapse rates, and increasing abstinence rates, though there are a few factors that influence the outcome of any treatment 

The most important factor is the social support of the patient.  In 1999, Humphreys et al found that enhanced friendship networks and increased active coping responses led to more positive results in patients.  They studied a group of 2,337 substance abuse patients and surveyed them on general friendship quality, friends’ support for abstinence, involvement in support groups (AA, CA, or NA), and active coping responses (measured by the Coping Responses Inventory, CRI).   Through this analysis, it was found that group therapy, and friends that support recovery greatly increased abstinence rates. 

This idea is supported in Turner’s article (1998) regarding Expressed Emotion (EE).  EE is a “score derived from ratings made by a clinician based on a semistructured interview.”  High EE ratings have been associated with criticism from a family member, or from another person close to the patient  Thus, high EE ratings serve as a good predictor of relapse.  This again illustrates the idea that a social support system is critical when treating a substance abuser.

 

 

*** Disclaimer: Though the information presented on this page was found solely in peer-reviewed journals, do not use this information as a treatment guide.  If you are looking for treatments for Substance abuse problems, please seek professional help. Thank you.  ***

                                                                                                                                                                                                                      

References

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