Write at least 300 words in a word document about this topic. Post your word count in your assignment.

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  • Please read the Psychology Discussion Requirements fully, and then Read pages 174 – 184 in your text. Opioid use, addiction, and overdoses have increased to alarming rates in the United States in recent years. Millions of Americans are affected by the opioid epidemic every day.Read Volkow et al.’s (2014) article and Brown’s (2018) articles (PDF’s below) before discussing the following questions.
  • ReferencesBrown, A. R. (2018). A systematic review of psychosocial interventions in treatment of opioid addiction, Journal of Social Work Practice in the Addictions. Advance online publication. doi:10.1080/1533256X.2018.1485574
    Coon, D., Mitterer, J.O., & Martini, T. (2022). Introduction to psychology: Gateways to mind and behavior (16th ed.). Cengage Learning.
    Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies — tackling the opioid-overdose epidemic. New England Journal of Medicine370(22), 2063-2066. doi:10.1056/NEJMp1402780For this week’s main post, answer all of the following questions. Be sure to include factual, properly cited information in your post.

    • What are some ways that opioid addiction is affecting the United States?
    • What are some forms of treatment available to those suffering from opioid addiction?
    • If you had a friend or family member suffering from opioid addiction, what sort of help would you recommend they seek?

    PSY1012 Week 2 Discussion Brown-2018.pdf PSY1012 Week 2 Discussion Brown-2018.pdf – Alternative Formats
    PSY1012 Week Two Discussion Volkow-2014.pdf PSY1012 Week Two Discussion Volkow-2014.pdf – Alternative Formats

    To post to the discussion, click on the title: Week 2 Psy Discussion Forum and then Create Thread.

  • Week 2 Dream Assignment

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    Week 2 Assignment- DreamsYour AssignmentRead the section titled “REM Sleep and Dreaming” on page 168 and “Dream Theories” on pages 169-170 in your textbook. These sections discuss theories on dreams, the history of dream interpretation, the most common characteristics of dreams, and the meaning of dreams.
    Check out these websites:
    For this week’s Assignment, answer the following questions in APA Format and in a word document. Be sure to include factual, properly cited information in your Assignment.Write about a dream that really made an impact on you. It can be a recurring dream, a scary dream, a happy dream, or an especially vivid dream. What do the above websites say about the interpretation of your dream? Do you feel these interpretations are accurate? Why or why not?What do you think is the meaning behind this dream? Directions:
    1. Write at least 300 words in a word document about this topic. Post your word count in your assignment.
    2. Make sure to cite sources in your assignment using APA format. The source for question 2 must be the websites listed, for question 1 and 3, it may be your textbook or any other source you research. The entire assignment, from title page to reference page must be in APA 7th edition format.
    3. Submit your assignment using the Week 2 Dream Assignment link above.

    Example Week 2 Assignment Example Week 2 Assignment – Alternative Formats

    Tips for your Assignment:

    • Always use the 7th edition of APA for your references and in-text citations (Wikipedia is not a reliable source and cannot be used in this class).
    • The assignment must be written in 7th edition APA format in a Microsoft Word document with header page numbers at top right side of each page, Title page, no more than 12 point font, double spaced and indented paragraphs, 7th edition APA citations in each paragraph to support what is shared throughout, and a complete 7th edition APA reference page, word count posted (there is an example below).
    • Please be sure to back up your answers with facts from the source, and put together complete and well thought out responses.
    • Also make sure that you support and reinforce your answers and replies with factual information from the source.
    • Make sure to do a spelling and grammar check before submitting.
    • Double check that you meet the word requirement (title page information, section headings, and references do not get included in a word count).



Journal of Social Work Practice in the Addictions ISSN: 1533-256X (Print) 1533-2578 (Online) Journal homepage: http://www.tandfonline.com/loi/wswp20 A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction Aaron R. Brown To cite this article: Aaron R. Brown (2018): A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction, Journal of Social Work Practice in the Addictions, DOI: 10.1080/1533256X.2018.1485574 To link to this article: https://doi.org/10.1080/1533256X.2018.1485574 Published online: 06 Jul 2018. Submit your article to this journal Article views: 18 View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wswp20 Journal of Social Work Practice in the Addictions, 00:1–21, 2018 Copyright © Taylor & Francis Group, LLC ISSN: 1533-256X print/1533-2578 online DOI: https://doi.org/10.1080/1533256X.2018.1485574 A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction AARON R. BROWN, LCSW College of Social Work, University of Tennessee, Knoxville, Tennessee, USA Opioid addiction has become a U.S. epidemic. It is important to determine whether psychosocial interventions help prevent relapse. A total of 14 studies were included in this systematic review. Most studies compared psychosocial interventions in conjunction with pharmacological maintenance. Only 2 studies found that psychosocial interventions led to statistically significant benefits for outcomes related to opioid abuse when compared to maintenance and less or no psychosocial intervention. Psychosocial interventions were not found to be additive to pharmacological treatments during induction or maintenance stages. Further research is needed to determine effectiveness of psychosocial interventions during dose reduction and long-term relapse prevention. KEYWORDS addiction, intervention, maintenance, opioid, prevention, psychosocial, relapse, substance In the last 20 years, both therapeutic and illicit opioid use have escalated in the United States (Manchikanti et al., 2012). The total number of opioid prescriptions dispensed from U.S. outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Governale, 2010). Hydrocodone is not only the most commonly prescribed opioid, it is the most prescribed medication in the United States (Manchikanti et al., 2012). Manchikanti et al. (2012) stated, “Drug dealers are no longer the primary source of illicit drugs” (p. ES31). As the number of opioids prescribed has increased, so has their illicit use. According to the 2014 National Survey on Received March 11, 2017;revised June 6, 2016;accepted May 30, 2017. Address correspondence to Aaron R. Brown LCSW, College of Social Work, University of Tennessee, Knoxville, 1618 Cumberland Ave., Knoxville, TN 37996. E-mail: Abrown89@vols.utk.edu 1 2 A. R. Brown Drug Use and Health (NSDUH), prescription opioids have been the most frequently abused psychotherapeutic drug for more than a decade, and are second only to marijuana for all illicit drugs (Hedden et al., 2014). An estimated 4.3 million individuals 12 or older are current nonmedical users of prescription opioids, which represents 1.6% of the population aged 12 or older in the United States (Hedden et al.). The problem of opioid abuse is most prevalent among young adults. The same 2014 survey estimated that 2.8% of young adults aged 18 to 25 in the United States were current nonmedical users of opioids (Hedden et al.). Looking at the problem in a more local context, Wright et al. (2014) examined opioid abuse at the county level in Indiana and found a significant association between the rate of opioid dispensed and the rate of opioid abuse. A serious risk associated with prescription opioid abuse is the development of opioid addiction, which can be defined as a pattern of compulsive, prolonged use of opioids for nonmedical reasons or in excess of the amount necessary for legitimate medical use marked by psychological and physiological dependence and leading to significant impairment (American Psychiatric Association, 2013). An estimated 2.4 million Americans suffer from a substance use disorder related to prescription opioids, more than for cocaine and heroin combined and second only to marijuana for illicit drugs (Ali & Mutter, 2016; Hedden et al., 2014). Societal Cost Prescription opioid abuse is taking an increasingly large toll on the United States in terms of the costs related to its prevention and treatment as well as the losses it inflicts on families and communities. Between 2005 and 2011, the number of emergency room visits in the United States involving abuse of prescription opioids more than doubled from 168,379 to 366,181 (Crane, 2015). There has also been a substantial increase in those seeking treatment for opioid abuse. The number of individuals in the United States reporting substance abuse treatment related to prescription opioid abuse more than doubled between 2002 and 2014 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015b). The mortality rate in the United States associated with opioid abuse drastically increased during this same time period, from 4,400 to 18,893 (Centers for Disease Control and Prevention, 2016). There have been numerous indications that costs associated with the growing prescription opioid abuse problem in the United States are substantial. However, there are many aspects of the problem that incur costs, and research on the overall economic burden has been limited. These aspects can be grouped into categories of criminal justice, workplace, and health care costs. Two systematic analyses of the total U.S. societal costs of prescription opioid abuse estimated it at more than $50 billion as of 2007 (Birnbaum et al., Psychosocial Interventions and Opioid Addiction 3 2011; Hansen, Oster, Edelsberg, Woody, & Sullivan, 2011). Florence, Zhou, Luo, and Xu (2016) estimated the economic burden of prescription opioid overdose, abuse, and dependence to be $78.5 billion as of the end of 2013. Relapse Prevention and Opioid Abuse Prescription opioid use and abuse in the United States have significantly increased over the last decade. Given the substantial number of individuals with substance use disorders related to prescription opioid abuse and the increasing utilization of treatment for these disorders, outpatient clinicians are more and more likely to encounter individuals who abuse prescription opioids in their practice (Hedden et al., 2014; SAMHSA, 2015b). Typically, these clients seek assistance in preventing relapse to maintain abstinence from the abuse of prescription opioids. A better understanding of whether psychosocial interventions are effective for relapse prevention is needed. The first line of treatment for opioid use disorders is often medical detoxification, a short-term inpatient process of providing medical supervision to assist in the achievement of abstinence while treating the symptoms of withdrawal (Veilleux, Colvin, Anderson, York, & Heinz, 2010). The adverse symptoms associated with withdrawal are rarely medically serious, but fear of withdrawal might discourage individuals from seeking treatment and the discomfort experienced during withdrawal might lead clients to drop out of treatment (Gossop, 2006). For these reasons, detoxification is typically a prerequisite for admission to long-term abstinence-based treatment programs, whether residential or outpatient. Detoxification may positively influence long-term treatment outcomes for opioid use disorders, but it is not sufficient as a standalone intervention (Gossop, 2006; Veilleux et al., 2010). A relapse prevention phase is needed to help those suffering from opioid addiction achieve longterm recovery, even after detoxification. Relapse prevention often includes a pharmacological component such as the use of an opioid agonist and conjunctive psychosocial components. Pharmacological maintenance is sometimes derided as merely a substitution of one addictive drug for another. However, there is substantial evidence that medication-assisted therapies (MATs) are effective in preventing relapse when properly used (Mattick, Breen, Kimber, & Davoli, 2014; Volkow, Frieden, Hyde, & Cha, 2014). It is for this reason that the National Institute of Drug Abuse (NIDA) refers to these pharmacological components as treatments and not substitutions (NIDA, 2016). Psychosocial interventions are often strongly encouraged or required as a part of maintenance treatments in the United States (SAMHSA, 2015a). This leads to the question of whether psychotherapy is a useful component of relapse prevention, either in conjunction with pharmacological treatment or in medication-free treatment modalities. Previous systematic reviews have addressed similar questions pertaining to opioid addiction in general, but 4 A. R. Brown none has looked at psychosocial interventions in the specific context of prescription opioid addiction (Amato, Minozzi, Davoli, & Vecchi, 2011; Dugosh et al., 2016; Veilleux et al., 2010). Are psychosocial interventions effective for treating individuals with prescription opioid addiction during relapse prevention? Which psychosocial interventions are most effective for relapse prevention of prescription opioid addiction? Definition of Terms Relapse is defined as the use of nonmedical prescription opioids after a voluntary period of abstinence. Relapse prevention is defined as a treatment phase after voluntary abstinence has been achieved during which efforts are made to maintain an opioid-free lifestyle. Psychosocial intervention is defined as individual or group sessions with a licensed clinician implementing a behavioral intervention intended to prevent relapse for which the clinician has received sufficient training. Prescription opioid addiction is a pattern of compulsive, prolonged use of prescription opioids for nonmedical reasons or in excess of the amount necessary for legitimate medical use marked by psychological and physiological dependence and leading to significant impairment (American Psychiatric Association, 2013). Individuals recovering from opioid addiction are defined as Americans aged 18 years or older who have previously been diagnosed with opioid use disorder related to prescription opioid abuse according to Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]) criteria and have achieved a voluntary period of abstinence. METHODS Inclusion and Exclusion Criteria A systematic review of studies comparing psychosocial interventions and outcome measures related to relapse prevention for prescription opioid abuse was conducted solely by the author. The inclusion criteria for this study were as follows: ● Studies published in the English language. ● Studies included in at least one of the following databases: Web of Science Core Collection: Citation Indexes, Social Work Abstracts, PsychINFO, Social Science Research Network, or Cochrane Library. ● Studies published after 2010, specifically, from January 1, 2010 until September 30, 2016. ● Studies that compared at least one psychosocial intervention as a primary condition. Psychosocial Interventions and Opioid Addiction ● ● ● ● ● ● ● ● 5 Studies conducted on individuals 18 years or older who were in treatment for prescription opioid addiction, whether in detox or a relapse prevention phase. Studies that examined outcomes related to relapse and opioid abuse such as opioid use, treatment completion, abstinence from opioid use, treatment duration, or treatment retention. Studies that included quantitative data analysis. Articles were excluded from this study based on the following criteria: Studies conducted outside of the United States. Studies that are qualitative. Studies that did not specifically describe the types of psychosocial interventions implemented. Studies that did not specifically describe the types of pharmacological interventions used if pharmacological interventions were used. Rationale for Inclusion and Exclusion Criteria This review is primarily concerned with the treatment of prescription opioid addiction in the United States due to the rapid growth of prescription opioid abuse over the last decade. For this reason, studies conducted outside of the United States were excluded. Because English is the language primarily used for research and publication in the United States, only studies published in English were included. This review’s focus on prescription opioid abuse required a wide catchnet of journals within multidisciplinary fields such as social work, counseling, psychology, psychiatry, pharmacology, substance abuse, addiction, and public health. Search databases were chosen based on whether they included journals related to these multidisciplinary fields of research. Studies were included that used quantitative data analysis. This inclusion criterion was chosen to focus on those studies that showed the most conclusive evidence to support the opioid abuse treatment protocols. Studies that were primarily qualitative were excluded to maximize homogeneity of outcome measures and form relevant conclusions across studies. This review was limited to studies published after 2010 to include only the most recent and relevant research related to a problem that has been increasing over the last decade. Also, to the author’s knowledge, the oft-cited reviews by Veilleux et al. (2010) and Amato et al. (2011) are the most recent and rigorous systematic reviews focused on comparing treatment protocols for opioid abuse that included both psychosocial and pharmacological interventions. Since these reviews, new relapse prevention interventions have been developed and studied. For instance, mindfulness-based relapse prevention (MBRP) is a recent and promising intervention that was first studied in a pilot randomized controlled trial by Bowen et al. (2009). 6 A. R. Brown Because the primary aim of this review was to identify whether and under which conditions psychosocial interventions are effective in prescription opioid addiction treatment, only those studies that implemented psychosocial interventions were included. Studies that focused on other types of treatment interventions (e.g., pharmacological ones) were also included so long as they included at least one psychosocial intervention as a component of comparison. Focusing only on reviewing studies of a specific type of intervention would limit best practice recommendations. It is important for clinicians to be informed about the most effective interventions with this population. It was also important for this review to exclude those studies that did not describe the specific interventions implemented. In their systematic review, Veilleux et al. (2010) found that targeted psychosocial interventions showed the most promise for use in treatment of opioid addiction. For best practice recommendations to be made, it was necessary to understand whether specific interventions were more effective than others, and to avoid the assumption that any pharmacological or any psychosocial intervention is as effective as others. Studies were also chosen based on population criteria. The focus of this review is on relapse prevention from prescription opioid abuse. As such, only those studies that specifically studied outcome measures related to relapse prevention and opioid abuse were included. Additionally, only studies that focused on adults, which is the population of interest for this review, were included. Data indicate that individuals 18 to 25 years old make up the largest percentage of those who abuse prescription opioids (Hedden et al., 2014). Search and Distillation Using the stated inclusion and exclusion criteria, a search was conducted in three phases (see Figure 1). Phase I used Boolean terms to identify articles in any of the included databases. The following Boolean terms were used for topic search: opioid AND (addict* OR dependen* OR abuse OR misuse) AND (psychotherapy OR psychosocial OR counseling OR “relapse prevention”) NOT (child* OR adolesce* OR youth OR infant) NOT (cannabis OR marijuana OR cannabinoid OR cocaine OR alcohol* OR heroin OR methamphetamine). Searches were limited to those results written in English between January 2010 and October 2016. To capture studies that implemented counseling-only treatment protocols, a second search was conducted using the following Boolean terms in a title search: opioid AND (addict* OR dependen* OR abuse OR misuse OR “use disorder”) AND (psychotherapy OR psychosocial OR counsel* OR therapy OR behavioral OR “relapse prevention”) NOT (maintenance OR pharmacological OR naltrexone OR naloxone OR methadone OR Buprenorphine OR Psychosocial Interventions and Opioid Addiction 7 FIGURE 1 Phases of search and distillation. suboxone) NOT (child* OR adolesce* OR youth OR infant) NOT (cannabis OR marijuana OR cannabinoid OR cocaine OR alcohol* OR heroin OR methamphetamine). Phase I of the first search captured a total of 255 articles from Web of Science (n = 144), Social Work Abstracts (n = 0), PsycINFO (n = 38), Social Science Research Network (n = 0), and Cochrane Library (n = 73). Phases II and III implemented distillation per inclusion and exclusion criteria (see Figure 1). In Phase II, duplicates (n = 47) and articles with topics outside of inclusion criteria (n = 180) were excluded from the results. Then in Phase III of the first search, qualitative studies (n = 6), reviews (n = 9), and studies outside the United Stated (n = 5) were excluded. After distillation, eight articles were included from the first search. Phase I of the second search captured a total of 111 articles from Web of Science (n = 66), Social Work Abstracts (n = 0), PsycINFO (n = 33), Social Science Research Network (n = 0), and Cochrane Library (n = 12). In Phase II, duplicates (n = 37) and articles with topics outside of inclusion criteria (n = 51) were excluded from the results. Then in Phase III of the second search, qualitative studies (n = 5), reviews (n = 10), and studies outside the United States (n = 4) were excluded. Articles already included from previous search were also excluded (n = 1). After distillation, two articles were included from the second search. In an effort to capture more articles meeting inclusion criteria, the citations from already included articles were reviewed. A total of three articles 8 A. R. Brown meeting inclusion criteria were found among citations of those articles already included from two searches (Fiellin et al., 2013; Ling, Hillhouse, Ang, Jenkins, & Fahey, 2013; Moore et al., 2016). An additional article (Schwartz, Kelly, O’Grady, Gandhi, & Jaffe, 2012) was included based on a response written by Schwartz (2016) to a very recent systematic review that failed to include this relevant article (Dugosh et al., 2016). These articles were not captured by the search methodology used here, but they were deemed important to include due to their direct relevancy to this review and their meeting criteria for inclusion. These four articles were combined with the 10 captured by two searches for a total of 14 articles included in this review (see Table 1). FINDINGS Treatment Protocols Several types of psychosocial interventions were compared within the various articles. All but one of the studies included in this review used random assignment to treatment conditions (Barry, Cutter, Beitel, Liong, & Schottenfeld, 2015). As seen in Table 1, the most common psychosocial intervention studied was cognitive-behavioral therapy (CBT), which was compared in 6 of the 14 studies (Barry et al., 2015; Fiellin et al., 2013; Lander, Gurka, Marshalek, Riffon, & Sullivan, 2015; Ling et al., 2013; Moore et al., 2016; Otto et al., 2014). Other types of psychosocial …
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