By the end of this section, you will be able to: * Recognize the
goal of substance-related and addictive disorders treatment *
Discuss what makes for effective treatment * Describe how comorbid
disorders are treated
Addiction is often viewed as a chronic disease
([link]). The choice to use a
substance is initially voluntary; however, because chronic substance use
can permanently alter the neural structure in the prefrontal cortex, an
area of the brain associated with decision-making and judgment, a person
becomes driven to use drugs and/or alcohol (Muñoz-Cuevas, Athilingam,
Piscopo, & Wilbrecht, 2013). This helps explain why relapse rates tend
to be high. About 40%–60% of individuals relapse{:
data-type=“term”}, which means they return to abusing drugs and/or
alcohol after a period of improvement (National Institute on Drug Abuse
[NIDA], 2008).
{:
#CNX_Psych_16_04_DrugSurvey}
The goal of substance-related treatment is to help an addicted person
stop compulsive drug-seeking behaviors (NIDA, 2012). This means an
addicted person will need long-term treatment, similar to a person
battling a chronic physical disease such as hypertension or diabetes.
Treatment usually includes behavioral therapy and/or medication,
depending on the individual (NIDA, 2012). Specialized therapies have
also been developed for specific types of substance-related disorders,
including alcohol, cocaine, and opioids (McGovern & Carroll, 2003).
Substance-related treatment is considered much more cost-effective than
incarceration or not treating those with addictions (NIDA, 2012)
([link]).
Specific factors make substance-related treatment much more effective.
One factor is duration of treatment. Generally, the addict needs to be
in treatment for at least three months to achieve a positive outcome
(Simpson, 1981; Simpson, Joe, & Bracy, 1982; NIDA, 2012). This is due to
the psychological, physiological, behavioral, and social aspects of
abuse (Simpson, 1981; Simpson et al., 1982; NIDA, 2012). While in
treatment, an addict might receive behavior therapy, which can help
motivate the addict to participate in the treatment program and teach
strategies for dealing with cravings and how to prevent relapse. Also,
treatment needs to be holistic and address multiple needs, not just the
drug addiction. This means that treatment will address factors such as
communication, stress management, relationship issues, parenting,
vocational concerns, and legal concerns (McGovern & Carroll, 2003; NIDA,
2012).
While individual therapy is used in the treatment of substance-related
disorders, group therapy is the most widespread treatment modality
(Weiss, Jaffee, de Menil, & Cogley, 2004). The rationale behind using
group therapy for addiction treatment is that addicts are much more
likely to maintain sobriety in a group format. It has been suggested
that this is due to the rewarding and therapeutic benefits of the group,
such as support, affiliation, identification, and even confrontation
(Center for Substance Abuse Treatment, 2005). For teenagers, the whole
family often needs to participate in treatment to address issues such as
family dynamics, communication, and relapse prevention. Family
involvement in teen drug addiction is vital. Research suggests that
greater parental involvement is correlated with a greater reduction in
use by teen substance abusers. Also, mothers who participated in
treatment displayed better mental health and greater warmth toward their
children (Bertrand et al., 2013). However, neither individual nor group
therapy has been found to be more effective (Weiss et al., 2004).
Regardless of the type of treatment service, the primary focus is on
abstinence or at the very least a significant reduction in use (McGovern
& Carroll, 2003).
Treatment also usually involves medications to detox the addict safely
after an overdose, to prevent seizures and agitation that often occur in
detox, to prevent reuse of the drug, and to manage withdrawal symptoms.
Getting off drugs often involves the use of drugs—some of which can be
just as addictive. Detox can be difficult and dangerous.
See also
Watch this video to find out
more about treating substance-related disorders using the biological,
behavioral, and psychodynamic approaches.
Frequently, a person who is addicted to drugs and/or alcohol has an
additional psychological disorder. Saying a person has comorbid
disorders{: data-type=“term”} means the individual has two or more
diagnoses. This can often be a substance-related diagnosis and another
psychiatric diagnosis, such as depression, bipolar disorder, or
schizophrenia. These individuals fall into the category of mentally ill
and chemically addicted (MICA)—their problems are often chronic and
expensive to treat, with limited success. Compared with the overall
population, substance abusers are twice as likely to have a mood or
anxiety disorder. Drug abuse can cause symptoms of mood and anxiety
disorders and the reverse is also true—people with debilitating symptoms
of a psychiatric disorder may self-medicate and abuse substances.
In cases of comorbiditypastehere, the best
treatment is thought to address both (or multiple) disorders
simultaneously (NIDA, 2012). Behavior therapies are used to treat
comorbid conditions, and in many cases, psychotropic medications are
used along with psychotherapy. For example, evidence suggests that
bupropion (trade names: Wellbutrin and Zyban), approved for treating
depression and nicotine dependence, might also help reduce craving and
use of the drug methamphetamine (NIDA, 2011). However, more research is
needed to better understand how these medications work—particularly when
combined in patients with comorbidities.
Addiction is often viewed as a chronic disease that rewires the brain.
This helps explain why relapse rates tend to be high, around 40%–60%
(McLellan, Lewis, & O’Brien, & Kleber, 2000). The goal of treatment is
to help an addict stop compulsive drug-seeking behaviors. Treatment
usually includes behavioral therapy, which can take place individually
or in a group setting. Treatment may also include medication. Sometimes
a person has comorbid disorders, which usually means that they have a
substance-related disorder diagnosis and another psychiatric diagnosis,
such as depression, bipolar disorder, or schizophrenia. The best
treatment would address both problems simultaneously.
Question
What is the minimum amount of time addicts should receive
treatment if they are to achieve a desired outcome?
3 months
6 months
9 months
12 months {: type=“a”}
Check Answer
A
Question
When an individual has two or more diagnoses, which often includes
a substance-related diagnosis and another psychiatric diagnosis,
this is known as ________.
bipolar disorder
comorbid disorder
codependency
bi-morbid disorder {: type=“a”}
Check Answer
B
Question
John was drug-free for almost six months. Then he started hanging
out with his addict friends, and he has now started abusing drugs
again. This is an example of ________.
You are conducting an intake assessment. Your client is a
45-year-old single, employed male with cocaine dependence. He
failed a drug screen at work and is mandated to treatment by his
employer if he wants to keep his job. Your client admits that he
needs help. Why would you recommend group therapy for him?
The rationale behind using group therapy for addiction treatment
is that addicts are much more likely to maintain sobriety when
treatment is in a group format. It has been suggested that it’s
due to the rewarding and therapeutic benefits of the group, such
as support, affiliation, identification, and even confrontation.
Because this client is single, he may not have family support, so
support from the group may be even more important in his ability
to recover and maintain his sobriety.
What are some substance-related and addictive disorder treatment
facilities in your community, and what types of services do they
provide? Would you recommend any of them to a friend or family
member with a substance abuse problem? Why or why not?
individual who has two or more diagnoses, which often includes a
substance abuse diagnosis and another psychiatric diagnosis, such
as depression, bipolar disorder, or schizophrenia ^
repeated drug use and/or alcohol use after a period of improvement
from substance abuse
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