Drug rehabilitation (often drug rehab or just rehabilitation ) is a process of medical treatment or psychotherapy for dependence on psychoactive substances such as alcohol, prescription drugs, and drugs street treatments such as cocaine, heroin or amphetamines. The general purpose is to enable the patient to face substance dependence, if any, and to stop substance abuse to avoid the psychological, legal, financial, social and physical consequences that can be caused, especially by extreme abuse. Treatments include medications for depression or other disorders, counseling by experts and sharing experiences with other addicts.
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Psychological dependency
Psychological dependence is discussed in many drug rehabilitation programs by trying to teach new patient interaction methods in a drug-free environment. In particular, patients are generally encouraged, or perhaps even necessary, not to associate with friends who still use addictive substances. The twelve-step program encourages addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addiction. Many programs emphasize that recovery is a permanent process without a peak. For legal drugs such as alcohol, complete abstain - rather than moderation, which can cause relapse - is also emphasized ("One is too much, and a thousand is never enough.") Whether moderation can be achieved by those whose history of abuse is still a controversial issue , but it is generally considered unsustainable.
Maps Drug rehabilitation
Type of care
The brain's chemical structure is affected by drug abuse and this change takes place long after a person stops using, This change in brain structure increases the risk for relapse, making care an important part of the rehabilitation process.
Different types of programs offer assistance in drug rehabilitation, including: residential care (inpatients/outpatients), local support groups, advanced care centers, recovery or simple homes, addiction counseling, mental health, and medical care. Some rehabilitation centers offer special programs of age and gender.
In a survey of treatment providers from three separate institutions (National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems, and Society of Psychologists in Adictive Behaviors) measured care provider responses on the Spiritual Confidence Scale (beliefs scale in four AA spiritual characteristics identified by Ernest Kurtz); scores were found to account for 41% of the variance in the treatment provider response on the Trusted Addiction Scale (scale of adherence to disease model or addiction-free model).
Scientific research since 1970 shows that effective treatment overcomes many patients' needs rather than treating addictions alone. In addition, detoxification of medically assisted drugs or alcohol detoxification alone is not as effective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both drugs (if any) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment should address medical and mental health services and follow-up options, such as community-based or family-based recovery systems. Whatever the methodology, patient motivation is an important factor in the success of treatment.
For individuals who are addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs that affect the same brain system. Drugs such as methadone and buprenorphine can be used to treat prescription opiate addiction, and behavioral therapy can be used to treat addiction of prescription stimulants, benzodiazepines, and other medications.
Types of behavior 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, designed to support patient recovery by improving family function.
- Motivational interviews, designed to improve the motivation of patients to change behavior and enter care.
- Motivational incentives, which use positive reinforcement to encourage abstinence from addictive substances.
Treatment can be a long process and the duration depends on the patient's needs and history of abuse. Studies have shown that most patients need at least 3 months of treatment and a longer period of time is associated with better outcomes.
Drugs
Certain opioid drugs such as methadone and recently buprenorphine (in America, "Subutex" and "Suboxone") are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance treatments intended to reduce the desire for opiates, thereby reducing illegal drug use, and their associated risks, such as illness, arrest, detention, and death, in line with the hazard reduction philosophy. Both drugs can be used as maintenance medications (taken indefinitely), or used as detoxifying aids. All available studies collected in the 2005 Australian Pharmacotherapy Evaluation for Opioid Addiction suggest that care care is preferable, with very high rates (79-100%) recurring within three months of detoxification of LAAM, buprenorphine, and methadone.
According to the National Institute on Drug Abuse (NIDA), patients are stabilized at adequate doses of methadone or buprenorphine and can sustain their work, avoid crime and violence, and reduce their exposure to HIV and hepatitis C by stopping or reducing injecting drug use and risky sexual behavior high drug-related. Naltrexone is a long-acting opioid antagonist with few side effects. It is usually prescribed in an outpatient medical condition. Naltrexone blocks the effects of alcohol and opiate euphoria. Naltrexone cut the risk of relapse during the first 3 months by about 36%. However, it is far less effective in helping patients maintain abstinence or retain them in drug-treatment systems (average retention rate of 12% at 90 days for naltrexone, averaging 57% at 90 days for buprenorphine, a median of 61% on 90 days for methadone).
Ibogaine is a hallucinogenic drug promoted by certain peripheral groups to interfere with physical dependence and psychological desire for various drugs including narcotics, stimulants, alcohol and nicotine. Until now, there has never been a controlled study that showed it to be effective, and it was accepted as a treatment by no physician association, pharmacist, or addiction expert. There are several deaths associated with the use of ibogain, which causes tachycardia and long QT syndrome. The drug is illegally monitored Schedule I in the United States, and the foreign facility in which it is managed tends to have little supervision, and ranges from motel rooms to a medium-sized rehabilitation center.
Some antidepressants have proven useful in the context of quitting smoking/nicotine dependence, these drugs include bupropion and nortriptyline. Bupropion inhibits the reuptake of norepinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant that has been used to assist in quitting smoking even though it has not been FDA approved for this indication.
Acamprosate, disulfiram and topiramate (new anticonvulsant sulphonated sugars) are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them maintain abstinence for several weeks or months. Disulfiram (also called Antabuse) produces a very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. This is more effective for patients with high motivation and some addicts use it only for high-risk situations. Patients who wish to continue drinking or may recur, should not be disulfiram because it can cause the previously mentioned disulfiram-alcohol reaction, which is very serious and can even be fatal.
Nitrous oxide, also sometimes known as laughing gas, is a legally available gas used for purposes that include anesthesia during specific dental and surgical procedures, as well as food preparation and refueling of rockets and racing machines. The substance of the offender also sometimes uses gas as inhalation. Like all other inhalants, it is popular because it provides a change-awareness effect while allowing users to avoid some legal issues surrounding illegal or illegal drug abuse. Abuse of nitrous oxide can produce significant long-term and long-term damage to human health, including forms of oxygen starvation called hypoxia, brain damage, and serious vitamin B12 deficiency that can cause nerve damage.
Though dangerous and addictive in itself, nitrous oxide has proven to be an effective treatment for a number of addictions.
Housing care
Hospitalization in hospital for alcohol abuse is usually quite expensive without proper insurance. Most American programs follow the traditional 28-30 day program. Its length is based solely on the provider's experience in the 1940s that clients need about a week to cope with physical changes, another week to understand the program, and another week or two to be stable. 70 to 80 percent of residential alcohol care programs in America provide 12-step support services. These include, but are not limited to AA, NA, CA, Al-Anon One recent study demonstrating the importance of family participation in the retention of residential care patients, finding "increased completion rates for those with significant family members or significant others involved in the program family of seven days. "
Experimental treatment
The Nature of Things , CBC Television program by David Suzuki, explores experimental drug treatment by Dr. Gabor MatÃÆ'Â © where the Ayahuasca substance is used to treat addicts in Vancouver.
Recovery
The definition of recovery remains subdivided and subjective in drug rehabilitation, as there are no established standards for measuring recovery. The Betty Ford Institute defines recovery as achieving complete abstinence as well as personal wellbeing while other studies have considered "almost no abstinence" as a definition. Various meanings have complicated the process of choosing a rehabilitation program.
Criminal justice
Drug rehabilitation is sometimes part of the criminal justice system. Persons convicted of minor drug offenses may be sentenced to rehab instead of prison, and those convicted of drunk driving are sometimes required to attend the Alcoholics Anonymous meeting. There are a number of ways to overcome alternative sentences in drug possession or DUI cases; increasingly, American courts are willing to explore out-of-box methods to deliver this service. There have been lawsuits filed, and won, on the requirement of attending Alcoholics Anonymous and other twelve-step meetings as inconsistent with the First Amendment of the Constitution US Constitution Clause, which mandates the separation of church and state.
In some cases, individuals may be ordered by courts for drug rehabilitation by the state through legislation such as the Marchman Act.
Counseling
Traditional addiction treatments are mainly based on counseling.
Counselors help individuals identify behaviors and problems associated with their addiction. This can be done individually, but it is more common to find it in group settings and may include crisis counseling, weekly or daily counseling, and drop-in counseling support. They are trained to develop recovery programs that help rebuild healthy behaviors and provide coping strategies whenever a risk situation occurs. It is common to see them working also with family members who are affected by individual addiction, or in communities to prevent addiction and educate the public. The counselor should be able to recognize how addiction affects the whole person and the people around him. Counseling is also associated with "Interventions"; a process whereby a family request a help addict from a professional to bring this person into drug treatment. This process begins with one of the first goals of these professionals: breaking the rejection of people with addiction. Disclaimers imply a lack of patient's willingness or fear to face the true nature of addiction and to take any action to improve their lives, in addition to continuing destructive behavior. Once this is achieved, coordinate professionals with an addict family to support them in order for this family member to get immediate alcohol drug rehabilitation, with care and concern for this person. Otherwise, this person will be asked to leave and expect no support whatsoever until going into drug rehab or alcoholism treatment. Interventions can also be done in a workplace environment with non-family colleagues.
One approach with limited application is the Sober Coach. In this approach, the client is served by the provider (s) at home and workplace - for efficacy, around the clock - which functions like a caregiver to guide or control the patient's behavior.
Twelve-step program
The model of addiction has long argued the maladaptive pattern of alcohol and the use of substances displayed by the addicted individual is the result of a lifelong biological disease in origin and exacerbated by environmental possibilities. This conceptualization makes individuals essentially powerless over their troubled behavior and can not remain self conscious, just as individuals with terminal illness can not fight the disease itself without drugs. Therefore, behavioral treatment requires individuals to recognize their addiction, abandon their previous lifestyle, and seek out supportive social networks that can help them stay conscious. Such an approach is the classic features of the Twelve-step program, originally published in the book Alcoholics Anonymous in 1939. These approaches have faced many criticisms, coming from opponents who disagree with the spiritual-religious orientation both psychologically and legally. Nevertheless, despite these criticisms, research results have revealed that affiliates with a twelve-step program predict successful abstinence at a 1 year follow-up for alcoholism. Different results have been achieved for other drugs, with twelve steps less useful for substance addicts, and at least beneficial to those addicted to physiological and psychological addictive opioids, where maintenance therapy is the standard of care for gold.
Client-centered approach
In his influential book, Client-Centered Therapy, where he presented a client-centered approach to therapeutic change, psychologist Carl Rogers proposed there were three necessary and sufficient conditions for personal change: unconditionally positive, accurate empathy, and authenticity. Rogers believes that the presence of these three items in therapeutic relationships can help one solve troublesome problems, including alcohol abuse. For this purpose, a 1957 study compared the relative effectiveness of three different psychotherapy in treating alcoholics who have committed to state hospitals for sixty days: therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Although the author expects the two-factor theory to be the most effective, it actually proves to be detrimental to results. Curiously, client-centered therapy proved most effective. It has been argued, however, that this finding may be due to profound differences in the therapist's view between two factors and client-centered approaches, rather than client-centered techniques. The authors note the two-factor theory involves a sharp disagreement of the client's "irrational behavior" (p.Ã, 350); This very negative view can explain the outcome.
Variations of the Rogers approach have been developed where the client is directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed (CDOI) therapy, this approach has been used by several drug treatment programs, such as the Arizona Department of Health Services.
Psychoanalysis
Psychoanalysis, a psychotherapeutic approach to behavioral change developed by Sigmund Freud and modified by his followers, also offers an explanation of substance abuse. This orientation shows the main cause of the syndrome of addiction is the need for the subconscious to entertain and impose various kinds of fantasy homosexual and perverted, and at the same time to avoid taking responsibility for this. This is a hypothesis of certain drugs that facilitate certain delusions and the use of drugs is considered a shift from, and along with, the drive to masturbate while entertaining homosexual and perverted fantasies. Addiction syndrome is also hypothesized to be associated with the trajectory of life that has taken place in the context of a traumatogenic process, a phase that includes social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of calming. Such an approach contrasts strongly with the social cognitive theories approach to addiction - and indeed, to the behavior in general - that governs humans to regulate and control their own environmental and cognitive environments, and not only driven by internal, impulse driving. In addition, homosexual content is not involved as a necessary feature in addiction.
Relapse prevention
The cognitive-behavioral approach that affects recovery and addiction therapy is the approach of Relapse Prevention Alan Marlatt (1985). Marlatt describes four psychosocial processes relevant to the process of addiction and relapse: self-efficacy, outcome expectancies, causality attribution, and decision-making processes. Self-efficacy refers to a person's ability to deal competently and effectively with high-risk situations, leading to recurrence. The results of hope refer to individual expectations about the psychoactive effects of addictive substances. Causality attribution refers to the pattern of individual beliefs relaping to drug use is the result of an internal, or somewhat external, cause (eg, Allows oneself to make exceptions when faced with what is considered an unusual circumstance). Finally, the decision-making process is involved in the recurrence process as well. The use of substances is the result of decisions whose collective effects produce an intoxicating consumption. Furthermore, Marlatt emphasizes some decisions - so-called seemingly irrelevant decisions - may appear unimportant to relapse, but actually have downstream implications that place users in high-risk situations.
For example: As a result of heavy traffic, a recovering alcoholic can decide one afternoon to get off the highway and travel on the side of the road. This will result in the creation of a high-risk situation when he realizes that he accidentally drove with his old favorite bar. If this individual is capable of using a successful coping strategy, such as diverting his attention from his desire by turning on his favorite music, then he will avoid the risk of relapse (PATH 1) and increase his efficacy for future abstinence. However, if he lacks coping mechanisms - for example, he may begin to contemplate his desire (PATH 2) - his efficacy for abstinence will diminish, his expectation of positive results will increase, and he may have an interval - an isolated return to substance intoxication. Thus, the results referred to by Marlatt as the Abstinence Abuse Effect, are characterized by guilt for low drunkenness and efficacy for future abstinence in the same seductive situation. This is a dangerous path, says Marlatt, to relapse completely.
Cognitive therapy
An additional cognitive model based on substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 Cognitive Therapy of Substance Abuse. This therapy relies on the assumption of an addicted individual having a core belief, often inaccessible to immediate consciousness (unless the patient is also depressed). This core belief, such as "I am not wanted," activates an addictive belief system that generates anticipatory benefits imaginable from the use of matter and, consequently, the desire. Once craving is activated, a permissive belief ("I can cope only high once again") is facilitated. Once a series of permissive beliefs has been activated, the individual will activate drug-seeking behavior and take drugs. The work of a cognitive therapist is to uncover the underlying belief system, analyze it with the patient, and thus indicate its dysfunctionality. As with behavioral cognitive therapy, homework and behavioral exercises serve to reinforce what is learned and discussed during the treatment.
Emotion and awareness settings
A growing literature shows the importance of emotional regulation in the treatment of substance abuse. Considering that nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, the approach to emotional regulation can be applied to a wide range of substance abuse. The proposed models of influenced tobacco use have focused on negative reinforcement as the main driving force for addiction; according to such theories, tobacco is used because it helps one to break away from the effects of nicotine withdrawal or other undesirable negative moods. Acceptance and therapy commitment (ACT), showing evidence that it is effective in treating substance abuse, including the treatment of substance abuse and cigarettes. The mindfulness program that encourages patients to realize their own current experience and the emotions arising from the mind, emerges to prevent an impulsive/compulsive response. Research also shows that awareness programs can reduce consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates.
Behavioral model
Behavioral models use the principles of functional analysis of drinking behavior. Models of behavior exist for both working with substance abuse agents (Community Reinforcement Approach) and their families (Community Reinforcement Approach and Family Training). Both models have considerable research success for effectiveness and effectiveness. This model puts much emphasis on the use of problem-solving techniques as a means of helping addicts to overcome their addictions.
Criticism
Despite ongoing efforts to combat addiction, there is clinical evidence that charges patients for treatment that may not guarantee its recovery. This is a big problem as there are many fraudulent claims in drug rehab centers, where these centers are billing insurance companies for lacking the much needed medical care while exhausting the insurance benefits of patients. In California, there are moves and laws on this issue, especially the California Insurance Prevention Prevention Act (IFPA) which states that it violates the law to do such business illegally.
Under the Affordable Care Act and Mental Health Mental Act, a rehabilitation center may bill insurance companies for substance abuse treatments. With a long waiting list in restricted state-funded rehabilitation centers, controversial private centers are rapidly emerging. One popular model, known as the Florida Model for Rehabilitation Centers, is often criticized for billing fraud to insurance companies. Under the guise of assisting patients with opioid addiction, these centers will offer free rent to addicts or up to $ 500 a month to live in their "modest home", then charge insurance companies as high as $ 5,000 to $ 10,000 per test for simple urine tests. Little attention is given to the patient in terms of addiction intervention because these patients are often known to continue using drugs during their stay in these centers. Since 2015, these centers have been under federal and state criminal investigations. In 2017 in California, there are only 16 researchers in the CA Health Care Services Department who are investigating more than 2,000 licensed rehabilitation centers.
See also
- forced prohibition
- Drug policy of the Soviet Union
- Double diagnosis
- Self treatment
- A quiet living environment
- Trainer
- Procovery
References
Further reading
- Karasaki et al., (2013). Place of Difficulties in Addiction: Different Approaches and Their Implications for the Policy and Terms of Service .
- Kinsella, M. (2017). Fostering client autonomy in additive rehabilitation practices: Therapeutic 'presence' role. Journal Of Theoretical And Philosophical Psychology, 37 (2), 91-108.
External links
- Drug Rehabilitation at Curlie (based on DMOZ)
- Reviews of Drugs and Alcohol by Australasian Professional Society on Alcohol and Other Drugs (APSAD)
Source of the article : Wikipedia
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