Treatment for drug addiction
Treatment for drug addiction has a long history going back 100's of years. It has only been in recent years that it has been seen for what it really is - a disease of the brain. Some say that since some people can "just quit" without any help, and it is simply a matter of will power. That argument does not stand up in research. Once a person starts using drugs regularly,, their mind begins to change, significantly. It becomes a matter of chemistry rather than moral fiber.
Before 1935, addiction treatment was very unsuccessful, experimental, and unsuccessful. Much of the emphasis was put on isolation and scorn for the person, as people believed it was a moral issue. Some believed addicts were in fact, possessed by demonic forces and even jailed or put to death.
Treatment can only be successful if the addicted person wants very much to stop and stay stopped. Like any other serious habit, it has to be of primary importance, if they are going to
keep it from coming back i.e. in remission.
For over 50 years the AA 12 step model has been the standard of the recovery industry. Gradually there is a shift happening towards a much more individualized, cognitive behavioral approach.
Addiction treatment always starts with any and all necessary detox to make sure all the toxic substances are safely removed from the client's body. Until they are clean and stable no treatment can begin in earnest.
Definition
Addiction treatment is what takes place in any number of various types of rehabilitation programs for drug abuse. Drug addiction treatment is the general term used for the process of rehabilitation on someone suffering from drug abuse.
Composition
Treatment for addiction has various levels of intensity. Over the years it has become more and more specialized in its approach. Drug centers for addiction have evolved so someone can go to programs for a variety of individualized issues, including gender specific, gay lesbian, young adults, adolescents, older adults, dual diagnosis, religious oriented, and job- occupation specific are just some of the splinter, focus, specialty areas.
Narcotics Anonymous (AA) Based Treatment Model
Since its inception, and for the past 50 years, the vast majority of addiction treatment programs have made the 12 step model of recovery the primary focus of their program. It was, for the first time, a proven effective way to put the disease of addiction in remission. So it is understandable the treatment community embarrassed it fully.
One of the concerns is the foundation of all 12 step based recovery groups is spiritual in nature. This often drives people away who refuse to accept its "higher power" approach.
Treatment consists of detox and then introducing the client to AA/NA. Most addiction treatment centers still focus on the 12 step model, relying on it to change the individual and give them its wide net of support and fellowship. Some therapy, mostly group, was conducted and all clients were required to go to AA/NA meetings every day.
Recently, the treatment model has begun to shift to more of a clinical model, treating people for their unique set of problems and issues. One such program is in California, Malibu Horizon.
Detox
The first step in and treatment program process is medical detox, done under proper medical supervision. Not all drugs require detox. Drugs such as prescription medications, and heroin do require detox. Others, like cocaine, crack, crystal methamphetamine, do not technically require medical detox.
Intensive Outpatient (IOP)
IOP is attending group and individual counseling sessions at a clinic, several times per week. For many this is the right step towards recovery. Some insurance companies require someone to attend IOP first and will only approve of inpatient, full-time rehab after IOP has been unsuccessful.
Partial Hospitalization Programs (PHP)
Attending group and individual counseling sessions at a hospital based program, either all morning or all afternoon, 5 times per week. And some are 9 to 5, Monday through Friday. Partial Hospitalization Programs (PHP) is mostly held in hospital based programs, as a step down between detox and IOP. It is mostly group therapy.
Inpatient Residential
This is the level that gets the most attention. Most have a detox as a part of their services; others will send someone who needs detox to a facility nearby and then be readmitted. Clients check in for some period of full time, stay there 24 hours a day. Each day consists of group therapy, some individual counseling, lectures, some form of exercise. Room and board is included. Although 30 days is considered enough time to learn about the disease of addiction, there is no guarantee insurance will cover it.
Long Term, Extended Care
Like inpatient, residential, long term extended care requires the client to stay there 24 hours a day. There are, however, several key differences. One is the length of the drug program. Long term programs usually last 90 days. The other difference is the clinical therapeutic intensity level. Extended care has less individual therapy. And the cost of extended care is also much less than 30 day residential. Much of the emphasis in extended care is placed on AA's 12 steps. Much of the time is spent going to meetings and working on the 12 steps.
- No single drug addiction treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each 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.
- Drug Addiction Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
- Effective drug treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.
- An individual's drug treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's 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 at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.
- Remaining in a drug addiction treatment center for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
- Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding non drug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important.
- Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.
- Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.
- Drug Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.
- Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.
- Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior.
