Drug rehabilitation

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Drug rehabilitation
ICD-9-CM 94.64
The 2010 ISCD study "Drug Harms in the UK: a multi-criteria decision analysis" found that alcohol scored highest overall and in Economic cost, Injury, Family adversities, Environmental damage, and Community harm. HarmCausedByDrugsTableDetailed.svg
The 2010 ISCD study "Drug Harms in the UK: a multi-criteria decision analysis" found that alcohol scored highest overall and in Economic cost, Injury, Family adversities, Environmental damage, and Community harm.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and medical consequences that can be caused.[ citation needed ]

Contents

Treatment includes medication for comorbidities, counseling by experts, and sharing of experience with other recovering individuals. [1] [ medical citation needed ]

Psychological dependency

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach patients new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use addictive substances. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs but to examine and change habits related to their addictions. Many programs emphasize that recovery is an ongoing process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.")[ citation needed ]

Whether moderation is achievable by those with a history of misuse remains a controversial point. [2]

The brain's chemical structure is altered by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process. [3]

Types

Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups, extended care centers, recovery or sober houses, addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs.[ citation needed ]

In an American survey by three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring treatment responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics Alcoholics Anonymous identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction). [4]

Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. [5] In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. [3] The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. [6] Whatever the methodology, patient motivation is an important factor in treatment success. [7]

For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like methadone and buprenorphine can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs. [8]

Types of behavioral therapy include:

Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use. Research has shown that most patients need at least three months of treatment and longer durations are associated with better outcomes. [3] Prescription drug addiction does not discriminate. It affects people from all walks of life and can be a devastatingly destructive force. [21]

Medications

Certain opioid medications such as methadone and more buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use, and the risks associated with it, such as disease, arrest, incarceration, and death, in line with the philosophy of harm reduction. Both drugs may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids. [22] All available studies collected in the 2005 Australian National Evaluation of Pharmacotherapies for Opioid Dependence suggest that maintenance treatment is preferable, [22] with very high rates (79–100%) [22] of relapse within three months of detoxification from levo-α-acetylmethadol (LAAM), buprenorphine, and methadone. [22] [23]

According to the National Institute on Drug Abuse (NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and Hepatitis C by stopping or reducing injection drug use and drug-related high risk sexual behavior. Naltrexone is a long-acting opioid antagonist with few side effects. It is usually prescribed in outpatient medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk in the first three months by about 36%. [22] However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates average 12% at 90 days for naltrexone, average 57% at 90 days for buprenorphine, average 61% at 90 days for methadone). [22]

Ibogaine is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome. The drug is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered tend to have little oversight and range from motel rooms to one moderately-sized rehabilitation center. [24]

A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction. These medications include bupropion and nortriptyline. [25] Bupropion inhibits the re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant which has been used to aid in smoking cessation it has not been FDA approved for this indication. [25]

Acamprosate, disulfiram and topiramate (a novel anticonvulsant sulphonated sugar) are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them to maintain abstinence for several weeks, even months. [26] Disulfiram produces a very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. It is more effective for patients with high motivation and some addicts use it only for high-risk situations. [27] Patients who wish to continue drinking or may be likely to relapse should not take disulfiram as it can result in the disulfiram-alcohol reaction mentioned previously, which is very serious and can even be fatal. [26]

Nitrous oxide, also sometimes known as laughing gas, is a legally available gas used for anesthesia during certain dental and surgical procedures, in food preparation, and for the fueling of rocket and racing engines. People who use substances also sometimes use gas as an inhalant. Like all other inhalants, it is popular because it provides consciousness-altering effects while allowing users to avoid some of the legal issues surrounding illicit substances. Misuse of nitrous oxide can produce significant short-term and long-term damage to human health, including a form of oxygen starvation called hypoxia, brain damage and a serious vitamin B12 deficiency that can lead to nerve damage.[ citation needed ]

Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions. [28] [29] [30]

Residential treatment

In-patient residential treatment for people with an alcohol use disorder is usually quite expensive without insurance. [31] Most American programs follow a 28–30 day program length. The length is based solely upon providers' experience. During the 1940s, clients stayed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. [32] 70% to 80% of American residential alcohol treatment programs provide 12-step support services. These include, but are not limited to AA, Narcotics Anonymous, Cocaine Anonymous and Al-Anon. [32] One recent study suggests the importance of family participation in residential treatment patient retention, finding "increased program completion rate for those with a family member or significant other involved in a seven-day family program". [33]

Brain implants

Patients with severe opioid addiction are being given brain implants to help reduce their cravings, in the first trial of its kind in the US. Treatment starts with a series of brain scans. Surgery follows with doctors making a small hole in the skull to insert a tiny 1mm electrode in the specific area of the brain that regulates impulses such as addiction and self-control. This treatment is for those who have failed every other treatment, whether that is medicine, behavioral therapy, and/or social interventions. It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies. [34]

Recovery

The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. [35] The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal well-being [36] while other studies have considered "near abstinence" as a definition. [37]

The Recovery Model originates in the psychiatric survivor movement in the US, which argues that receiving a certain diagnoses can be stigmatizing and disempowering. [38] Some characteristics of the Recovery Model are social inclusion, empowerment to overcome substance use, focusing on strengths of the client instead of their deficits and providing help living more fulfilling lives in the presence of symptoms of addiction.[ citation needed ] Another key component of the Recovery Model is the collaborative relationship between client and provider in developing the client's path to abstinence. Under the Recovery Model a program is personally designed to meet an individual clients needs, and does not include a standard set of steps one must go through. [39]

The Recovery Model uses integral theory: [40] a four-part approach focusing on the individual, the collective society, along with individual and external factors. The four quadrants corresponding with each in Integral Theory are Consciousness, Behavior, Culture and Systems. [41] Quadrant One deals with the neurological aspect of addiction. Quadrant Two focuses on building self-esteem and a feeling of connectedness, sometimes through spirituality. Quadrant three works on mending the "eroded relationships" caused by active addiction. Quadrant Four often involves facing the harsh consequences of drug use such as unemployment, legal discrepancies, or eviction. [42] The use of integral theory aims to break the dichotomy of "using" or "not using" and focuses instead on emotional, spiritual, and intellectual growth, along with physical wellness.[ citation needed ]

Criminal justice

Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. [43] There are a great number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U.S. Constitution, mandating separation of church and state. [44] [45]

In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act.[ citation needed ]

Counseling

Traditional addiction treatment is based primarily on counseling.

Counselors help individuals with identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it's more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. Counselors are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It's very common to see them also work with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her. [46] Counseling is also related to "Intervention"; a process in which the addict's family and loved ones request help from a professional to get an individual into drug treatment.[ citation needed ]

This process begins with a professionals' first goal: breaking down denial of the person with the addiction. Denial implies a lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, instead of continuing the destructive behavior. Once this has been achieved, the counselor coordinates with the addict's family to support them in getting the individual to drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family.[ citation needed ]

One approach with limited applicability is the sober coach. In this approach, the client is serviced by the provider(s) in his or her home and workplace—for any efficacy, around-the-clock—who functions much like a nanny to guide or control the patient's behavior. [47]

Twelve-step programs

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displays addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network that can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939. [48] These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological [49] and legal [50] grounds. Opponents also contend that it lacks valid scientific evidence for claims of efficacy. [51] However, there is survey-based research that suggests there is a correlation between attendance and alcohol sobriety. [52] Different results have been reached for other drugs, with the twelve steps being less beneficial for addicts to illicit substances, and least beneficial to those addicted to the physiologically and psychologically addicting opioids, for which maintenance therapies are the gold standard of care. [53]

SMART Recovery

SMART Recovery was founded by Joe Gerstein in 1994 by basing REBT as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. [54] It does not subscribe to disease theory and powerlessness. [55] The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of the SMART Recovery programs are: [56]

This is considered to be similar to other self-help groups who work within mutual aid concepts. [57]

Client-centered approaches

In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items, in the therapeutic relationship, could help an individual overcome any troublesome issue, including but not limited to alcohol use disorder. To this end, a 1957 study [58] compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in the outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques. [59] The authors note two-factor theory involves stark disapproval of the clients' "irrational behavior" (p. 350); this notably negative outlook could explain the results.

A variation of Rogers' approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs, such as Arizona's Department of Health Services. [60]

Psychoanalysis

Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also explained substance use. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesized specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural, and political factors, encapsulation, traumatophobia, and masturbation as a form of self-soothing. [61] Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings to regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.[ citation needed ]

Relapse prevention

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt's (1985) Relapse Prevention approach. [62] Marlatt describes four psycho-social processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancy, attributions of causality, and decision-making processes. Self-efficacy refers to one's ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancy refers to an individual's expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual's pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in the consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation. [63]

For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual can employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse.[ citation needed ]

Cognitive therapy

An additional cognitively-based model of substance use recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse. [64] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as "I am undesirable," activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs ("I can handle getting high just this one more time") are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist's job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunction. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.[ citation needed ]

Emotion regulation and mindfulness

A growing literature is demonstrating the importance of emotion regulation in the treatment of substance use. Considering that nicotine and other psychoactive substances such as cocaine activate similar psycho-pharmacological pathways, [65] an emotion regulation approach may be applicable to a wide array of substance use. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. [66] Acceptance and commitment therapy (ACT), is showing evidence that it is effective in treating substance use, including the treatment of polysubstance use disorder and tobacco smoking. [67] [68] Mindfulness programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts, appear to prevent impulsive/compulsive responses. [66] [69] Research also indicates that mindfulness programs can reduce the consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates. [69] [70] [71]

Dual diagnosis

People who are diagnosed with a mental health disorder and a simultaneous substance use disorder are known as having a dual diagnosis. For example, someone with bipolar disorder who also has an alcohol use disorder would have dual diagnosis. On such occasions, two treatment plans are needed with the mental health disorder requiring treatment first. According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder.[ citation needed ]

Behavioral models

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exist for both working with the person using the substance (community reinforcement approach) and their family (community reinforcement approach and family training). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on the use of problem-solving techniques as a means of helping the addict to overcome his/her addiction. [72]

The way researchers think about how addictions are formed shapes the models we have. Four main Behavioral Models of addiction exist: the Moral Model, Disease Model, Socio-Cultural Model and Psycho-dynamic Model.[ citation needed ] The Moral Model of addiction theorizes that addiction is a moral weakness and that it is the sole fault of the person for becoming addicted. Supporters of the Moral Model view drug use as a choice, even for those who are addicted, and addicts as people of bad character. [73] Disease Model of addiction frames substance abuse as 'a chronic relapsing disease that changes the structure and function of the brain'. [74] Research conducted on the neurobiological factors of addiction has proven to have mixed results, and the only treatment idea it offers is abstinence. [75] The Socio-Cultural Model tries to provide an explanation of how certain populations are more susceptible to substance abuse than others. It focuses on how discrimination, poor quality of life, lack of opportunity and other problems common in marginalized communities can make them vulnerable to addiction. [76] The Psycho-Dynamic Model looks at trauma and mental illness as a precursor to addiction. Many rehabilitation centers treat "co-occurring" disorders, which refer to substance abuse disorder paired with a mental health diagnosis.[ citation needed ]

Barriers to treatment in the US

Barriers to accessing drug treatment may worsen negative health outcomes and further exacerbate health inequalities in the United States. Stigmatization of drug use, the War on Drugs and criminalization, and the social determinants of health should all be considered when discussing access to drug treatment and potential barriers.

Broad categories of barriers to drug treatment are: absences of problem, negative social support, fear of treatment, privacy concerns, time conflict, poor treatment availability, and admission difficulty. [77] Other barriers to treatment include high costs, lack of tailored programs to address specific needs, and prerequisites that require participants to be house, abstinent from all substances, and/or employed. [78] (See low-threshold treatment and housing first for more context on the latter point.)

Loss of Child/Dependent Access

In certain states, providers due to mandatory reporting methods and guidelines inform Child Protective Services of substance abusing parents for Schedule 1 substances including cannabis/marijuana. [79] If a mother tests positive for using the substance during pregnancy in South Carolina she may be required to forfeit her child. [80]

Further, barriers to treatment can vary depending on the geographical location, gender, race, socioeconomic status, and status of past or current criminal justice system involvement of the person seeking treatment. [81] [82] [83]

Criticism

Despite ongoing efforts to combat addiction, there has been evidence of clinics billing patients for treatments that may not guarantee their recovery. [1] This is a major problem as there are numerous claims of fraud in drug rehabilitation centers, where these centers are billing insurance companies for under-delivering much-needed medical treatment while exhausting patients' insurance benefits. In California, there are movements and laws regarding this matter, particularly the California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses.[ citation needed ]

Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance use treatment. [84] With long wait lists in limited state-funded rehabilitation centers, controversial private centers rapidly emerged. [84] One popular model, known as the Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies. [84] Under the guise of helping patients with opioid addiction, these centers would offer addicts free rent or up to $500 per month to stay in their "sober homes", then charge insurance companies as high as $5,000 to $10,000 per test for simple urine tests. [84] Little attention is paid to patients in terms of addiction intervention as these patients have often been known to continue drug use during their stay in these centers. [84] Since 2015, these centers have been under federal and state criminal investigation. [84] As of 2017 in California, there are only 16 investigators in the CA Department of Health Care Services investigating over 2,000 licensed rehab centers. [85]

By country

Afghanistan

In Afghanistan since the Taliban took power in 2021, they have forced drug addicts into compulsory drug rehab. [86] [87] [88] [89]

China

As of 2013 China has compulsory drug rehabilitation centers. It was reported in 2018 1.3 million drug addicts were treated in China's compulsory detox centers. [90] [91]

Compulsory drug rehabilitation has a long history in China: The Mao Zedong government is credited with eradicating both consumption and production of opium during the 1950s using unrestrained repression and social reform. [92] Ten million addicts were forced into compulsory treatment, dealers were executed, and opium-producing regions were planted with new crops. Remaining opium production shifted south of the Chinese border into the Golden Triangle region. [92]

Indonesia

In 2015 the National Narcotics Board (Indonesia) was pushing for compulsory drug treatment for people with drug dependence. [93] [94]

Iran

According to statistics best case scenario less than a 25% of addicts go back to being healthy. [95] There are two types of rehab one is Revolutionary Guard Corp or FARAJA run article 16 quarantine which is part of operations cleaning the cities from addicts and homeless just as well, the others article 15 and article 17 run by others including State Welfare Organization of Iran and also those run by Ministry of health and medical education. [96] [97] There are also places called Trust houses since July 2023 run by IRGC. [98] [99] [100]

Italy

In 1963, Pierino Gelmini founded Comunità Incontro, a drug rehabilitation center in Amelia, Italy. [101]

See also

Related Research Articles

Rational Recovery (RR) was a commercial vendor of material related to counseling, guidance, and direct instruction for addiction designed as a direct counterpoint to Alcoholics Anonymous (AA) and twelve-step programs.

<span class="mw-page-title-main">Substance abuse</span> Harmful use of drugs

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

In internal medicine, relapse or recidivism is a recurrence of a past condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or recrudescence.

An intervention is an orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with a substance use disorder or some kind of traumatic event or crisis, or other serious problem. Intervention can also refer to the act of using a similar technique within a therapy session.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

A methadone clinic is a medical facility where medications for opioid use disorder (MOUD) are dispensed-—historically and most commonly methadone, although buprenorphine is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence. Methadone is a schedule II (USA) opioid analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the opioid withdrawal symptoms that patients experience from taking short-acting opioids, like heroin, and allow time for withdrawal management. In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through the Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration and registered with the Drug Enforcement Administration.

Contingency management (CM) is the application of the three-term contingency, which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavioral therapy (CBT) framework as well.

The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. Today, alcohol use disorder (AUD) is used as a more scientific and suitable approach to alcohol dependence and alcohol-related problems.

Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction. Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programs may advocate a reduction in the use of drugs rather than outright abstention. One survey of members found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. Although there is not a difference in whether group or individual therapy is better for the patient, studies show that any therapy increases positive outcomes for patients with substance use disorders. The survey found group participation increased when the individual members' beliefs matched those of their primary support group. Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs and to a lesser level in non-religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organizations for Sobriety.

SMART Recovery is an international community of peer support groups that help people recover from addictive and problematic behaviors, using a self-empowering and evidence-informed program. SMART stands for Self-Management and Recovery Training. The SMART approach is secular and research-based. SMART has a global reach with a presence established in more than 30 countries. SMART Recovery is effective with a range of addictive and problematic behaviors.

Drug detoxification is variously construed or interpreted as a type of "medical" intervention or technique in regards to a physical dependence mediated by a drug; as well as the process and experience of a withdrawal syndrome or any of the treatments for acute drug overdose (toxidrome). The first definition however, in relation to substance dependence and its treatment is arguably a misnomer and even directly contradictory since withdrawal is neither contingent upon nor alleviated through biological excretion or clearance of the drug. In fact, excretion of a given drug from the body is one of the very processes that leads to withdrawal since the syndrome arises largely due to the cessation itself and the drug being absent from the body; especially the blood plasma, not from ‘leftover toxins’ or traces of the drug still being in the system.

<span class="mw-page-title-main">Polysubstance dependence</span> A type of substance use disorder

Polysubstance dependence refers to a type of substance use disorder in which an individual uses at least three different classes of substances indiscriminately and does not have a favorite substance that qualifies for dependence on its own. Although any combination of three substances can be used, studies have shown that alcohol is commonly used with another substance. One study on polysubstance use categorized participants who used multiple substances according to their substance of preference. The results of a longitudinal study on substance use led the researchers to observe that excessively using or relying on one substance increased the probability of excessively using or relying on another substance.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development.

<span class="mw-page-title-main">Alberta Adolescent Recovery Centre</span> Canadian drug rehabilitation centre

The Alberta Adolescent Recovery Centre, or AARC, is a drug rehabilitation centre for adolescents and family members located in Calgary, Alberta. AARC specializes in treating young people suffering from drug addiction and alcoholism, and takes in clients who have been thought of as being too far-gone for recovery. The AARC program is a multifaceted drug treatment program that uses twelve-step recovery processes, peer counselling, family and group therapy. A survey conducted by AARC found they had an 80% success rate, and that former addicts can permanently abstain from using drugs or alcohol following treatment at the centre. Another study found that the "AARC program is a unique model for comprehensive, long-term adolescent substance use treatment with a high rate of treatment completion (80.5%)."

Motivational enhancement therapy (MET) is a time-limited, four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems, and the "Drinkers' Check-up", which provides normative-based feedback and explores client motivation to change in light of the feedback. It is a development of motivational interviewing and motivational therapy. It focuses on the treatment of alcohol and other substance use disorders. The goal of the therapy is not to guide the patient through the recovery process, but to invoke inwardly motivated change through motivational strategies. The method has two elements: initial assessment battery session, and two to four individual therapeutic sessions with a therapist. During the first session, the specialist stimulates discussion on the patient's experiences with substance use disorder and elicits self-motivational statements by providing feedback to the initial assessment. The principles of MET are utilized to increase motivation and develop a plan for further change; coping strategies are also presented and talked over with the patient. Changes in the patients behavior are monitored and cessation strategies used are reviewed by the therapist in the subsequent sessions, where patients are encouraged to sustain abstinence and progress.

About 1 in 7 Americans reportedly suffered from active addiction to a particular substance. Addiction can cause physical, emotional and psychological harm to those affected by it. The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences."

Relapse prevention (RP) is a cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending, obesity, and depression. It is an important component in the treatment process for alcohol use disorder, or alcohol dependence. This model founding is attributed to Terence Gorski's 1986 book Staying Sober.

Community reinforcement approach and family training is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Myers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to assist those with addictions live healthily. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to commence and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Linda Carter Sobell, Ph.D., ABPP, is the President's Distinguished Professor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida. She is a professor of clinical psychology, addiction specialist, co-director of NSU's Guided Self-Change clinic, a Motivational Interviewing Trainer, and is board-certified in cognitive and behavioral psychology.

Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.

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