STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

TREATMENTS FOR PEOPLE WITH SPECIFIC NEEDS

Adolescents

Adolescents with substance use disorders have special needs derived from the neurocognitive and psychosocial immaturity of this stage of development. Drug abuse in adolescents is often associated with other mental health problems, such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, behavioural problems, or depression and anxiety. Adolescents are particularly sensitive to social cues, and family and friends have a great deal of influence on them, so the most effective treatments are those that facilitate positive parental involvement, incorporate other fields involving adolescents (such as school or sports) and recognising the importance of peer relationships.¹ Family interventions on adolescent drug users increase commitment to treatment by both patients and family, reducing drug use afterwards. They also improve family functioning, and social normalisation and inclusion, including reducing affiliation with groups of peers who use drugs.²

Therapeutic options include cognitive behavioural therapy, which is effective in adolescent substance abusers (especially for cannabis abuse)³ and prolongs changes if combined with work with the family (multidimensional and multi-systemic family therapy). Brief strategic family therapy is also a particularly appropriate treatment option for families of teenage drug abusers with higher levels of dysfunction.²

With regard to treating peer groups of adolescents, certain conditions must be met to prevent overlearning of antisocial and maladaptive behaviours: recruit participants from different sources, include prosocial adolescents to keep the group heterogeneous, employ trained and competent therapists, maintain effective supervision and develop hands-on interventions that include protocols to solve any problems that might appear in the group.⁴

Women

The dichotomous view of gender is widening to include perspectives that understand the sociocultural factors that lead to drug use and abuse in a different way in both genders.⁵ Gender significantly affects men and women’s relationship to drugs, makes female specificity necessary in both prevention and treatment of drug dependence.⁶ For example, physical and sexual trauma and post-traumatic stress disorder are more common in drug-dependent women than in men.¹ However, this is usually a neglected subject. Mainstreaming the gender perspective involves considering the gender differences (physical, psychological and social) that affect the various motivations for using drugs, patterns of use and consequences, and eliminating gender inequalities in accessing preventive and care resources.

In many places, detection and intervention services for people with drug problems are mostly orientated towards men, ignoring the fact that they do not meet the practical needs that women often have (e.g., care for young children) and preventing them from accessing basic drug treatment services.⁷ Women also present higher rates of physical and psychiatric comorbidity than men, so it is likely that more general and multidisciplinary treatment programmes might benefit them more. They also tend to achieve better results in women-specific treatment contexts than in mixed contexts.¹

Drug addicts with dual pathology

The term dual pathology refers here to the coexistence of a mental disorder and a drug use disorder. Addressing this comorbidity is important because of its high incidence in the drug-using population and its impact on treatment prognosis (it makes it worse and more complex), making establishment of individualised treatment programmes necessary. It is also essential to diagnose the dual conditions correctly to implement effective and appropriate interventions in each particular case.⁸

In this regard, treatment of dual disorders in different units is unsuitable,⁹ as  integrated treatments (where the same therapeutic team simultaneously addresses drug use disorders and concomitant psychopathology) demonstrate better results, both in use reduction and in the number of hospitalisations and various other personal and social indicators.² All the evidence seems to indicate that the most effective treatment in cases of dual pathology arises because the team of professionals administering the treatment is trained in the field of drug addiction and mental health.¹⁰

 

References:

1 National Institute on Drug Abuse (NIDA). (2010). Principles of drug addiction treatment: a research-based guide. Washington: National Institute on Drug Abuse.

2 Becoña E & Cortés T. (coords.). (2008). Guía clínica de intervención psicológica en adicciones. Guías clínicas Socidrogalcohol basadas en la evidencia científica [Clinical guide to psychological intervention in addictions. Socidrogalcohol clinical guides based on scientific evidence]. Barcelona: Socidrogalcohol

3 Dennis M et al. (2004). The Cannabis Youth Treatment (CYT) Study: Main faindings from two randomized trials. Journal of Substance Abuse Treatment. 27: 197-213

4 Kaminer Y. (2005). Challenges and opportunities of group therapy for adolescent substance abuse: A critical review. Addictive Behaviors. 30: 1765-1774.

5 Rojas MJ (ed.). (2013). Pasta Básica de Cocaína. Cuatro décadas de historia, actualidad y desafíos [Cocaine base paste. Four decades of history, current situation and challenges]. Lima: United Nations Office on Drugs and Crime (UNODC).

6 UNODC. (2005). Tratamiento del abuso de sustancias y atención para la mujer: Estudios monográficos y experiencia adquirida [Treatment of substance abuse and assistance for women: Monographs and experience]. Nueva York: United Nations.

7 Svikis DS. (2010). Opinió. Prevenim.DRO. Butlletí d’informació sobre prevenció de drogodependències a Catalunya, 30:4.

8 Becoña E & Cortés MT. (2011). Manual de adicciones para psicólogos especialistas en psicología clínica en formación [Manual of addictions for psychologists in training specialising in clinical psychology]. Barcelona: Socidrogalcohol.

9 Rubio G. (1998). Tratamiento de los trastornos psiquiátricos comórbidos con las patologías adictivas [Treatment of comorbid psychiatric disorders and addictive pathologies]. In Cabrera J., Patología Dual (pp. 103-121). Madrid: Ediciones Gráficas.

10 Guardia J et al. (2003). Manejo del paciente con patología dual [Management of patients with dual pathology]. IEn García E  et al. (Eds.), Manual SET de Alcoholismo [SET manual of alcoholism] (pp. 494-509). Madrid: Editorial Panamericana.