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Drug rehabilitation | Holistic Rehab

Drug rehabilitation


Drug rehabilitation

(often

drug rehab

or just

rehab

) is the processes of medical or

psychotherapeutic

treatment for dependency on

psychoactive substances

such as

alcohol

,

prescription drugs

, and

street drugs

such as

cocaine

,

heroin

or

amphetamines

. The general intent is to enable the patient to confront

substance dependence

, if present, and cease

substance abuse

to avoid the

psychological

, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. Treatment includes medication for depression or other disorders,

counseling

by experts and sharing of experience with other

addicts

.


[1]

The 2 Week Diet

diet, fitness, anxiety relief, holistic, rehabilitation, home health remedies, detox, behavioral problems, menopause problems, health tips, nutrition tips

Psychological dependency

[


edit

]

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with friends 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 a permanent 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.”) Whether moderation is achievable by those with a history of abuse remains a controversial point, but is generally considered unsustainable.


[2]

Types of treatment

[


edit

]

The brain’s chemical structure is impacted by drugs of abuse and these changes are present long after an individual stops using, This change in brain structure increases risk for relapse, making treatment an important part of the rehabilitation process.


[3]

Various types of programs offer help in drug rehabilitation, including:

residential treatment

(in-patient/ out-patient), local

support groups

, extended care centers, recovery or

sober houses

, addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs.

In a 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)

[

where?



]

measuring the treatment provider’s responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics

AA

identified by Ernest Kurtz); the scores were found to

explain

41% of the

variance

in the treatment provider’s responses on the Addiction Belief Scale (a scale measuring adherence to the

disease model

or the free-will model addiction).


[4]

Scientific research since 1970 shows that effective treatment addresses the multiple needs of the patient rather than treating addiction alone.

[

citation needed



]

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.


[5]

Whatever the methodology, patient motivation is an important factor in treatment success.

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.


[6]

Types of behavioral therapy include:

Treatment can be a long process and the duration is dependent upon the patient’s needs and history of abuse. Research has shown that most patients need at least 3 months of treatment and longer durations are associated with better outcomes.


[3]

Medications

[


edit

]

Certain opioid medications such as

methadone

and more 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 therapies

intended to reduce cravings for opiates, thereby reducing

illegal drug use

, and the risks associated with it, such as disease, arrest,

incarceration

, and death, in line with the philosophy of

harm reduction

. Both drugs may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids.


[9]

All available studies collected in the 2005 Australian National Evaluation of Pharmacotherapies for Opioid Dependence suggest that maintenance treatment is preferable,


[9]

with very high rates (79–100%)


[9]

of

relapse

within three months of detoxification from

LAAM

, buprenorphine, and methadone.


[9]


[10]

According to the

National Institute on Drug Abuse

(NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and

Hepatitis C

by stopping or reducing injection drug use and drug-related high risk

sexual behavior

.

Naltrexone

is a long-acting

opioid antagonist

with few side effects. It is usually prescribed in

outpatient

medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk during the first 3 months by about 36%.


[9]

However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates average 12% at 90 days for naltrexone, average 57% at 90 days for buprenorphine, average 61% at 90 days for methadone).


[9]


Ibogaine

is a

hallucinogenic

drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is accepted as a treatment by no association of physicians, pharmacists, or addictionologists. There have 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.


[11]

A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction, these medications include bupropion and nortriptyline.


[12]

Bupropion inhibits the reuptake of norepinephrine 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 though it has not been FDA approved for this indication.


[12]


Acamprosate

,

disulfiram

and

topiramate

(a novel

anticonvulsant


sulphonated

sugar) are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them to maintain abstinence for several weeks or months.


[13]

Disulfiram (also called Antabuse) produces a very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. It is more effective for patients with high motivation and some addicts use it only for high risk situations.


[14]

Patients who wish to continue drinking or may be likely to relapse, should not take disulfiram as it can result in the disulfiram-alcohol reaction mentioned previously, which is very serious and can even be fatal


[13]

Nitrous oxide, also sometimes known as laughing gas, is a legally available gas used for purposes that include anesthesia during certain dental and surgical procedures, as well as food preparation and the fueling of rocket and racing engines. Substance abusers also sometimes use the gas as an inhalant. Like all other inhalants, it’s popular because it provides consciousness-altering effects while allowing users to avoid some of the legal issues surrounding illicit or illegal drugs of abuse. Abuse of nitrous oxide can produce significant short-term and long-term damage to human health, including a form of oxygen starvation called hypoxia, brain damage, and a serious vitamin B12 deficiency that can lead to nerve damage.

Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions.


[15]


[16]


[17]

Residential treatment

[


edit

]

In-patient residential treatment for alcohol abuse is usually quite expensive without proper insurance. Most American programs follow a traditional 28–30 day program length. The length is based solely upon providers’ experience in the 1940s that clients needed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable.


[18]

70 to 80 percent of American residential alcohol treatment programs provide 12-step support services. These include, but are not limited to AA, NA, CA, Al-Anon


[18]

One recent study suggests the importance of family participation in residential treatment patient retention, finding “increased program completion rate for those with a family member or significant other involved in a seven-day family program.”


[19]

Experimental treatment

[


edit

]



The Nature of Things


, a

CBC Television

program by

David Suzuki

, explored an experimental drug treatment by Dr.

Gabor Maté

in which the substance

Ayahuasca

was used to treat addicts in

Vancouver

.


[20]

Recovery

[


edit

]

The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal wellbeing


[21]

while other studies have considered “near abstinence” as a definition.


[22]

The wide range of meanings has complicated the process of choosing rehabilitation programs.

Criminal justice

[


edit

]

Drug rehabilitation is sometimes part of the

criminal justice system

. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of

driving while intoxicated

are sometimes required to attend

Alcoholics Anonymous

meetings. There are a number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U. S. Constitution, mandating separation of church and state.


[23]


[24]

In some cases, individuals can be court ordered to drug rehabilitation by the state through legislation like the

Marchman Act

.

Counseling

[


edit

]

Traditional addiction treatment is based primarily on counseling.

Counselors help individuals 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. They 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 work also 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.


[25]

Counseling is also related to “Intervention”; a process in which the addict’s family requests help from a professional to get this person into drug treatment. This process begins with one of this professionals’ first goals: breaking down denial of the person with the addiction. Denial implies 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, besides of continuing the destructive behavior. Once this has been achieved, professional coordinates with the addict’s family to support them on getting this family member to alcohol 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.

One approach with limited applicability is the

Sober Coach

. In this approach, the client is serviced by 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.

Twelve-step programs

[


edit

]

The

disease model of addiction

has long contended the maladaptive patterns of alcohol and substance use displayed by 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 who can help them remain sober. Such approaches are the quintessential features of

Twelve-step programs

, originally published in the book Alcoholics Anonymous in 1939.


[26]

These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological


[27]

and legal


[28]

grounds. Opponents also contend that it lacks valid scientific evidence for claims of efficacy


[29]

. However, there is survey based research that suggests there is a correlation between attendance and alcohol sobriety


[30]

. 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.


[31]

SMART Recovery

[


edit

]


SMART Recovery

was founded by Joe Gerstein in 1994 by basing

REBT

as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance.


[32]

It does not subscribe to disease theory and powerlessness.


[33]

The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of the SMART Recovery programs are:

  • Building and Maintaining Motivation,
  • Coping with Urges,
  • Managing Thoughts, Feelings and Behaviors,
  • Living a balanced Life.


    [34]

This is considered to be similar to other

self-help

groups who work within

mutual aid

concepts.


[35]

Client-centered approaches

[


edit

]

In his influential book,

Client-Centered Therapy

, in which he presented the

client-centered approach

to therapeutic change, psychologist

Carl Rogers

proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the

therapeutic relationship

could help an individual overcome any troublesome issue, including

alcohol abuse

. To this end, a 1957 study


[36]

compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on

two-factor learning theory

,

client-centered therapy

, and

psychoanalytic therapy

. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques per se.


[37]

The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.

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

Arizona’s Department of Health Services

.


[38]

Psychoanalysis

[


edit

]


Psychoanalysis

, a psychotherapeutic approach to behavior change developed by

Sigmund Freud

and modified by his followers, has also offered an explanation of substance abuse. 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 hypothesised 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 hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing.


[39]

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 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.

Relapse prevention

[


edit

]

An influential

cognitive-behavioral

approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach.


[40]

Marlatt describes four psychosocial processes relevant to the addiction and

relapse

processes:

self-efficacy

, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the

psychoactive

effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

[

citation needed



]

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 is able to employ successful

coping strategies

, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse.

Cognitive therapy

[


edit

]

An additional cognitively-based model of substance abuse recovery has been offered by

Aaron Beck

, the father of

cognitive therapy

and championed in his 1993 book

Cognitive Therapy of Substance Abuse

.


[41]

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 dysfunctionality. As with any cognitive-behavioral therapy,

homework assignments

and behavioral exercises serve to solidify what is learned and discussed during treatment.


[42]

Emotion regulation and mindfulness

[


edit

]

A growing literature is demonstrating the importance of

emotion regulation

in the treatment of substance abuse. Considering that

nicotine

and other psychoactive substances such as

cocaine

activate similar psychopharmacological pathways,


[43]

an emotion regulation approach may be applicable to a wide array of substance abuse. Proposed models of affect-driven tobacco use have focused on

negative reinforcement

as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of

nicotine withdrawal

or other negative moods.


[44]


Acceptance and commitment therapy

(ACT), is showing evidence that it is effective in treating substance abuse, including the treatment of

poly-substance abuse

and cigarette smoking.


[45]


[46]


Mindfulness

programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts, appear to prevent impulsive/compulsive responses.


[44]


[47]

Research also indicates that mindfulness programs can reduce the consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates.


[47]


[48]


[49]

Behavioral models

[


edit

]

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exists for both working with the substance abuser (

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.

Criticism

[


edit

]

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.


[2]

In California, there are movements and law regarding this matter, particularly the California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses.


[2]

Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance abuse treatment.


[50]

With long waitlists in limited state funded rehabilitation centers, controversial private centers rapidly emerged.


[50]

One popular model, known as the Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies.


[50]

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.


[50]

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.


[50]

Since 2015, these centers have been under federal and state criminal investigation.


[50]

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.


[51]

See also

[


edit

]

References

[


edit

]

Further reading

[


edit

]

  • Karasaki et al.,(2013).

    The Place of Volition in Addiction: Differing Approaches and their Implications for Policy and Service Provision

    .
  • Kinsella, M. (2017). Fostering client autonomy in addiction rehabilitative practice: The role of therapeutic ‘presence’. Journal Of Theoretical And Philosophical Psychology, 37(2), 91-108.

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