CHAPTER 9

I. Drug addiction is a disease of the brain. Chemical dependency and addiction are more prevalent than mental illness, brain and nervous system diseases, and head trauma. Current Issues in Treatment. 1. The prescribing of medications to treat the problems of drug abuse 2. The use of imaging techniques to visual the effects of drugs on the brain 3. Lack of funding for treatment 4. Abstinence-oriented recovery vs. harm reduction-oriented recovery II. Treatment effectiveness. Although it is the world's number one health problem, chemical dependency is treatable and cost effective. Treatment Studies 1. The CALDATA (California Drug and Alcohol Treatment Assessment) Study showed successful abstinence in over 50% of persons treated in a variety of programs and cost savings of $7 for every $1 spent on treatment. 2. DATOS (Drug Abuse Treatment Outcome Study) found treatment reduced use of drugs 50-70%, with residential programs offering the best results. 3. Treatment and Prisons. Only 10% of inmates with serious drug problems are in treatment, even though treatment reduces recidivism and is very cost effective.

III. PRINCIPLES & GOALS OF TREATMENT A. Principles of Effective Treatment 1. 2. 3. 4. 5. No single treatment fits all people Counseling must accompany treatment Treatment must address accompanying mental disorders Detoxification is only the first stage Treatment must monitor drug use

B. Goals of Effective Treatment 1. Primary Goals. Motivation towards abstinence and creating a drug-free lifestyle 2. Supporting Goals include enriching job or career functioning, optimizing mental functioning, optimizing psychiatric & emotional functioning.

IV BEGINNING TREATMENT A. Recognition & Acceptance often require an addict hitting bottom or being the subject of an intervention. 1. Hitting Bottom need not be literally life- threatening, only a sense of hopelessness that sometimes propels an addict to seek help. 2. Denial is a defense mechanism that prevents or delays recognition and acceptance of chemical dependency or compulsive behavior and a refusal to recognize the negative impact on a person's life. 3. Breaking through Denial is best initiated by the family, coworkers, and friends of an addict. Intervention can begin with legal intervention, workplace intervention, doctors' warnings, mental health problems, and financial difficulties.

4. Intervention uses special strategies including a. Love. An intervention begins with a statement of love and special concern. b. Facilitator. A professional intervention specialist organizes the intervention, educates the participants, and trains the team members. c. Intervention Statements which are prepared by each team member. d. Anticipate Defenses & Outcomes d. The Intervention is made, with timing, location, and surprise as crucial components. e. Contingency. The intervention team continues to meet after the intervention.

V. TREATMENT CONTINUUM. Recovery is a gradual, multi-part process. A. Detoxification is the first step, one that involves getting the drug out of the body's system, taking about a week. Assessment is an important part of the treatment process. 1. Medication Therapy for Detoxification. A variety of medications are used to ease withdrawal and minimize craving. These drugs include Clonidine, Methadone, Antipsychotics, Nicotine patches, Antabuse, and Naltrexone.

2. Psychosocial Therapy is often used with medical intervention. Psychosocial therapy includes counseling, group work, and 12- step programs.

B. Initial Abstinence is required so body chemistry can regain balance. Anticraving medications can be used to control desire to use, as are counseling, group, and 12-step meetings. C. Long-Term Abstinence is based on acceptance and surrender of addicts to the fact that they are helpless over the addiction. They need to continue 12-step programs, treatment, and abstinence from all psychoactive drugs and compulsive behaviors. D. Recovery is more than treatment and abstinence. Restructuring one's life and discovering of non-drug highs are needed. E. Outcome & Follow-Up are needed both to reassure funding sources and to improve treatment and intervention. Factors needing to be monitored include relapses, retention, completion, family functioning, adjustments, vocational or educational functioning, criminal activity.

VI. TREATMENT AND THE FAMILY. Since addiction is a family disease and impacts every member of an addict's family, family members need to be (but are often not) involved in treatment. A. Goals of Family Treatment include acceptance by the family that addiction is a treatable disease, maintenance of a drug-free family system, improving family communication and interaction, and helping the family readjust after cessation of abuse. B. Different Family Approaches 1. Family-Systems Approach focuses on family interactions in daily routines, family rituals, and short-time problem solving strategies. 2. Family-Behavioral Approach works on those family behaviors that bear on drug use and help eliminate negative ones while reinforcing positive ones. 3. Social-Network Approach focuses on the treatment of the addict while providing a support network for the family.
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4. Tough-Love Approach is the approach that addresses denial in the addict and the family and encourages the family to establish limits for interacting with the addict, including kicking the addict out until he or she agrees to treatment.

C. Other Behaviors 1. Codependency is the relationship in which a family member becomes dependent on the addict to fill the family member's own needs through the addictive behavior. 2. Enabling is the action of a family to avoid confronting the addictive behavior. Enablers help perpetuate the addictive cycle. 3. Children of Addicts & Adult Children of Addicts take on predictable roles, including the model child, the problem child, the lost child, and the mascot or family clown. Adult children of alcoholics (ACOA) or addicts are often isolated, lack strong identities, are frightened by angry people, become or marry alcoholics, feel guilty standing up for themselves, and manifest other confused and repressed feelings. ACOA is a 12-step group to help adult children of alcoholics, and AlAnon or Nar-Anon are similar groups targeted for families of addicts or alcoholics. VII. DRUG-SPECIFIC TREATMENT A. Polydrug Abuse is frequent among addicts. Alcoholics often use sedatives, cocaine, and opioids. Treatment needs to aggressively identify the total drug profile of clients and to address addiction as chemical dependency, not a drug-specific problem.

B. Stimulants (cocaine & amphetamines). Abuse of stimulants leads to many psychiatric symptoms, including acute paranoia, schizophrenia, major depression, and bipolar disorder, all of which require psychiatric intervention. Detoxification is accompanied by prolonged craving, exhaustion, and both lack of an ability to feel pleasure and recurrent feelings of elation.

C. Tobacco addiction is successfully treated only by complete abstinence. Even 10 years after cessation of smoking, one cigarette can trigger relapse. The failure rate is 70% to 80%, even though 80% of all smokers want to quit. D. Opioids. Along with treatment for nicotine addiction, treatment for opioid addiction has the highest rate of relapse because of the high level of tissue dependence and severe withdrawal effects. 1. Detoxification sometimes uses mild opioids to taper the habit. 2. Recovery means learning a new life style. E. Sedative-Hypnoties (barbiturates, benzodiazepines) cause severe, life-threatening seizures that accompany withdrawal. Intensive medical assessment and treatment are necessary when treating people addicted to these drugs.

F. Alcohol 1. Denial is the biggest barrier to initial treatment for alcoholism, probably because it takes a long time for drinking to advance to abuse and addiction. 2. Detoxification manages life-threatening withdrawal with sedating drugs to taper the effects. 3. Initial Abstinence is encouraged with Antabuse , a drug that makes people ill if they drink alcohol. Also, an alcoholic is encouraged to go to 90 AA meetings in 90 days
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4. Long-Term Abstinence & Recovery involve avoiding relapse by healing the emotional scars caused by the extensive drinking. Recovery is a lifetime process.

VIII. TREATMENT OBSTACLES. Denial and lack of financial or treatment resources have been the biggest obstacles to addiction treatment. There are others, including the following: A. Development Arrest. Drugs can delay users' emotional development, keeping them from relying on their own resources to solve problems. B. Follow-Through (monitoring). Two causes of poor treatment outcome are early program dropout and lack of compliance to treatment protocol C. Conflicting Goals occur because sometimes clients use treatment merely to better manage their abuse or to qualify for social benefits, whereas most treatment programs insist on immediate commitment to abstinence. D. Treatment Resources need to be funded since immediate access to treatment makes treatment effective. Two-thirds of those on waiting lists never make it into treatment.