Abnormal Psychology

424 CHAPTER 9

Hallucinogens

Those who abuse LSD and want to quit can generally do so without withdrawal

symptoms or signifi cant cravings. Thus, marijuana is the only substance in this

category that has been the focus of research on treatment, which generally targets

psychological factors and social factors, not neurological ones (McRae, Budney, &

Brady, 2003).

Targeting Psychological Factors

Treatments that target psychological factors focus on several elements: (1) increasing

a user’s motivation to cease or decrease substance use, (2) changing the user’s expec-

tations of the drug experience, (3) increasing the user’s involvement in treatment,

and (4) decreasing the (classically and operantly) conditioned behaviors associated

with use of the drug.

Motivation

For those with substance abuse or dependence, stopping or decreasing use is, at

best, unpleasant and, at worst, very painful and extremely aversive. Therefore, the

user’s motivation to stop or decrease strongly affects the ultimate success of any

treatment.

Stages of Change

Extensive research has led to a theory of treatment that posits different stages of

readiness for changing problematic behaviors of the sort associated with substance

abuse and dependence. Research on this theory of stages of change has also led

to methods that promote readiness for the next stage (Prochaska & DiClemente,

1994). Whereas most other treatments rely on a dichotomous view of substance

use—users are either abstinent or not—this approach rests on the idea of intermedi-

ate states between theses two extremes; the fi ve stages of readiness to change are as

follows:

1. Precontemplation. The user does not admit that there is a problem and doesn’t
   intend to change. A temporary decrease in use in response to pressure from
   others will be followed by a relapse when the pressure is lifted.


2. Contemplation. The user admits that there is a problem and may contemplate
   taking action. However, no actual behavioral change is undertaken at this stage;
   behavior change is something considered for the future. People with substance
   abuse and dependence may never get past this stage.


3. Preparation. The user is prepared to change. He or she has a specifi c commit-
   ment to change, a plan for change, and the ability to adjust the plan of action

Class of Drugs To Treat Withdrawal To Promote Maintenance

Stimulants:

Nicotine

Nicotine products (chewing gum, patch),

buproprion (Zyban)

Depressants Longer-acting depressants (such as

Valium) that block withdrawal symptoms

Antabuse, acamprosate, naltrexone

Narcotic Analgesics Methadone, buprenorphine, clonadine Methadone (technically, promotes

maintenance by binding to receptors

that would otherwise bind with heroin),

buprenorphine, LAAM, naltrexone

Table 9.10 • Medications Used to Treat Withdrawal and Promote

Maintenance in People with Substance Use Disorders

Stages of change
A series of fi ve stages that characterizes
how ready a person is to change problematic
behaviors: precontemplation, contemplation,
preparation, action, and maintenance.