Drug rehabilitation (or simply rehabilitation) is a term used for medical or psychotherapeutic treatment processes, due to the dependence of psychoactive substances such as alcohol, drugs and illegal drugs such as cocaine, heroin or amphetamines. The general intention is to make the patient cease substance abuse, in order to avoid the psychological, legal, financial, social and physical consequences that may occur, especially after extreme abuse.
- 1 Psychological dependence
- 2 Types of drug rehabilitation treatment
- 3 Historical methods of drug treatment and rehabilitation
- 4 Criminal justice
Psychological dependence is treated in many drug rehabilitation programs, trying to teach patients new methods of interaction in a drug-free environment. In particular, patients are encouraged, or even required not to associate with friends who continue to use addictive substances. There are twelve-step programs that help addicts not only stop using alcohol and other drugs, but also examine and change habits related to addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, emphasis is placed on complete abstention rather than attempts at moderation, which can lead to relapse. If moderation is attainable for those who have a history of abuse it is still a moot point, but in general it is considered unsustainable.
Types of drug rehabilitation treatment
There are several types of programs that offer help in drug rehabilitation, including: residential treatment, outpatients, local support groups, drug rehabilitation clinics, addiction counseling, mental health, orthomolecular medicine and medical care. Some drug rehabilitation clinics offer specific programs based on the patient’s age and gender.
Scientific research started in 1970 shows that effective treatment addresses the multiple needs of the patient instead of just treating addiction. In addition, medication detoxification is only ineffective as a treatment for addiction. The institutes on drug abuse recommend detoxification with medications (if applicable) and behavioral therapy, followed by relapse prevention. According to these institutes, effective treatment should deal with medical and mental health services, and other options, such as recovery support with the community or family. Whatever the methodology, patient motivation is an important factor in the success of drug treatment.
For people addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs that affect the same brain systems. Medications such as methadone and buprenorphine can be used to treat prescription opioid addiction, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines and other medications.
Types of behavioral therapies:
- Cognitive behavioral therapy, which seeks to help patients recognize, avoid and cope with situations in which they are more willing to use drugs again.
- Multidimensional family therapy, which is designed to help the recovery of the patient by improving the functioning of the family.
- The motivational interview, which is designed to increase the patient’s motivation to change behavior and begin treatment.
- Motivational incentives, which use positive reinforcement to encourage abstinence from the addictive substance.
The state has provided a list of programs and institutions that offer various treatments according to age group, type of addiction and other aspects.
Certain opioid medications such as methadone and, more recently, buprenorphine are widely used to treat addiction and dependence on other opiates, such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies aimed at reducing the desire for opiates, reducing the consumption of illegal drugs, and the associated risks, such as illness, detention, imprisonment and death, in line with philosophy of damage reduction. Both drugs can be used as maintenance medications (and taken for an indefinite period of time), or are used as detoxification aids. All studies compiled in the Australian National Assessment of pharmacological therapies for opioid dependence in 2005 suggest that maintenance treatment is preferred, with very high relapse rates (79-100%) within three months of buprenorphine detoxification and methadone.
Ibogaine is a hallucinogenic drug promoted by certain marginal groups to disrupt physical and psychological dependence on a wide range or drugs including narcotics, stimulants, alcohol and nicotine. To date, there have never been controlled studies showing that it is effective, and it is not accepted as a treatment by any association of doctors and pharmacists. There have been several deaths related to ibogaine consumption, because it causes tachycardia and QT syndrome. The drug is illegal and “centers” abroad where it is administered tend to have little supervision, and range from motel rooms to a moderate-sized rehabilitation center. Some antidepressants also show utility in moderating drug use, particularly nicotine, and it has become common for scientific researchers to reexamine already approved medications to find new uses in drug rehabilitation.
According to the institutes on drug abuse, patients stabilized with adequate doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and hepatitis C by stopping or reducing drug use injectables or drugs related to sexual behavior. Naltrexone is a long-acting opioid antagonist with few side effects (it is said), and is usually prescribed in ambulatory medical conditions, although the start of treatment is started after medical detoxification in a drug rehabilitation clinic. Naltrexone blocks the euphoric and all other effects of self-administration (and administration by the doctor) of pills or injections (not recommended if planned surgery or other painful procedure or other conditions that require pain control or general anesthesia, because the chemicals, fentanyl and sufentanil, most commonly used to induce anesthesia are also opioids). It has also been used as a treatment for alcohol addiction. Specialists claim that naltrexone reduces the risk of relapse during the first 3 months by 36%. However, it is much less effective in helping patients maintain withdrawal or retain them in the drug treatment system (retention rates are 12% in 90 days for naltrexone, 57% in 90 days for buprenorphine and 61% in 90 days for methadone).
Acamprosate, disulfiram and topiramate are also used to treat alcohol addiction. Acamprosate has proven effective in patients with severe dependence, because it helps maintain withdrawal for several weeks or months. Disulfiram produces a very unpleasant reaction when you drink alcohol, which includes redness, nausea and palpitations. It is more effective for patients with high motivation and some addicts who use it only for high-risk situations.
Nitrous oxide has been proven to be an effective treatment for some addictions.
The traditional treatment of addictions is mainly based on counseling. However, recent discoveries have shown that those suffering from addiction often have chemical imbalances that make the recovery process more difficult.
Counselors help individuals identify behaviors and problems related to addiction. It can be done individually, but it is usually done in a group setting and can include crisis counseling, weekly or daily counseling. Counselors are trained to develop recovery programs that help restore healthy behaviors and provide coping strategies if any risk situation occurs. It is very common to see them also work with family members who are affected by the addictions of one of them, or in a community in order to prevent dependence and educate the public. Counselors should be able to recognize how addiction affects the person and those around them.
Counseling also relates to “intervention.” A process in which the help of a professional is requested by the family of the addict to get this person to start a treatment.
This process begins with one of the objectives of these professionals: overcome the denial of the person with addiction. Denial implies a lack of will on the part of patients or the fear of facing the true nature of addiction and taking any action to improve their lives, in addition to continuing destructive behavior. Once this has been achieved, professionals work with the addict’s family to get the addict into one of the drug rehab clinics immediately, with concern and care for this person. If not, this person will be asked to leave and not wait for any support until they enter a drug rehabilitation or alcoholism treatment program. An intervention can also be done in the work environment with your colleagues instead of the family.
Historical methods of drug treatment and rehabilitation
The disease model and twelve-step programs
The addiction disease model has always maintained that the consumption of substances shown by addicts is the result of a disease that is of biological origin and exacerbated by environmental contingencies. This concept says that the individual is essentially powerless before their problematic behaviors and unable to remain sober on their own, as people with a terminal illness are unable to fight the disease on their own without the need for medication. Behavioral treatment, therefore, necessarily requires that individuals admit addiction, and give up their previous lifestyles, and should seek a social support network that can help them stay sober. These approaches are the characteristics of the twelve-step programs, originally published in the book Alcoholics Anonymous in 1939 (Alcoholics Anonymous). These approaches have had a considerable amount of criticism. However, despite these criticisms, studies of the results have shown that twelve-step programs achieve abstinence success after 1 year of follow-up for alcoholism. Different results have been achieved for other drugs, but less beneficial for addicts to illicit substances, and much less beneficial for addicts to physiologically and psychologically addictive opiates, for whom maintenance therapies are the gold standard in the rehabilitation of drugs
Customer Centered Methods
In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed that there are three necessary and sufficient conditions for personal change: Unconditional positive consideration, precise empathy, and authenticity. Rogers believes that the presence of these three elements of the therapeutic relationship could help a person overcome any problem, including drug abuse. In this regard, a 1957 study compared the relative efficacy of three different psychotherapies in the treatment of drug addicts who had been committed in a state hospital for sixty days: a therapy based on two-factor learning theory, therapy focused on the client, and psychoanalytic therapy. Although the authors expected that the two-factor theory will be the most effective, it actually turned out to have a harmful result. Surprisingly, client-centered therapy proved to be more effective. It has been argued, however, that these results can be attributed to the profound difference in perspective between the two-factor therapist and that of patient-centered therapy, rather than the patient-centered techniques themselves.
A variation of Rogers’ approach has been that clients are directly responsible for determining the goals and objectives of the treatment. This approach was used by several drug treatment programs.
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also offered an explanation of substance abuse. This orientation suggests that the main cause of the addiction syndrome is the unconscious need to entertain and promulgate various types of fantasies and at the same time to avoid taking responsibility for them. It is stated that specific substances facilitate specific fantasies. The addiction syndrome also raised the hypothesis of being associated with life trajectories that have occurred in the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation and traumatophilia. This approach is in sharp contrast to the methods of cognitive social theory to addiction, and in fact, to behavior in general that make normal human beings control their own behaviors, and are not simply driven by internal impulses.
Cognitive models of addiction recovery
An influential cognitive-behavioral approach to recovery from addiction has been Alan Marlatt’s relapse prevention approach, which describes four psychosocial processes related to addiction and relapse processes:
- Results Expectations
- The attributions of causality
- Decision making
Self-efficacy refers to the ability to cope competently and effectively in situations of high risk of relapse. The outcome expectations refer to the expectations of an individual about the psychoactive effects of the addictive substance. Causative attributions refer to the belief model of a person who relapses in drug use is the result of temporary internal or external situations (for example, being allowed to make exceptions when faced with what is considered unusual circumstances). Finally, decision-making processes are involved in the relapse process as well. Substance use is the result of multiple decisions. Some of these decisions may also be unconscious or seem unimportant.
For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to leave the road and travel on secondary roads. This will lead to the creation of a high risk situation when you realize that you are near your favorite bar. If this individual is able to successfully employ coping strategies, such as distracting from their desires through other activities such as listening to music, then the risk of relapse will be avoided and their effectiveness for withdrawal in the future will be increased. Yes, however, it lacks mechanisms for confronting desires, for example, you can start by reflecting on them, then your effectiveness for withdrawal decreases, your expectations for positive results will increase, and you may experience a temporary relapse. In doing so it gives rise to what Marlatt describes as the Effect of Violation of Abstinence, characterized by guilt for having consumed the substances and the diminished effectiveness of abstinence in the future in similar tempting situations.
Cognitive substance abuse therapy
An additional cognitive model based on the recovery of substance abuse has been offered by Aaron Beck, the father of cognitive therapy and described it in his 1993 book, Cognitive Therapy of Substance Abuse. This therapy is based on the assumption that addicted people have fundamental beliefs, which are not accessible to immediate awareness (when the patient is not depressed). These basic beliefs, such as “Nobody loves me,” activate a system of addictive beliefs that produce imagined benefits in advance of substance use and, consequently, once permissive beliefs have been activated (“I can get high only once more. “) are provided. Once a set of permissive beliefs have been activated, then the individual will activate the drug-seeking and drug-taking behavior. The cognitive therapist’s job is to discover this underlying belief system, analyze it with the patient, and therefore demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, behavior tasks and exercises serve to consolidate what has been learned and discussed during treatment.
Regulation of emotions, attention and substance abuse
A growing literature is demonstrating the importance of emotion regulation in drug rehabilitation. According to these theories, tobacco (for example) is used because it helps provide an escape from the undesirable effects of nicotine withdrawal or other negative states.
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of jail, and those convicted of drunk driving sometimes have to attend Alcoholics Anonymous meetings. There are a number of ways to address an alternative penalty in a case of drug possession or drug use, every time the courts are willing to explore methods for drug rehabilitation before incarceration.