DR. NEAL HOUSTON

Adult Integrative/Behavioral Health Specialist

The Life Therapy Group®™ Mental Health & Life Wellness Site

MJA Healthcare Network

570-688-9888
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Changing Minds, Transforming Lives - Life Can Work When You Get The Right Support

PROVIDING INTEGRATIVE HEALTH & COGNITIVE BEHAVIOR ENHANCEMENT SERVICES TO ADULTS IN A FLEXIBLE & PERSONALIZED APPROACH.
WHILE OFFERING AFFORDABLE INDIVIDUALIZED SERVICES FOR EFFECTIVE TREATMENT.

Thursday, May 30, 2013

SUBSTANCE ABUSE - THE GOALS & EFFECTIVENESS OF TREATMENT



While each individual in treatment will have specific long and short-term goals, all specialized substance abuse treatment programs have three similar generalized goals:

  • Reducing substance abuse or achieving a substance free life.
  • Maximizing multiple aspects of life functioning.
  • Preventing or reducing the frequency and severity of relapse.

For most patients, the primary goal of treatment is attainment and maintenance of abstinence with the exception of methadone maintained patients, but this may take numerous attempts and failures at "controlled" use before sufficient motivation is mobilized. Until the patient accepts that abstinence is necessary, the treatment program usually tries to minimize the effects of continuing use and abuse through education, counseling, and self-help groups that stress reducing risky behavior, building new relationships with drug-free friends, changing recreation activities and lifestyle patterns, substituting substances used with less risky ones, and reducing the amount and frequency of consumption, with a goal of convincing patients of their individual responsibility for becoming abstinent. Total abstinence is strongly associated with a positive long-term prognosis.

Becoming alcohol or drug free, however, is only a beginning. Most patients in treatment for substance abuse have multiple and complex problems in many aspects of living, including medical and mental illnesses, disrupted relationships, underdeveloped or deteriorated social and vocational skills, impaired performance at work or in school, and legal or financial troubles.

Increasingly, treatment programs are also preparing patients for the possibility of relapse and helping them understand and avoid dangerous "triggers" of resumed drinking or drug use. Patients are taught how to recognize clues, how to handle cravings, how to develop contingency plans for handling stressful situations, and what to do if there is a "slip."

Relapse prevention is particularly important as a treatment goal in an era of shortened formal, intensive intervention and more emphasis on aftercare following discharge.

Patients who remain in treatment for longer periods of time are also likely to achieve maximum benefits - duration of treatment episode for three months or longer is often a predictor of a successful outcome. Almost 90% of those who remain abstinent for two years are also drug and alcohol free after 10 years according to the American Psychiatric Association (APA).

TREATMENT TECHNIQUES

Within each treatment approach, a variety of specialized techniques also known as elements, modalities, components, or services are offered to achieve specific goals.

The principal elements are:

  • Pharmacotherapies
  • Psychosocial or Psychosocial Interventions
  • Behavioral Therapies
  • Self-Help Groups

Pharmacotherapies:

Medications to manage withdrawal take advantage of cross tolerance to replace the abused drug with another or safer drug in the same class. The latter can then be gradually tapered until physiological homeostasis is restored.

  • Disulfiram (Antabuse) - this agent inhibits the activity of the enzyme that metabolizes a major metabolite of alcohol resulting in the accumulation of toxic levels of acetaldehyde and numerous side effects such as flushing, nausea, vomiting, hypo-tension, and anxiety.
  • Naltrexone - this keeps opiates from occupying receptor sites, thereby inhibiting their euphoric effects.
Agonist Substitution Therapy - The leading substitution therapy are methadone and the even longer acting levo-alpha-acetyl-methadol (LAAM). Buprenorphine, a mixed opioidagonist-antagonist, is also being used to suppress withdrawal, reduce craving, and block euphoric and reinforcing effects.

Medications to treat comorbid psychiatric conditions are an essential adjunct to substance abuse treatment for patients diagnosed with both a substance use disorder and a psychiatric disorder. Since there is a high prevalence of comorbid psychiatric disorders among people with substance dependence, pharmacotherapy directed at these conditions is often indicated.

Psychosocial Interventions:

  • Individual therapy - uses psychodynamic principles with such modifications as limit setting and explicit advice or suggestions to help patients address difficulties in interpersonal functioning.
  • Group Therapy - is one of the most frequently used techniques during primary and extended care phases of substance abuse treatment programs. Group therapy offers the experience of providing closeness, sharing painful experiences, communication of feelings, and helping others who are struggling with control over substance abuse.
  • Marital therapy and Family Therapy - focuses on the substance abuse behaviors of the identified patient and on maladaptive patterns of familial interaction and communication.

  • Cognitive Behavioral Therapy - attempts to alter the cognitive processes that lead to maladaptive behavior, intervene in a chain of events that lead to substance abuse, and then promote and reinforce necessary skills and behaviors for achieving and maintaining abstinence.
  • Behavioral Contracting or Contingency Management - uses a set of predetermined rewards and punishments established by a therapist and patient and possibly involved their significant other to reinforce desired behaviors.
Relapse prevention helps patients first recognize potentially high risk situations or emotional "triggers" that have led to substance abuse and help them to learn a repertoire of substitute responses to cravings.


  • Mutually supportive, twelve-step groups such as alcoholic anonymous, their products anonymous, cocaine anonymous, or more recent alternatives: rational recovery and women for Sobriety, are the backbone of many treatment efforts as well as a major source of continuing care.


ALL THE COMPONENTS,APPROACHES,TECHNIQUES,AND SETTINGS DISCUSSED ABOVE MUST BE MONITORED AND ADJUSTED AS TREATMENT PROGRESSES.