Drug rehabilitation
The examples and perspective in this article may not represent a worldwide view of the subject. (November 2020) |
Drug rehabilitation | |
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ICD-9-CM | 94.64 |
Drug rehabilitation is the process of medical or
Treatment includes medication for depression or other disorders,
Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the person new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs but to examine and change habits related to their addictions. Many programs emphasize that recovery is an ongoing process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.")[citation needed]
Whether moderation is achievable by those with a history of misuse remains a controversial point.[2]
The brain's chemical structure is impacted by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process.[3]
Types
Various types of programs offer help in drug rehabilitation, including
In an American survey of treatment providers from three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring the treatment provider's responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics
Effective treatment addresses the multiple needs of the patient rather than treating addiction alone.[5] In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction.[3] The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems.[6] Whatever the methodology, patient motivation is an important factor in treatment success.[7]
For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like methadone and buprenorphine can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs.[8]
Types of behavioral therapy include:
- Cognitive-behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse.
- Multidimensional family therapy, which is designed to support the recovery of the patient by improving family functioning.
- Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment.[9]
- Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance.[10]
- EEG Biofeedback augmented treatment improves abstinence rates of 12-step, faith-based, and medically assisted addiction for cocaine, methamphetamine, alcohol use disorder, and opioid addictions.[11][12][13][14][15][16][17][18][19][20]
Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use. Research has shown that most patients need at least three months of treatment and longer durations are associated with better outcomes.[3] Prescription drug addiction does not discriminate. It affects people from all walks of life and can be a devastatingly destructive force.[21]
Medications
Certain
According to the
Ibogaine is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome. The drug is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered tend to have little oversight and range from motel rooms to one moderately-sized rehabilitation center.[24]
A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction. These medications include bupropion and nortriptyline.[25] Bupropion inhibits the re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant which has been used to aid in smoking cessation it has not been FDA approved for this indication.[25]
Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions.[28][29][30]
Residential treatment
In-patient residential treatment for people with an
Brain implants
Patients with severe opioid addiction are being given brain implants to help reduce their cravings, in the first trial of its kind in the US. Treatment starts with a series of brain scans. Surgery follows with doctors making a small hole in the skull to insert a tiny 1mm electrode in the specific area of the brain that regulates impulses such as addiction and self-control. This treatment is for those who have failed every other treatment, whether that is medicine, behavioral therapy, and/or social interventions. It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies.[34]
Recovery
The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery.[35] The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal well-being[36] while other studies have considered "near abstinence" as a definition.[37] The wide range of meanings has complicated the process of choosing rehabilitation programs.[citation needed]
The Recovery Model originates in the psychiatric survivor movement in the US, which argues that receiving a certain diagnoses can be stigmatizing and disempowering.[38] While other treatment programs are focused on remission or a cure for substance abuse, the Recovery Model takes a humanistic approach to help people navigate addiction.[citation needed] Some characteristics of the Recovery Model are social inclusion, empowerment to overcome substance use, focusing on strengths of the client instead of their deficits and providing help living more fulfilling lives in the presence of symptoms of addiction.[citation needed] Another key component of the Recovery Model is the collaborative relationship between client and provider in developing the client's path to abstinence. Under the Recovery Model a program is personally designed to meet an individual clients needs, and does not include a standard set of steps one must go through.[39]
The Recovery Model uses integral theory:[40] a four-part approach focusing on the individual, the collective society, along with individual and external factors. The four quadrants corresponding with each in Integral Theory are Consciousness, Behavior, Culture and Systems.[41] Quadrant One deals with the neurological aspect of addiction. Quadrant Two focuses on building self-esteem and a feeling of connectedness, sometimes through spirituality. Quadrant three works on mending the "eroded relationships" caused by active addiction. Quadrant Four often involves facing the harsh consequences of drug use such as unemployment, legal discrepancies, or eviction.[42] The use of integral theory aims to break the dichotomy of "using" or "not using" and focuses instead on emotional, spiritual, and intellectual growth, along with physical wellness.[citation needed]
Criminal justice
Drug rehabilitation is sometimes part of the
In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act.[citation needed]
Counseling
Traditional addiction treatment is based primarily on counseling.
Counselors help individuals with identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it's more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. Counselors are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It's very common to see them also work with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her.[46] Counseling is also related to "Intervention"; a process in which the addict's family and loved ones request help from a professional to get an individual into drug treatment.[citation needed]
This process begins with a professionals' first goal: breaking down denial of the person with the addiction. Denial implies a lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, instead of continuing the destructive behavior. Once this has been achieved, the counselor coordinates with the addict's family to support them in getting the individual to drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family.[citation needed]
One approach with limited applicability is the sober coach. In this approach, the client is serviced by the provider(s) in his or her home and workplace—for any efficacy, around-the-clock—who functions much like a nanny to guide or control the patient's behavior.[47]
Twelve-step programs
The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displays addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network that can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939.[48] These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological[49] and legal[50] grounds. Opponents also contend that it lacks valid scientific evidence for claims of efficacy.[51] However, there is survey-based research that suggests there is a correlation between attendance and alcohol sobriety.[52] Different results have been reached for other drugs, with the twelve steps being less beneficial for addicts to illicit substances, and least beneficial to those addicted to the physiologically and psychologically addicting opioids, for which maintenance therapies are the gold standard of care.[53]
SMART Recovery
- Building and Maintaining Motivation,
- Coping with Urges,
- Managing Thoughts, Feelings, and Behaviors,
- Living a Balanced Life.
This is considered to be similar to other self-help groups who work within mutual aid concepts.[57]
Client-centered approaches
In his influential book, Client-Centered Therapy, in which he presented the
A variation of Rogers' approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs, such as
Psychoanalysis
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also explained substance use. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesized specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural, and political factors, encapsulation, traumatophobia, and masturbation as a form of self-soothing.[61] Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings to regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.[citation needed]
Relapse prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt's (1985) Relapse Prevention approach.
For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual can employ successful
Cognitive therapy
An additional cognitively-based model of substance use recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse.[64] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as "I am undesirable," activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs ("I can handle getting high just this one more time") are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist's job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunction. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.[citation needed]
Emotion regulation and mindfulness
A growing literature is demonstrating the importance of
Dual diagnosis
People who are diagnosed with a mental health disorder and a simultaneous substance use disorder are known as having a dual diagnosis. For example, someone with bipolar disorder who also has an alcohol use disorder would have dual diagnosis. On such occasions, two treatment plans are needed with the mental health disorder requiring treatment first. According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder.[citation needed]
Behavioral models
Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exist for both working with the person using the substance (community reinforcement approach) and their family (community reinforcement approach and family training). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on the use of problem-solving techniques as a means of helping the addict to overcome his/her addiction.[72]
The way researchers think about how addictions are formed shapes the models we have. Four main Behavioral Models of addiction exist: the Moral Model, Disease Model, Socio-Cultural Model and Psycho-dynamic Model.[citation needed] The Moral Model of addiction theorizes that addiction is a moral weakness and that it is the sole fault of the person for becoming addicted. Supporters of the Moral Model view drug use as a choice, even for those who are addicted, and addicts as people of bad character.[73] Disease Model of addiction frames substance abuse as 'a chronic relapsing disease that changes the structure and function of the brain'.[74] Research conducted on the neurobiological factors of addiction has proven to have mixed results, and the only treatment idea it offers is abstinence.[75] The Socio-Cultural Model tries to provide an explanation of how certain populations are more susceptible to substance abuse than others. It focuses on how discrimination, poor quality of life, lack of opportunity and other problems common in marginalized communities can make them vulnerable to addiction.[76] The Psycho-Dynamic Model looks at trauma and mental illness as a precursor to addiction. Many rehabilitation centers treat "co-occurring" disorders, which refer to substance abuse disorder paired with a mental health diagnosis.[citation needed]
Barriers to treatment in the US
Barriers to accessing drug treatment may worsen negative health outcomes and further exacerbate
Broad categories of barriers to drug treatment are: absences of problem, negative social support, fear of treatment, privacy concerns, time conflict, poor treatment availability, and admission difficulty.
Loss of Child/Dependent Access
In certain states,
Further, barriers to treatment can vary depending on the geographical location, gender, race, socioeconomic status, and status of past or current criminal justice system involvement of the person seeking treatment.[81][82][83]
Criticism
Despite ongoing efforts to combat addiction, there has been evidence of clinics billing patients for treatments that may not guarantee their recovery.[1] This is a major problem as there are numerous claims of fraud in drug rehabilitation centers, where these centers are billing insurance companies for under-delivering much-needed medical treatment while exhausting patients' insurance benefits. In California, there are movements and laws regarding this matter, particularly the California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses.[citation needed]
Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance use treatment.[84] With long wait lists in limited state-funded rehabilitation centers, controversial private centers rapidly emerged.[84] One popular model, known as the Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies.[84] Under the guise of helping patients with opioid addiction, these centers would offer addicts free rent or up to $500 per month to stay in their "sober homes", then charge insurance companies as high as $5,000 to $10,000 per test for simple urine tests.[84] Little attention is paid to patients in terms of addiction intervention as these patients have often been known to continue drug use during their stay in these centers.[84] Since 2015, these centers have been under federal and state criminal investigation.[84] As of 2017 in California, there are only 16 investigators in the CA Department of Health Care Services investigating over 2,000 licensed rehab centers.[85]
By country
Afghanistan
In Afghanistan since the Taliban took power in 2021, they have forced drug addicts into compulsory drug rehab.[86][87][88][89]
China
As of 2013 China has compulsory drug rehabilitation centers. It was reported in 2018 1.3 million drug addicts were treated in China's compulsory detox centers.[90][91]
Compulsory drug rehabilitation has a long history in China: The Mao Zedong government is credited with eradicating both consumption and production of opium during the 1950s using unrestrained repression and social reform.[92] Ten million addicts were forced into compulsory treatment, dealers were executed, and opium-producing regions were planted with new crops. Remaining opium production shifted south of the Chinese border into the Golden Triangle region.[92]
Indonesia
In 2015 the
Iran
According to statistics best case scenario less than a 25% of addicts go back to being healthy.[95] There are two types of rehab one is Revolutionary Guard Corp or FARAJA run article 16 quarantine which is part of operations cleaning the cities from addicts and homeless just as well, the others article 15 and article 17 run by others including State Welfare Organization of Iran and also those run by Ministry of health and medical education.[96][97] There are also places called Trust houses since July 2023 run by IRGC.[98][99][100]
Italy
In 1963,
See also
- Coerced abstinence
- Drug policy of the Soviet Union
- Dual diagnosis
- Florida shuffle
- Low-threshold treatment programs
- Self-medication
- Sober living environment
- Sober Coach
- Baclofen
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Further reading
- Karasaki M, Fraser S, Moore D, Dietze P (March 2013). "The place of volition in addiction: differing approaches and their implications for policy and service provision". Drug and Alcohol Review. 32 (2): 195–204. PMID 22963577.
- Kinsella M (May 2017). "Fostering client autonomy in addiction rehabilitative practice: The role of therapeutic "presence"". Journal of Theoretical and Philosophical Psychology. 37 (2): 91–108. S2CID 151726043.