Substance Abuse Treatment Issues

Substance abuse treatment is the only real option for many people addicted to alcohol or drugs. Treatment can be done on an inpatient or outpatient basis and there are advantages and disadvantages to both types of treatment. Some programs are restricted to alcohol or other drugs, while other programs incorporate both alcohol and drugs into the same program.

Inpatient substance abuse treatment is more intense than the outpatient programs. The inpatient program can last for 30 days or can extend indefinitely, depending on the funding of the patient. People live in a confined setting and are monitored for detoxification. They are often prevented from leaving the program and they attend group and individual therapy during the day. They may have recreational programs but these are not part of the actual treatment. Inpatients work hard on their issues and try to find out the underlying problems that have contributed to their substance use. If they graduate from this type of program, they often go to outpatient therapy, AA or NA programs.

Outpatient substance abuse treatment is appropriate for those who don’t expect to have any problems with detoxification and who have a strong family support. Many outpatient programs are day programs, with the bulk of the day spent in various group therapies, family therapies and sometimes individual therapies. AA or NA is often part of outpatient programs and the individual is encouraged to find a sponsor. Outpatient programs can last for up to a month as well but it depends on the program and the funding of the abuser.

Some substance abuse treatment is directed solely at those addicted to alcohol. Issues around detoxification are addressed and medication can be prescribed which lowers ones risk of drinking again. There are even medications that control the urge to drink. Alcoholics can come together to discuss issues related to their alcohol use and are encouraged to attend AA and find a sponsor. Many patients are asked to attend alcohol treatment by a judge after they were arrested for a DWI or DUI. A court ordered alcohol treatment doesn’t share the same success as voluntary treatment.

There are some who believe that narcotic substance abuse treatment should be separate from alcohol treatment because the issues are so different. Narcotic users can be given medication to help with cravings. Users of other drugs have their own issues with withdrawal and learning to stay away from drugs. Those who use drugs, particularly narcotics, can transition into NA as an outpatient to get as much support for staying clean as possible.

The goals of substance abuse treatment are (1) the detoxification of the patient from their drugs of choice, (2) managing withdrawal symptoms, (3) learning new coping methods around drug abuse and (4) reintegrating into society without drugs. If the person doesn’t have a stable living situation or has a lot of friends who use and abuse drugs or alcohol, it will be more difficult for the individual to recover completely from substance abuse. This is why inpatient therapy is sometimes better for those who don’t have the family or other support they need.

How to Stop Substance Abuse and Drug Addiction

Most people associate dangerous addiction with the use of illegal drugs, but substance abuse consists of any dangerous dependence, including alcoholism and reliance on prescription drugs. For centuries, substance abuse was regarded by society as a personal failing or moral fault, and addicts were shunned and forced to the fringes of the community. Substance abuse today is recognized as a disease, typified by the brain becoming reliant on certain substances to deliver neurotransmitters like dopamine or serotonin. Street drugs like marijuana, cocaine and methamphetamines react with the brain in a similar way to legal addictives, such as alcohol, tobacco, and inhalants.

These substances all increase the production of certain neurotransmitters in the brain, resulting in various “highs,” drunkenness, or relaxation of the nerves and it is this rise in dopamine levels which is the root of substance abuse. As drug abusers, alcoholics, pill poppers or cigarette smokers continue to engage in substance abuse, their brains eventually lose the ability to produce critical neurotransmitters on their own. Because dopamine and similar neurotransmitters are responsible for feelings like pleasure, the drug user becomes dependent on the substance being abused which causes the intense cravings and feelings of addiction.

Fortunately for the victims of chemical dependency, societal attitudes towards addiction have softened and treatment programs for drug, alcohol, prescription pills or tobacco use are commonplace. Rehabilitation clinics strive to assist those suffering from substance abuse, helping them to cope with their cravings incrementally, and providing personal, psychological, and spiritual guidance through the recovery process. There are national substance abuse programs, such as the 12-step Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), psychiatric help, medicinal options and even loving support from friends and family can help addicts rid themselves of their dependencies.

People afflicted with substance addictions can rely on an extremely accessible network of meetings, found in almost every city or town in the country, which serve as a coping mechanism, a therapy session, and a confessional at the same time. Drug testing kits are now readily and cheaply available for home use to help stop the addictions privately. Substance abuse is worth the efforts being made to combat it, because the damage caused by addiction is extensive and far reaching. Almost every aspect of society, from the legal system and the medical field to families and schools, is touched in some way by the destructive power of substance abuse, and the battle to prevent dangerous addictions will always be one worth fighting.

Help put a stop to substance abuse and chemical dependency by interfering and impeding at the first signs of addiction. Openly talking to the individual about your concerns and the effects of their addiction is the first stride towards acceptance and recovery. Do not be afraid to drug test at the first signs of misuse. This is especially true of prescription pills abuse as many individuals do not view Oxycontin or Vicodin as habit forming because of a prescription.

There are many home drug tests that can uncover traces of harmful narcotics like Percocet and the mind altering diazepams Xanax or Valium. Alcohol breathalyzers and oral saliva testing kits are available to discover a hidden drinking habit. Regardless of the specific substance addiction, there are many options available to help stop the cycle of drug dependency.

Anger Management, a Neglected Topic in Substance Abuse Intervention

A long standing issue

Problems managing anger has always been a concern for patients suffering from addictive disorders. Pioneering research by my mentor, Dr. Sidney Cohen at the UCLA Neuropsychiatric Institute demonstrated the relationship between, anger, violence and the use of alcohol and or cocaine. One of the most popular articles written by Dr. Cohen, was entitled, “Alcohol, the most dangerous drug known to man”. In this and other publications, Dr. Cohen systematically demonstrated the causal relationship between cocaine and alcohol abuse and aggression. Much of this research was done in the 70s and 80s.

Anger has always been a factor in substance abuse intervention. Unfortunately, until recently, it has been overlooked or treated as an after thought by substance abuse programs nationwide. Substance use and abuse often coexist with anger, aggressive behavior and person-directed violence. Data from the Substance Abuse and Mental Health Administration’s National Household Survey on Drug Abuse indicated that 40 % of frequent cocaine users reported engaging in some form of violence or aggressive behavior. Anger and aggression often can have a causal role in the initiation of drug and alcohol use and can also be a consequence associated with substance abuse. Persons who experience traumatic events, for example, often experience anger and act violently, as well as abuse drugs or alcohol. This is currently occurring with recently returned combat veterans from Iraq.

ANGER AND SUBSTANCE ABUSE

Substance abuse and dependence has grown beyond even the bleakest predictions of the past. In the United States alone, there are an estimated 23 million people who are struggling (on a daily basis) with some form of substance abuse or dependence. The toll it is having on our society is dramatically increased when we factor in the number of families who suffer the consequences of living with a person with an addiction, such as:

o Job loss

o Incarceration

o Loss of child Custody

o DUI’s

o Domestic Violence/Aggression

o Marital problems/divorce

o Accidents/injuries

o Financial problems

o Depression/anxiety/chronic anger

Unfortunately, most substance abusers may not even be aware that they have an underlying anger problem and do not “connect” their anger problem to their alcoholism, drug addiction and substance abuse. Therefore, they do not seek (or get) help for their anger problem. But more often than not, their anger is the underlying source of their disorder.
Anger precedes the use of cocaine and alcohol for many alcohol and cocaine dependent individuals. Anger is an emotional and mental form of “suffering” that occurs whenever our desires and expectations of life, others or self are thwarted or unfulfilled. Addictive behavior and substance abuse is an addict’s way of relieving themselves of the agony of their anger by “numbing” themselves with drugs, alcohol and so on. This is not “managing their anger”, but self medication.

When we do not know how to manage our anger appropriately, we try to keep the anger inside ourselves. Over time, it festers and often gives rise to even more painful emotions, such as depression and anxiety. Thus, the individual has now created an additional problem for themselves besides their substance abuse, and must be treated with an additional disorder. Several clinical studies have demonstrated that anger management intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.

Medical research has found that alcohol, cocaine and methamphetamine dependence are medical diseases associated with biochemical changes in the brain. Traditional treatment approaches for drug and alcohol dependency focus mainly on group therapy and cognitive behavior modification, which very often does not deal with either the anger or the “physiological” components underlying the addictive behavior.

Anger precedes the use of cocaine for many cocaine-dependent individuals; thus, cocaine-dependent individuals who experience frequent and intense episodes of anger may be more likely to relapse to cocaine use than individuals who can control their anger effectively. Several clinical trials have demonstrated that cognitive-behavioral interventions for the treatment of mood and anxiety disorders can be used to help individuals with anger control problems reduce the frequency and intensity with which they experience anger.

Although studies have indirectly examined anger management group treatments in populations with a high prevalence of substance abuse, few studies have directly examined the efficacy of an anger management treatment for cocaine-dependent individuals. A number of studies demonstrating the effectiveness of an anger management treatment in a sample of participants who had a primary diagnosis of post-traumatic stress disorder have been conducted by the Department of Veterans Affairs. Although many participants in these studies had a history of drug or alcohol dependence, the sample was not selected based on inclusion criteria for a substance dependence disorder, such as cocaine dependence. Considering the possible mediating role of anger for substance abuse, a study examining the efficacy of anger management treatment in a sample of cocaine-dependent patients would be informative.

Anger management as an after thought

In spite of the information available to all professional substance abuse treatment providers, anger management has not received the attention which is deserved and needed for successful substance abuse treatment. Many if not most substance abuse programs claim to offer anger management as one of the topics in its treatment yet few substance abuse counseling programs include anger certification for these counselors.

Typically, new substance abuse counselors are simply told that they will need to teach a certain numbers of hours or sessions on anger management and then left to find there own anger management information and teaching material. These counselors tend to piece together whatever they can find and present it as anger management.

Despite the connection of anger and violence to substance abuse, few substance abuse providers have attempted to either connect the two or provide intervention for both. In the Los Angeles area, a number of primarily upscale residential rehab programs for drug and alcohol treatment have contracted with Certified Anger Management Providers to offer anger management either in groups on an individual basis for inpatient substance abuse clients. Malibu based Promises (which caters to the stars) has contracted with Certified Providers to offer anger management on an individual coaching bases.

It may also be of interest to note that SAMSHA has published an excellent client workbook along with teacher’s manual entitled, Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual [and] Participant Workbook.
This publication free and any program can order as many copies as needed without cost. There is simply no excuse for shortchanging substance abuse clients by not providing real anger management classes.

Limited anger management research

What has been offered as anger management in substance abuse programs has lacked integrity. The Canadian Bureau of Prisons has conducted a 15 year longitudinal study on the effectiveness of anger management classes for incarcerated defendants whose original crime included substance abuse, aggression and violence. One of first findings was that in order to be useful, the anger management model used must have integrity. Integrity is defined as using a client workbook containing all of the material needed for an anger management class, consistency among trainers in terms of how the material is taught and a pre and post test to document change made by clients who complete the class.
It is not possible to determine the effective of anger management which is fragmented and not based on any particular structure of theoretical base.

Anger management training is rarely integrated into substance abuse treatment
At the present time, anger management is rarely integrated into any model of substance abuse intervention. Rather, it is simply filler tacked on to a standard twelve step program,

Trends in anger management and substance abuse treatment.

Several years ago, the California state legislature established statewide guidelines for all state and locally supported substance abuse programs. This legislation is included in what is commonly referred to as proposition 36. As a result of this legislation, all substance abuse counselors must have documented training in anger management facilitator certification. This training requires 40 hours of core training plus 16 hours of continuing anger management education of a yearly basis.

What is Anger Management?

Anger management is rapidly becoming the most requested intervention in human services. It may be worthwhile to define what anger management is and is not. According to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological condition therefore; it is not listed as a defined illness in the Diagnostic and Statistical Manual of Nervous and Mental Disorders. Rather, anger is considered a lifestyle issue. This means that psychotherapy or psychotropic medication is not an appropriate intervention for teaching skills for managing anger.

The American Association of Anger Management Providers defines anger management as a skill enhancement course which teaches skills in recognizing and managing anger, stress, assertive communication and emotional intelligence. Anger is seen a normal human emotion which is a problem when it occurs too frequently, lasts too long, is too intense, is harmful to self or others or leads to person or property directed aggression.

The Anderson & Anderson anger management curriculum is currently the most widely used model of anger management in the world. This model includes an assessment at intake which is designed to determine the client’s level of functioning in the following four areas, anger, stress, communication and emotional intelligence. The intervention/classes which are provided teach skills in these four areas. Post test are administered after course completion to determine the success or lack thereof of the program.

In Summary

All anger management programs should conduct an assessment at intake for substance abuse and psychopathology and all substance abuse programs should assess all participants for the current level of functioning in recognizing anger, stress, assertive communication and emotional intelligence.

All substance abuse programs should have their intervention staff certified in anger management facilitation.

Guidelines should be established to determine the number of hours/sessions that each client will receive in teaching skill enhancement in anger management, stress management, communication and emotional intelligence.

Substance Abuse and Heath Insurance

In the world of addiction and recovery there are several options for treatment when the addict decides to become sober. Often the first step once a path to recovery is being sought is the residential treatment center. Residential treatment centers are inpatient programs that typically address the specific addiction problem a patient is struggling to break free and recover from. In years past, health insurance plans did not cover any part of substance abuse programs or mental disorder treatment. That has changed and now many health insurance plans do have limited provisions for residential treatment center stays. Evolving health insurance to fit the needs of the consumers is a positive change in the medical world.

While programs that are in place at residential treatment centers may vary in specifics, the general overview is quite similar in that the options offered include family counseling, one on one counseling, group therapy, nutrition and exercise help. Health insurance plans will typically provide limited coverage for at least a minimum length stay in such treatment centers.. In some cases the residential treatment centers will help the addict care for children while they are undergoing treatment

Therapy is something that is new to the health insurance coverage world. Typically the policy will have limits as to how many sessions over a certain period of time, but some coverage is provided under many plans. Group therapy is often an essential element to residential treatment center programs as well as individual therapy sessions. With qualified professionals in a setting of fellow addicts, the patient can share experiences, get and give feedback to others and build a support network that can be very beneficial in the recovery process. Knowing that one is not alone in the addiction battle is a big deal and helps with emotional health as the healing process gets under way.

Individual therapy is also important in the recovery process because it allows addicts to learn about themselves, to try and understand what causes the substance abuse and subsequent addiction problem. Health insurance plans help with coverage of the residential treatment and many will allow several outpatient counseling sessions as well. Residential treatment centers are an ideal first step because inpatient treatment gives the patient a break from the stresses of life and from the availability of substances. Patients can be successful in breaking the habit and go forth to live a sober, fulfilling life.

If you need assistance in this regard, please feel free to visit our website at http://www.health-insurance-buyer.com and provide your contact information so we can respond to your request and help.