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Chapter 17. Substance-Abuse Treatment: Strategies for Change. Five Major Substances of Abuse. Alcohol, opiates, marijuana/hashish, cocaine and other stimulants account for almost all cases (96%) of abusers seeking and receiving treatment. Source: SAMHSA.

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Chapter 17


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    1. Chapter 17 Substance-Abuse Treatment: Strategies for Change

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

    3. Source: SAMHSA

    4. Designing Effective Substance-Abuse Treatment Programs Polydrug use is a common abuse or dependence profile. Others have co-existing mental health problems Thus, 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.

    5. 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.

    6. 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

    7. Figure 17.2

    8. 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.

    9. 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.

    10. In the United States, most drug-related offenses are prosecuted __________. A. at the federal level B. at the state level C. at the municipal (city) level D. at the county level E. by ticked off landlords tired of having addicts trash their places

    11. 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.

    12. The Personal Journey to Treatment and Recovery RECOVERY as five distinct “stages of change.” 1. pre-contemplation recognition of a potential problem but no immediate concern or intent to address it 2. contemplation recognition that something should be done about abuse problem, but not ready to take action 3. preparation decision to take action has been made

    13. The Personal Journey to Treatment and Recovery RECOVERY as five distinct “stages of change.” 4. action cessation of use and treatment—the scary part 5. maintenance clean and sober for at least six months, or beyond the PAWS stage continuing a drug free lifestyle

    14. repeat as necessary

    15. 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.

    16. The Impact of Family Systems on Treatment and Recovery Family units typically pass through the following stages denial avoid shame, humiliation, responsibility, guilt anger fault-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 persists acceptance recognition and acceptance that help must be sought

    17. The Impact of Family Systems on Treatment and Recovery Codependency can take many forms Enabling behavior family members assume the failed responsibilities of the drug abuser jeopardizes recovery of the user

    18. The Impact of Family Systems on Treatment and Recovery avoiding and shielding avoid seeing drug use, hide the problem (“head in the sand”) attempting to control bribing or cajoling user taking over responsibilities paying bills, picking up the kids from school, etc. rationalizing and accepting “It’s not that bad.” cooperation and collaboration helping buy or use drugs, doing drugs with the abuser

    19. Enabling behavior is a result of __________. A. the family taking over responsibility when the abuser has not B. a healthy pattern of interpersonal relationships C. the final portion of the maintenance stage D. overcoming the embarrassment and shame of drug abuse

    20. The Impact of Family Systems on Treatment and Recovery 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

    21. 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.

    22. Finding the Right Substance-Abuse Treatment Program The treatment program should: address the full range of individual needs have diverse forms of treatment available medical, psychiatric, counseling, behavioral be licensed and/or accredited

    23. Finding the Right Substance-Abuse Treatment Program outpatient less costly, more like “real world” than is residential residential is the treatment of choice when outpatient has failed facilities are a great distance from home medical or psychiatric conditions demand inpatient treatment problems are severe enough to warrant separation of the user from others it is required by employer or licensing body (e.g. AMA)

    24. Features of comprehensive treatment programs

    25. 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

    26. Figure 17.5

    27. Needing versus Receiving Substance-Abuse Treatment 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.

    28. Needing versus Receiving Substance-Abuse Treatment 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.

    29. Are you an alcoholic? 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?

    30. 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

    31. 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.

    32. Table 9.2

    33. Approaches to Treatment for Alcoholism • 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.

    34. Alcoholics Anonymous is based upon the idea of ______. • A. absolute devotion to its ideals • B. absolute abstinence • C. absolute commitment toward responsible drinking • D. absolute allegiance to one’s country • E. providing a safe place to drink where identities will not be revealed

    35. Approaches to Treatment for Alcoholism • Moderation Management (MM) • secular, teaches that controlled drinking is possible • goal is reduction in alcohol consumption • 9-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.

    36. Approaches to Treatment for Alcoholism • 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.

    37. Approaches to Treatment for Alcoholism • 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.

    38. Approaches to Treatment for Alcoholism • Self-Management And Recovery Training (SMART) Recovery • secular and evidenced based • Four Points in the recovery process: • Building Motivation • Coping with Urges • Problem Solving • Lifestyle Balance

    39. Approaches to Treatment for Alcoholism • 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.[

    40. Approaches to Treatment for Alcoholism • 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.

    41. Approaches to Treatment for Alcoholism • 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.

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

    43. Approaches to Treatment for Alcoholism • 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.

    44. A Final Note: For Those Who Need Help… The most comprehensive source for information about substance-abuse treatment in the United States is the National Clearinghouse for Alcohol and Drug Information (NCADI).

    45. 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 & UF http://floridarecoverycenter.ufandshands.org 352-265-4FRC (4372) Call for help.  Meridian Behavioral Healthcare, Inc. http://www.mbhci.org/ 352-374-5600  Drug Strategies http://www.drugstrategies.org/Florida/Gainesville/ 800-559-9503

    46. 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. Group Therapy (12-Step Programs) in Gainesville North Central Florida Alcoholics Anonymous www.northcentralflaa.org 352-372-8091 (24 hour hotline)  Narcotics Anonymous Meetings, Gainesville http://www.drugstrategies.org/NA-Meetings/Florida/Gainesville/  North Florida Al-Anon and Alateen http://www.northfloridaal-anon.org/ Adult Children of Alcoholics Mondays, 7:00 p.m. 1521 N.W. 34th St. (Westminster Church, corner of 16th Avenue and 34th St.) Directory for 12-step meetings across Florida http://www.recovery-world.com/florida.html