Summer House

A Review of What Works

Introduction

Alcoholism affects millions of people in the United States alone. According to the National Institute of Alcohol Abuse (NIAA), a division of the National Institutes of Health in Bethesda, Maryland USA, at least 700,000 Americans receive treatment for this disease every day. Some kinds of treatment, such as Alcoholics Anonymous (AA) have been around for many years while others are relatively new. Clinical research to determine the effectiveness of these various treatments has resulted in some important findings.

In October 2000 the NIAA released a summary of its conclusions based on fifteen years of research on alcohol treatments. According to the NIAA, self-help programs such as AA, psychotherapy and pharmacotherapy, either alone or in combination, are in fact effective and do reduce the use of alcohol.

Alcoholics Anonymous

Of all the treatments for alcohol misuse, Alcoholics Anonymous (AA) is probably the most well known. In AA, a form of "self-help" treatment, participants take part in a series of mental, written and verbal activities that can lead to recovery and abstinence. In one study, alcoholic patients who received inpatient and outpatient psychotherapy, as well as AA, had better outcomes than those patients who attended only one kind of treatment.

It is thought that AA helps people because it provides a new social network that replaces the alcohol abuser’s usual group of friends who drink with him or her, and provides a fellowship that inspires motivation and lends support toward the goal of reaching and maintaining abstinence. AA also teaches a set of coping skills so that, when stressed, the alcohol abuser has more constructive ways of coping, and does not need to turn to alcohol to escape his or her problems.

Another study, conducted at a Department of Veteran Affairs hospital, indicated that those alcoholic patients who underwent either cognitive-behavioral therapy (CBT) or a 12-step program in combination with CBT did better, over the long run, than those who participated in the 12-step program alone. (CBT entails learning coping skills, new ways of interpreting and reacting to stressful situations, and changing one’s destructive or maladaptive behavior patterns.) The patients who received the combination treatment stayed sober longer and were able to hold down a job for longer periods than those patients who received only CBT.

Both of these studies seem to show that a combination of some kind of psychotherapy and a 12-step program such as AA produces the most beneficial results for patients who use alcohol in excess.

Other beneficial treatments

Other promising treatments of alcohol abuse that are being studied include Motivational Enhancement Therapy (MET); couples therapy; Brief Intervention Therapy; dual-addiction treatment; and pharmacotherapy.

Motivational Enhancement Therapy: The key component of MET is an interviewing technique conducted by a trained psycho-therapist. The goal of this method is to increase an individual’s degree of motivation to stop drinking and to maintain abstinence. This is accomplished by the therapist gauging the individual’s readiness to change and then adjusting feedback accordingly. An intensive, individualized interviewing strategy, MET was demonstrated to overcome many patients’ disinclination to address their alcohol problem in treatment and increase their willingness to change.
Couples Therapy: Patients who include their non-alcohol abusing partners in their psychotherapy are more apt to attend therapy, and more likely to alter their unhealthy drinking habits. In one model of couples therapy known as Behavioral-Marital Therapy (BMT), communication and conflict-resolution skills are taught. When a relapse-prevention plan was added to this model, alcohol abstinence rates were even higher.

Brief Intervention Therapy: This treatment method usually takes place when alcohol users visit their primary care physicians. It typically entails the imparting of information about the negative consequences of drinking to excess, as well as supportive programs in the community. Two studies, carried out in the United States and Canada, showed that patients did reduce their alcohol consumption as a result of these interventions. This treatment seems to work best with those individuals who are at-risk for alcohol abuse. Those who are already dependent are better off being referred to specialized treatment programs.

Dual-addiction treatment: This method attempts to target both cigarette (nicotine) and alcohol dependencies at once. The use of one of these substances seems to make an individual more susceptible to dependence on the other. The rationale behind dual-addiction treatment is that reducing dependence on one may help a person reduce his or her reliance on the other. Although this is a newer approach to treatment, a recent study seems to suggest that this is indeed the case.
Pharmacotherapy: Finally, if taken on a regular basis, the drug naltrexone, approved by the U.S. Food and Drug Administration in 1995, can be a valuable aid in preventing relapse among recovering alcoholics receiving psychotherapy. Another medication, acamprosate, proved helpful in several European trials. (Editor’s note: It is now undergoing clinical trials in the United States.) Zofran, a medication usually used to prevent nausea during chemotherapy for cancer, was beneficial in the treatment of early-onset (i.e. those who started drinking heavily before age 25) alcoholism. Sertraline (Zoloft), an anti-depressant, was found to be helpful in reducing drinking in those with late-onset alcoholism.

Summary

Using proven methods of evaluating medical therapies, recent research reveals that many effective treatments exist to help people to stop drinking and maintain abstinence. These treatments include self-help groups such as AA, psychosocial approaches and medications.

Continued research in the field of alcoholism is likely to produce highly specific medications that will reduce the craving for alcohol. It will also yield an even broader range of therapies, including those mentioned here, that will improve the alcohol abusing person’s chance for recovery.

Over time, those who suffer from alcohol abuse and/or dependence will have even more and possibly better options for successful treatment. In the meantime, effective treatments already being offered by mental health professionals and community groups have been demonstrated to reduce alcohol use and promise a better life for people who make use of them.

Individuals, who engage in substance abuse use, are often facing more than one issue. Research literature has shown, time and time again, that there is a stereotypical personality that accompanies the addict, rightly named, the ‘addictive personality’. Some characteristics that accompany said individual are as follows:
 

* Impulsivity
* Difficulty in delaying gratification, sensation seeking
* Nonconformity combined with a weak commitment to the goals for achievement valued by the society.
* Social alienation and a general tolerance for deviance.
* Poor tolerance for stress, increased sensation of distress
 

This is being outlined, to assist the lay person in understanding why addicts cannot just stop using drugs. Substance use is not just an action it is in effect a lifestyle. This implies that in order for an individual to stop utilizing drugs, he or she must not only actually stop using but must change aspects of personality that may lead him or her in that unhealthy direction. Once this has been outlined and agreed, the individual next needs to decide a plan of action. It is unadvisable for an individual to attempt to stop using drugs on his or her own. Breaking such habits is difficult for anyone with the assistance of others let alone as a solitary mission.
 

So, now the question comes, inpatient or outpatient?
 

Research conducted over the last few decades indicates that longer treatment periods are associated with more positive outcomes. On average, a treatment period of three months was correlated with more positive results. In the case of substance abuse treatment, this is to mean less incidence of relapse. Patients expressed more positive feelings towards more intense treatment plans. So, those individuals who were in residential treatment and received one on one consistent attention were more likely to indicate a better sense of overall satisfaction in regards to treatment. However, there is little statistically significant difference between outpatient and inpatient long term treatment recidivism. Meaning, long term effects of staying clean do not differ.
 

In order to understand the above findings, one must integrate the information previously presented. In order for substance use to cease permanently, an individual must totally change his or her behavior and surroundings. Going into a residential facility assists in removing one from his or her life. This cuts out locations and individuals that probably assisted in facilitating drug use. One is also in the presence of others with a similar goal. All of these factors are positive and if one can integrate them into his or her psyche, inpatient treatment can longitudinally provide the basis for healthy living. The one factor that proves to sabotage all this is properly presented in one question often asked by residents of treatment programs:
 

What Happens When I Get Out?
 

It is a valid question. In a controlled environment anything is possible. If temptation is outlawed, the individual does not have to utilize his or her decision making skills because in effect, the decisions are made for them. Substance users in this context can be thought of as a child. As children, our parents monitor our behaviors and our actions often giving us the proverbial slap on the wrist if we reach too close to the fire. As adults, we must utilize our decision making skills or else we have the potential to be severely burned. For this reason, substance abuse recovery must take place in small steps with much reinforcement utilized.
 

The main variable shown to influence whether treatment programs work or not is continued monitoring. One study that analyzed outcomes of parolees who participated in treatment communities (TC), either outpatient or inpatient, found that the outcome variable: return to prison, was correlated with longer participation in ‘aftercare’ treatment programs. Thus, those individuals who left prison and had some level of reinforcement, was more likely to stay clean and not return to incarceration.
 

McLellan (2004), a researcher out of the University of Pennsylvania, compares substance abuse treatment to treatment for any other chronic illness. Mclellan point out, that what will make treatment effective is the three following variables noted:
 

* Making treatment options attractive
* Offer options/alternatives
* Constant and continued monitoring of the individual
 

It is no shocker that most people are more inclined to do something they view as positive or attractive. So, first things first, treatment options should be something that the individual in fact beckons to the individuals tastes. Varying options in the form of treatment (i.e group versus individual therapy for instance) keep treatment ‘entertaining’ if you will, thereby making continued treatment as an option. Finally, when an individual leaves treatment he or she needs to continue with what we will call ‘stabilization’. Whether that means switching from residential to outpatient treatment or joining a group like alcoholics anonymous or narcotics anonymous after intense treatment depends on the individual and the program from which he or she graduated.
 

No one program will fit every individual as every person is different. Residential treatment may very well be the best option for some and not for others. It is up to the individual to decide what will suit him or her better. Having said that, when considering substance abuse treatment one must remember that treatment consists of a plan that must unfold longitudinally. Changing one’s behaviors and in effect, one’s personality is a long process which, with proper guidance and support can occur. Like any task worth undertaking it takes time, perseverance and most importantly assistance from those who can help to attain a life free of drug use.

Drug and Alcohol addictions continue to effect people from all walks of life. Many people believe that all drug and alcohol abusers are criminals or are morally weak. But, that simply is not the case. Whether one is a doctor, stay-at-home mom, lawyer, teacher, preacher, mill worker, teenager or even a child, drug and alcohol addictions respect no one. Addiction is a physiological dependence on something, meaning it is both physical and psychological in nature. Therefore, when one is addicted one literally needs whatever it is that feeds that addiction.
 

Education remains a key factor in fighting drug and alcohol dependencies. When people understand drug and alcohol abuse prevention becomes visible and effective. The National Institute on Drug Abuse (NIDA) notes, a tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data NIDA has amassed. NIDA further states that overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" - the gap between the public perception of drug abuse and addiction and the scientific facts.
 

In the mean time, it is necessary to facilitate assistance for the current drug and alcohol abusers. There are diverse options in treatment and rehabilitation programs. Those options include: 12-step programs; 12-step alternatives; programs, wilderness camps and schools for troubled teens with addictions; inpatient residential; day treatment; outpatient treatment; faith-based facilities; and holistic treatment.
 

The 12-step program, one of the most popular rehabilitation programs, originated for Alcoholics Anonymous, but later versions were adapted for other addictions. The synopsis of the 12-step programs consists of: 1) Admit that we are powerless over drugs or alcohol and that our lives have become unmanageable. 2) Come to believe that a Power greater than ourselves can restore us to sanity. 3) Turn our will and our lives over to the care of a Higher Power. 4) Make a searching and fearless moral inventory of ourselves. 5) Admit to a Higher Power, to ourselves and to another human being the exact nature of our wrongs. 6) Be entirely ready to have a Higher Power remove all these defects of character. 7) Humbly ask a Higher Power to remove our shortcomings. Make a list of all persons we have harmed, and be willing to make amends to them all.
9) Make direct amends to such people wherever possible, except when to do so would injure them or others. 10) Continue to take personal inventory and when we are wrong promptly admit it. 11) Seek through prayer and meditation to improve our conscious contact with a Higher Power, praying only for knowledge of the Higher Power’s will for us, and the power to carry that out. 12) Having had a spiritual awakening as the result of these steps, try to carry this message to other drug addicts or alcoholics, and to practice these principles in all of our affairs.
 

The Comeback Treatment Center of California states several facts regarding drug and alcohol rehabilitation: drug addiction and alcoholism is a highly treatable disease (continued suffering is optional); no drug addict really likes the way he or she has to use drugs and alcohol; drug addiction can be outgrown in an honest, responsible, character-building environment; personal growth feels better and lasts longer than any drug; the hardest part about drug rehab recovery is getting started, the rest is reward, once earned, sobriety becomes a precious gift of spirit and mind that overcomes negative emotions and mental blocks that could keep one from continuing in a responsible direction towards self-fulfillment.
 

In conclusion, drug and alcohol abuse will be around as long as there are people, drugs and alcohol. One must make a proactive choice to educate and understand these addictions so that early intervention can be made as soon as abusers are identified. Ideally, education and training would decline the statistics on addictive behavior, but personal pleasure and the masking of personal problems through addiction remain prevalent today.

Introduction
 

Cocaine is a intensely powerful addictive stimulant that acts directly on the brain. Cocaine was first extracted from the leaf of the Erythroxylon coca bush, which is endemic in South America, West Indies and Indonesia. Cocaine is one of the most commonly abused drugs and the majority of the individuals who use cocaine are also users of other drugs. The drug can generate a feeling of euphoria, hyperactivity and mental alertness. It can be rapidly highly addictive leading to relentless mental and physical problems.

The neuro-stimulating properties of the coca leaves are thought to have played some role in the development of the Inca People. Soon, the Spanish invaders quickly discovered the euphoric effects of the coca plant and introduced the plant to the Europeans, who also developed a great liking for the plant and its stimulating effects.
 

History
 

The plant was used for medicinal purposes as early as the 15th Century in Europe. In the 18th Century, concentrated forms of cocaine became available and it was soon discovered that the plant extract had some medical benefits. The drug was then widely used as a topical local anesthetic and because of its mental stimulating properties, was also used to treat depression. The use of cocaine in tonics and elixirs became widespread and it was also added to coca cola.
 

However, soon it was soon observed that drug was addictive and had profound effect on the psyche of the individual. Because of cocaine’s potent side effects, in the early part of the 20th Century, the Pure Food and Drug Act was introduced, which required that all cocaine be labeled in all medical products. However, this did not limit the use of cocaine and addiction to cocaine reached endemic proportions. In 1914, the Harrison Narcotics Act was introduced and banned the nonprescription use of cocaine products and labeled cocaine as a narcotic.
 

The Harrison Narcotics Act did nothing to diminish the use of cocaine and over the next 50 years, cocaine became the number one illicit drug used in North America. In the 70s and 80s, a new cheaper formulation of cocaine became available on the market and it has today become the favorite drug among teenagers and socially deprived individuals. By the mid-1980s, the emergency rooms were again becoming full with individuals with cocaine-related problems. Physicians again re-affirmed the abuse potential of cocaine.
 

Today, cocaine is classified as a Schedule II drug — it has towering potential for abuse and can only be administered by a doctor for legitimate medical uses. Today, the medical use of cocaine is limited to topical anesthesia of the upper respiratory tract and eye because the vasoconstrictive properties of cocaine are desirable during these procedures. However, it is not available in majority of the hospitals in North America, because safer and better agents are available.
 

Addiction Potential
 

Cocaine is an addictive psycho-stimulant with euphoric effects. The addictive properties of cocaine are thought to be due to brain dopamine D2-receptor stimulation. Dopamine is released as part of the brain’s reward system and is implicated in the high that is typical of cocaine consumption. Patient dependence depends on a number of different factors, including genetics, social and environmental factors, preexisting medical and mental conditions.

There are two fundamental forms of cocaine: powdered and "freebase." The powdered form easily dissolves in water whereas freebase is a mixture that has not been neutralized by an acid. The freebase form is usually smoked or snorted.
Warning signs of cocaine use include a change in behavior, acting isolated, careless about personal appearance, loss of interest in school, family, friends and frequently needing money. Physical exam may reveal red eyes, runny nose, frequent sniffing, change in eating and sleeping patterns and a change in friends

Cocaine induces an artificial “high” that gives its user a feeling of limitless ability and energy. When users come down, they are usually depressed, nervous, and crave for more. Todate, it has been impossible to predict who will become addicted and when the fatality will occur.
 

Frequency of Use
 

In the US, as of 2005, according to the Office of National Drug Control Policy, more than 3 million people in the United States are considered long-term cocaine users. Cocaine abuse is also widespread universally and has become a major public health issue in North America. Data suggest that the prevalence of cocaine use in the world is approximately 13 million people, or 0.23% of the global population. Cocaine use is also increasing in a number of Latin American countries, including the countries that are the main producers of cocaine.
 

All races and both genders are known to use cocaine. Individuals between the ages of 18-30 are the most frequent users. Men not only are more heavy users but also account for more overdose and toxicity from cocaine.
 

Routes of Intake
 

Cocaine may be inhaled (snorting), injected or smoked. Irrespective of the method of intake, cocaine is still a potentially deadly agent. Most individuals report that the psychotic features and habituation are more rapid and pronounced after smoking cocaine, compared to other methods. The “high” generated with smoking is instant but of a shorter duration, but the addiction potential is the same by all routes. Like all illicit drugs, injection of drugs carries with it the potential for transmission of HIV/AIDs. This becomes of more concern when the needles and other injection paraphernalia are shared.
 

A common route of transportation of cocaine is by swallowing cocaine packed in condoms. Body stuffers usually hide packages of cocaine in the rectum, vagina or mouth. These individuals usually get away until the packages rupture and cocaine intoxication becomes obvious.
 

Street cocaine is often accidentally/intentionally contaminated during the preparation process in order to dilute the cocaine used and increase profits. Commonly used cocaine adulterants may include local anesthetics, phenytoin, sugars, amphetamines, phencyclidine, phenylpropanolamine, quinine, talc, and others.
 

Mortality/Morbidity
 

Data from the Drug Abuse Warning Network (DAWN) indicate that there are about 4-5000 cocaine related deaths annually in the US. Cocaine-related deaths are rare and not always due to high dose intoxication. The lethal dose of cocaine remains unknown. Fatalities are multifactorial, and, often the cause remains unknown. Occasionally, massive exposure of cocaine occurs in body packers and results in rapid death.
 

However, the majority of cocaine users are prone to serious long term medical complications. These complications may include seizures, abnormal heart rhythms, heart attacks, stroke, blindness, liver and kidney failure, lung fibrosis and heart failure.
 

Symptoms
 

Cocaine has numerous physiological and psychological side effects. The adverse effects of cocaine’s appear almost immediately after a single dose, and fade away within a few minutes or hours. Cocaine can cause intense vasospasm of blood vessels, dilate pupils, increase the heart rate and blood pressure and can also generate a febrile response.
 

The psychological effects include euphoria, decreased fatigue, extreme hyperactivity and mental lucidity. The sense of sight, sound and touch are over amplified. During the cocaine euphoria, the need for food, sleep and personal hygiene are significantly absent. The majority of individuals report that cocaine aids them completing simple chores swiftly, whereas others experience mental confusion and are unable to carry out any tasks

The quicker the cocaine is absorbed, the more intense is the “high”, however, the duration of action is short lived. The euphoria from snorting may last 15-30 minutes, while that from smoking may last 5-10 minutes. Increased utilization can diminish the period of stimulation due to development of tolerance. High doses of cocaine and/or extended use can generate an aggressive paranoid behavior, tremors, vertigo, muscle twitches, extreme restlessness and auditory hallucinations.
 

When addicted individuals discontinue using cocaine, they frequently become depressed. This may lead to additional cocaine use to lessen the depression. Extensive cocaine snorting is known to cause ulceration of the nasal mucous membrane and even perforate the nasal septum. Cocaine-related deaths are often a consequence of cardiac arrest or seizures followed by respiratory arrest.
 

When both cocaine and alcohol are consumed, the adverse risks are increased by several folds. Combination of cocaine and alcohol in the liver is known to generate a substance called cocaethylene, which is known to potentiate cocaine’s euphoric effects and also increasing the danger of sudden death.
 

Treatment of Acute Intoxication
 

Patients with cocaine poisoning may exhibit severe CNS and cardiovascular dysfunction, leading to a loss of airway protective reflexes, cardiovascular collapse, and mortality. The goals of pharmacotherapy are to neutralize toxicity, reduce morbidity, and prevent complications.
 

The immediate control of mental agitation is critical in preventing the mortality associated with cocaine overdose. Benzodiazepines are the mainstay of therapy and may be used generously until sedation is accomplished. Avoid physical restraints in patients with psychomotor agitation because they may interfere with heat dissipation. Seizures should be aggressively treated because they may worsen hyperthermia, rhabdomyolysis, hypoxia, and acidosis. In some cases, ventilatory support and neuromuscular blockade may be required

Body packers and body stuffers may require critical care monitoring. The body packers pack their gastrointestinal tract with bags of cocaine. However, occasionally the cocaine-containing package ruptures or the packages may cause gastrointestinal obstruction.
 

All symptomatic body packers and body stuffers require intensive therapy. Charcoal may have to be introduced in the stomach to bind the cocaine and prevent absorption and surgery may be required to remove the packages.
 

Asymptomatic patients may be treated with laxatives and bowel irrigation to remove the cocaine bags. Surgical removal may also be indicated in patients with bowel obstruction.
 

Some individuals may suffer a Cocaine washout syndrome (cocaine crash syndrome) which is characterized by sudden and severe exhaustion with mental slowness, depression, suicidal ideation, anxiety and increased appetite, lasting as long as 18 hours after the last consumption. Cocaine washout syndrome is usually self-limited, and only requires supportive therapy.

Once the acute phase is stabilized, patients may require further therapy to treat the complications of cocaine. It is highly recommended that these individuals enter into a rehabilitation therapy program.
 

Treatment approaches to Addiction
 

Treatment of cocaine addicts is a multi million dollar business. Treatment programs are available throughout North America. The treatment is complex and involves changing the mind as well as altering the psychological, social, familial and environmental factors
 

Pharmacological Approaches
 

There are no approved medications currently available to specifically treat cocaine addiction. Few emerging compounds currently being investigated to assess their safety and efficacy in treating cocaine addiction include disulfiram, terguride, topiramate and modafanil. Additionally, baclofen, a GABA-B agonist, has shown promise in a few individuals who use excessive cocaine. The use of anti depressant drugs has been recommended during the early phase of cocaine abstinence, because of the moderate depression that occurs.
 

Behavioral Interventions
 

Many types of behavior therapies have been used to treat cocaine addiction, and involve both residential and outpatient approaches. Behavioral therapies are frequently the only available effective treatment for cocaine addiction. However, amalgamation of both medical and behavior treatments are more effective in the treatment of cocaine addiction.
 

Behavior therapy which has been shown to be beneficial includes vocational rehabilitation, career counseling, contingency administration and cognitive-behavioral treatment. Therapeutic communities (TCs), or residential programs with intended lengths of stay of 6 to 12 months, present another option to those in need of treatment for cocaine addiction. TCs concentrate on remobilization of the individual to society, and can incorporate on-site vocational rehabilitation and other helpful services.

Enrollment in deterrence programs, such as Narcotics Anonymous, may be of benefit for some patients.

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.

Xanax is a Central Nervous System (CNA) depressant known as benzodiazepine, which is commonly prescribed by physicians to treat panic attacks, nervousness, and tension. Xanax, also known as alprazolam, is considered to be a Schedule IV controlled substance under the Controlled Substance Act (CSA). Xanax has been used as a tranquilizer since the 1960s. With strong opposition to the use of benzodiazepines in the 1970s, there was a 25 percent drop in the number of prescriptions written and today, with approximately 3 million Americans (1.6% of the adult population) having used benzodiazepine on a daily basis for at least 12 months, they are the most controversial of all psychotropic medicines.

According to the United States Department of Justice Drug Enforcement Agency (DEA) and under the CSA, all controlled substances are rated on a five-schedule system. Schedule V, the lowest, for the potential for abuse and dependency and I, the highest. Xanax is a Schedule IV. All Schedule IV controlled substances have the following attributes: a low potential for abuse, a currently accepted medical use in treatment in the United States, and if abused, may lead to limited physical dependence or psychological dependence. Other examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®, Valium®, and Xanax®.

Although there are many benefits to taking Xanax and other Schedule IV drugs, many patients are becoming addicted and therefore require an intervention and drug treatment program to overcome their addictions. The patient’s body can also build up a tolerance to the drug and require larger doses if taken for long periods of time. With these increases in Xanax use come physical and psychological dependencies. Xanax is not drug to quit cold turkey. The Journal of Postgraduate Medicine stated that up to 25 percent of patients who stop taking their medication experienced withdrawal symptoms such as: nausea, vomiting, dizziness, headache, anxiety, irritability, insomnia, chills, lethargy, fatigue, moodiness, crying, dystonia, paresthesia, tremor, vivid dreams, and myalgias.

The National Institute on Drug Abuse found during a two-year treatment outcome study that 15 percent of heroin users also used benzodiazepines daily for more than one year, and 73 percent used benzodiazepines more often than weekly. Studies also indicate that from 5 percent to as many as 90 percent of methadone users are also regular users of benzodiazepines.

With this information in mind, the Xanax abuse treatment involves careful monitoring and counseling in an in-patient or outpatient treatment facility. The American Psychiatric Association’s (APA) report on benzodiazepines revealed that 11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year, but only 1 to 2 percent have taken benzodiazepines daily for 12 months or longer. However, in psychiatric treatment settings and in substance-abuse populations, the prevalence of benzodiazepine use, abuse and dependence is substantially higher than that in the general population. Treatment encompasses a patient’s thought process, behavior, and helps them to cope with everyday life. Patients suffering from Xanax addiction should be tapered off gradually. There are basic outpatient plans available for discontinuation of the drug including: gradual discontinuance over a six to 12 week schedule, monitoring and helping the patient to feel in control of their dosage, and supplying a helpline when the patient needs reassurance. Other plans include inpatient treatment centers and 12-step programs such as Narcotics Anonymous, and drug treatment exchanges such as, Clonidine, propranolol, or carbamazepine. Although these substitutes can be dangerous, an inpatient setting where dosages can be physician monitored until the patient can reach a zero dose of the benzodiazepine is recommended.

In conclusion, Xanax and other benzodiazepines can be addictive drugs that are hard to discontinue however, they are also drugs of great benefit to patients who suffer from anxiety, depression, fear of open spaces (agoraphobia), premenstrual syndrome, and panic attacks. The patient and the physician should work together to regulate long-term usage, monitoring side effects, and any signs of abuse.