Summer House

Addiction to drugs and alcohol encompasses more than a behavioral intervention. The reason for this is drug addiction is a complex disease, however, it is treatable. Like chronic illnesses such as hypertension and asthma, relapse can occur with drug addiction even after extended periods of continued abstinence. For this reason, repeated treatments may be necessary. Treatments should be tailored to the individual in order to be more effective and long lasting, therefore allowing people to live long and productive lives.
 

In a study conducted in 2004, 22.5 million American needed treatment for substance abuse. Out of this large number, only 3.8 million received help (NSDUH2004).Leaving substance abuse and addiction cases untreated, though in the short-term can save money, in the long-term can lead to many extraneous costs to society. Some of these things include: court and criminal costs, emergency room visits, prison costs, child abuse and neglect, foster care, welfare costs, healthcare utilization, reduced productivity and unemployment.
 

For every dollar spent on addiction treatment, there is a four to seven dollar reduction in the cost of crimes related to drugs. In 2002, it was estimated that $181 billion dollars was the cost to society for drug use. Over $500 billion was spent when including tobacco and alcohol costs. This includes lost productivity, healthcare and criminal justice costs. Substance abuse programs that are run successfully and efficiently can help society in more than one way. Not only can they assist the person in need, they can also help reduce the amount of sexually transmitted disease that are spread such as HIV/AIDS and Hepatitis. In addition, crime and costs to society can also be reduced. So, the question comes, how can one develop an effective treatment program?
 

Effective Treatment Guidelines
 

Research has been conducted since the 1970s shows that treatment can help people avoid relapse, change destructive behaviors, and take them out of a life of substance abuse and addiction. Treatment tends to be a long term process and can require several episodes of treatment. This research has helped lay down the structure on which effective treatment programs should be based.
 

• Treatment does not need to be voluntary to be effective.
• For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
• No single treatment is appropriate for all individuals.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug addiction.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
• Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Possible drug use during treatment must be monitored continuously.
• Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
• Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
• As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.
 

An All Encompassing Treatment
 

When treating an individual for addiction treatment, it is important for the individual as a whole to be looked at. Usually, treatment begins with detoxification which is followed by treatment and relapse prevention. Initially, in order to ease the individual into treatment, medications may be needed in order to control symptoms of withdrawal. All encompassing care includes mental health services, medical care and of course aftercare. In order to make sure that someone in recovery continues to stay there is to make sure all bases have been covered. Follow up options such as community or family based recovery support systems can be essential to acquiring and maintaining a life that is free of drug use and abuse.
 

Medications

Medications can help in various different fashions. In some cases, coming off of a substance can be life threatening and medication is necessary. Often times, the symptoms of withdrawal can be so severe that medication is necessary. This is not considered treatment; it is however, the first step in the process of recovery. Going through withdrawal treatment is not sufficient. If one does not receive further treatment, it is like not receiving treatment at all.
 

Using chemical substances can help to establish brain functioning that may have gone awry. At present medications are available to help reestablish pathways for addiction related to heroin, morphine (opioid) and nicotine (tobacco). Other medications are currently being developed for treatment of cocaine and methamphetamines (stimulants) and marijuana (cannabis) addictions.
 

Methadone and buprenorphine act as antagonists on brain receptors which means that they block the pathways which opiates like heroin take. This helps to block the drugs effects, suppresses symptoms of withdrawal and can even reduce the incidence of cravings. Ideally, this helps patients to stop drug seeking behaviors and activities that may be criminally related. Thereby, patients should be more focused on treatment having reduced many outside stimuli.
 

Behavioral Treatments
 

This is a very important part of effective therapeutic treatment. Stopping substance abuse habits is only effective if behaviors change, therefore, attitudes have to be changed so that a healthy lifestyle is maintained. Life skills need to be altered, unhealthy patterns need to be changed. In addition, medication effectiveness is usually better, and this can help people stay in treatment longer which will hopefully improve the likelihood of the individual staying clean.
 

Outpatient behavioral treatment can include a wide variety of programs. Most include group or individual counseling. Some of the more popular forms of treatment include the following behavioral treatment programs:
 

• Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
 

Residential treatment can be very helpful, even more so for individuals with severe problems. Therapeutic communities are structured programs in which patients remain for half a year to twelve months. Those in treatment usually have long histories of drug addiction, have often been involved in criminal activity and may have reduced social functioning. Treatment communities have become so evolved that they may also be structured to accommodate women who are pregnant or have children. The purpose of treatment communities is to help the individual learn how to behave in society without drugs.
 

In conclusion, with the proper mix of effort on the part of the individual, the proper care by practitioners, medications and community, a formula for success on the part of the substance user can be acquired. With that formula put in motion, an addict can become a former one and go on to live a happy and fulfilling life.

The body’s reaction to the removal of a substance it has become dependent on is called withdrawal. Withdrawal causes craving for more of the substance being removed. The period of time when the body is trying to overcome its addiction is called detoxifica-tion (detox). Detox is the first step in overcoming a substance addiction such as drugs or alcohol. Detox is a pertinent step for the patient is to be successfully rehabilitated.
 

Opiate drugs such as heroin and methadone, and prescription medications including Hydrocodone, Oxycontin, Xanax, Vicodin and Lortab, require medical detox supervision. There are however, other illegal drugs such as marijuana, crystal methamphetamine, and cocaine that do not require medical detox. Since there is psychological dependence associated with these drugs, it would be wise to complete a period of stabilization. The process of drug detox requires the patient to be closely monitored by keeping vital signs, giving support and administering medications if needed. There are numerous withdrawal symptoms or side effects when a patient stops or dramatically reduces drugs after heavy or prolonged use. Those side effects include: sweating, shaking, headaches, drug cravings, nausea, vomiting, abdominal cramps, diarrhea, sleeplessness, confusion, agitation, depression, anxiety, and other behavioral changes.
There are two commonly used drugs to enable the patient to feel relief from these symptoms. First, Klonepin, which reduces physical symptoms, and Buprenophex, which is an anticonvulsant. These drugs must also be monitored as cessation produces withdrawal symptoms. Generally, the time period for drug detox is three to seven days under medically monitored supervision.
 

Alcohol detox, like drug detox, is usually accomplished in an inpatient medical facility. Duncan Raistrick identifies the key to a successful, planned detoxification is preparation. Raistrick goes further to detail that the first job of therapy is to bring the patient to a point of readiness to change their drinking behavior. Second, patients need to be given accurate information about what to expect during detoxification.
 

There are two withdrawal categories: minor, meaning early withdrawal and major, meaning late. The severity of withdrawal depends greatly on the duration of alcohol used. Alcohol Withdrawal Syndrome (AWS) falls into three main categories: central nervous system (CNS) excitation, excessive function of the autonomic nervous system (ANS), and cognitive dysfunction.5 Richard Saitz, M.D., M.P.H., states, since alcohol enhances gamma-aminobutyric acid’s (GABA) inhibitory effects on signal-receiving neurons, neuronal activity is lowered. This lowering leads to an increase in excitatory glutamate receptors. Tolerance occurs as GABA receptors become less responsive to neurotransmitters, which in turn requires more alcohol to produce the same inhibitory effect. During detox, the GABA is ineffective and unable to suppress the excitatory glutamate receptors. Detox is intended to relieve physical symptoms such as: shaking or tremors, headaches, vomiting, sweating, restlessness, loss of appetite, sleeplessness, Delirium Tremens (DT’s), hyperactivity, and convulsions. Alcohol detox medications are similar to drug detox medications: Buprenophex, certain benzodiazepines and anticonvulsant medications. Alcohol detox completion can take from three to fourteen days.
 

Norman S. Miller notes that medical management of alcohol and drug withdrawal during detoxification often is not sufficient to produce sustained abstinence from recurrent use. Therefore, further addiction treatments are needed to prevent relapse to alcohol and drug use following treatment of withdrawal.
 

In conclusion, drug and alcohol detoxification can effectively prepare the addicted abuser for rehabilitation and treatment.
 

Some physicians believe the withdrawal phase is related closely to the drug addiction – the worse the withdrawal, the more likely the continued use of the chemical to prevent withdrawal. Several factors are key to successful detoxification.
 

1. Acknowledge that there is a problem and decide to do something about it.
2. Get rid of all the drugs and paraphernalia.
3. Drop friends and associates that are tied to our drug problem.
4. Seek and accept spousal support, or support from friends, or relatives.
5. Prepare for symptoms with the support of a professional.
6. If tranquilizer drugs are needed for a few days or longer, they must be handled sensitively, as one addiction can easily replace another.

Close to a million Americans are treated for alcoholism on a daily basis. For the past 3 decades, the majority of treatments have been empirical and the success of the treatments has never been verified by clinical trials. The numerous methods developed in the treatment of alcohol addiction include the use of medications, psychological, social, behavioral methods and self help groups- all designed to help achieve abstinence from alcohol.

The initial approaches to alcohol treatment were all based on self help and over the years the 12-step self help program has become the gold standard. Other treatments include brief interventions by visiting the primary care physician or trained nurses. Behavioral and psychosocial support therapies have evolved over years and generally involve long term therapy. Over the last 2 decades, motivational enhancement therapy and involvement of the non-drinking spouse have evolved and produced good results.
Of course, over the past 4 decades, pharmacological approaches to alcoholism treatment have made some progress, but the ideal drug still remains to be discovered.

Alcoholism Treatment

The majority of individuals with alcohol dependence initially always deny that they have a problem and are reluctant to undergo therapy. Agreeing to undergo alcohol treatment usually occurs after the individual encounters health, family, employment or legal problems. Depending on the situation of the individual, various treatments are available to help with alcohol dependence. The initial part of the treatment involves evaluation, a brief intervention and either an in/outpatient program or counseling.

Principles of Alcohol Dependence Treatment

Before alcohol treatment can begin, one has to determine if the individual is alcohol dependent. For some who drink socially and are in control over their drinking, treatment may simply require reduction of drinking<. For those who have no control over their drinking, the best treatment is abstinence.

To maintain abstinence, the best approach is to be included with alcohol abuse therapists. These specialists can help develop specific-tailor made treatment plans, which may include objectives, behavioral modification skills, use of self-help manuals, counseling and follow-up care at a treatment center.

Non Drug Residential treatment programs

There are numerous non-drug residential alcoholism treatment institutions and include therapy to maintain abstinence, individual and group therapy, participation in alcoholism support groups (such as Alcoholics Anonymous), educational seminars, spousal involvement, work assignments, physical and non physical activity therapy. Most of these residential programs have professional counselors and staff involved in the treatment of alcohol dependence.

All individuals undergo a complete physical and medical assessment prior to therapy. The essence of all residential programs is to commence detoxification and treatment of withdrawal symptoms that may occur. Hard-hitting psychological counseling and psychiatric treatment is offered to individuals, couples and their families. The principal emphasis of all residential programs is on recognition of the problem and motivation for abstinence. Individuals who are unable to fulfill this basic criteria usually do not succeed with therapy.

Psychological, Behavioural and Social therapy

Numerous behavioral approaches to alcohol dependence treatment include psychological therapy. The primary component of these therapies is motivational enhancement therapy. This therapy is designed to help the individual become more responsible and develop a change in his lifestyle.

Various forms of counseling are available and may involve cognitive behavior therapy to help cope with distorted/abnormal thoughts and help develop a sense of control over these thoughts and feelings.

The majority of pychological therapies often involve the non-alcoholic spouse as most studies show that couple participation increases the likelihood of abstinence from alcohol. Behavioral –marital therapy is a combination of an approach to drinking treatment while strengthening the marital relationship through sharing, teaching and communication skills

Self-Help Programs

The most common self help group in the treatment of alcohol dependence is Alcoholics Anonymous (AA). This is one of the most common and easily available group in any community.

Alcoholics usually get involved with AA before seeking professional help, as a part of it, or as aftercare following professional treatment. Although anecdotal data on the success of AA are plentiful, results indicate that inpatient treatment, a combination of professional treatment and AA, will achieve better results for more people than AA alone. The reason why AA has been beneficial as a treatment for alcohol addiction includes isolating the individual from his social network of alcoholic friends, providing psychological/social support, teaching coping skills and structured behavior treatment.

Physician intervention

Some indivuals receive counseling from primary care physicians and trained nursing professionals. This consists of numerous office visits and counseling. The majority of these brief interventions help those with acute alcoholic crises. Following the brief intervention, all individuals are recommended to enter specialized treatment programs if the alcohol consumption continues.

Drug Treatments

Disulfiram (Antabuse) is an alcohol-sensitizing drug which has been around for at least 40 years. It was the first drug used for aversion therapy. It provides a strong deterrent to alcohol. It is not a cure and does not decrease the craving for alcohol. If taken before an alcoholic drink, it causes a severe reaction that includes nausea, vomiting, facial flushing and headaches. The drug is rarely used today as the severe reaction is not tolerated and most alcoholics are reluctant to take it.

Naltrexone (ReVia), is an antagonist of morphine and has been found to decrease the urge to drink. As is the case with all addiction disorders, however, naltrexone is only effective if taken on a regular basis.

Acamprosate (Campral) is a drug that decreases alcohol cravings and helps maintain abstinence from alcohol. Unlike disulfiram, naltrexone and acamprosate have fewer side effects and do not produce serious nausea and vomiting if alcohol is consumed.

Recently, the Food and Drug Administration (FDA) approved the first injectable drug to treat alcohol dependence. Vivitrol, a drug similar to naltrexone is administered by an intramuscular injection in the buttocks monthly. It has been shown to decrease the urge to drink by blocking neuro receptors/transmitters that may be coupled with alcohol dependence. Vivitrol has no effect on the withdrawal symptoms due to alcohol. The drug is recommended for use by alcoholics who are undergoing psychosocial therapy and have not consumed any alcohol in the recent past. The drug is also available as a pill, but it has been found that the injectable formulation is easier for individuals recovering from alcohol dependence and only has to be administered once a month.

Even though some drugs may reduce alcohol drinking, it is highly recommended that individuals enter in aftercare programs and prop up groups to help prevent relapse and encourage motivational behavioral and life style changes.

Conclusion

Research supports the idea of using drugs as an adjunct to the psychosocial/behavioral therapy for alcohol abuse and dependence. However, additional clinical trials are needed to identify those patients who will most likely benefit from such an approach, to determine the most appropriate medications for different individuals, to develop optimal dosing formulas, and to develop strategies for improving patient compliance with medication protocols.

With continued research on the effect of alcohol on the brain and behavior, hopefully this will lead to the magic pill. Drugs to decrease alcohol craving are around but specific medications are still missing. In the meantime, the combination of drug therapy and the use of behavioral therapies are the best hope for recovery of the individual -and the lives of loved ones-who suffer from alcohol abuse and dependence.

Palm Beach Post — She has a strong grip and broad shoulders and a rage that was so out-of-control she was called The Hulk.

Jen is just 22 and already has suffered years of abuse, from a boyfriend who burned her, beat her and tried to drown her, and from her own self-directed rage.

She believed she found a release and control over her anger and pain by cutting herself.

"It was sick and twisted," she said, curled up in a couch that wrapped its arms around her. "I would have the biggest smile on my face watching the blood run down my leg."

She tried to kill herself nine times, drank and took every kind of drug she could get.

It took courage and knowing that she was hitting bottom, but she finally got the guts to go to her father, who knew little about her abusive and addictive lifestyle, she said. He helped her find The Orchid Recovery Center in Delray Beach.

The staff there, in turn, helped her find a path toward peace through, among other treatments, yoga training.

Enter Angel Lucia, whose mission is to help heal women in recovery through yoga and meditation at her Bindu Yoga Studio in West Palm Beach.

Lucia partners with The Orchid and teaches at the facility and in her own studio.

Jen clearly has a loving addiction to Angel, who nods encouragingly at her while Jen talks about her horrendous experiences.

Nearby are the tranquil-looking yoga mats, candles, books and tapes that are an important part of this lifestyle.

The women in recovery are a close-knit group. They don’t like outsiders watching their yoga, but Jen explains how she is going from an enraged self-mutilator to accepting that life can hold joy for her.

"She winds us all down," Jen, who has been sober a little more than four months, says.

"I can come in angry, jumpy, and the yoga releases all the bad emotions. I like the breathing techniques."

Jen says she is clinically depressed, bi-polar and suffering from short-term memory loss. Yoga and the camaraderie of Angel and the addicted women in recovery at The Orchid have helped her become more centered, she says. She’s starting to like her life.

Angel smiles knowingly. She, herself, had an alcoholic father who threw the family into turmoil. She knows what it’s like to walk on eggshells around a person who can explode at any moment.

She attended family rehabilitation with her parents.

It was yoga and meditation that helped her physically unwind from the effects of a former career as a surgical assistant and a past laden with strained family relations.

"Mentally, I felt more balanced," she says of the yoga she learned and is teaching. "I moved into a more neutral state."

Now, she says, she takes what she knows works for her and tries to transfer it to her students.

"I can’t say I’m floating," she explains. "I can stop and reflect on what is building up in me. What is it and how can I reduce that? If I hold it, it will make me ill."

She watches Jen look at her with a little half-smile. You can almost imagine this powerful young woman she is helping, and whose fists could put Angel on the floor, breathing softly and learning to control her runaway emotions.

"She does have that understanding from having been through something like what we are going through," says Jen.

"When I’m with Angel, I turn off that cellphone, and I am moving and getting that hour of focus."

Angel says some of the women moan and groan and fight off her efforts to help them, not physically, but by withdrawing. She sends them out of the room until they re-engage.

Jen defends that kind of self-protective behavior.

"The feelings are new to us. Any kind of emotion is a shock and completely hard to deal with," she says of women who have learned to numb themselves with drugs and alcohol.

"She helps to keep people sober. She helps with acceptance of a lot of things and letting go. My anger has gone from major to manageable."

Adds Angel, "Yoga helps us to fill a spiritual void. I’m another bridge for them to that. I don’t want to say that I’m better than anyone else this way, but I know what I’ve overcome and know how to apply it to them."

Des Moines Register — Monitoring your teen’s activities is an important deterrent to drug use.
 

Research shows that more teens begin using tobacco, alcohol, and marijuana between spring break and the summer months than any other time.
 

Parents can play an important role in helping their teen stay drug-free by setting clear rules, knowing who their friends are, and by having open and honest discussions about drugs.
 

Q. Why is summer a risky time for teens?
 

A. Summer is a time that often has little structure for teens. This can lead to boredom.

According to a study by the National Center on Addiction and Substance Abuse, teens who report they are "often bored" are 50 percent more likely to smoke, drink, get drunk and use illegal drugs than teens who aren’t.

Another risk factor for teens during summer is having friends who use drugs. Teens are more likely to feel pressured to experiment with drugs if their friends do.

The summer months also have more unsupervised time, which can lead to involvement in risky behavior.

Q. My teen will be unsupervised at home for most of the summer. What can I do to make sure he stays out of trouble?

A. There are steps you can take to ensure your teen stays safe and healthy.

- Lean on other responsible adults in your neighborhood. Network with other adults in your community to build a safe environment for young people.

- Use technology to your advantage. Teens these days use many forms of communication technology including e-mail, cell phones, text messaging and instant messaging, to name a few. Use these forms of technology to check in with your teen each day.

- Get to know your teen’s friends. They can be an important factor in your teen’s decisions about alcohol, tobacco and other drugs.

- Plan regular check-in times throughout the day with your teen.

- Find supervised activities in your community that your teen enjoys. Youth who are involved in constructive, supervised activities during non-school hours are less likely to use drugs. Talk with your child about what she would like to do during the summer and see if you can find a summer program in your community.

Q. How do I start the discussion about drug use with my teen?

A. Teens need to be educated by their parents about drug abuse, expectations in the home, and consequences. This can be a difficult conversation to have but the steps below can help guide you though the process.

1. Talk with your partner to agree on rules and consequences if your teen does use drugs. This information should then be shared with your teen so he knows and understands the expectations.

2. Practice ahead of time what you are going to say to your teen. Be prepared for various reactions from your teen and practice how you will react.

3. Make an agreement with yourself to not get upset or angry. Stay as calm as possible. Remember, you are the parent and you are in charge. Be kind and direct in your statements to your child. Know that you are doing the right thing.

Q. What are some signs to watch for if my teen is using drugs?

A. Look for signs of depression, withdrawal from friends and family, carelessness with grooming, or hostility. Also ask yourself, is your teen doing well in school, getting along with friends, and taking part in regular activities? Some additional signs to look for are:

- Increased secrecy about possessions or activities.

- Increase in borrowing money.

- Unexplained injuries.

- Impaired short-term memory.

- Items or money missing from home.

- Illness, shakiness, or tremors.

Q. What other resources are available?
 

A. A great resource for parents is called "The Anti-Drug," which can be found at www.theantidrug.com. This Web site has a wealth of information for parents about drug education, support from other parents striving to keep their teens drug-free, and helpful articles and advice from experts in the parenting and substance abuse prevention field.

(HealthDay News) — Drinking and alcohol dependence has increased substantially among women, particularly white and Hispanic women born since 1945, new study finds.

Alcohol use and dependency appeared to remain stable for men, while young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop issues with drinking.

The findings were published in the May issue of Alcoholism: Clinical and Experimental Research.

"We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank," the study’s corresponding author, Richard A. Grucza, an epidemiologist at Washington University School of Medicine, said in a prepared statement. "However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention or higher levels of alcohol dependence."

The researchers’ findings came from analyzing two large, national surveys conducted 10 years apart (1991-1992 and 2001-2002). The polls compared lifetime alcohol-use rates from the same age groups and demographics.

The "closing gender-gap in alcoholism" may be due to higher levels of problems facing women, while men have been more or less steady in their levels of dependence, he said.

"Clearly, there were many changes in the cultural environment for women born in the ’40s, ’50s and ’60s compared to women born earlier," Grucza said. "Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power. They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems."

Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital, added to Grucza’s assessment.

"One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased. As it was more socially acceptable for women to drink, a greater number of them became drinkers. Because women have a heightened vulnerability to the effects of alcohol — that is, greater blood alcohol levels at similar doses of alcohol — we may therefore see a concomitant rise in alcohol dependence among those who ever drank."

Another potential factor: immigrants arriving to America from cultures with more conservative values about drinking tend to stick with their native cultural norms, but their children are more likely to follow comparatively lax U.S. norms regarding alcohol.

"We can think of U.S. culture as having been traditionally dominated by white men," added Grucza. "As women have immigrated into this culture, they have become acculturated with regard to alcohol use."

He said the added barrier of race may be what is keeping black women, who still have the lowest rates of drinking among the demographic groups looked at, from adopting the alcohol-use standards of the dominant U.S. culture.

Greenfield suggested that targeting females with gender-specific prevention programs might lower drinking rates or delay when drinking begins, which could help prevent later alcohol problems.

"It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men," she said.