CHEMICAL DEPENDENCY TREATMENT:
WHAT SHOULD WE EXPECT?
The objectives of this presentation were to review current treatment modalities in chemical dependency, discuss the clinical factors that may be important considerations affecting outcomes, and understand what reasonable outcomes we can expect.
1. Addiction as a chronic disease vs. being an acute condition
·Detoxification alone is not treatment.
·Addicting drugs produce changes in brain pathways that endure long after the person stops taking them.
·These protracted brain changes produce personal and social difficulties that do not go away after detoxification or even after rehabilitation.
·Treatment of addiction should be regarded as being long-term, and a "cure" is unlikely.
·Addictive diseases are often viewed as being self- inflicted and the use of valuable resources for treatment is not viewed with sympathy.
·In fact addiction has many components that are involuntary, such as:
=>heredity
=>external factors (family values,price, and availability)
·After repetitive voluntary drug-taking, the drug user loses the voluntary ability to control its use. The person than becomes addicted to the drug and there is compulsive use; an overwhelming involuntary craving for the drug that perpetuates its use.
·The transition for drug user to drug addict has been shown in animal experiments to be associated with changes in many of the known brain messengers.
·Drug addiction is not unlike many other chronic medical illnesses such as diabetes, hypertension and asthma.
A "cure" from these illnesses is generally not an expectation. Rates of remission from these illnesses are similar to the rates from diseases of addiction.
2.Goals of treatment The goal of contemporary addiction treatment is to provide appropriate initial placement of patients into services of appropriate intensity and to move them from one level of care to another over time, all the while respecting the chronic relapsing and remitting nature of addiction.
This continuum of care includes preventive, diagnostic and therapeutic services for alcohol or drug use, abuse and dependence, as well as case finding,emergency services, consultation, withdrawal management, rehabilitation and monitoring services.
3. Facts about treatment as we know them
· Need to look at outcome measures that do not focus solely on reduced substance use, such as physical and mental health, social function and reductions in public health and safety concerns.
· Patient characteristics associated with better prognoses:
=> low severity of dependence and psychiatric symptoms
=> accurate initial assessment, and motivation beyond the pre-contemplative stage
=> employed or self-supporting
=> having family and social supports for sobriety
· Factors reliably shown to be associated with improved outcomes:
=> staying in, and compliant with treatment longer
=> having an individual counselor and more counseling sessions
=> receiving proper medications (both anti-craving and psyche medications)
=> participating in 12-step programs
=> supplemental services for adjunctive medical,psychiatric, and family problems
· Treatment components and modalities:=> detoxification/medical treatment of withdrawal
=> behavioral therapies=> 12-Step programs
=> other self-help programs
=> pharmacological therapies
4. National Treatment Improvement Evaluation Study(NTIES)· One of the most rigorous studies of Substance Abuse treatment ever conducted.
· Drug and alcohol use, criminal activity, and employment outcomes were measurably better among individuals who completed their treatment plans, received more intensive treatment and we retreated longer.
· Treatment appears to be cost effective, particularly when compared to incarceration, which is often the alternative. Treatment costs ranged from $1,800 to a high of $6,800 per client, compared to an estimated cost of incarceration of $18,330 annually.
Presented by:
Wayne A. Gavryck, MD Connecticut River Internists Advisor,
Franklin County Drug Court
Via:addiction21stcentury.blogspot.com
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