- Ingredients of Effective Drug/Alcohol Treatment
- Overview of Different Types/Stages of Treatment
- Wikipedia: Drug Rehabilitation
Detoxification and rehabilitation from drugs is considered by some people to be the single hardest thing one will ever encounter in life. Many people will try detoxifying from drugs at home, and equipped with a hefty stash of over-the-counter “comfort” medicine, as well as some benzodiazepines, a valid attempt is made. Some may last a day or two, others will succeed, but the majority will need some sort of outside help. Unfortunately, many people will say, “I can’t go into a drug rehab! I need to work!” Drug abuse negatively affects every aspect of the addicts life, as well as those around him or her. Pretty soon, that addict may find himself without a job. Thankfully, there are ways of getting help for drug addiction, even if completely broke.
“Ensuring Solutions to Alcohol Problems, a research-based project at George Washington University Medical Center, reviewed research literature and consulted with professionals in the treatment and rehabilitation industry to identify 13 active ingredients of effective alcohol treatment,” said About.com about the Ingredients of Effective Alcohol Treatment. The following, though it talks about alcohol treatment, applies to opioid depedency treatment as well, and is a good starting point in judging whether or not a facility is effective.
- Early detection, including screening and brief interventions (for non-dependent problem drinkers). The earlier the treatment for drinking problems begins, the better the chance for success.
- Comprehensive assessment and individualized treatment plan. Treatment for alcoholism and drug abuse is not a one-size-fits-all proposition. Not all patients require the “acute care” approach.
- Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
- Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient’s gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
- Contracting with patients. Also called contingency management or behavior contracting, contracting with patients to reward good behavior and to punish bad behavior can improve treatment outcomes.
- Social skills training. The basis for cognitive behavioral therapy, people with alcohol problems can be taught to recognize stressful situations, in which their drinking has been a problem in the past, and skills to help them cope with those situations.
- Medications. Medical treatments cannot “cure” drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective.
- Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through “problem-to-service matching.”
- Continuing care. Most who enter treatment have at least one relapse. Follow-up contact, as well as participation in support groups, have both been shown to improve long-term treatment outcomes.
- Strong bond with therapist or counselor. Research shows that counselors and therapists who bond with patients through empathy, rather than confrontation, are powerful motivating influences in alcohol treatment.
- Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
- Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous, can be an active ingredient of treatment– both during a professional intervention and after.
- Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.
Source: Ensuring Solutions to Alcohol Problems, The George Washington University Medical Center. The Active Ingredients of Effective Alcohol Treatment (PDF). June 2003.
- Detoxification (i.e. detox) – This is the first step toward a better life. At a detox, the patient will rid themselves of the drug in a safe, clean medical environment. Often comfort medications are provided to make the transition a little easier. Some places may use methadone or buprenorphine for a few days to help ease withdrawal symptoms. At the end of this phase, the patient may be on some sort of maintenance therapy, but will be clean of their drug of choice with, hopefully, few lingering physical symptoms.
- Inpatient drug rehab – Treatment for the behavioral, social, and psychological problems associated with drug use will be taken care of at this stage. This is a very hard period, many times marked by intense, frequent cravings, lingering withdrawal symptoms, and a complete reprogramming. Drug addicts often lose all coping mechanisms, to the point where if a problem arises, he or she compulsively turns to drugs to fix the problem, which only worsens things. At this stage, the patient is learning how to live again, without drugs. Some places are very strict as far as male-female contact, what time to get up in the morning, keeping the room clean, making the bed, etc. The support groups at residential drug rehabs are very helpful, and it is important to attend all of them. Don’t worry! It’s not as bad as it sounds!
- Extended care – Extended care includes any programs attended after leaving the inpatient (residential) facility. Most programs include attending a few support groups a week, seeing a therapist, and/or a psychiatrist. This usually continues anywhere from three months to a year depending on circumstances.
- Faith-based groups – Alcoholics Anonymous (AA), and Narcotics Anonymous are included in this group. Many opioid addicts actually prefer AA over NA because it’s easier to find a meeting, and there are usually more people with more clean time. For some people, the idea of submitting to a “higher power” is not conceivable, so alternative groups are used. SMART Recovery is probably the best one out there. (http://www.smartrecovery.org)
- Halfway houses / sober houses – Halfway houses are more restrictive than sober houses, but both promote a sober lifestyle. The good thing about something like this is that the recovering addict is surrounded by people in the same situation, so there is a degree of empathy, and understanding. The bad side is that there are rules, and they must be followed. TRUTH – this part of treatment has saved many lives!
Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.
Drug rehabilitation tends to address a stated two-fold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so that normal functioning can occur. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal.
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention–rather than attempts at moderation, which may lead to relapse–is also emphasized (“One drink is too many; one hundred drinks is not enough.”) Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centres, and sober houses.
Pharmacotherapies to a greater or lesser extent have come to play a part in drug rehabilitation. Certain opioid medications such as methadone and more recently buprenorphine are widely used and show significant efficacy in the treatment of dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offences may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the United States’ Constitutional mandate of separation of church and state, although there is no such provision in the Constitution itself. Opponents cite a personal letter from President Thomas Jefferson, and attribute it to the First Amendment right. (source: http://www.usconstitution.net/jeffwall.html) (source: http://www.loc.gov/loc/lcib/9806/danpre.html)
Some psychotherapists question the validity of the “diseased person” model used within the drug rehabilitation environment. Instead, they state that the individual person is entirely capable of rejecting previous behaviours. Further, they contend that the use of the disease model of addiction simply perpetuates the addicts’ feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that would be easily resolved if the addict were to approach addiction as simply behaviour that is no longer productive, the same as childhood tantrums. Drug rehabilitation does not utilize any of these ideas, inasmuch as they intrinsically contradict the assumption that the addict is a sick person in need of help.
Traditional addiction treatment is based primarily on counselling. However, recent discoveries have shown that those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Often times, these imbalances may be corrected through improved diet, nutritional supplements and leading a healthy lifestyle. Some of the more innovative treatment centres are now offering a “Biochemical Restoration” process to supplement the counselling portion of treatment.