Drug rehabilitation is a term for the processes of medical or psychotherapeutic treatment, for dependency on
psychoactive substancesA psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
such as
alcoholAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
,
prescription drugsA prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
, and so-called street drugs such as
cocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
,
heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.
Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with friends who still use the addictive substance.
Twelve-step programA Twelve-Step Program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems...
s encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their
addictionsSubstance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....
. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at
moderationModeration is the process of eliminating or lessening extremes. It is used to ensure normality throughout the medium on which it is being conducted...
, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point, but is generally considered unsustainable.
Types of treatment
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Some rehab centers offer age- and gender-specific programs.
In a survey of treatment providers from three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring the treatment provider's responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics AA identified by Ernest Kurtz); the scores were found to explain 41% of the
varianceIn statistics, analysis of variance is a collection of statistical models, and their associated procedures, in which the observed variance in a particular variable is partitioned into components attributable to different sources of variation...
in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the
disease modelThe disease model of addiction describes an addiction as a lifelong disease involving biologic and environmental sources of origin. The traditional medical model of disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual...
or the free-will model addiction).
Scientific research since 1970 shows that effective treatment attends multiple needs of the addict person and not just his or her drug abuse. In addition, medically assisted detoxification is only the first stage of treatment and it does not help much to change long-term drug abuse. Professionals from the National Institute on Drug Abuse (NIDA) recommend medication and behavioral therapy combined, as important elements of a therapeutic process that begins with detoxification, follows with treatment and doesn't set aside relapse prevention, since this is essential to maintain the positive effects of therapy. Therefore, every kind of treatment should address all aspects of a patient's life: medical and mental health services; as well as follow-up options, such as community of family based recovery support systems.
Drug and alcohol treatment centers provide medication, guidance and the right environment needed, with doctors and staff qualified to provide help and support to patients and assist them with their habits rather well. Despite of this, patients are expected to also desire to break free from these addictions, since after rehabilitation they will reincorporate into society. The alcohol and drug treatment administered to a patient will depend on the level and intensity of addiction. Therefore, if the patient is strongly addicted to the substance,many centers provide facilities as the ones listed at the beginning: residential treatment, recovery houses and sober houses. Other centers may aim to a more general addiction and work better with counseling and other similar strategies.
For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Hence, medication like buprenorphine and behavioral therapies for stimulant and Central Nervous System depressant addiction are often used. Among behavioral therapies there are:
Cognitive-behavioral therapy: a method that helps patients to recognize, avoid and cope with situations in which they are most likely to relapse.
Multidimensional family therapy: designed to improve family functioning as well as the member who has drug abuse problems.
Motivational interviewing: emphasizes on the willingness of patients to change their behavior and enter treatment.
Motivational incentives: This method takes advantage of positive reinforcement to encourage abstinence from the addictive substance.
The Substance Abuse and Mental Health Services Administration has provided a list of programs and institutions that offer diverse treatments according to the age group, type of addiction and other aspects. Among these programs can be found: Partners for Recovery (PFR), Medication Assisted Treatment (MAT), Recovery Community Services Program (RCSP), and the National Center on Substance Abuse and Child Welfare (NCSACW).
Experimental treatment
The Nature of ThingsThe Nature of Things is a Canadian television series of documentary programs. It debuted on the CBC on November 6, 1960. Many of the programs document nature and the effect that humans have on it. The program was one of the first to explore environmental issues, such as clear-cut logging...
, a
CBC TelevisionCBC Television is a Canadian television network owned by the Canadian Broadcasting Corporation, the national public broadcaster.Although the CBC is supported by public funding, the television network supplements this funding with commercial advertising revenue, in contrast to CBC Radio which are...
program by
David SuzukiDavid Suzuki, CC, OBC is a Canadian academic, science broadcaster and environmental activist. Suzuki earned a Ph.D in zoology from the University of Chicago in 1961, and was a professor in the genetics department of the University of British Columbia from 1963 until his retirement in 2001...
, explored an experimental drug treatment by Dr.
Gabor MatéGábor Máté is a Hungarian discus thrower.His personal best throw is 66.54 metres, achieved in April 2000 in Walnut.-Achievements:-References:...
who works with addicts in
VancouverVancouver is a coastal seaport city on the mainland of British Columbia, Canada. It is the hub of Greater Vancouver, which, with over 2.3 million residents, is the third most populous metropolitan area in the country,...
which uses the substance Ayawaska.
Pharmacotherapies
Certain opioid medications such as
methadoneMethadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
and more recently
buprenorphineBuprenorphine is a semi-synthetic opioid that is used...
(In America, "Subutex" and "Suboxone") are widely used to treat addiction and dependence on other opioids such as
heroin,
morphineMorphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
or
oxycodoneOxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing a patient and reducing illegal drug use, and the risks associated with it, such as
diseaseA disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
,
arrestAn arrest is the act of depriving a person of his or her liberty usually in relation to the purported investigation and prevention of crime and presenting into the criminal justice system or harm to oneself or others...
,
incarcerationIncarceration is the detention of a person in prison, typically as punishment for a crime .People are most commonly incarcerated upon suspicion or conviction of committing a crime, and different jurisdictions have differing laws governing the function of incarceration within a larger system of...
, and
deathDeath is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
, in line with the philosophy of
harm reductionHarm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
. Both drugs may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids. All available studies collected in the 2005 Australian National Evaluation of Pharmacotherapies for Opioid Dependence suggest that maintenance treatment is preferable, with very high rates (79-100%) of
relapseRelapse, in relation to drug misuse, is resuming the use of a drug or a dependent substance after one or more periods of abstinence. The term is a landmark feature of both substance dependence and substance abuse, which are learned behaviors, and is maintained by neuronal adaptations that mediate...
within three months of detoxification from
LAAMLââm is a French female singer of Tunisian descent. She has sold more than 500,000 albums and more than 2 million singles.-Biography:...
, buprenorphine, and methadone.
IbogaineIbogaine is a naturally occurring psychoactive substance found in a number of plants, principally in a member of the Apocynaceae family known as Iboga . A hallucinogen with both psychedelic and dissociative properties, the substance is banned in some countries; in other countries it is being used...
is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is accepted as a treatment by no association of physicians, pharmacists, or addictionologists. There have been several deaths related to ibogaine use, which causes
tachycardiaTachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
and
long QT syndromeThe long QT syndrome is a rare inborn heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsade de pointes . These episodes may lead to palpitations, fainting and sudden death due to ventricular fibrillation...
. 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 most often motel rooms to one moderately-sized rehabilitation center. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.
According to the
National Institute on Drug AbuseThe National Institute on Drug Abuse is a United States federal-government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction."-History:...
(NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid
crimeCrime is the breach of rules or laws for which some governing authority can ultimately prescribe a conviction...
and
violenceViolence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
, and reduce their exposure to
HIVHuman immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
and
Hepatitis CHepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
by stopping or reducing injection drug use and drug-related high risk
sexual behaviorHuman sexual activities or human sexual practices or human sexual behavior refers to the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts from time to time, and for a wide variety of reasons...
.
NaltrexoneNaltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade...
is a long-acting
opioid antagonistAn opioid antagonist is a receptor antagonist that acts on opioid receptors.Naloxone and naltrexone are commonly used opioid antagonist drugs which are competitive antagonists that bind to the opioid receptors with higher affinity than agonists but do not activate the receptors...
with few side effects, and it's usually prescribed in outpatient medical conditions; even though initiation of the treatment begins after medical detoxification in a residential setting. Naltrexone blocks the euphoric and all other effects of self-administered (and physician-administered) pills or injections (leaving the patient at a loss if he requires unplanned
surgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
or another
painPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
ful procedure or condition requiring pain control or even
general anaesthesiaGeneral anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
, as the chemicals, fentanil and
sufentanilSufentanil is a powerful synthetic opioid analgesic drug, approximately 5 to 10 times more potent than its analog, fentanyl. Sufentanil is marketed for use by specialist centres under different trade names, such as Sufenta and Sufentil...
, most commonly used to induce anaesthesia are also opioids which are blocked), reducing with this the craving or
addictionIn the APA Dictionary of Psychology, psychological dependence is defined as "dependence on a psychoactive substance for the reinforcement it provides." Most times psychological dependence is classified under addiction...
to the drug. It also works as treatment against
alcohol addictionAlcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
. Specialists claim that Naltrexone cuts relapse risk during the first 3 months by about 36%. 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).
AcamprosateAcamprosate, also known as N-acetyl homotaurine and by the brand name Campral, is a drug used for treating alcohol dependence.Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic...
,
disulfiramDisulfiram is a drug discovered in the 1920s and used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. Trade names for disulfiram in different countries are Antabuse and Antabus manufactured by Odyssey Pharmaceuticals...
and
topiramateTopiramate is an anticonvulsant drug. It was originally produced by Ortho-McNeil Neurologics and Noramco, Inc., both divisions of the Johnson & Johnson Corporation. This medication was discovered in 1979 by Bruce E. Maryanoff and Joseph F. Gardocki during their research work at McNeil...
(a novel
anticonvulsantThe anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
sulphonated sugar) are also medications that help patients treat alcohol addiction. Acamprosate has shown to work in patients with severe dependence, since they can keep abstinence for several weeks to months. Disulfiram (also called Antabuse) produces a very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. It works better on patients with high motivation and some addicts use it just for high risk situations.
Criminal justice
Drug rehabilitation is sometimes part of the
criminal justice systemCriminal Justice is the system of practices and institutions of governments directed at upholding social control, deterring and mitigating crime, or sanctioning those who violate laws with criminal penalties and rehabilitation efforts...
. 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 AnonymousAlcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...
meetings. There are a 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.
Counseling
Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult.
Counselors help individuals 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. They 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 work also with family members who are affected by the addictions of the individual, or in a community in order 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.
Counseling is also related to "Intervention"; a process in which the addict's family requests help from a professional in order to get this person into drug treatment. This process begins with one of this professionals' first goals: breaking down denial of the person with the addiction. Denial implies 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, besides of continuing the destructive behavior. Once this has been achieved, professional coordinates with the addict's family to support them on getting this family member to alcohol 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.
Disease model and twelve-step programs
The
disease model of addictionThe disease model of addiction describes an addiction as a lifelong disease involving biologic and environmental sources of origin. The traditional medical model of disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual...
has long contended the maladaptive patterns of alcohol and substance use displayed by 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 who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939. These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological and legal grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year follow-up for alcoholism. 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
opioidAn opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
s, for which
maintenance therapiesOpioid replacement therapy is the medical procedure of replacing an illegal opioid drug such as heroin with a longer acting but less euphoric opioid, usually methadone or buprenorphine, that is taken under medical supervision. In some countries patients may be treated with slow-release morphine...
are the gold standard of care.
Client-centered approaches
In his influential book, Client-Centered Therapy, in which he presented the
client-centered approachPerson-centered therapy is also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s...
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 relationshipThe therapeutic relationship, also called the helping alliance, the therapeutic alliance, and the working alliance, refers to the relationship between a healthcare professional and a client...
could help an individual overcome any troublesome issue, including
alcohol abuseAlcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
. To this end, a 1957 study 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 therapyPerson-centered therapy is also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s...
, and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in 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 per se. The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.
There are newer, more-client-specific methods of delivering addiction and alcoholism treatment. One effective, although very expensive, method of delivering treatment is the
Sober CoachA sober companion or sober coach provides one-on-one assistance to newly recovering drug addicts and alcoholics. The goal is to help the client maintain total abstinence from alcohol and drugs to establish healthy routines outside of a residential treatment facility. Controversy exists between...
. In this approach, the client is serviced by provider(s) in his or her home and workplace - for any efficacy, around-the-clock - who functions much like a
nannyA nanny, childminder or child care provider, is an individual who provides care for one or more children in a family as a service...
to guide or control the patient's behaviour.
Psychoanalytic approaches
PsychoanalysisPsychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
, a psychotherapeutic approach to behavior change developed by
Sigmund FreudSigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
and modified by his followers, has also offered an explanation of
substance abuseA substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
. 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 hypothesised 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 hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing. Such an approach lies in stark contrast to the approaches of
social cognitive theorySocial cognitive theory, used in psychology, education, and communication, posits that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences.-History:Social cognitive theory...
to addiction—and indeed, to behavior in general—which holds human beings 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.
Relapse prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. Marlatt describes four psychosocial processes relevant to the addiction and
relapseRelapse, in relation to drug misuse, is resuming the use of a drug or a dependent substance after one or more periods of abstinence. The term is a landmark feature of both substance dependence and substance abuse, which are learned behaviors, and is maintained by neuronal adaptations that mediate...
processes:
self-efficacySelf-efficacy is a term used in psychology, roughly corresponding to a person's belief in their own competence.It has been defined as the belief that one is capable of performing in a certain manner to attain certain set of goals. It is believed that our personalized ideas of self-efficacy affect...
, outcome expectancies, 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 expectancies refer 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 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.
Consider Figure 1 as an 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 is able to 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. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38), which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.
Cognitive therapy of substance abuse
An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of
cognitive therapyCognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...
and championed in his 1993 book, Cognitive Therapy of Substance Abuse. 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 dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.
Emotion regulation, mindfulness, and substance abuse
A growing literature is demonstrating the importance of emotion regulation in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. 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 withdrawalNicotine withdrawal is a term used to describe the effects felt by a person who is nicotine dependent and suddenly stops or significantly reduces his/her nicotine intake. Since smoking cigarettes is the most popular form of nicotine use, the effects of nicotine withdrawal have been most commonly...
or other negative moods. Currently, research is being conducted to determine the efficacy of
mindfulnessModern clinical psychology and psychiatry since the 1970s have developed a number of therapeutic applications based on the concept of mindfulness in Buddhist meditation.-Definitions:...
based approaches to smoking cessation, in which patients are encouraged to identify and recognize their negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have developed to deal with them (such as cigarette smoking or other substance use).
Behavioral models
Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exists for both working with the substance abuser (Community reinforcement approach) and their family (community reinforcement and family training). Both these models have had conierable research success for both efficacy and effectiveness. This model lays much empahsis on the use of problem solving techniques as a means of helping the addict to overcome his addiction.
See also
- Coerced abstinence
Coerced abstinence is a drug rehabilitation strategy which uses frequent monitoring and immediate punishment to reduce drug use among participants. This strategy can dramatically reduce recidivism rates among chronic drug users, especially those on probation and parole...
- Drug policy of the Soviet Union
The drug policy of the Soviet Union changed little throughout the existence of the state, other than slowly becoming stricter, although some differences in penalties existed in the different Union Republics...
- Dual diagnosis
The term dual diagnosis is used to describe the comorbid condition of a person considered to be suffering from a mental illness and a substance abuse problem. There is considerable debate surrounding the appropriateness of the term being used to describe a heterogeneous group of individuals with...
- Self-medication
Self-medication is a term used to describe the use of drugs or other self-soothing forms of behavior to treat untreated and often undiagnosed mental distress, stress and anxiety, including mental illnesses and/or psychological trauma...
- Sober living environment
Sober living environments are facilities used by addicts recovering from substance abuse, which serve as an interim environment between rehab and a return to their former lives. SLEs grew out of a need to have safe and supportive place for people to live while they were in recovery...
- Sober Coach
A sober companion or sober coach provides one-on-one assistance to newly recovering drug addicts and alcoholics. The goal is to help the client maintain total abstinence from alcohol and drugs to establish healthy routines outside of a residential treatment facility. Controversy exists between...
External links
- The Narcotic Farm - documentary film on drug addiction research from 1935 at the Addiction Research Center, Federal Medical Center
The Federal Medical Center, Lexington is a federal prison in Lexington, Kentucky housing 1,464 male inmates at high security and 296 female inmates at a low security camp.-History:...
in Lexington, KentuckyLexington is the second-largest city in Kentucky and the 63rd largest in the US. Known as the "Thoroughbred City" and the "Horse Capital of the World", it is located in the heart of Kentucky's Bluegrass region...