Addiction to drugs and alcohol encompasses more than a behavioral intervention. The reason for this is drug addiction is a complex disease, however, it is treatable. Like chronic illnesses such as hypertension and asthma, relapse can occur with drug addiction even after extended periods of continued abstinence. For this reason, repeated treatments may be necessary. Treatments should be tailored to the inpidual in order to be more effective and long lasting, therefore allowing people to live long and productive lives.
A study conducted in 2004, showed 22.5 million Americans needed treatment for substance abuse. Out of this large number, only 3.8 million received help (NSDUH2004) leaving substance abuse and addiction cases untreated. This in the short-term can save money but in the long-term it can lead to many extraneous costs to society. Some of these costs include:
- Court and criminal costs
- Emergency room visits
- Prison costs
- Child abuse and neglect
- Foster care
- Welfare costs
- Healthcare utilization
- Reduced productivity
For every dollar spent on addiction treatment, there is a four to seven dollar reduction in the cost of crimes related to drugs. In 2002, it was estimated that $181 billion dollars was the cost to society for drug use. Over $500 billion was spent when including tobacco and alcohol costs. This includes lost productivity, healthcare and criminal justice costs. Substance abuse programs that are run successfully and efficiently can help society in more than one way. Not only can they assist the person in need, they can also help reduce the amount of sexually transmitted diseases that are spread such as HIV/AIDS and Hepatitis. In addition, crime and costs to society can also be reduced. So, the question comes, how can one develop an effective treatment program?
Effective Treatment Guidelines
Research conducted since the 1970's show that treatment can help people avoid relapse, change destructive behaviors and take them out of a life of substance abuse and addiction. Treatment tends to be a long term process and can require several periods of treatment. This research has helped established the organization on which effective treatment programs should be constructed.
- Treatment does not need to be voluntary to be effective.
- For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
- No single treatment is appropriate for all inpiduals.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the inpidual, not just his or her drug addiction.
- Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
- Addicted or drug-abusing inpiduals with coexisting mental disorders should have both disorders treated in an integrated way.
- An inpidual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
- Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
- Possible drug use during treatment must be monitored continuously.
- Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
- Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
- As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.
An All Encompassing Treatment
When treating an inpidual for addiction, it is important for the inpidual as a whole to be looked at. Usually, treatment begins with detoxification which is followed by relapse prevention treatment. While easing the inpidual into treatment, medications may be needed to control symptoms of withdrawal. All-encompassing care includes mental health services, medical care and of course aftercare. To make sure an inpidual stays in recovery you have to make sure all your bases are covered. Follow up options such as community or family based recovery support systems can be essential to acquiring and maintaining a life that is free of drug use and abuse.
Medication can help in various different fashions. In some cases, coming off of a substance can be life threatening and medication is necessary. Often times, the symptoms of withdrawal can be so severe that medication is necessary. This is not considered treatment; it is however, the first step in the process of recovery. Going through withdrawal treatment is not sufficient. If one does not receive further treatment, it's like not receiving treatment at all.
Using chemical substances can help to establish brain functioning that may have gone awry. At present medications are available to help reestablish pathways for addiction related to heroin, morphine (opioid) and nicotine (tobacco). Other medications are currently being developed for treatment of cocaine and methamphetamines (stimulants) and marijuana (cannabis) addictions.
Methadone and buprenorphine act as antagonists on brain receptors which mean that they block the pathways which opiates like heroin take. This helps to block the effects of the drugs, suppresses symptoms of withdrawal and can even reduce the incidence of cravings. Ideally, this helps patients to stop drug seeking behaviors and activities that may be criminally related. Thereby, patients should be more focused on treatment having reduced many outside stimuli.
This is a very important part of effective therapeutic treatment. Stopping substance abuse habits is only effective if behaviors change, therefore, attitudes have to be changed so that a healthy lifestyle is maintained. Life skills need to be altered; unhealthy patterns need to be changed. In addition, medication effectiveness is usually better, and this can help people stay in treatment longer which will hopefully improve the likelihood of the inpidual staying clean.
Outpatient behavioral treatment can include a wide variety of programs. Most include group or inpidual counseling. Some of the more popular forms of treatment include the following behavioral treatment programs:
- Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
- Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
- Motivational Interviewing, which capitalizes on the readiness of inpiduals to change their behavior and enter treatment.
- Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
Residential treatment can be very helpful, even more so for inpiduals with severe problems. Therapeutic communities are structured programs in which patients remain for half a year to twelve months. Those in treatment usually have long histories of drug addiction, often been involved in criminal activity and may have reduced social functioning. Treatment communities have become so evolved that they may also be structured to accommodate women who are pregnant or have children. The purpose of treatment communities is to help the inpidual learn how to behave in society without drugs.
In conclusion, with the proper mix of effort on the part of the inpidual, the proper care by practitioners, medications and community, a formula for success on the part of the substance user can be acquired. With that formula put in motion, an addict can become a former addict and go on to live a happy and fulfilling life.
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