Dependence and Addiction Treatment
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Introduction
Evidence-based treatment of addictions draws on the current views that problematic use of substances is due to physiologic (ie genetic) psychologic, interpersonal, social, and other factors.
Social learning theory suggests cognitive, emotional, and environmental factors are at work.
Actively teaching people new skills to handle high-risk situations, a type of cognitive-behavioural therapy, focuses on thoughts, feelings, and choices which can change.
Many evidence-based behavioural approaches include:
- Skill development exercises, including role-plays, active rehearsal and repetitive practice
- Cognitive-behavioural relapse prevention training
- “High risk” identification training;
- Social skills training;
- Problem-solving skills training;
- Coping skills training (e.g., dealing with “cravings” and “urges”);
- Goal-setting;
- “Motivational Interviewing”/motivational enhancement techniques;
- Employment skills training;
- Behavioural marital counselling;
- Stress management training;
- Maintenance, “booster” sessions, monitoring and aftercare; and
- Community reinforcement and support services.
Services should also be tailored to specific populations and individuals.
Follow-up, by health care providers and with support groups, are a key component of successful living.
A full range of services should be provided to address health, social, vocational, employment and legal challenges. Interprofessional care needs to be coordinated in a seamless fashion, avoiding duplication and filling in gaps.
Obstacles to successful and long term treatment include housing, transportation to and from the treatment setting, scheduling conflicts with work or school, competing work and school priorities, lack of money, outstanding legal issues, lack of a support network, and a number of gender-specific issues for women such as the availability of child care, fear of loss of child custody, and anger/retaliation from spouse/partner.
Resources and References
The Canadian Centre on Substance Abuse has published a report on evidence-based care.
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