The Application of Evidence-Based Strategies in Substance Abuse Treatment

The Application of

Evidence-Based Strategies in

Substance Abuse Treatment

Richard A. Rawson, Ph.D.

Richard A. Rawson, Ph.D.

Matrix Institute on Addictions

Matrix Institute on Addictions

UCLA School of Medicine

UCLA School of Medicine

Los Angeles Addiction Research Consortium

Los Angeles Addiction Research Consortium

Des Moines, Iowa

Des Moines, Iowa

October 1998

Supported By

Supported By

NIDA Grants and Cooperative Agreements to Richard

NIDA Grants and Cooperative Agreements to Richard

Rawson, Walter Ling, Steven Shoptaw, Alice Huber,

Rawson, Walter Ling, Steven Shoptaw, Alice Huber,

Edyth London, and

Edyth London, and

M. Douglas Anglin

M. Douglas Anglin

and

and

CSAT KDA to M.D. Anglin and

CSAT KDA to M.D. Anglin and

Richard Rawson



 _{How do we reduce the damage from substance abuse How do we reduce the damage from substance abuse}

to individuals and society?

to individuals and society?



 What are the treatment strategies that help people _{What are the treatment strategies that help people}

reduce/stop their drug use?

reduce/stop their drug use?



 _{How do we best apply these treatment techniques How do we best apply these treatment techniques}

within the treatment system?

Does Treatment for

Does Treatment for

Substance Abuse Work?

Substance Abuse Work?

Does Treatment for

Does Treatment for

Cardiovascular Disease Work?

Cardiovascular Disease Work?

“

“

Treatments

Treatments

”

”

for

for

Cardiovascular Disease

Cardiovascular Disease



 _DietDiet 

 _{ExerciseExercise} 

 Reduced cigarette smoking_{Reduced cigarette smoking}



 Medications_Medications



 _{AngioplastyAngioplasty} 

 _{Bypass surgeryBypass surgery} 

Cardiovascular Disease

Cardiovascular Disease

L E V E L S O F S E V E R I T Y

A P P R O P R I A T E T R E A T M E N T S

H i g h c h o l e s t r e r o l O v e r w e i g h t

D i e t E x e r c i s e

S h o r t n e s s o f b r e a t h H i g h b l o o d p r e s s u r e

N o c i g a r e t t e s M e d i c a t i o n

A n g i n a

A r t e r i a l b l o c k a g e

A n g i o p l a s t y B y p a s s s u r g e r y

Levels of Problem Severity

Levels of Problem Severity

D rug experim entation Drug use

N o functional im pairm ent No crim inal involvem ent

D rug abuse

Functional im pairm ent

M inim al crim inal involvem ent D rug dependency

Substantial functional im pairm ent Som e crim inal involvem ent

Long term drug dependency and extensive involvem ent in crim inal justice system

Variations in Problem Severity

Variations in Problem Severity



 _{Not all drug experimentation results in regular drug Not all drug experimentation results in regular drug}

use

use



 Not all drug use results in drug abuse_{Not all drug use results in drug abuse}



 Not all drug abuse results in drug dependence_{Not all drug abuse results in drug dependence}



Involvement Involvement with with Drug Use Drug Use “

“SelfSelf--DirectedDirected Cessation

Cessation””

“

“NaturalNatural Recovery

Recovery””

No Further No Further Problem Problem Drug Use Drug Use Continued Continued Problem Problem Drug Use Drug Use No No Yes Yes

“

“

Self

Self

-

-

Directed Cessation

Directed Cessation

”

”

or

or

“

“

Natural

Natural

Recovery

Recovery

”

”

Factors

Factors

 _{Recognition of health/legal/family hazardsRecognition of health/legal/family hazards} 

 _{Financial considerationsFinancial considerations} 

 _{Conflict with career goalsConflict with career goals} 

 Social mores and peer pressure_{Social mores and peer pressure}



 _{Reduced access/availability of drugsReduced access/availability of drugs} 

 _{Conflict with personal valuesConflict with personal values} 

Continuing Continuing Problem Problem Drug Use Drug Use BRIEF INTERVENTION BRIEF INTERVENTION Professional Professional Family Family Consequential Consequential No Further No Further Problem Problem Drug use Drug use Continued Continued Problem Problem Drug Use Drug Use Unsuccessful Unsuccessful Succe ssful Succe ssful

“

“

Brief Interventions

Brief Interventions

”

”

Professional

Professional



 Primary care physicians_{Primary care physicians}



 _{Mental health professionalsMental health professionals} 

 _{EAPEAP’’ss} 

 _ClergyClergy 

 _{Law enforcement personnelLaw enforcement personnel} 

“

“

Brief Interventions

Brief Interventions

”

”

Family

Family



“

“

Brief Intervention

Brief Intervention

”

”

Consequential

Consequential



 Accident_Accident



 _ArrestArrest 

 _{Job lossJob loss} 

 Relationship loss_{Relationship loss}



 Work place drug test_{Work place drug test}



 _{Negative drug experienceNegative drug experience} 

Measures to Promote Effective

Measures to Promote Effective

“

“

Brief

Brief

Interventions

Interventions

”

”

 _{Recognition of drug use and accurate information for Recognition of drug use and accurate information for}

family/professionals

family/professionals



 Open discussion of drug use risks/consequences_{Open discussion of drug use risks/consequences}



 Non confrontational presentation of concerns_{Non confrontational presentation of concerns}



 _{Positive, motivational stylePositive, motivational style} 

 _{Expression of care and compassionExpression of care and compassion} 

Continuing

Continuing

Problem

Problem

Drug Use

Drug Use

Treatment

Treatment

Consideration

Consideration

Point

Point

Treatment

Treatment

Inquiry

Inquiry

Continued

Continued

Problem

Problem

Drug Use

Drug Use No

No Yes Yes

Factors Affecting

Factors Affecting

Treatment Consideration

Treatment Consideration



 _{Recognition of drug use as a problemRecognition of drug use as a problem} 

 _{Medical/legal/financial problemsMedical/legal/financial problems} 

 Employer influence (EAP)_{Employer influence (EAP)}



 Family influence_{Family influence}



 _{Awareness of treatmentAwareness of treatment} 

Treatment

Treatment

Inquiry

Inquiry

Decision

Decision

to Enter

to Enter

Treatment

Treatment

Treatment

Treatment

Entry

Entry

Continued

Continued

Problem

Problem

Drug Use

Drug Use No

No Yes Yes

Factors Affecting

Factors Affecting

Treatment Entry

Treatment Entry



 Access to treatment (geographical, logistical, etc.)_{Access to treatment (geographical, logistical, etc.)}



 _{Resources for treatmentResources for treatment} 

 _{Responsiveness of treatment staffResponsiveness of treatment staff} 

 Relevance of treatment to treatment needs_{Relevance of treatment to treatment needs}



 “_“CongruenceCongruence” ” of treatmentof treatment



 _{Stigma of treatmentStigma of treatment} 

Treatment Treatment Entry Entry Adequate Adequate Treatment Treatment Participation?

Participation? _{TreatmentTreatment}

Participation Participation (W/Without (W/Without Reduced Reduced Drug Use Drug Use Continued Continued Problem Problem Drug Use Drug Use No No Yes Yes

Factors Affecting

Factors Affecting

Treatment Participation

Treatment Participation



 Access issues (time of day, transportation, child care, _{Access issues (time of day, transportation, child care,}

etc)

etc)



 _{Treatment environmentTreatment environment} 

 Treatment context_{Treatment context}



 Treatment content_{Treatment content}



 _{External pressureExternal pressure} 

 _{Participant need/treatment service matchParticipant need/treatment service match} 

Treatment

Treatment

Participation

Participation

Use of

Use of

Effective

Effective

Strategies

Strategies

Successful

Successful

Ongoing

Ongoing

Treatment

Treatment

Continued

Continued

Problem

Problem

Drug Use

Drug Use No

No Yes Yes

Effective Treatment Strategies

Effective Treatment Strategies



 Accurate information_{Accurate information}



 Contingency management techniques_{Contingency management techniques}



 _{CognitiveCognitive--Behavioral approachesBehavioral approaches} 

 _{MedicationsMedications} 

 Family participation_{Family participation}



 Drug and alcohol testing_{Drug and alcohol testing}



 _{SelfSelf--help supporthelp support} 

Treatment

Treatment

Participation

Participation

Is Treatment

Is Treatment

Completed?

Completed?

Successful

Successful

Treatment

Treatment

Episode

Episode

Continued

Continued

Problem

Problem

Drug Use

Drug Use No

No Yes Yes

Factors Affecting

Factors Affecting

Treatment Completion

Treatment Completion



 Explicit definition of treatment parameters_{Explicit definition of treatment parameters}



 _{Appropriate Appropriate ““dosedose” ” of treatmentof treatment} 

 _{Available continuing support systemAvailable continuing support system} 

 _{Family participationFamily participation} 

 _{Contingencies involving treatment completionContingencies involving treatment completion} 

Does Treatment for Cardiovascular

Does Treatment for Cardiovascular

Disease Work?

Disease Work?

One of the leading causes of mortality in the

One of the leading causes of mortality in the

United States is cardiovascular disease. In spite

United States is cardiovascular disease. In spite

of the vast investment of work and money into

of the vast investment of work and money into

research and treatment, people still die from

research and treatment, people still die from

cardiovascular disease.

Does Treatment for

Does Treatment for

Substance Abuse Work?

Substance Abuse Work?

The appropriate application of effective strategies

The appropriate application of effective strategies

for the treatment of substance abuse disorders

for the treatment of substance abuse disorders

results in extensive benefits to individuals and

results in extensive benefits to individuals and

society.