TREATING THE SUBSTANCE ABUSER-052

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 TREATING THE SUBSTANCE ABUSER
Treatments Options For Alcohol/Drug Abusers


People who have substance abuse problem or know of a friend or relative who does often wonder what treatment options are available for them. In fact, there are a variety of alcohol/drug treatments programs available.  However, these treatments vary according to the type of drug and the characteristics of the patient.  The most effective programs provide a combination of therapies and other psychosocial or community services.
 
Drug addiction is a complex disorder that can affect almost every aspect of the individual's functioning spectrum. It affects the quality of the persons' state of the health as well as their interactions with family, friends, and others.  It can also interfere with their personal, social, and/or occupational functioning. Therefore, drug addiction treatment needs to include a variety of components in order to address the individuals' functioning in all of the above arenas. Also, the type of treatments differs depending on the specific type of drugs.  For instance the remedies differ for heroin, alcohol abuse, marijuana, or cigarette smoking. 
 
A comprehensive program should provide a combination of therapies and other services that are tailored according to the specific needs of each person in regards to their age, culture, race, gender, financial needs, family issues, community resources, parenting, housing, employment and psychosocial concerns as well as the person's state of physical and emotional health. 
 
Most drug treatment programs include detoxification and participation in an inpatient or outpatient program that involves several group treatment activities.  These programs often include an initial inpatient residential detoxification plan with an average of a week to month duration. Followed by a period of out-patient treatment aimed at relapse prevention and life style restructuring that are accomplished through medication, counseling, and utilization of community or family resources.
 
Individual drug counseling on the other hand involves weekly visits to the therapist's office for outpatient counseling. These programs are usually augmented by the individual's concurrent attendance at weekly meetings at an Alcoholic Anonymous (AA) or Narcotic Anonymous (NA) or other support groups.
 
Research shows that, regardless of the type of program, combining the medication treatment with psychosocial interventions is the most effective approach for treating alcohol/drug problems.  The medication regimens involve the administration of agonist or antagonist agents.  For example, for opiate or heroine addicts the maintenance treatment, which follows the detoxification phase, is usually conducted on an outpatient setting and a long-acting synthetic opiate agonist agent such as methadone or LAAM, is administered orally at a minimum dose that is sufficient to prevent opiate withdrawal and decrease opiate craving.
 
For most people these drugs are not addictive and patients that are stabilized on adequate sustained amount of these drugs and at the same time receive individual or group counseling and psychosocial services, can function normally.  Methadone, however, is an opiate analgesic that may cause morphine-like drug dependence in some individuals and has the potential to be abused by such persons. Thus, patient's compliant with prescribed regimen will need to be monitored closely.
 
Other narcotic antagonist treatments on the other hand, involve a long-acting synthetic opiate antagonist such as Naltrexone that is taken orally, on a daily or three-time-a-week basis, for a sustained period of time. The patient should have been medically detoxified for several days before administration of this drug and as with all drug treatments, medical supervision by a specialized medical professional is required for these treatments. 
 
When used as above, Naltrexone blocks all the effects of self-administered opiates such as euphoria. The theory behind this kind of treatment is that since the desired opiate effect is not achieved even with repeated opiate consumption the urge and craving will eventually subside. Research has shown that this treatment when accompanied with counseling can be successfully used for treatment of alcohol and opiate addictions.  When used in conjunction with cognitive behavioral psychotherapy, Naltrexone has also been proven effective in the treatment of alcohol abuse.
 
Another antagonist medication is the old "antabuse" that works by inducing vomiting. Antabuse spoils the joy of drinking. Alcoholics who take antabuse cannot enjoy drinking alcohol anymore as they become nauseated and vomit during their drinking binges.  Due to side effect and noncompliance problems most programs prefer Naltrexone to antabuse. Studies show that people who are in counseling and take naltrexone can hold jobs, avoid violence or crime, follow safe sex rules, and show good impulse controls.
 
Counseling programs include, cognitive-behavior psychotherapy, or other behavioral techniques. Many drug abusers also suffer from psychological disorders including depression and anxiety as well as social or financial problems. Case management and referral to other medical, psychological, or social services are crucial for effective treatment of these patients.
 
The main problem with most substance abusers is their inability to accept the existence or the severity of their problems and their need to seek professional help. At the beginning, almost all addicts believe that they do not have a problem or if they do they can stop on their own. However, studies indicate that most of these self-treatment attempts result in failure.
 
In fact, research has shown that long-term drug use cause significant changes in brain function that persists long after the individual quits. These drug-induced abnormalities in brain function can result in many cognitive and behavioral problems such as poor judgment, craving, and compulsion to use the drug regardless of its adverse consequences.
 
Interested readers can call NIDA (National Institute on Drug Abuse) public information office at 310 443-1124 for further inquiries or visit their website at http://www.nida.nih.gov