Chapter 9 - Current Issues in Treatment 1 Expanding use of...

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Unformatted text preview: Current Issues in Treatment 1. Expanding use of medications for treatment 2. New imaging techniques to visualize addiction 3. Lack of treatment resources 4. Coerced treatment as good as voluntary treatment 5. Abstinence-oriented recovery vs. harm reduction Copyright, 2004, CNS Productions, Inc. 1 Keeley Cure Alcohol Strychnine Willowbark Ginger Ammonia Belladonna Atropine Hyoscine Scopolamine Coca Opium Morphine Copyright, 2004, CNS Productions, Inc. 2 Medical model detoxification programs Social model detoxification programs Social model recovery programs Therapeutic communities Halfway houses Sober-living or transitional-living programs Partial hospitalization & day hospitals Harm reduction U.S. Public Health Service Hospital programs Lexington, Kentucky Copyright, 2004, CNS Productions, Inc. 3 Cost of Drug Addiction Treatment $30,000-$150,000 Untreated addiction Incarceration Probation Res. Treat: long-term Res. Treat.: short-term Methadone maintenance Intensive outpatient Outpatient treatment $0 $20,000-$30,000 $15,000-$20,000 $6,800-$12,000 $4,400-$6,800 $3,900 $2,500 $1,800 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 Cost in Dollars Copyright, 2004, CNS Productions, Inc. 4 Drug Use Among Arrestees 80% % testing positive for any drug 70% 60% Women Men 50% 40% 30% 20% 10% 0% 1990 1992 1994 1996 1998 2000 2002 5 Male juveniles Female juveniles Copyright, 2004, CNS Productions, Inc. One Day Census of Clients in Drug Treatment by Institution in the United States Type of Institution Outpatient Inpatient Totals 1987 523,699 89,686 613,385 1995 864,285 144,842 1,044,074 2002 1,044,074 120,755 1,164,829 Copyright, 2004, CNS Productions, Inc. 6 Protocol for Client Intake Client Emergency Non-emergency Physician Intake Counselor Group process Individual counseling Pharmacy/ medical team Hospital Other referrals Primary Counselor Dual diagnosis: Psychiatric services Copyright, 2004, CNS Productions, Inc. Pharmacy Complete medical assessment 7 Participation in Drug Abuse Treatment & 12Step Program Improves Treatment Outcomes Percentage of patients remaining drug-free in the 6 months prior to follup 100% 80% 60% 40% 20% 0% Treatment dropout. No weekly 12-step attendance Completed treatment. No weekly 12-step attendance Completed treatment. Weekly 12-step attendance 8 Copyright, 2004, CNS Productions, Inc. Relapse Triggers The sight of money Associating with drug-using friends Seeing drug paraphernalia Visiting old drug using haunts and bars The smell of drugs or alcohol The sight of any white powder Gambling Copyright, 2004, CNS Productions, Inc. 9 Children of Addicts & Alcoholics Model child Problem child Lost child Mascot child or family clown Copyright, 2004, CNS Productions, Inc. 10 Admissions to Drug Treatment by Primary Substance of Abuse - United States 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 1992 1994 1996 1998 2000 11 Stimulants Marijuana Cocaine Opiates Alcohol Copyright, 2004, CNS Productions, Inc. Treatment for Stimulant Abuse Detoxification 3-7 days Initial abstinence From 1st week through 1-3 mos. Long-term abstinence 3-18 months, sometimes 5 yrs. Recovery Lifetime Copyright, 2004, CNS Productions, Inc. 12 Medical Treatments for Opioid Detoxification Naloxone (antagonist: antidote for overdose) Methadone or LAAM (heroin substitutes) Clonidine (mediates withdrawal symptoms) Naltrexone (antagonist: helps decrease craving) Buprenorphine (blocks opioid receptors, helps control craving) Copyright, 2004, CNS Productions, Inc. 13 Alcohol Only Treatment Admissions by Sex & Age - 2000 120,000 Number of admissions 100,000 80,000 60,000 40,000 20,000 0 <20 20-24 25-29 30-34 35-39 40-44 45 + Women Men Age of client Copyright, 2004, CNS Productions, Inc. 14 Treatment for Bad Trips Psychedelics A R R R T Acceptance: gain user's trust & confidence Reduction of stimuli: get user to quiet, nonthreatening environment Reassurance: convince users they are safe and will be all right Rest: assist users to relax Talk-down: discuss peaceful nonthreatening subjects Copyright, 2004, CNS Productions, Inc. 15 Marijuana/Hashish Treatment Admissions by Sex & Age - 2000 120,000 Number of admissions 100,000 80,000 60,000 40,000 20,000 0 <20 20-24 25-29 30-34 35-39 40-44 45 + Women Men Age of client Copyright, 2004, CNS Productions, Inc. 16 ...
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