From the Guidelines
Ropati's risk factors for substance use include his history of using methamphetamine, cocaine, and barbiturates, which suggests a pattern of polysubstance abuse, and to lessen these risks, he should implement a comprehensive relapse prevention plan that includes regular attendance at support group meetings, individual counseling, and possibly medication-assisted treatment. To develop an effective plan, it is essential to consider the biopsychosocial perspective of addiction, as outlined in the American Society of Addiction Medicine's current definition of addiction 1. This approach acknowledges that addiction is a chronic medical condition that should be managed as such, and that a combination of behavioral therapies, medication-assisted therapies, and peer support/12-step fellowship approaches can be effective in treating substance use disorder 1.
Some key strategies for Ropati to consider include:
- Regular attendance at support group meetings like Narcotics Anonymous, which can provide a sense of community and support throughout the recovery process
- Individual counseling with a substance abuse specialist, which can help address underlying issues and develop healthy coping mechanisms
- Possibly medication-assisted treatment, such as naltrexone or acamprosate, depending on his specific addiction profile
- Avoiding people, places, and situations associated with his drug use, while developing healthy coping mechanisms for stress, anxiety, or other emotional triggers that previously led to substance use
- Creating a structured daily routine with meaningful activities, exercise, and proper sleep hygiene to reduce idle time that might lead to cravings
- Building a strong support network of non-using friends and family members who understand his recovery journey
According to a systematic review and network meta-analysis published in 2018, contingency management (CM) alone and in combination with community reinforcement approach (CRA) showed greater efficacy and acceptability than treatment as usual (TAU) for abstinence and dropout at 12 weeks of treatment and at the end of treatment 1. Additionally, a meta-analysis published in 2020 found that combined pharmacotherapy and cognitive behavioral therapy (CBT) for adults with alcohol or substance use disorders resulted in improved outcomes compared to either treatment alone 1.
Overall, a comprehensive relapse prevention plan that incorporates these strategies and is tailored to Ropati's specific needs and circumstances can help him achieve and maintain long-term sobriety. Regular check-ins with healthcare providers to monitor progress and adjust treatment as needed will also be crucial in maintaining long-term sobriety.
From the Research
Risk Factors for Substance Use
Ropati's treatment planning and relapse prevention includes identifying risk factors such as meth, cocaine, and barbiturate use. The risk factors for substance use include:
- Lower educational attainment 2
- Lower annual household income 2
- Lack of insurance 2
- Housing instability 2
- Criminal justice involvement 2
- Comorbidities (e.g., HIV/AIDS, hepatitis B or C virus, depression) 2
- Suicidal ideation 2
- Polysubstance use 2
- Trauma and parenting style during adolescence 2
- Social support, coping with bereavement, and medical complications in middle-age and older adults 2
Lessening the Risks
To lessen the risks of substance use, evidence-based prevention and treatment interventions are needed 3. These interventions may include:
- Addressing socioeconomic risk factors and comorbidities 3
- Providing client-centered factors, such as client preference, when selecting treatment options 4
- Improving retention in treatment 4
- Harmonizing data collection and reporting to strengthen future syntheses 4
- Using medications such as buprenorphine, which has been shown to reduce cocaine use and cravings 4
- Implementing age-specific risk factors in alcohol use in relation to underlying developmental processes 2