Transcription
Hi everyone. In this ETH video, we discuss how to assess and treat addictions. To complement the previous module, the treatment of addiction is complex and requires a thorough understanding of the patient's state.
In the first phase of evaluation, we look at the patient's history, reviewing the patient's addictology history, the patient's reasons for wanting to put an end to their addiction, the patient's plans and ambitions at the end of their treatment, and the patient's physical and psychological state. Then come the neuropsychological and psychometric assessments: evaluation of episodic memory, evaluation of visual constructional abilities, evaluation of working memory, evaluation of faculty of attention, evaluation of executive functions, analysis of the patient's medical file.
Certain evaluation tests complete the dialogue between the professional and the patient. We've listed a few of them here, and you'll find others in your course material:
The AUDIT questionnaire (Alcohol Use Disorders Identification Test). This simple test was developed by the World Health Organization. It is used to diagnose the risks of alcohol addiction.
The LRU and LRUON test. This test analyzes smokers' motivation to put an end to their addiction.
The D20 questionnaire (Drug Abuse Screening Test in 20 Questions). Developed by the Addiction Research Foundation, the test highlights the level of drug use severity and can be adapted to all psychoactive substances except tobacco and alcohol.
The IAT test (Internet Addiction Test). This 20-question test highlights the degree of cyber addiction. It concerns all forms of addiction related to the internet.
The EAT-26 test (Eating Attitudes Test). This assesses the patient's relationship with food and helps detect problematic behaviors relating to food and/or eating.
Once the evaluation is complete, it is time for treatment. This is established according to the patient's personality and the type of addiction. Indeed, the therapeutic approach will be different depending on whether the addiction relates to a psychoactive substance or a behavior. Treatments generally involve a drug treatment to cope with withdrawal, psychological treatment so that the patient becomes aware of the reasons that led them to the addiction, and motivational strategies to encourage the patient to change their addictive behavior and avoid relapse.
The patient will also have to undergo a complete medical checkup. It should be noted that while medication can help put an end to addictive behavior, its effect is not immediate and not enough. The patient also needs psychological support. In addition, abstinence is no longer a prerequisite for treatment; it is a consequence. The patient and their family must receive training, especially if the withdrawal phase takes place at home. The patient should understand their condition, treatment, medication, side effects, and withdrawal symptoms. During this delicate phase, the patient might experience heart palpitations, dizziness, nausea, and feelings of anxiety. Medication aims to eliminate these symptoms, thereby strengthening resistance to temptations and helping to avoid a relapse.
Let's see what medications are used for addiction. They are divided into three main categories:
Withdrawal medications. Their goal is to reduce or eliminate all withdrawal symptoms. For alcohol: benzodiazepines, neuroleptics, anti-convulsants, and beta-blockers. For opiates: clonidine, analgesics, anti-diarrheal, anti-spasmodic, and sedatives. For tobacco: the anti-depressant bupropion and varenicline.
Substitution drugs. They help to stop the use of psychoactive substances; however, they do not address the addictive behavior itself. For alcohol: naltrexone. For opiates: methadone and buprenorphine. For tobacco: nicotine substitutes such as chewing gum, patches, and inhalers.
Addictotic drugs. They are designed to modify the addictive behavior, either to maintain abstinence or reduce the risk of loss of control. For alcohol: naltrexone, acamprosate, and disulfiram. For opiates: methadone and buprenorphine.
Food supplements, such as vitamins B1 and PP (a form of vitamin B3), are sometimes also given to address deficiencies.
We mentioned substitution treatments. These are used for patients who are addicted to opiates or tobacco. They help the patient stop the use of the psychoactive substance but not to suspend the addictive behavior per se. This type of treatment can be long and gradual but offers an additional benefit to opiate users: a clean, medicalized, and safe environment in which to obtain their fix without risking physical and/or sexual assault or having to commit a crime such as theft.
In terms of psychological support, there are three main approaches:
Individual therapy in the form of one-to-one sessions, and perfect for shy patients.
Family therapy, if the family is the source of the addiction or when the family wishes to support the patient.
Group therapy, a protective and benevolent environment where everyone is free to express themselves.
Psychology professors Miller and Rollnick established the theory of motivational interviewing. The addict is torn between the need to put an end to their addiction and return to a normal existence with its advantages but also its problems, and the desire to maintain their destructive behaviors and the pleasure/comfort they bring. For treatment to be successful, the patient must be aware of the benefits of abstinence. This is called motivational processing, which is broken down into five main phases:
Precontemplation, when the patient is unaware or under-aware of the problem and has no intention of changing their behavior.
Contemplation, during which the patient wants to make changes but does not have the necessary psychological resources.
Preparation, also known as the determination stage, during which the patient is preparing to make changes.
Action, during which the patient takes action to make changes and comply with the treatment despite difficulties.
Maintenance, at which point the patient has overcome their addiction.
As you can see, patient motivation is essential to success. In our next video, we will therefore study the components of motivation.