Drug Addiction Treatment

Principles of Drug Addiction and Alcoholism Treatment: A Research-Based Guide (Third Edition)

Principles of Effective Treatment

1. Addiction is a complex but treatable disease that affects brain function and behavior.  Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone.  Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

3. Treatment needs to be readily available.  Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.  To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical.  The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.   Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.  For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.  A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.

9. Many drug-addicted individuals also have other mental disorders.  Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.  Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective.  Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.  Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.   Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

More at; http://www.drugabuse.gov/publications/principles-drug-addiction-treatment

Hepatitis C

Hepatitis C in alcoholism, addiction The highest rates of hepatitis C are in addicts and alcoholics.

Hepatitis C is a chronic liver disease caused by the hepatitis C virus (HCV). Because many people do not have symptoms when they are infected, it is important for those at risk to take action to avoid infecting others.

Background

Although HCV has existed for a long time, it was only identified in 1989. HCV causes inflammation of the liver, which can progress to cirrhosis (extensive scarring that can affect the normal function of the liver).

Some people recover from their infection, but 75-85% progress to the chronic (carrier) state. People with chronic hepatitis C may not have symptoms for decades. Approximately 35% of those who have chronic hepatitis C, do not know that they are infected.

Other topics in this article are;

  • Health Risks of Hepatitis C
  • The Health Effects of Hepatitis C
  • Minimizing Your Risk

Full story at; Health Canada

See also;

Hepatitis B

Doctor assessing Hepatitis B in alcoholism Some of the highest rates of hepatitis B are in alcoholics and addicts.

Hepatitis B is a liver disease caused by the hepatitis B virus. The virus is carried in blood and body fluids. It can lead to serious liver damage, life-long infection, liver cancer, liver failure and even death. Fortunately, there is a vaccine that can protect you against hepatitis B.

Background

Hepatitis B virus (HBV) is one of a group of viruses that attacks the liver. Six hepatitis viruses have been identified but three – known as A, B, and C – cause about 90% of the acute hepatitis cases in Canada.

HBV is the most common form of hepatitis virus in the world. It is easily transmitted and is significantly more infective than HIV. HBV is primarily transmitted from one person to another through blood or other body fluids, such as vaginal secretions and semen. It is usually spread through sexual contact or by sharing contaminated needles or other drug equipment. It can also be transmitted from mother to child during pregnancy and birth.

The majority of people infected with HBV do not have noticeable symptoms and may unknowingly be experiencing liver damage and infecting others. That is why it is important for those most at risk to be vaccinated against the virus and avoid risky behaviour.

Topics in the linked article include;

  • Symptoms of HBV
  • Risks of Hepatitis B Exposure
  • The Health Effects of Hepatitis B
  • Minimizing Your Risk

Full story at; Health Canada

See also;

Recovery Focused Approach to Tackling Drug Use in Scotland

Scots flag Recovery Focused Approach to Tackling Drug Use in Scotland

Scotland’s first national drugs strategy The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem was launched on May 29, 2008. The Government believes that preventing drug use is more effective than treating established drug problems and that treatment services in Scotland should be based on the principle of recovery.

The key priorities are:

  • better prevention of drug problems, with improved life chances for children and young people
  • more people recovering from problem drug use
  • communities that are safer and stronger places to live and work
  • ensuring that children affected by parental substance use are safer
  • improving the effectiveness of delivery at a national and local level

The Government’s vision for how drug treatment services in Scotland should be delivered is based on the principle that recovery should be the explicit aim of all services providing treatment and rehabilitation for people with problem drug use.

‘Recovery’ is the principle that people suffering from problem drug use should receive support which does more than just reduce the immediate risks and harms of addiction. Individuals become active participants in their own care, moving forward in the hope and belief that they will get better.

What do we mean by recovery?

We mean a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society. Recovery is most effective when service users’ needs and aspirations are placed at the centre of their care and treatment. There is no right or wrong way to recover.

The Road to Recovery sets out the Government’s vision of recovery as an achievable goal for people with problem drug use and the actions it intends to carry out to promote a shared understanding of how to promote and support recovery. These include establishing and supporting a ‘recovery network’, building the capacity of services which can help services users choose the treatment that is right for them, and ensuring that the principles of recovery are reflected in the reform of delivery arrangements and in training and workforce development programmes.

Coping With Stress

Stress is a fact of daily life and is the result of both the good and bad things that happen. Too much stress can cause serious health concerns, but there are many ways of dealing with stress that can reduce your risk.

Background

Stress can come from major events in life such as getting married or changing jobs, or from minor daily incidents, such as job pressures or holiday planning. The things that cause you stress may not be a problem for someone else. If you did not feel stress of some sort, you would not be alive. Good stress, such as winning a game or going on vacation, can make you feel more involved and energized. But the negative effects of too much stress associated with being under pressure can affect your health.

When you find an event stressful, your body undergoes a series of responses. These come in three stages:

Mobilizing Energy

Your body releases adrenaline, your heart beats faster and you start to breathe more quickly. Both good and bad events can trigger this reaction.

Consuming Energy Stores

If you remain in the mobilizing energy stage for a period of time, your body begins to release stored sugars and fats. You will then feel driven, pressured and tired. You may drink more coffee, smoke more and drink more alcohol. You may also experience anxiety, negative thinking or memory loss, catch a cold or get the flu more often than normal.

Draining Energy Stores

If you do not resolve your stress problem, your body’s need for energy will become greater than its ability to provide it. At this stage, you may experience insomnia, errors in judgement and personality changes. You may also develop a serious illness such as heart disease or be at risk of mental illness.

Symptoms of Stress

Signs that you are over-stressed may include:

  • Feelings of irritability, sadness or guilt
  • Change in sleep patterns
  • Change in weight or appetite
  • Difficulty in concentrating or making decisions
  • Negative thinking
  • Loss of interest, enjoyment or energy in something you used to enjoy
  • Restlessness

Health Effects of Stress

While some people may appear to thrive on it, stress is considered to be a risk factor in a great many diseases, including:

  • heart disease
  • some types of bowel disease
  • herpes
  • mental illness

Stress also makes it hard for people with diabetes to control their blood sugar.

Stress is also a risk factor in alcohol and substance abuse, as well as weight loss and gain.

Stress has even been identified as a possible risk factor in Alzheimer’s Disease.

Severe stress can cause biochemical changes in the body, affecting the immune system, leaving your body vulnerable to disease.

Minimizing Your Risk

Here are several strategies to help you deal with stress.

Understanding stress

Notice and remember when you experience the signs of stress. This will help you figure out what triggers stress in you. It may be:

  • Major events such as getting married, changing jobs, moving your home, getting divorced or coping with the death of a loved one
  • Long term worries such as financial problems, your children’s future, your job or an ongoing illness
  • Daily hassles such as traffic jams, rude people or machines that don’t work.

Coping with stress

Because everyone is different, there is no single way to cope with stress. However, there are a number of approaches you can try to deal with short and long term stress.

  • Identify your problems. What is causing your stress? It can be your job, a relationship or another source altogether. Is an unimportant surface problem masking a deeper one? Once you know what the problem is, you can do something about it.
  • Work on solutions. Start thinking about what you can do to relieve the problem. Take control over the issues you can manage. This might mean looking for another job, talking with a health professional about personal problems or a financial counsellor. Also ask yourself what will happen if you do nothing. Once you make some changes to deal with the issue, you will take pressure off yourself.
  • Talk about your problems. Friends, work colleagues and family members may not know you are having a hard time. If you talk to them about it, it may help in two ways. First of all, just by venting your feelings, you will relieve some stress. Secondly, they may suggest solutions to your problems. If you need to talk to someone outside your circle of family and friends, speak to your family physician or contact a mental health professional.
  • Learn about stress management. In addition to health professionals who specialize in stress, there are many helpful books, films, videos, courses and workshops available to help you learn stress management techniques.
  • Reduce tension. Physical activity is a great stress reducer. Walk, do some exercises or garden to relieve your stress. There are also relaxation exercises you can learn that will take the pressure off, such as deep breathing and stretching your whole body. Tension meditation and progressive relaxation are techniques that work for many people.
  • Take your mind off your problems. By reading, taking up a hobby or becoming involved in sports, you can give yourself a `mental holiday’ from stress. It will also give you distance from your problems, so that they become easier to solve.
  • Try not to be too hard on yourself. Stress can cause lots of negative thinking. You may notice yourself saying things like “I can’t, won’t, should, must”. Be realistic. Find realistic solutions you can achieve in steps that will bring success.

Stress prevention

Once you have lowered your stress level, there are techniques that will help prevent it from building up again.

  • Make decisions. Worrying about making a decision causes stress.
  • Avoid putting things off. Make up a weekly schedule that includes leisure activities as well as things you must do.
  • Delegate to others. Let others take on some of the tasks you have set yourself so that you are not trying to do everything yourself.
  • Keep your thinking positive and realistic.

 

Indigo Dreams: Relaxation and Stress Management Bedtime Stories for Children, Improve Sleep, Manage Stress and Anxiety (Indigo Dreams)
by Lori Lite

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Mental Health Needs

Global survey reveals significant gap in meeting world’s mental health care needs

Mental disorders rank among the top ten illnesses causing disability-more than 37 percent worldwide-with depression being the leading cause of disability among people ages 15 and older, according to the Global Burden of Disease and Risk Factors published in 2006.

Yet, the world’s mental health care needs are largely going unmet, especially in less developed nations but also in high-income countries, according to results from a new survey of 17 countries conducted as part of the World Health Organization’s (WHO) World Mental Health Survey Initiative. The results of the initiative, partially funded by the National Institutes of Health’s National Institute of Mental Health (NIMH), were published in The Lancet in September 2007.

“Good treatments are available for many mental disorders. Yet, the world continues to struggle with the very real challenge of providing these services to the people who most need them,” said NIMH Director Thomas R. Insel. “The WHO survey unmistakably reinforces the urgency that we must do better.”

Philip S. Wang, M.D., Dr.P.H., currently director of the NIMH Division of Services and Intervention Research, and colleagues analyzed data from face-to-face interviews on mental health service use with 84,848 adults across all economic spectrums in countries around the world.

Respondents were asked about anxiety, post-traumatic stress, mood, and substance abuse disorders. They were also asked if they received any services in the past year for mental disorders; and if so, what types of services they had used, such as general medical professional, mental health professional, religious counselors or traditional healers.

The survey found that mental health service use varied significantly among the 17 countries. Overall, fewer people in less developed countries with mental disorders sought services compared with people in developed countries. In addition, the survey found that people in countries spending more of their gross national product (GDP) on health care used services more often.

The U.S. population used services more than any other country, at 18 percent. By comparison, 11 percent of France’s population used services. The lowest rate of services use was 1.6 percent in Nigeria.

In all countries surveyed, women were more likely than men to seek mental health services. Additional results of countries surveyed found that,

  • middle-aged people were more likely to receive services than those younger or older;
  • people with more education were more likely to seek out services for mental problems; and
  • married people were less likely to use mental health services than unmarried people

Most of those who sought care for mental disorders received help from the general medical sector (primary care doctors, nurses) rather than specialized mental health services (psychiatrists, psychologists), religious or community counselors, or complementary and alternative medicine providers (including traditional healers).

Among those receiving services, a substantial number of survey respondents reported that they did not receive minimally adequate services. The survey defines minimally adequate services as at least eight visits to any service sector, or being in ongoing treatment at the time of the interview, or receiving a medication for at least one month with four or more visits to a medical professional over a 12-month period.

Inadequate services were most commonly found in low-income countries, but even in some high-income countries, people received inadequate services. For example, in the United States, only 18 percent received minimally adequate services-much lower than any other high-income country. The next lowest level of minimally adequate services in a high-income country was 32 percent, in Japan. France and Germany had the highest level of adequate services, at 43 percent each.

“Although people sought and used services more in the United States, most did not receive adequate care-evidence of a striking disconnect in the U.S. mental health care system,” said Dr. Wang, who conducted the research while he was at Harvard University. “We need to help developing countries implement more effective mental health care services, but we also need to do a better job at home. The global mental health care situation appears dire,” concluded Dr. Wang.

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov.

How to help a self-injurer

What can you do to help a friend or family member who is a self-injurer?

It is very hard to realize that someone you care about is physically harming herself or himself. Your concern may come out in frustration and even comments that can drive the person farther away. Some things that might be helpful are:

  • Understand that self-harming behavior is an attempt to maintain a certain amount of control, and that it is a way of self-soothing
  • Let her or him know that you care and that you will listen
  • Encourage expression of emotions, including anger
  • Spend time doing enjoyable activities together
  • Offer to help find a therapist or support group
  • Do not tell the person to stop the behavior or make judgmental comments – people who feel worthless and powerless are even more likely to self-injure

If you are the parent of a self-injuring child, prepare yourself to address your family’s difficulties with expression of feelings, as this is a common factor in self-injury – this is not about blame, but about a learning process that will help the entire family


The Breakthrough Healing Program for Self-Injurers