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6 results

  • 16 - Treatment of Alcohol, Tobacco, and Other Drug (ATOD) Misuse

  • from Part IV - Prevention and Treatment
  • Edited by Steve Sussman, University of Southern California
  • Book:
    The Cambridge Handbook of Substance and Behavioral Addictions
    Published online:
    13 July 2020
    Print publication:
    06 August 2020, pp 215-229

  • Summary

    Approximately 23.5 million people in America need assistance for an alcohol, tobacco, or other drug use (ATOD) disorder, although many do not obtain the help that they need. This disorder is extremely difficult to resolve, as it can be hard to make the necessary lifestyle changes to accommodate sobriety. Sometimes, individuals may recover without formalized treatment, otherwise known as natural recovery. Other times, inpatient or outpatient treatment, or partial-hospitalization, is warranted. Even for individuals taking the proper steps and going to treatment, attrition rates are high, with consistent drop-out rates of 30 percent to 40 percent within three months of treatment initiation. Racial and gender disparities in both treatment participation and outcomes exist, indicating a need for tailoring of treatments and further research on breaking barriers to treatment entrance. Motivation is central in several recovery models proposed to explain stages of change in treatment. Treatment options include initial detoxification and pharmacological options (such as medication-assisted treatment using buprenorphine for opioid use disorder), cognitive-behavioral therapy, motivational interviewing, cue exposure, attentional retraining, twelve-step programs, and group/family therapy. Relapse rates are high, and oftentimes individuals move from one addiction to another. Harm reduction approaches may be beneficial to those that cannot fully quit an addiction, and relapse prevention is an important treatment component, as addiction is a life-long battle.

  • 8 - Post-traumatic stress disorder

  • Edited by Stefan Hofmann, Boston University, Mark Reinecke, Northwestern University, Illinois
  • Book:
    Cognitive-behavioral Therapy with Adults
    Published online:
    10 November 2010
    Print publication:
    28 October 2010, pp 107-120

  • Summary

    Bipolar disorder is characterized by the occurrence of one or more manic, hypomanic, or mixed episodes and is typified by periods of mood instability. Pharmacologic treatment of bipolar disorder is associated with significant problems of medication adherence. Cognitive-behavioral therapy is an effective and empirically supported psychosocial treatment for bipolar disorder. Key elements of the CBT intervention include psychoeducation, training in medication adherence, stress management, and cognitive restructuring. In addition to CBT, several other psychosocial treatments have been applied to bipolar disorder. Group treatment has been used for bipolar disorder as a potentially cost-effective method to prevent recurrence. High rates of comorbidity exist among patients with bipolar disorder. At the present time, the evidence for the efficacy of psychosocial interventions for bipolar disorder has never been stronger. The efficacy of psychosocial treatment on specific symptom areas, prominently including the role of anger and anxiety management, needs to be investigated.

  • 6 - Insomnias

  • from SECTION 2 - SLEEP DISORDERS
  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp 97-112

  • Summary

    Insomnia is amongst the most frequent complaints seen in medical practice, due to its high prevalence rate as a chronic medical condition and its high incidence as an acute condition. This chapter provides an overview of the development of insomnia, information required to make a diagnosis of insomnia, the various recognized insomnia diagnoses, and the pharmacologic, cognitive, and behavioral treatments available. The most important component involved in the diagnosis of insomnia is a thorough and in-depth sleep history. Insomnia due to a mental disorder is the most common diagnosis among people presenting to a sleep center with a complaint of insomnia. Mood disorders such as depression, dysthymia, bipolar disorder, as well as anxiety disorders can be associated with a complaint of insomnia. Aside from progressive muscle relaxation, data are lacking to demonstrate efficacy in insomnia treatment. The most intriguing treatment for insomnia is paradoxical intention.

  • 10 - Pervasive development disorder

    • By Sandra N. Fisman, Children's Hospital of Western Ontario, London, Ontario, Canada
  • Edited by Stan Kutcher, Dalhousie University, Nova Scotia
  • Book:
    Practical Child and Adolescent Psychopharmacology
    Published online:
    31 August 2009
    Print publication:
    18 April 2002, pp 265-304

  • Summary

    The pervasive developmental disorders (PDDs) are characterized by impairments in socialization, communication, and imagination, and the presence of repetitive and ritualistic behaviors (American Psychiatric Association, DSM-IV, 1994). The PDDs do share some of the positive and negative symptoms of schizophrenia. Autistic disorder is the paradigmatic PDD. Disturbance in social relatedness remains a major defining feature of the disorder. A number of neuroanatomic loci, as well as abnormalities in cerebral lateralization, have been described in the PDD. The most consistent neurotransmitter abnormalities in the PDDs have been found in the serotonin. Since the PDDs are early-onset developmental disorders more readily identifiable in childhood, there is a paucity of information available on the psychopharmacologic treatment of adults with PDD. Currently, the best guide for pharmacologic management of these disorders is empirical treatment of target symptoms. Pharmacologic treatment must be seen in the context of an overall treatment plan.