Dr A Prabhu Dessai
Panaji, Goa 403001
Psychotherapy and Counseling in the Treatment of Drug Abuse
What is remarkable is that some form of drug abuse counseling or psychotherapy is almost invariably a part of every type of comprehensive drug abuse treatment. Individual therapy orcounseling is available in about 99 percent of the drug-free, methadone maintenance, and multiple-modality drug abuse treatment units in this country (National Drug and Alcoholism Treatment Unit Survey 1982). It is also available in approximately 97 percent of the detoxification units.
Despite the fact that drug abuse counseling and psychotherapy are nearly universal in drug abuse treatment, surprisingly little is known about these forms of treatment. Much more research has focused on pharmacological treatments for drug abuse than on nonpharmacological, even though nonpharmacological interventions are almost always utilized and are sometimes the only form of treatment offered to the drug abuser.
Counseling and Addiction: How Therapy Can Help
Kicking the prescription drug abuse habit is a major accomplishment. But for most people with opioid addiction, detox is only the beginning of a long-term battle against craving and relapse.
Counseling is an essential part of drug abuse treatment for many people. Cognitive behavioral therapy, family counseling, and other therapy approaches can help people recovering from opioidaddiction stay clean. Psychotherapy can also treat the other mental health conditions that often contribute to prescription drug abuse.
Why Counseling Is Important
Opioid addiction is more than a physical dependence on drugs. Even after detox, when physical dependence is cured, addicts are at high risk for relapse. Psychological and social factors are often powerful stimuli for prescription drug abuse relapse:
These factors can create ongoing, nearly irresistible urges to use drugs. Prescription drug abuse counseling helps addicts escape craving and learn to cope with life, without using drugs.
Several counseling therapies are available for prescription drug abuse, and no method is known to be the best. Likewise, no one approach is appropriate for everyone with opiate addiction. The right drug abuse treatment plan is tailored to a person's addiction and his or her individual needs.
Individual vs. Group Therapy
While any counseling therapy for drug abuse treatment is better than none, group therapy is generally preferred over individual therapy. In group therapy, a person is more likely to be both challenged and supported by peers who are also going through drug rehab.
Twelve-step programs like Narcotics Anonymous are the most well-known group therapy organizations.
Individual therapy can be helpful in the case of a dual diagnosis: coexisting depression, bipolar disorder, or other significant mental health condition that requires treatment in its own right, separate from the opioid addiction.
Outpatient vs. Residential Treatment
Residential therapy allows the addicted person to temporarily escape the environment that allowed him to use drugs. A person goes away to a specialized facility for a period of weeks to months. While highly effective in the short term, there is debate as to whether residential programs lead to longer abstinence from prescription drug abuse than outpatient programs. Residential drug abuse treatment programs are expensive, usually costing tens of thousands of dollars.
Outpatient treatment programs are the usual setting for ongoing prescription drug abuse treatment. The largest and most well-known outpatient therapy organization, Narcotics Anonymous (NA), is a 12-step program modeled after Alcoholics Anonymous. More than 43,000 NA group meetings take place every week worldwide.
Cognitive Behavioral Therapy
Cognitive behavioral therapy teaches a person how to recognize moods, thoughts, and situations that cause drug craving. A therapist helps the person avoid these triggers, and replace negative thoughts and feelings with ones that are healthier.
The skills learned in cognitive behavioral therapy can last a lifetime, making it a potentially powerful method of drug abuse treatment. However, not all therapists are trained in cognitive behavioral therapy techniques, which can be complex.
Contingency Management Therapy
In contingency management therapy, a person in drug abuse treatment receives positive incentives for staying clean. Vouchers for goods and services, or privileges in a more rigid treatment setting are common incentives. Contingency management therapy is effective in drug rehab studies. But skeptics point out its high costs, and that when incentives stop, its positive effects decline.
Traditional therapies for drug abuse treatment involved confrontation. Addicts are masters of denial, the thinking went, and therapy should break down walls to force them to accept the reality of their addiction.
While confrontation may still have a role, many therapists instead promote motivational interviewing, a newer counseling method. In motivational interviewing, a therapist seeks to understand and enhance an addicted person's natural motivation for change. For example, if the person reveals he is motivated by love of his family, or returning to work, these may become the focus of therapy.
Couples and Family Therapy
Prescription drug abuse and opioid addiction don't only affect the user's life; the whole family is transformed. Strong relationships with family and friends are essential for successful drug abuse treatment. Various counseling methods include the spouse and other family members of the addicted person.
There are several potential benefits of family or couples therapy:
Studies show family therapy results in lower relapse rates, increased happiness in the family, and better functioning in children of addicted parents.
Most experts today consider opioid addiction to be a chronic, relapsing illness. Just like other chronic illnesses such as diabetes or high blood pressure, opioid addiction treatment in some form must be lifelong.
Many people with opioid addiction will continue to take maintenance therapy in the form of methadone or Suboxone (buprenorphine/ naloxone), sometimes for decades. By the same token, experts say, they should also continue some form of counseling.
This idea runs counter to traditional views of drug rehab, in which a person was considered "cured" after a relatively short period in treatment. However, evidence is mounting that lifelong treatment with counseling, maintenance therapy, or often both, should be standard drug abuse treatment for most people with relapsing opioid addiction.
Rapid Detox in Drug and Alcohol Detoxification
There have been substantial advances when it comes to understanding the biochemical and genetic basis for substance abuse and addiction over the past ten years. In spite of this knowledge very little information is disseminated in regards to alternative forms of detox treatment. One form of alternative treatment is rapid detox and is a viable alternative for certain patients. Rapid detoxification and rapid opiate detox can be beneficial if you are suffering from an addiction to heroin, prescription painkillers, Oxycontin, Methadone, Suboxone, Vicodin, Darvocet, Percocet, Hydrocodone or any other opioid.
Traditional treatment entails a detoxification period that is often debilitating and has horrendous withdrawal symptoms that are both painful and often dangerous for the patient. Not only is there intense physical pain there is often psychological cravings for months beyond treatment. Statistics show that with regular detox methods within a year 85 to 90 percent of all patients have suffered a relapse and are using again.
The most visible and widely talked about rapid detox method is the Waismann Method. The Waismann Method also known as Neuro-Regulation is performed in a hospital intensive care unit. It involves cleansing the opiate receptors in the patient’s brain of the narcotics while the patient is under anesthesia. During the procedure, the patient will experience no conscious withdrawal, and will be able to return home within days. Over 65 percent of the patients who are treated with the Waismann Method remain drug free after one year.
In April 2000, the American Society of Addiction Medicine (ASAM) released a public policy statement on rapid and ultra rapid opioid detoxification. Based on their policy and further studies, ASAM updated April 2005, to include their policy recommendations which are listed below and should be considered when considering detox.
1. Opioid detoxification alone is not a treatment of opioid addiction. ASAM does not support the initiation of acute opioid detoxification interventions unless they are part of an integrated continuum of services that promote ongoing recovery from addiction.
2. Ultra-Rapid Opioid Detoxification (UROD) is a procedure with uncertain risks and benefits, and its use in clinical settings is not supportable until a clearly positive risk-benefit relationship can be demonstrated. Further research on UROD should be conducted.
3. Although there is medical literature describing various techniques of Rapid Opioid Detoxification (ROD), further research into the physiology and consequences of ROD should be supported so that patients may be directed to the most effective treatment methods and practices.
4. Prior to participation in any particular modality of opioid detoxification, a patient should be provided with sufficient information by which to provide informed consent, including information about the risks of termination of a treatment plan of prescribed agonist medications such as methadone, buprenorphine, as well as the need to comply with medical monitoring of their clinical status for a defined period of time following the procedure to ensure a safe outcome. Patients should also be informed of the risks, benefits and costs of alternative methods of treatment available.
In rebuttal to ASAM’s policy Clifford Bernstein, M.D., medical director of AAMOD, the leading practitioners of the Waismann Method treatment for opiate dependency, stated that the study offered misleading results and failed to recognize those who have had success with rapid detox. He states that anesthesia-based detox is a humane and effective medical treatment that allows patients to avoid most of the unnecessary withdrawal symptoms. Furthermore, he points out that the study misleads the reader into believing that anesthesia-based detox is not a successful method for opiate treatment by stating that 80% of participants dropped out of follow-up treatment. This statistic does not say anything about the success of the detox treatment or whether or not patients were able to stay off of the drugs. Since the opiates have been blocked from their brains and they no longer feel cravings following the anesthesia-based detox, many of these patients do not need an aftercare program. He stated that the study did not accurately represent the procedure, the merits of the doctors performing it nor the benefits of this treatment. He states that the procedure is safe, however one should use the same precautions as any other procedure under anesthesia as well as verify the qualifications of the doctor performing and to be sure to do it at an hospital with appropriate emergency resources if they are necessary.
Rapid detox is a relatively painless way for people suffering from addiction to opiates. While rapid detoxification can be effective, it is should be undertaken only after discussing the pro’s and con’s as well as follow- up treatment.
Mood Disorders Predict Later Substance Abuse Problems
"Science Update" January 09, 2008
People with manic symptoms and bipolar disorder type II are at significant risk of later developing an alcohol abuse or dependence problem, a long-term study conducted in Switzerland confirms. The study was published in the January 2008 issue of the Archives of General Psychiatry.
Extensive research using retrospective reports has demonstrated a clear association between mood disorders and substance abuse. But few prospective long-term studies have been able to show evidence of this.
Kathleen Merikangas, Ph.D., of the NIMH Mood and Anxiety Disorders Program, collaborated with colleagues to follow 591 people (292 men and 299 women) over two decades, beginning in 1978 when the participants were 19 or 20 years old. The participants were interviewed six times between 1979 and 1999.
By 1993, almost 10 percent met criteria for major depression. Although bipolar disorder type I was very rare, 4 percent met criteria for bipolar disorder II—a milder form of the disorder. In addition, 24 percent had symptoms of mania but did not meet specific criteria for bipolar disorder.
By 1999, when participants were about 40 years old, 18 percent met criteria for alcohol abuse or dependence problems, while 8 percent met criteria for cannabis (marijuana) abuse and 3 percent met criteria for benzodiazepine abuse.
Merikangas and colleagues found that people who showed symptoms of mania, but who did not meet criteria for bipolar disorder, were at significantly greater risk for later developing an alcohol abuse or dependence problem. Those with bipolar disorder II were even more at risk of developing an alcohol problem or benzodiazepine abuse problem. Major depression was associated only with developing a benzodiazepine abuse problem among this population.
“The findings confirm the link between mood disorders and substance abuse or dependence problems,” said Dr. Merikangas. “They also suggest that earlier detection of bipolar symptoms could help to prevent consequent substance abuse problems.”
The study was known as the Zurich Cohort Study.
Merikangas, KR, Herrell R, Swendsen J, Rossler W, Ajdacic-Gross V, Angst J. Specificity of bipolar spectrum conditions in the comorbidity of mood and substance abuse disorders. Archives of General Psychiatry. 2008;65(1): 47-52.
Codependence and Addiction
Codependency – This is a relationship addiction in which a person living with or caring for a person with a substance abuse problem hinders their recovery by enabling or allowing that person to carry on with their addiction. People who are codependent often suffer from a low self-esteem and feel victimized. They are characterized as living through or for another person. Many substance abuse treatment centers also offer treatment for codependency. See Abuse & PTSDhttp://www.drug-alcohol-rehabcenters.com/addiction-glossary-terms/
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Dr A Prabhu Dessai
Panaji, Goa 403001