Substance Abuse Programs
Substance Abuse Programs Need To Be Unique
Each drug addiction case is unique so Substance Abuse Programs have to be tailor-made to fit the needs of the individual.
One size does not fit all and people have to be in the right setting in order for healing to take place.
So whether the judge ordered the treatment, whether it’s in-patient or out-patient, look for programs that treat body, mind and spirit. All three components work together. Even if a person can get back to health, the destruction on their lives that the addiction has inflicted may require emotional and spiritual support. Good Substance Abuse Programs recognize this important aspect of drug recovery.
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Types of Substance Abuse Programs
Let’s begin by stating that Substance Abuse Programs may consist of several different elements. For example, a program may center on behavioral therapy, which is counseling, cognitive therapy and psychotherapy. Sometimes the needs of the individual necessitate a medical treatment component.
This presents an interesting point for consideration. Just as people are complex and all Substance Abuse Programs are different, so too are the theories surrounding drug treatment. I once worked with a psychotherapist who would bristle at the idea of ANY medical intervention in drug treatment, and likewise worked with medical people who ONLY saw the value of a using medicine to help the patient work through the clutches of addiction. A balanced program is usually the best.
12-Step Substance Abuse Programs: Under behavioral therapy is the 12-Step program which was developed by Alcoholics Anonymous, a program so successful that over 250 self-help groups have adopted it. Instead of “alcohol” just insert your drug of choice. Written by addicts, the 12-step has proven to be a powerful tool for fighting through addiction. The driving force behind the 12-step is the relationship that is formed between the recovering addict and the “power outside them” that guides and sustains them. Relationships and support are important healing elements in recovery. For more about 12-stepSubstance Abuse Programs click here
Agonist Maintenance Treatment: This is used for the treatment of addiction to opiates and is usually an out-patient program. This is also called Methadone Treatment, and a synthetic opiate medication, usually methadone or LAAM, is used to prevent opiate withdrawal and decrease the craving associated with opiate addiction.
Moreover, once the patient is stabilized, the synthetic opiate will block the effects of the street opiate. The medication is given orally for a specific period of time, and the program is designed to help patients live a “normal” life, go to work and get on with life. Patients are helped because they can engage in the therapy sessions and better resist any criminal or violent behavior. These programs include group sessions, individual counseling and referral for other needed medical or social services.
Narcotic Antagonist Treatment: This is also an out-patient program for opiate addicts, but the medication, in this case Naltrexone, is not given until after the patient has gone through medical detoxification in a residential setting. Naltrexone, like Methadone, is a synthetic and has few side effects. It’s long-lasting and patients will take it two or three times a week. The reason patients need to go through detox first is that the drug will not work if there is any lingering opiate in the system. If this is not done, the drug can produce what is called an opiate abstinence syndrome. When all is right, the Naltrexone will block the effects of opiates, and that is the idea behind this treatment; patients gradually change their habits because of the continued lack of the desired effect of the opiate. To receive benefit, patients in this treatment program need to be constantly monitored for compliance, be in therapy sessions.
Out-Patient Drug-Free Treatment: This type of service is less costly than the previously mentioned treatments, but some of the more streamlined versions of this treatment may offer little more than some education. Do your homework first. This is a good program for those who have social support, hold jobs and have connections to resources. Some out-patient, non-drug programs can offer the same intensity of the in-patient treatments, with an emphasis on individual patient needs, such as medical and psychological.
Long-Term Residential Treatment: Long-term residential provides 24-hour service in a non-hospital setting. Most popular and well known is the therapeutic community model (TC). Some residential centers may use other models, like cognitive-behavioral therapy, but the TC is most common. By long term, we mean six to 12 months, as these programs focus on “re-socialization” and sometimes that means rebuilding a life. Patients interact with staff and other residents during treatment, and addiction is viewed in terms of the patient’s social setting, his/her psychological factors, and treatment takes place in a highly structured setting, as the patients’ schedule from wake-up to bed-time is programmed. Sometimes this form of therapy can be confrontational, as patients are encouraged to take responsibility for their actions, and rethink their views on themselves, their view of the world and their place in it. Some treatment centers offer employment training and referral. The person who needs this treatment has more severe problems. They may have mental issues, criminal/legal complications.
Short-Term Residential Programs(Rehabilitation): These programs began as a treatment for alcoholism, using the 12-step program. Centers began treating drug addiction in the 1980’s, when cocaine use reached epidemic proportions. Originally, patients would participate in a hospital-based program for three to six weeks, then enter into out-patient therapy. Also included in this model were self-help groups. Unfortunately, cutbacks in healthcare coverage for drug and alcohol abuse have resulted in fewer of these programs, and under managed care, the length of stay is much shorter.
Medical Detoxification: We mentioned this before, but a note of explanation is necessary to clear up any misconceptions. People have this image of detox being a torture chamber, an image brought on my Hollywood. Patients are systematically taken off drugs and are under the care of a physician. It used to be thought that detoxification was a treatment in and of itself, but it is most often just a precursor to treatment. Think of it as helping a patient get back to square one and get the drugs out of the system. For most types of drug abuse, detoxification can include medications to make the withdrawal process safer. Sometimes, just going through this process without medication or the care of a physician can be fatal. Detoxification does not address psychological, behavioral or social issues, and so treatment is necessary to meet all of the patient’s needs.
Criminal Justice System: The research into treating abusers and addicts involved in the criminal justice system suggests that using the law and providing treatment can go hand-in-hand in reducing both drug use and the crime that goes with it. Whether a patient has court-ordered treatment, or voluntary, people who are under legal authority tend to stay in treatment longer than those who do not have any “legal” pressure to do so. Because addicts are so often the last ones to know they have a problem, the criminal justice system can often be the first to respond to an individual’s need, even sooner than health care or social systems. Sometimes the drug treatment is given in lieu of incarceration, or if incarceration is necessary, drug treatment takes place during that time period.
Prison-Based Treatment Programs: Drug users can get a variety of services while in prison, from classes, to self-help programs. The TC we discussed before has been found to be very effective in a prison setting. The therapeutic community is effective in reducing recidivism, not only to drug use but to criminal behavior. Inmates who are in treatment need to be separated from the general population to avoid the bad influences of the prison culture. The benefits of treatment can also be easily lost once a prisoner is returned to the general population, so they are encouraged to continue in the program, both in and out of incarceration.
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Community-Based Treatment for Criminal Justice Populations: Rather than incarceration, criminal justice systems have tried pretrial entry into treatment, conditional probation or other limited diversion programs. Each carry sanctions and those being allowed to use this path are well advised to take full advantage of the treatment offered. The idea of the drug court shows promise, as drug courts have the muscle to order treatment and can facilitate treatment avenues. The courts monitor progress and can play a role in changing programs to meet individual needs. A resource for additional information is the U.S. Department of Justice Drug Courts Program Office.
Availability Critical for Substance Abuse Programs
Everything needs to be in place in order for Substance Abuse Programs to be effective. If a person is in need of treatment, treatment needs to be available.
If a person is put on a waiting-list, or if there is not treatment available in their community, or perhaps a short distance away, the degree of difficulty increases.
By the time people are entering Substance Abuse Programs, in so many cases, they have lost their driving privileges, or they’ve recently lost their job, or worse yet, they have nowhere to live. In many cases the Substance Abuse Programs have been ordered by a judge. Regardless of the circumstances, people need services, individual services to meet the needs of their condition.
Some people who enter Substance Abuse Programs must first go through medical detoxification, which in effect gets the drug out of their system, but that isn’t the answer to the problem. While they may not have the drugs in their system, patients completing detoxification needs to begin work on managing their drug addiction.
In-Patient can be either short-term or long-term, depending on the needs of the patient, and all too sadly, the patient’s ability to pay. People have a busy schedule of therapy sessions, which are not limited to drug addiction but can include job counseling, socialization skills, etc. The day is filled from early morning to bedtime.
Out-Patient can be very similar only sometimes people just come in for their therapy sessions, but are well enough to go home at the end of the day. These programs are well-designed for people with jobs, people who have family support and access to resources.
Substance Abuse Programs Take Time
Substance Abuse Programs can be long and arduous and because of that people need encouragement to stick with it and finish. According to research statistics, drug recovery patients will reach a milestone in their recovery after three months, but that doesn’t necessarily mean that the treatment program is finished, or that additional treatment will not be helpful.
When people leave their treatment programs early, and do not hit that all important stage in their recovery, their chances for full recovery drop. Even with full completion of the program, patients can fail and need to return to treatment. It’s important to stay with it.
While in Substance Abuse Programs patients need to stay off drugs. This is a minimum expectation, but centers will inspect wheat they expect, and drug testing is routine. If a patient relapses and uses during treatment, the program will require modification to meet the needs of the patient.
Even if a patient makes it through the program, there is a change they may fail sometime in the future, and therefore, some people need to go back into treatment to completely manage the addiction problem. People fail. But it’s important to remember that the person’s health is most important, so if it takes two or three attempts, or more, so be it.
Whether in-patient or out-patient, Substance Abuse Programs can vary in intensity and length, and so careful examination of each program is necessary to make the best choice of treatment.
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We end this section where we began, by noting that no two drug treatment programs are alike nor should they be. The important thing to keep in mind is that other than denying a person access to drugs, successful treatment hinges on an individual’s willingness to be treated. It’s all about management of the problem.
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