Drug rehabilitation (often drug rehab or just rehab) is the processes of medical or   psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cocaine, heroin or amphetamines.

The general intent is to enable the patient to confront substance dependence, if present, and cease substance abuse to avoid the psychological legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. Treatment includes medication for depression or other disorders, counseling by experts and sharing of experience with other addicts.

 

Psychological dependency-

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with friends who still use the addictive substance.

Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but also to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized, (“One is too many, and a thousand is never enough.”)

 

Types of treatment

The brain’s chemical structure is impacted by drugs of abuse and these changes are present long after an individual stops using, this change in brain structure increases risk for relapse, making treatment an important part of the rehabilitation process.

 

Various types of programs offer help in drug rehabilitation, including:

1)            Residential treatment (in-patient/ out-patient),

2)            Local support groups,

3)            Extended care centers,

4)            Recovery or sober houses,

5)            Addiction counselling,

6)            Mental health and medical care.

For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems.

 

Rehab pathways.

 

Types of behavioral therapy include:

Cognitive-behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse.

Multidimensional family therapy, which is designed to support recovery of the patient by improving family functioning.

Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment.

Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance.

Treatment can be a long process and the duration is dependent upon the patient’s needs and history of abuse. Research has shown that most patients need at least 3 months of treatment and longer durations are associated with better outcomes.

Medications

Medicines are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use, and the risks associated with it, such as disease, arrest, incarceration, and death, in line with the philosophy of harm reduction. Both drugs may be used as maintenance medications (taken for an indefinite period), or used as detoxification aids.

 

A few antidepressants have been proven helpful in the context of smoking cessation/nicotine addiction; these medications include bupropion and nortriptyline.

Residential treatment

In-patient residential treatment for alcohol abuse is usually quite expensive without proper insurance. Most American programs follow a traditional 28–30 day program length. The length is based solely upon providers’ experience in the 1940s that clients needed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. 70 to 80 percent of American residential alcohol treatment programs provide 12-step support services.

These include, but are not limited to AA, NA, CA, Al-Anon. One recent study suggests the importance of family participation in residential treatment patient retention, finding “increased program completion rate for those with a family member or significant other involved in a seven-day family program.”

 

 

 

Recovery

The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal wellbeing while other studies have considered “near abstinence” as a definition.

 

Counseling

Traditional addiction treatment is based primarily on counseling.

Counselors help individuals identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it is more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. They are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It is very common to see them work also with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her.

 Counseling is also related to “Intervention”; a process in which the addict’s family requests help from a professional to get this person into drug treatment. This process begins with one of this professionals’ first goals: breaking down denial of the person with the addiction. Denial implies lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, besides of continuing the destructive behavior. Once this has been achieved, professional coordinates with the addict’s family to support them on getting this family member to alcohol drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family.

One approach with limited applicability is the Sober Coach. In this approach, the client is serviced by provider(s) in his or her home and workplace – for any efficacy, around-the-clock – who functions much like a nanny to guide or control the patient’s behavior.

Twelve-step programs (12 steps)–

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939.

 

 

 SMART Recovery

Joe Gerstein founded SMART Recovery in 1994 by basing REBT as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. [32] It does not subscribe to disease theory and powerlessness. The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of the SMART Recovery programs are:

  1. Building and Maintaining Motivation.
  2. Coping with Urges.
  3. Managing Thoughts, Feelings and Behaviors.
  4. Living a balanced Life.
  5. This is considered similar to other self-help groups who work within mutual aid concepts.
  6. Client-centered approaches

In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the therapeutic relationship could help an individual overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques per se.[37] The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.

A variation of Rogers’ approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs

Relapse prevention

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach.

 Marlatt describes four psychosocial processes relevant to the addiction and relapse processes:

  1.  self-efficacy,
  2. outcome expectancies ,
  3.  attributions of causality, and
  4.  decision-making processes.

Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant.

 

Cognitive therapy-

An additional cognitively based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

Emotion regulation and mindfulness

Acceptance and commitment therapy (ACT) is showing evidence that it is effective in treating substance abuse, including the treatment of poly-substance abuse and cigarette smoking. Mindfulness programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts appear to prevent impulsive/compulsive responses. Research also indicates that mindfulness programs can reduce the consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates.

Behavioral models

Community Reinforcement Approach and Family Training

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exists for both working with the substance abuser (Community Reinforcement Approach) and their family (Community Reinforcement Approach and Family Training). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on the use of problem solving techniques as a means of helping the addict to overcome his/her addiction.

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