Chapter15 Substance Abuse Treatment


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  • Figure 15.1 Percentages of Reasons* for Not Receiving Substance Use Treatment in the Past Year among Women Aged 18 to 49 Who Needed Treatment and Who Perceived a Need for It: 2004–2006
  • Should drug addiction be considered a medical or a legal problem?
  • The longer drug abusers stay in treatment, the more effective the treatment.
  • Chapter15 Substance Abuse Treatment

    1. 1. Albia Dugger • Miami Dade CollegeChapter 15Substance AbuseTreatment
    2. 2. The Need for Treatment Programs• 23.5 million persons aged 12 and older need treatment foreither an illicit drug or alcohol• Only 11.2% of those individuals receive treatment from aspecialized facility• The federal government allocates more than two-thirds of itsdrug-control budget to law enforcement and interdictionefforts, rather than treatment
    3. 3. Underlying Causes of Drug Abuse• People in treatment for substance abuse:• Disadvantaged in education and employment• More likely to be male, Caucasian, aged 25 to 45• Increasing trend toward veterans and the elderly• The goals of a treatment program differ, depending onwhether drug abuse is seen as a medical problem, as abreakdown in society, or as a personality weakness
    4. 4. Drug Courts• Drug treatment courts combine the power of the justicesystem with effective treatment services• First drug court was established in 1989 for nonviolent drugoffenders whose underlying problem is substance use• Offenders who complete substance abuse programs mayhave their sentences dismissed or reduced
    5. 5. Profile of the Drug Abuser• Most people in drug treatment :• Caucasian males• Average age at admission is 34• Less than one-fourth are employed• One third completed high school or a GED• Many have mental health problems• 30-40% of homeless population are drug abusers• Most use more than one drug
    6. 6. Admissions to Treatment
    7. 7. History of Treatment• Using drugs to treat drug abuse was common in earlytreatment programs• US Public Health Service established two hospitals to servethe growing number of addicts in federal prisons• The relapse rate of people released in the 1940s throughearly 1960s ranged between 87% and 96%
    8. 8. Current Treatment Options• Therapeutic community – a residential facility staffed byformer drug addicts• Methadone maintenance programs – outpatient programsin which opiate addicts receive methadone daily• Detoxification – a medically supervised program to withdrawfrom drugs on which they are physically dependent
    9. 9. Current Treatment Options• Three immediate goals of detoxification:1. To provide safe withdrawal from drugs2. To provide withdrawal that is humane and protects theperson’s dignity3. To prepare the person for ongoing treatment• Self-help programs based on the principles of AlcoholicsAnonymous are growing in popularity
    10. 10. Benefits of Treatment• Benefits of drug treatment:• Less expensive than incarceration• Reduced use of illicit drugs• Decline in criminal activity• More stable employment• Reduced transmission of AIDS
    11. 11. Drug Treatment and Criminal Activity
    12. 12. National Treatment ImprovementEvaluation Study• Reported benefits:• Drug use declined from 73% before treatment to 38% oneyear after treatment• Increase in employment from 51% to 60%• Decline in clients receiving welfare from 40% to 35%• Drop in homelessness from 19% to 11%• 53% decline in substance-related medical visits• 56% reduction in people exchanging sex for drugs• 51% drop in people having sex with an IV drug user
    13. 13. HIV Transmission Categories
    14. 14. Treatment Issues• Four pertinent issues in treating drug abuse:1. Voluntary or compulsory treatment2. Matching patients to the best treatment3. Effectiveness of treatment programs designed for adultsfor adolescent substance abusers4. Programs to address female addicts
    15. 15. Voluntary Versus Compulsory Treatment• Some studies show that volunteers fare better than thoserequired to be in treatment• Other studies show that those required to receive treatmentmake as much progress, as those who enter voluntarily• The key issue could be how long the person stays intreatment
    16. 16. Matching Patients and Treatments• Questions to be addressed:• Which treatment produces the best outcomes for aspecific group or person?• Do members of certain ethnic or socioeconomic groupsrespond similarly to certain types of treatment?• Is the effectiveness of a specific program linked to age ofparticipants?• Do females and males differ in their responses totreatment?
    17. 17. Treating Adolescent Drug Abusers• In 2009, in the US, 149,277 individuals aged 12 to 17 wereadmitted to a drug treatment facility• The primary drug of abuse was marijuana• More intensive, longer programs (three months) are moreeffective than short (two session) programs• Teens who enter treatment do better academically than teenswho do not receive treatment
    18. 18. Women and Treatment• Treatment programs for women are scarce• Women substance abusers are more likely to have poorfamily relationships and psychological health than men• Even when treatment is available, many women are reluctantto enter a program• Women in female-only drug abuse treatment centers aremore likely to benefit from treatment
    19. 19. Reasons Women Avoid Treatment
    20. 20. Problems Associated with Treatment• Client Resistance to Treatment:• Many treatment facilities are not readily available oraccessible• A large percentage of clients lack insurance and cannotafford the cost of treatment• Policies and philosophies of some facilities deter drugabusers from pursuing help• Benefits of using drugs outweigh the disadvantages• Clients think that legal authorities will be made aware oftheir drug-taking behavior if they enter treatment
    21. 21. Problems Associated with Treatment• Community Resistance:• People do not want drug treatment centers in theirneighborhoods• Concerned about more crime, more traffic, exposure ofchildren to bad influences, and lower property values• NIMBY (not in my backyard) syndrome
    22. 22. Problems Associated with Treatment• Continuing Drug Use:• The goal of abstinence is often not realized• Treatment of at least six months seems to be necessary toreduce drug use significantly• One study of adolescents in treatment reported that drugusage declined somewhat ,but remained high
    23. 23. Problems Associated with Treatment• Factors that contribute to relapse among alcoholics:1. Negative emotional states such as frustration, anxiety,depression, anger, or boredom2. Interpersonal conflicts with a spouse, family member,friend, or employer3. Social pressure from a person or group of people
    24. 24. Problems Associated with Treatment• Factors in Personnel Recruitment and Retention:• Reluctance to work with drug abusers• Undesirable locations of facilities• Inadequate supply of applicants with professionalexperiences and qualifications• Fear of contracting AIDS
    25. 25. Medical or Legal Problem?
    26. 26. Treatment Programs• Methadone Maintenance• Treatment that involves the dispensing of methadone foropiate addiction for more than 30 days• Eliminates withdrawal symptoms and prevents euphoria• Given orally, every 24 hours• Effective only for heroin addiction• Psychotherapy in conjunction with methadone yields thebest results• Crime reduction and relapse rates improve with duration oftreatment
    27. 27. Treatment Programs• Alternatives to Methadone:• Extended-release form of naltrexone allows patients to betreated on a monthly rather daily basis• Levo-alpha-acetylmethadol (LAAM) works for threedays, but has side effects• Other drugs that block the effects of opiates arenaltrexone, naloxone, clonidine, and buprenorphine• Some narcotic addicts say that methadone withdrawal isworse than going cold turkey
    28. 28. Treatment Programs• Therapeutic communities (TCs)• Drug-free residential settings where abusers reside for oneor two years• Philosophy is that drug abuse is incurable, but can benefitfrom behavioral intervention• Stress group intervention techniques, especiallyencounter groups• Provide vocational and educational assistance andimprove the self-esteem of residents
    29. 29. Longer Treatment is More Effective
    30. 30. Treatment Programs• Outpatient Treatment:• Most common form of drug abuse treatment• Less disruptive and stigmatizing than inpatient treatment• Ranges from counseling centers to halfway houses tocommunity centers• Frequently is used after a client leaves methadonemaintenance• Clients often go back to the environments that contributedto their drug abuse initially
    31. 31. Treatment Programs• Inpatient Treatment:• Typically hospital based• Expensive• No more effective than intensive outpatient treatment• Tend to be highly structured• Group therapy and drug education are stressed
    32. 32. Cost of Treatment
    33. 33. Treatment Programs• Self-Help Groups:• Members are bound by a common denominator such asalcohol, gambling, food, shopping, or sex• Largest self-help group is Alcoholics Anonymous (AA),based on a 12-step model• Offer fellowship and support• Used in lieu of traditional therapies or after a person stopsother therapies• Cost-effective for maintaining changes and preventingrelapse
    34. 34. Narcotics Anonymous• Narcotics Anonymous (NA)• Emanated from Alcoholics Anonymous• Open to all drug addicts• Principles of the NA recovery program:• Admitting there is a problem• Seeking help• Engaging in a thorough self-examination;• Confidential self-disclosure;• Making amends for harm done• Helping other drug addicts who want to recover
    35. 35. Alcohol Treatment• AA advocates total abstinence, a view that is not universallyaccepted• Some treatments advocate a controlled drinking approachin which the patient learns to drink in a nonabusive manner• Drug therapy in the form of Antabuse (disulfiram) has beenused as well
    36. 36. Alcoholics Anonymous• Started in 1935 by an alcoholic surgeon (Dr. Bob) and analcoholic stockbroker (Bill W.)• Goals are sobriety and spiritual renewal• Based on the premise that alcoholism is a disease over whichthe person has no control• Based on a 12-step plan
    37. 37. 12 Steps of Alcoholics Anonymous1. We admitted we were powerless over alcohol—that our liveshad become unmanageable2. Came to believe that a Power greater than ourselves couldrestore us to sanity3. Made a decision to turn our will and our lives over to the careof God as we understood Him4. Made a searching and fearless moral inventory of ourselves
    38. 38. 12 Steps of Alcoholics Anonymous5. Admitted to God, to ourselves, and to another human beingthe exact nature of our wrongs6. Were entirely ready to have God remove all these defects ofcharacter.7. Humbly asked Him to remove our shortcomings8. Made a list of all persons we had harmed, and became willingto make amends to them all
    39. 39. 12 Steps of Alcoholics Anonymous9. Made direct amends to such people wherever possible,except when to do so would injure them or others10. Continued to take personal inventory and when we werewrong promptly admitted it11. Sought through prayer and meditation to improve ourconscious contact with God as we understood Him12. We tried to carry this message to alcoholics and to practicethese principles in all our affairs
    40. 40. Moderate Drinking• Moderation Management (MM) is a controlled drinking modelof behavioral self-management• Drinkers are taught to cope with peer pressure and situationsthat tempt them to drink excessively• The longer a person has been an alcoholic, the less likely it isthat he or she can return to social drinking• The controlled drinking model is contrary to the diseasemodel
    41. 41. Medications• Disulfiram (Antabuse)• Acts as an aversive agent by interacting with alcohol insuch a way that the drinker becomes violently ill• Naltrexone• Reduces alcohol craving among heavy drinkers, but hasnot been shown to result in abstinence• Acamprosate• Inhibits the craving for alcohol and food