Group Rs6: Treatment for Addiction

Introduction

The term addiction can be defined as having an uncontrollable habit of doing something whether it’d be physical or emotional. These sort of uncontrollable habits ultimately take over your life and they lead to a detrimental/unhealthy lifestyle. Since there are so many different types of activities or substances one could be addicted to, we will be only be focusing on alcohol and opioid addiction (methadone treatment). To introduce the topic of drug addiction, we must come to an understanding why individuals take it in the first place. People generally take drugs for many various motives, but there can be different variables which influence their decision to do so, such as peer pressure or even depression. The key principle to highlight is that these individuals choose to take it on their own will but over the course of time, that choice is stripped away from them since they become absorbed by the drug. (National Institute on Drug Abuse) “Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.” (National Institute on Drug Abuse) As mentioned earlier, having a drug addiction does not prove to be beneficial and is actually very harmful to one’s body and mind. Repeated doses of these drugs can become destructive to the point it can ruin their life and potential future. A realistic situation can include a teenager who is addicted to methamphetamine and is a repeated offender. He starts to neglect other priorities/obligations such as school work and his social relationships deteriorate, isolating him from friends and family. In the short term, his life can still be turned around if properly treated, but in the long term, if he continues to live this unfortunate lifestyle, then premature death could be possible. Therefore, patients suffering from drug addictions are highly recommended to get treated as soon as possible to promote a long and healthy life for themselves.

Vulnerability to Substance Abuse - Genetics

Uhl, T., Johnson, C., & Liu, Q. (2010). Vulnerability to Substance Abuse. Addiction Medicine: Science and Practice, Volume 1, 201-216.
This journal publication discusses whether substance abuse can be a product of hereditary genes. The authors does so through the correlation in scientific studies of family, adoption and twin studies. The authors are ultimately able to conclude that yes we are more vulnerable to substance abuse based on our genetic history. Classical genetic studies show strong genetic influences on legal and illegal addictive substances. It is also found that the closer genetically related one is to a substance abuser, the more likely they are to become a substance abuser themselves compared to those of distance relatives. Like most adoption studies, the behaviors including addictions of adopted individuals is closer to that of their biological family than adoptive family. To conclude, based on all the data presented to us, 50% of total addiction vulnerability is heritable. We can however also continue to be more specific in our observation of if individuals are more substance-specific or general substance abuse vulnerability. Though the general understanding of this is that individuals are more generally inclined to substance abuse. This representing the “higher order” pharmacogenomics which is largely neural.
To conclude the findings of this article: 50% of total addiction vulnerability is heritable, “these results do not exclude additional contributions to addiction vulnerability from genomic variants that influence vulnerability to specific substances or variants that are found only in specific populations” (216). Possible influential factors that could have altered the results are environmental. It has been established that substance abuse can be hereditary, though based on one's environment, they might be more voluntarily or forcibly influenced to substance abuse. All in all, with the all the data provided from the authors, they support the idea that substance abuse can be directly explain through, but not limited to hereditary genes.

Findings

National Institute on Drug Abuse. Treatment Approaches for Drug Addiction Retrieved from http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction on April 13, 2015
Choosing the appropriate treatment for an individual is not always easy but needs to be addressed as soon as possible. I say this because not only do addictions negatively affect you physically and emotionally, but it negatively affects the world around you and the environment in which you live in. Generally speaking, some treatments are more efficient than others, though aside from that, some treatments are more suitable and effective for certain individuals. The goal of any effective addiction treatment is to help the individual stop using drugs, maintain a drug-free lifestyle and achieve productive functioning in all aspects of their life. (National Institute on Drug Abuse) Treatment is not a rapid process or an easy fix, it requires time and dedication. Many patients will require long-term treatment in order to successfully achieve a healthy abstinent lifestyle. The reason for treatment usually being long term being due to the common possibility of a relapse into addiction, therefore long-term treatments minimizing the risk for an individual to relapse.

There are two directions one could take in their treatment plan, behavioral treatment (emotional) and medication (physical). Though this does not eliminate the possibility of using both forms of treatment together because it is understood to be most effective. Research has found that there are certain key principles in which a psychologist might refer to when forming the basis of their treatment programs. (National Institute on Drug Abuse) Some principles may include: “No single treatment is appropriate for everyone.”, “Remaining in treatment for an adequate period of time is critical.”, “Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.”, “Many drug–addicted individuals also have other mental disorders.” and “Drug use during treatment must be monitored continuously, as lapses during treatment do occur.” (National Institute on Drug Abuse) The first step in any treatment plan for addiction is to go through a detox, where you they rid your body of all the consumed drugs and begin the prevention process. Treatment for addiction is a continuous process of therapy that not only addresses the drug abuse but all aspects of an individuals life, further supporting

Medication is used both during the withdrawal and treatment stages. The detoxification process (first stage in one’s treatment) goes hand in hand with the withdrawal process. Alternative drugs can be used during this process to suppress the withdrawal symptoms. Medication can be used during treatment as well in hopes to reestablish normal brain function, prevent relapse and aid in the diminishment of cravings. (National Institute on Drug Abuse) However the use of medication is limited based on the addiction.
Behavioral treatments includes treatments such as therapy (individual or group) and counselling. This form of treatment allows the patient to be involved and engaged in their treatment process. There are many approaches one could take in their behavioral treatment, though the main aim being to encourage positive and productive behaviors.

Social Services

McLellan, T., Hagan, T., Levine, M., Gould, F., Meyers, K., Bencivengo, M., & Durell, J. (1998, January 1). Supplemental social services improve outcomes in public addiction treatment. Retrieved April 15, 2015, from http://journals2.scholarsportal.info.ezproxy.library.yorku.ca/pdf/09652140/v93i0010/1489_sssioipat.xml
This article was constructed by Thomas Mclellan, Teresa A. Hagan, Marvin Levine, Frank Gould, Kathleen Meyes, Mark Bencievengo and Jack Durell. They are affiliated with the treatment research institute at the university of Pennsylvania and coordinating office for drug and alcohol abuse programs. Their main objective of this article was to prove the effectiveness of social services being used with the addition to a standard addiction rehabilitation(Mclellan, Hagan, Levine, Gould, Meyes, Bencievengo, Durell). The evidence they did to prove this was an experiment where they made two groups that were part of the control program(meet twice in a week and outpatient counseling) and they wanted to implement enhanced programs(such as, medical screening, housing assistance, parenting classes, etc) in addition to the control program to see how it would affect the effectiveness of addiction treatment(Mclellan, Hagan, Levine, Gould, Meyes, Bencievengo, Durell). The groups were divided into waves, being 1,2 and 3. The outcome of their experiment resulted in wave 1 not having much difference in patient behaviour while wave 2 and 3 patients showed a substantial decrease in substance use, along with fewer mental/physical issues(Mclellan, Hagan, Levine, Gould, Meyes, Bencievengo, Durell). The reason for this result was that wave 2 and 3 had more enhanced programs that implemented social and medical services. For more in depth information on this experiment, it can be found within the link. Ultimately, the authors all could agree and support the idea that the more services a patient receives, the better the outcome they get. This information can help towards our cause because we are trying to find many different ways drug addiction can be treated and which methods are effective. What can be learnt for this article is that adding social services to normal therapeutic programs can have many benefits to addicted patients such as improving not only their physical but mental state, along with decreasing their addiction.

Science-Based Views

Leshner, A. (1999, October 13). Science-Based Views of Drug Addiction and Its Treatment. Retrieved April 14, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=191976
Alan I. Leshner, PhD is the author of of the article, “science-based views of drug addiction and its treatment” and is currently a scientist, educator and earned his PH.D degree in physiological psychology from Rutgers in 1969. In addition, Alan states that his scientistic research was derived over the course of 20 years. The focus of this article is to give a basic understanding of the nature of drug addiction and how it can be treated. The author’s claim was that there is not a general treatment program that can help with all types of addictions, but that these type of programs are broken up into 3 types being, outpatient, inpatient and residential setting (Leshner). He brought up statistics that supported his claim these treatments were successful and they reduced drug use by 40%-60% while decreasing criminal activity while on and after the treatment(Leshner). Alan I. Leshner came to the conclusion that addiction is a treatable disease and that health professionals need to diagnose the patient with the addiction severity index to see if they’re also suffering with any other psychiatric disorder, in order to determine a treatment right for them(Leshner). The intended audience the author was trying to reach out would most likely be young adults studying in the field of psychology because of the insight he tries to share with others who are interested in psychiatry. This article is useful because it gives a good foundation on where to begin exploring behavioral therapy (such as counseling, cognitive therapy, or psychotherapy) and medications for drug treatment.

The table shows a list of services and therapy available for addiction treatment.

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Alcoholism - Motivation for Treatment

Miller, W. (1985, July 1). Motivation for Treatment: A Review With Special Emphasis on Alcoholism. Retrieved April 14, 2015, from http://journals2.scholarsportal.info/details/00332909/v98i0001/84_mftarwseoa.xml
William R. Miller is a prestigious professor of Psychology and Psychiatry at the University of New Mexico in Albuquerque and also obtained his PH.D in clinical psychology. His works include “Motivation for Treatment: A Review With Special Emphasis on Alcoholism” and his main focus is how motivation is correlated to alcohol addiction. His claim was that treatments that fail tend to lead to the lack of motivation one has (Miller). He defines alcoholics to generally share the same characteristics, being unmotivated, resistant, denying and having poor prognosis (Miller). Miller states that these views are agreed upon both the therapists and the alcoholics themselves (Miller). Miller heavily emphasises that motivation plays a major role in the recovery of alcoholism and there has been a survey conducted from Sterne and Pittman in 1965 that discovered that 75% believed motivation was very significant to recovery and that 50% thought it was essential (Miller). Thus, the conclusion, he came formulated was that it is part of the therapist and the patients job to maintain and increase the level of motivation in order for treatments to continue to work. What can be taken from this article are the many ways, one can increase their motivation, as suggested Miller’s study that therapists who constantly maintain contact with calls or letters have proved to increase treatment efficiency. The therapist is also the one who is responsible for the motivation of their patient as Miller states that the therapist’s personal characteristics, for instance, empathy can have a huge influence on their client to continue and succeed in their treatment (Miller). This article should be used in our research due to the fact that it gives a glimpse of knowledge into an alcoholic’s mind and they’re nature as to why they drink since understanding clients should be the number one priority. Most patients do not want to admit to themselves that they have an alcohol problem by pushing it off, saying they drink for social or business reasons (Miller). Since they do not confront their problems after many years, it progresses to a worst state until they’ve reached rock bottom. Then, do they accept the issue at hand and try to fix the problem by addressing their concerns to health professionals (Miller). In addition, Miller integrates a lot of other reputable psychologists ideologies and works to formulate his own ideas as he often references them in his article.

Alcoholism - Withdrawal

Myrick, H., & Anton, R. (1999, April 1). TREATMENT OF ALCOHOL WITHDRAWAL. Retrieved April 15, 2015, from http://web.ebscohost.com.ezproxy.library.yorku.ca/ehost/detail/detail?sid=3f137150-8f1b-4b95-81d4-70deb8350320@sessionmgr112&vid=0&hid=101&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ==#db=rzh&AN=1999023655
Hugh Myrick and Raymond Anton are professors affiliated with the medical university of South Carolina and department of Psychiatry, center for drug and alcohol programs in Charleston, South Carolina. This article highlights the process an individual with go through when dealing with alcohol withdrawal. It starts off by discussing the patient will start to feel many symptoms such as headache, tremor, sweating, vomiting, etc after just 6-48 hours of not consuming alcohol(Myrick, Anton). The authors include two types of ways one can go about with alcohol withdrawal treatments, which are inpatient treatment and outpatient treatment. To keep it brief, in the inpatient program, it is mandatory for patients to stay at a facility or hospital for 24 hours a day over a course of time, while outpatient programs get treatment within the facility and then are free to go back home(Myrick, Anton). Throughout the article, the authors indicate that they prefer patients to undergo a inpatient treatment as opposed to outpatient due to the fact that it seems more safe and patients are constantly monitored just incase of an emergency. Monitoring patients over a course of time is crucial, since patients might not only be dealing with alcohol withdrawal, as severe cases of alcoholism also go hand in hand with other mental illnesses(Myrick, Anton). Not only that, but they suggest that professionals can help ease the pain of severe symptoms from alcohol withdrawal and at the same time, closing them off from any alcohol related thoughts that might trigger anything(Myrick, Anton). This article would be helpful to take a look at since it tells you what you need to prepare before integrating them into a treatment. For instance,they should be tested for a physical examination to look for potential irregular conditions like stabilized blood pressure(Myrick, Anton). The value that this article brings is also a cost comparison between the two treatments. Outpatient is relatively cheaper, ranging from $175-$388 and inpatient would be around $3319-$3665(Myrick, Anton). This piece of information would be vital since patients might not have access to such large amounts of money even though the inpatient treatment might be more effective.

Motivational Interviewing

Miller, W. (1996, January 1). MOTIVATIONAL INTERVIEWING: RESEARCH, PRACTICE, AND PUZZLES. Retrieved April 15, 2015, from http://journals1.scholarsportal.info.ezproxy.library.yorku.ca/pdf/03064603/v21i0006/835_mirpap.xml
The concept of motivational interviewing is a concept that was developed by William R. Miller. Miller describes motivational interviewing to be more of a style of therapy as opposed to a certain technique one uses(Miller,3). We already confirmed that Miller is already a reputable source to use so we believe that his ideas can be utilized to help us. He established that therapeutic intervention would greatly increase a patient’s mindset, reinforcing an optimistic view and ability to succeed(Miller, 3). So, he coined the term of “drinker’s check up” aka DCU and it was an opportunity for alcoholics to check if drinking is affecting them negatively. The information given to these patients would just be feedback and it was their responsibility to do whatever they wanted with that knowledge(Miller, 3). He found some success in the DCU as there was a 27% reduction in drinking behaviour after the DCU happened and eventually rose to a 55-76% reduction.Therapists started offering feedback and suggested treatment outcomes for the patients in an empathetic tone. In contrast, the more a therapist confronts a client by arguing and disagreeing, the more the client drank. This created more denial and resistance which causes the patient to have a behaviour change(Miller,3). The evidence was shown through an experiment he did with Agoestinelli, Brown and himself in 1995 where he offered feedback through email to college heavy drinkers. He randomly selected a group of students to send feedback to and not give feedback to another group to see if his DCU did indeed work. The results showed that there was a 48% reduction in drinking within 6 weeks of feedback, and the ones who did not receive feedback showed no change(Miller, 4). The conclusion Miller arrived to was that motivational interviewing required five basic practices which was to “ express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy”(Miller, 5). What can be learnt about this article is that motivational interviewing disapproves of the infamous quotes,“shut up and listen” and “alcohols are liars, so we don’t want to hear what you have to say”. We can learn that the goal of motivational interviewing is to maintain a supportive mood for the patient to explore and discuss feelings to which the therapist will be empathetic and listening(Miller, 6).

Opioid Drug Treatment

Johnson, R., Chutuape, M., Strain, E., Walsh, S., Stitzer, M., & Bigelow, G. (2000). A COMPARISON OF LEVOMETHADYL ACETATE, BUPRENORPHINE, AND METHADONE FOR OPIOID DEPENDENCE. The New England Journal of Medicine, Vol. 343 , No. 13, P.1290-P. 1297.
This article was written by a team of researchers, pharmacists, nurses and doctors. It provides a very detailed statistical analysis of the increase/decrease of opioid drug use while taking the following prescribed drugs: Levomethadyl acetate, Buprenorphine and Methadone in high and low doses. The written portion describes how the three sets of drugs were monitored throughout the trial. In detail they discuss the different ways the drugs were being administered and the maintenance involved throughout the study. It also describes the the pool of subjects, how they were chosen (what requirements they had to meet) and the randomization of the treatment groups (which drug would be administered to who). There are several graphs that show the characteristics of the participants, the stages of the trial, outcome measures and the study retention.
“Opioid dependence is an important national health problem, with an estimated 980,000 long-term users of heroin in the United States.1 Methadone, introduced in the late 1960s,2 and levomethadyl acetate, approved in 1993, are two full µ-opioid agonist substitutes” (Johnson et al. , 2000). Opioid drug users need a variety of different treatment options, this is one that is proven to potentially work well on its own or work even better while adding another form of treatment such as CBT (cognitive behavioural therapy), Family Based Therapy or even the 12 step program. Combining Methadone or other drug related treatments with therapy is a great option, this will allow the patient to have the medical and cognitive support he/she needs.
See graphs below as part of the study conducted.

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Methadone Maintenance Therapy vs. No Opioid Replacement Therapy

Mattick, R., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane Collaboration, (Issue 3), P. 1-P. 32.
This article is written by four reputable researchers from 3 different research centres with strong interests in drug abuse and treatment. RP Mattick and C Breen are from The National Drug and Alcohol Research Centre at University of New South Wales in Sydney, Australia. J Kimber is from The Centre for Research on Drugs and Health Behaviour in London, UK, and M Davoli is from The Department of Epidemiology in Rome, Italy.
The article touches on the comparison between opioid treatment with Methadone replacement therapy and without Methadone replacement therapy. The participants who were part of the study were opioid dependent and no restrictions were imposed on them regarding current or past participation in outpatient or inpatient treatment. The review had several primary outcomes including, mortality, retention in treatments, proportion of urine or hair analysis results positive for heroin (or morphine), self-reported heroin use and criminal activity (p.6).
“Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed” (Mattick, Breen, Kimber & Davoli p. 1). Methadone is a drug prescribed as a substitute for heroin and/or other opioid drugs. Methadone lasts 24 hours and needs to be administered once a day, it stops patients from having withdrawal symptoms, which stops/slows down the need of constant opioid use to avoid going through withdrawal. Methadone also enables the receptors in the brain to block the euphoric feeling one gets from using heroin or other opioid drugs. Committing to properly using Methadone allows for drug users to be able to go about their day with the absence of using an illegal drug to feel “normal”, as it creates the feeling of having a “normal” “drug free” lifestyle. This enables patients to seek further help with their drug addiction, ex. going to a treatment centre or drug therapy.
I feel like this is a good article because it includes information about more than just methadone treatment on it’s own but other relevant treatments for opioid drug users that work hand in hand with MMT - Methadone Maintenance Treatment.

Behavioral Therapy

Carroll, K., & Onken, L. (2005). Behavioral Therapies for Drug Abuse. Vol. 162(Issue 8), P. 1452-P. 1460. Retrieved April 1, 2015, from http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.162.8.1452

Dr. Kathleen Carroll is a Psychiatrist at Yale University, school of medicine, she has written a number of articles on public health, substance abuse as well as treatments. Dr. Lisa Onken is a researcher for the National Drug Institute and has written many articles with Kathleen Carroll as they share similar views.
Cognitive Behavioural Therapy also known as CBT has been used for alcohol/drug related therapy since the early 1980’s. “Cognitive behavior approaches, such as relapse prevention, are grounded in social learning theories and principles of operant conditioning” (p. 2). CBT aids the patient in understanding negative thoughts and associating them with the negative behaviour. The therapist will help guide the patient to develop skills that can help them cope with existing behavioural problems. CBT is a good choice of therapy for drug users as many of them have concurrent mental health disabilities that would can be address by behavioural therapy. Since CBT is about learning how to change bad behaviours it allows the patient to build and use these tools in the future after treatment is completed. “Although end-of-treatment outcomes favored contingency management over cognitive behavior therapy, 1-year follow-up indicated significant continuing improvement for patients assigned to cognitive behavior therapy, in contrast to weakening effects for contingency management, which resulted in comparable, or slightly better, outcomes for cognitive behavior therapy at the end of follow-up”(p. 2).
This article is important as it provide information on a treatment that has been proven to be effective over the years, it provides a good description of what CBT is like in compared to other types of therapy as well as gives some insight on which therapy is best suited for the patient depending on the issue.

Family Based Therapy for Adolescent Drug Use

Ozechowski, T., & Liddle, H. (2000). Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns. Clinical Child and Family Psychology Review, Vol. 3 , No. 4, P. 269-P. 298. Retrieved April 1, 2015, from http://journals1.scholarsportal.info.ezproxy.library.yorku.ca/pdf/10964037/v03i0004/269_ftfadakau.xml
Dr. Timothy Ozechowski is a researcher at the Oregon Research Institute who specializes in marriage and family therapy. Dr. Howard Liddle is a family psychologist as well as a professor at University of Miami, Miller School of Medicine, he is interested in studying family based intervention for adolescent drug abuse and conduct disorder.
The purpose of family based therapy is to make sure that the adolescent has support from not only the therapist but the family as well. MDFT (Multidimensional Family Based Treatment) also aid in improving other aspects of the adolescence life such as, family dynamics, school life and overall mental health. MDFT is not only about aiding the adolescent but helping the family understand and acknowledge the issue. It assists the family members in learning how to correctly support the drug user while helping themselves build knowledge on the cause and effect of inappropriate support measures. It is important to keep the adolescent engage during the entire length of the treatment as this heightens the chance of a full recovery, it is very easy for teens to become disconnected and uninterested in something over a period of time.
This article describes in detail the importance of all aspect of MDFT and how the work together to provide the best support possible for the adolescent and the family. It touches on the importance of trust building between the adolescent and the therapist and making sure that everyone is kept engaged throughout the recovery process.

Video

Dr. Howard Little speaks about Multidimensional Family Treatment (MDFT)

12-Step Program
Fiorentine, R. (1999). After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence? AM. J. DRUG ALCOHOL ABUSE,, Vol. 25, No. 1, P.93-P.116. Retrieved April 1, 2015, from http://journals2.scholarsportal.info.ezproxy.library.yorku.ca/pdf/00952990/v25i0001/93_adta1peima.xml
Dr. Robert Fiorentine is a researcher at UCLA drug abuse research centre and Neuropsychiatric institute. Throughout this study Dr. Fiorentine does not make it known what his stance is on drug and alcohol treatment, he keeps his beliefs aside and provides evidence based information on the topic. The paper mainly focuses on the differences between motivational therapy and 12 step programs. He looks at which treatment is effective and the success rates for long and short term patients. I believe this paper is useful because it has a lot of insight on what methods of treatment are most effective, it is a reliable source and seems to be written free of the authors personal based opinions.
It is known that the 12 step program is continuously growing “Since its inception in 1935, AA, the 12-step prototype, burgeoned to an estimated membership of nearly 1 million in 1990 in the United States and Canada”(p. 94). It seems obvious to state that the 12 step program works well for most of the population hence the growth in the number of participants, but evidence shows that “Approximately 50% of AA participants will drop out within the first 3 months of attendance (11), and only about 13% of initial attendees will maintain a long-term relationship with AA”(Fiorentine). This information suggests that AA’s 12-step program might not be as effective as some may believe it to be. Many people also have the idea that the 12 step program is mainly used by caucasian, middle class with Christian beliefs but as studies have shown this is not entirely true (p. 95). This means that people accessing the 12 step programs are diverse in socioeconomic class and race as well as different faith based belief systems or no faith belief system at all.
In contradiction with the above suggested information on success rates within the 12 step programs “A treatment-matching study that randomly assigned alcohol dependent clients to Cognitive-Behavioral Coping Skills Therapy, Motivational Enhancement Therapy, or Twelve-step Facilitation Therapy found few differences in outcomes by type of treatment or facilitation; however, clients low in psychiatric severity reported increased abstinence as a result of 12-step facilitation treatment than from cognitive-behavioral treatment”(p. 95).
There is clearly discrepancies between whether the 12 step program is actually successful or not, but this could be due to the lack of consistency in the programs. Every program is different in the sense that it has different facilitators and different group members, this could potentially have a negative or positive effect on the participants success rates.
Please see the table below for statistical information.
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Importance and Significance of Dual-Diagnosis

Drake, R. (2001). Implementing Dual Diagnosis Services for Clients With Severe Mental Illness. Psychiatric Services, Vol. 52(No. 4), 469-476.
In this paper the authors will be addressing comorbidity with substance abuse in the context of abuse and dependence, and long-term psychiatric disorders such as schizophrenia. They address “the barriers to the implementation of dual diagnosis services and current strategies for implementation in routine mental health settings” (pg. 470). For a patient to have comorbidity, means that the individual obtains the presence of two chronic diseases or conditions at the same time. This article addresses the possibility of dual diagnosis, though is not limited to the idea of two or more simultaneous illnesses. This is important to our study of substance abuse patients because we often find that they suffer from other illnesses as well, meaning it is a common occurrence. Around 50% of individuals who suffer severe mental disorders are affected by substance abuse and do not have the appropriate treatment plan. (pg. 470) Dual-diagnosis patients require high-quality services because they have so much more then one illness to overcome at a time, meaning the appropriate treatment for this being hard to find because it is not offered in routine mental health treatment settings. Many doctors and psychiatrists find it hard to resolve more then one illness at a time with their limited resources, possibly asking the patient to return to address another illness once another is conquered. Along with this, these services can find themselves to being some of the most expensive. When an individual is dual diagnosed, they are more prone to relapse, hospitalization, violence, incarceration, homelessness and infectious diseases (such as HIV); therefore they demand more attention. (pg. 470)
In dual diagnosis services, there is the treatment of both illnesses simultaneously separate or together. Though the treatments might be addressed individually, the caregivers to both remain the same. Because the individuals recovery entails the management of both illnesses to live a healthy and successful life. It has been found that all the research towards dual diagnosis being successful when the treatment is addressed accordingly. Some of the evidence proven components that have worked in dual diagnosis include: staged interventions, assertive outreach, motivational interventions, counseling, social support interventions, long-term perspective (process), comprehensiveness (learn to lead a symptom-free life) and cultural sensitivity. (pg. 471-472)
In conclusion, “successful implementation of dual diagnosis services within mental health systems will depend on changes at several levels: clear policy directives with consistent organizational and financing supports, program changes to incorporate the mission of addressing cooccurring substance abuse, supports for the acquisition of expertise at the clinical level, and availability of accurate information to consumers and family members.” (pg. 474 -475) Ultimately, dual diagnosis services are highly effective and efficient if addressed accordingly.

Relapse Prevention

Marlatt, G., & George, W. (1984). Relapse Prevention: Introduction and Overview of the Model. British Journal of Addiction, 79, 261-273.
As given to us in the summary, “this article briefly describes the conceptual and clinical features of the RP (Relapse Prevention) approach to altering excessive or addictive behaviour patterns.” (pg. 261) These two University of Washington professors gives this to us in form of an except from The British Journal of Addiction, introducing to us and giving us an overview of a relapse prevention model. In this approach, the instance of a relapse is not a failed attempt at recovery, rather a building block in the individual's recovery process. It is an indicator for prolonged treatment. With this alternative view on relapse, the authors go through various definitions of what the word “relapse” entails in ones treatment process. To their understanding, a “relapse” is viewed as a “transitional process” to their goal lifestyle. Differentiating two types of relapses, a total relapse when one has picked up old habits and partial relapse when one has flirted with the idea of or come close to a total relapse. This document is a guide that is generally used by psychiatrists to help them assess the situation and give their patient the appropriate care. This including the acknowledgment of the potential of a relapse and how to cope with it. The process not only targeting their substance abuse, but all aspects of their life, enabling them to succeed in all aspects of their life, it is a holistic approach. Which is good because it works to reduce the risk of physical disease or psychological disorders by ensuring that the patients don't pick up any more unhealthy habits whilst focusing on their personal lifestyle change. This approach is a “psychoeducational programme that combines behavioral skill-training procedures with cognitive intervention techniques”. One of these techniques being: the principle of moderation which simply means maintaining a balanced lifestyle. At times individuals might find themselves in “high-risk situations” that if not addressed accordingly can leave to a complete relapse. The three examples of “high-risk situations” given to us include: negative emotional states, interpersonal conflict and social pressure. Though if this approach has worked as successfully as planned, they are able to use their coping mechanisms to get past these triggers of old habits.
We found this model for relapse prevention affective seeing as it is a long term goal and complete lifestyle change, rather than just a temporary fix. Using this model, patients are able to redefine themselves and create a new environment. They can take into the world a “toolbox” to help them anticipate and overcome obstacles.

In Conclusion:

Importance of Recognition of Drug Abuse

National Institute on Drug Abuse. Treatment Approaches for Drug Addiction Retrieved from http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction on April 13, 2015
It is important to recognize that there are many cases in which addiction goes untreated. This information is supported by SAMHSA's National Survey on Drug Use and Health (NSDUH). Their research found that 23.2 million persons aged 12 or older required treatment for a substance abuse problem in 2007. Additionally, only 10.4% (2.4 million) of those 23.3 million individuals actually received their appropriate treatment, leaving the other 8.4% (20.8 million) of those individuals without any support or resources to overcome their substance abuse. (National Institute on Drug Abuse)

Evaluation of Treatments for Addiction

Backer, T. (2000). The Failure Of Success: Challenges Of Disseminating Effective Substance Abuse Prevention Programs. Journal of Community Psychology, 28(3), 363-373.
In this article, Thomas E. Backer examines the flaws in the substance abuse prevention programs that are considered effective. Explaining that we fail mostly because we make the same mistakes over and over again, therefore there is a need for change in the way we go about resolving substance abuse. Along with this, many individuals who struggle with substance abuse are unaware that there are others out there just like them with the same issues. Therefore there needs to be more dialogue on the common issue of substance abuse and the steps that need to be taken. Backer brings three factors to our attention that have contributed to the failure of success in substance abuse prevention programs. These factors include: language, repetitive mistakes and the need to think outside the box. Language is important because it is the first step in communication of important ideas and situations that need to be addressed on a global level. There is a huge emphasis on placing labels on individuals and their individual substance abuse, while the real pressing issue is how we can help them. Instead of focusing on the defining of a substance abuse, they should be focusing on incorporating the effectiveness of the program in the definition for the assurance of future use. There are two types of repetitive mistakes: decision level mistakes (being the limitation of critical publications) and implementation level mistakes (being the lack of sufficient information to make valid decisions). Ultimately, this is the lack of user friendly information that we as psychologists need in order to make the best decisions for our clients that work, rather than repeating flawed attempts because we do not yet have the knowledge that it has been debunked. With these publications need to be evaluations of their work, every case study should be treated as research towards a better substance abuse program.
Ultimately, the flaw in many substance abuse programs is that they do not apply their research and particle to one another.This article is important to all researchers and individuals looking to take advantage of substance abuse programs because it gives them a critical perspective when going in. It opens their minds to asking questions and make constructive criticism, all in the hopes for a more successful recovery.

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