chapter 17 substance-abuse treatment: strategies for change

Chapter 17

Substance-Abuse Treatment: Strategies for Change

Five Major Substancesof Abuse

Alcohol, opiates, marijuana/hashish, cocaine and other stimulants account for almost all cases (96%) of abusers seeking and receiving treatment.

Source: SAMHSA

Designing Effective Substance-Abuse Treatment Programs

Polydrug use is a common abuse or dependence profile.Others have co-existing mental health problemsThus, effective treatment programs should address polydrug abusers and include psychiatric care for those with other mental disorders.

Many clients in substance-abuse treatment have co-occurring mental-health problems (co-morbidity).

These individuals are often referred to as dual-diagnosis clients.

The Biopsychosocial Model for Substance-Abuse Treatment

Because many individuals experience problems stemming from polydrug abuse, treatment programs must consider common difficulties associated with alcohol and a range of other drugs.

Chances of success in drug-abuse treatment can be increased by looking at the combination of biological, psychological, and social factors leading to drug abuse.

This is referred to as the biopsychosocial model.

The Biopsychosocial Model for Substance-Abuse Treatment

NO program of treatment can succeed if the abuser (addict/alcoholic) does not really want to get clean and sober.

motivation is the most important ingredient in recovery from addiction

e.g. hitting bottom

Figure 17.2

Intervention though Incarceration and Other Punitive Measures

Federal laws since 1970 have established a hierarchy of criminal penalties for drug trafficking, depending on the schedule of the controlled substance, the amounts of drugs that are involved, and special circumstances under which violations have been committed.

Drug related offenses and enforcement of drug laws is generally considered to be the responsibility of individual states; by far, most prosecution for drug-related offenses occurs at the state level.

Intervention though Incarceration and Other

Punitive Measures In some cases, abusers of illicit drugs who are arrested for violating drug-control laws are given the option of entering a treatment program rather than undergoing prosecution and imprisonment.

For those who are sentenced to a prison term, a limited number of opportunities for drug treatment exist within the prison system.

In the United States, most drug-related offenses are prosecuted __________.

A. at the federal levelB. at the state levelC. at the municipal (city) levelD. at the county levelE. by ticked off landlords tired of having

addicts trash their places

Intervention though Incarceration and Other

Punitive Measures A growing number of drug courts, handling the cases of adult, nonviolent drug offenders, operate to adjudicate individual cases through supervised treatment rather than incarceration.

The Personal Journey to Treatment and Recovery

RECOVERY as five distinct “stages of change.”

1. pre-contemplationrecognition of a potential problem but no immediate

concern or intent to address it

2. contemplationrecognition that something should be done about abuse

problem, but not ready to take action

3. preparationdecision to take action has been made

The Personal Journey to Treatment and Recovery

RECOVERY as five distinct “stages of change.”

4. actioncessation of use and treatment—the scary part

5. maintenanceclean and sober for at least six months, or beyond the PAWS stagecontinuing a drug free lifestyle

repeatasnecessary

The Impact of Family Systems on Treatment and Recovery

It is critical to examine the family dynamics surrounding a drug abuser not only to understand the situational problems that have developed but also to anticipate and deal with the obstacles that might derail treatment.

It is important to remember that slips are not uncommon and do not signal failure; quitting a recovery program is the only failure.


Family units typically pass through the following stages

denialavoid shame, humiliation, responsibility, guilt

angerfault-finding, assignment of blame

bargaining“I’ll stop doing drugs if you’ll…”, or “Will you at least just drink

beer?”feelings

helplessness, anxiety as dysfunction persistsacceptance

recognition and acceptance that help must be sought


Codependency can take many forms

Enabling behaviorfamily members assume the failed responsibilities of

the drug abuserjeopardizes recovery of the user


avoiding and shieldingavoid seeing drug use, hide the problem(“head in the sand”)

attempting to controlbribing or cajoling user

taking over responsibilitiespaying bills, picking up the kids from school, etc.

rationalizing and accepting“It’s not that bad.”

cooperation and collaborationhelping buy or use drugs, doing drugs with the abuser

Enabling behavior is a result of __________.A. the family taking over responsibility

when the abuser has notB. a healthy pattern of interpersonal

relationshipsC. the final portion of the maintenance

stageD. overcoming the embarrassment and

shame of drug abuse


Family support is crucial for success

Primary responsibility always remains with the substance abuser

no program can work if the abuser does not really want to quit

Al-Anon, Alateen, ACOA are all organizations to help family members

substance abuse is a family disease

Finding the Right Substance-Abuse Treatment Program

Consider the goals and objectives of a treatment program to find the one best suited to the person seeking help.

Inpatient or outpatient?Format for treatment?Length of treatment?After-care, recovery houses?

It is also important to inspect the treatment facility in person.


The treatment program should:address the full range of individual needshave diverse forms of treatment available

medical, psychiatric, counseling, behavioralbe licensed and/or accredited


outpatientless costly, more like “real world” than is residential

residential is the treatment of choice when outpatient has failedfacilities are a great distance from homemedical or psychiatric conditions demand inpatient treatmentproblems are severe enough to warrant separation of the user from othersit is required by employer or licensing body (e.g. AMA)

Features of comprehensive treatment programs

Needing versus Receiving Substance-Abuse Treatment

According to U.S. government estimates

more than 7 million people, aged twelve or older, need treatment for an illicit drug problem;

approximately 19 million people need treatment for an alcohol problem.

Only a small fraction of these people in need, however, have received treatment in the past twelve months

Figure 17.5


Of those individuals who have needed treatment for problems with illicit drug or alcohol use but have not received it, a very small proportion of them personally felt the need to seek it out.

denial?

One reason for not seeking treatment, despite the perceived need, is the lack of financial means to pay for treatment services and inadequate health insurance coverage.

Twelve-step programs have no fees.


The Mental Health Parity and Addiction Equity Act of 2008 allows individuals in substance-abuse treatment to receive reimbursement on a par with treatment for medical conditions.

1. Do you lose time from work due to drinking? 2. Is drinking making your home life unhappy? 3. Do you drink because you are shy with other people?4. Is your drinking affecting your reputation? 5. Have you ever felt remorse after drinking?6. Have you ever got into financial difficulties as a result of drinking?7. Do you turn to lower companions and an inferior environment when drinking?8. Does your drinking make you careless of your family’s welfare?9. Has your ambition decreased since drinking?10. Do you crave a drink at a definite time?11. Do you want a drink the next morning?12. Does drinking cause you to have difficulty in sleeping?13. Has your efficiency decreased since drinking?14. Is drinking jeopardizing your job or business?15. Do you drink to escape from worries or trouble?16. Do you drink alone?17. Have you ever had a complete loss of memory as a result of drinking? 18. Has your physician ever treated you for drinking?19. Do you drink to build up your self-confidence?20. Have you ever been to a hospital or institution because of drinking?

Are you an alcoholic?

Chronic Alcohol Abuse and Alcoholism in the Workplace

Many corporations and other large organizations have instituted Employee Assistance Programs (EAPs), and unions have instituted Member Assistance Programs (MAPs), to help workers with problems of alcohol abuse or other forms of drug abuse.

e.g. Counseling and Wellness Center for UF students

Approaches to Treatment for Alcoholism

Approaches include behaviorally and psychologically based treatments (e.g., cognitive behavioral therapy, contingency management) and spiritually based treatments (e.g., Alcoholics Anonymous).

It is curious to note that although AA embraces the disease concept of alcoholism, it embraces a spiritual rather than a scientific or medical approach to its treatment.

Table 9.2


Objections to certain aspects of the AA philosophy (e.g., spirituality, need for total abstinence, life-long commitment) have promoted the growth of other self-help organizations, such as Moderation Management (MM) and Self-Management And Recovery Training (SMART) Recovery.

Alcoholics Anonymous is based upon the idea of ______.A. absolute devotion to its idealsB. absolute abstinenceC. absolute commitment toward responsible drinkingD. absolute allegiance to one’s country

E. providing a safe place to drink where identities will not be revealed


Moderation Management (MM)secular, teaches that controlled drinking is possiblegoal is reduction in alcohol consumption9-step program

Attend meetings or on-line groups and learn about the program of Moderation Management.

Abstain from alcoholic beverages for 30 days and complete steps three through six during this time.

Examine how drinking has affected your life.


Moderation Management (MM), cont’d

1. Write down your life priorities.

2. Take a look at how much, how often, and under what circumstances you had been drinking.

3. Learn the MM guidelines and limits for moderate drinking.

4. Set moderate drinking limits and start weekly "small steps" toward balance and moderation in other areas of your life.


Moderation Management (MM), cont’d

5. Review your progress and update your goals.

6. Continue to make positive lifestyle changes and attend meetings whenever you need ongoing support or would like to help newcomers.


Self-Management And Recovery Training (SMART) Recoverysecular and evidenced based

Four Points in the recovery process:Building MotivationCoping with UrgesProblem SolvingLifestyle Balance


SMART Seven Stages of Change:

Precontemplation - At this stage, the participant may not realize that they have a problem.

Contemplation - The participant evaluates the advantages and disadvantages of the addiction by performing a cost/benefit analysis.

Determination/Preparation - The participant completes a Change Plan Worksheet.[


SMART seven stages of change (cont’d)

Action - The participant seeks out new ways of handling their addiction behavior. This can include self-help, the support of addiction help group or professional guidance.

Maintenance - After a few months, the participant's behavior has been changed and now seeks to maintain their gains.


SMART seven stages of change (cont’d)

Relapse - Although not inevitable, relapses are a normal part of the change cycle and if handled well, can serve a learning experience in overcoming an addiction.

Termination - Once a participant has sustained a long period of change, they may choose to move on with their lives and "graduate" from SMART Recovery.

Self-help groups __________.A. should be considered as part of a multipronged approach B. are often very expensiveC. are always part of hospital careD. are useful only in the action stage of change


Regardless of differences, all programs emphasize the importance of learning life skills to enable the alcoholic to cope with life without the use of alcohol.

Comparison of effectiveness is virtually impossible given the different goals and criteria for success, the anonymity of A.A. and the importance of motivation.

The most comprehensive source for information about substance-abuse treatment in the United States is the National Clearinghouse for Alcohol and Drug Information (NCADI).

A Final Note: For Those Who Need Help…

The following is informational only and is not a recommendation or endorsement of any facility or program. Treatment Centers in Gainesville

Florida Recovery Center, Shands & UFhttp://floridarecoverycenter.ufandshands.org352-265-4FRC (4372) Call for help.

Meridian Behavioral Healthcare, Inc.http://www.mbhci.org/352-374-5600

Drug Strategieshttp://www.drugstrategies.org/Florida/Gainesville/800-559-9503


http://floridarecoverycenter.ufandshands.org/

http://www.mbhci.org/

http://www.drugstrategies.org/Florida/Gainesville/

The following is informational only and is not a recommendation or endorsement of any facility or program. Group Therapy (12-Step Programs) in Gainesville

North Central Florida Alcoholics Anonymouswww.northcentralflaa.org352-372-8091 (24 hour hotline)

Narcotics Anonymous Meetings, Gainesvillehttp://www.drugstrategies.org/NA-Meetings/Florida/Gainesville/

North Florida Al-Anon and Alateenhttp://www.northfloridaal-anon.org/

Adult Children of AlcoholicsMondays, 7:00 p.m. 1521 N.W. 34th St. (Westminster Church, corner of 16th Avenue and 34th St.)

Directory for 12-step meetings across Floridahttp://www.recovery-world.com/florida.html


http://www.northcentralflaa.org/

http://www.drugstrategies.org/NA-Meetings/Florida/Gainesville/

http://www.northfloridaal-anon.org/

http://www.recovery-world.com/florida.html

chapter 17 substance-abuse treatment: strategies for change

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