PHASES OF TREATMENT FOR SUBSTANCE DEPENDENCE
Introduction:
Substance dependence causes drama, chaos and burnt bridges, social and legal
problems, mental and financial collapse, despair and death. It is a complex and challenging process to overcome dependence and many professionals are reluctant to
handle it. Uninformed and untrained family members and friends often feel helpless
to tackle dependence.
The process of recovery is easier to understand if the phases of treatment are
distinguished from each other. It is safer to use proven, registered, professional
programs rather than unregistered, alternative programs by lay counselors.
The 6 phases of treatment are as follows:
1. Evaluation:
The following professionals should do a full assessment of the dependent as a first
step in the treatment process:
Psychiatrist: Determine full psychiatric history, do testing, determine readiness to
change, assess previous treatment, determine mental state and psychiatric problems
such as depression, anxiety, schizophrenia, low self-esteem, role of medication, etc..
Psychologistl: Rate maladjustment and ability to learn new behaviours and skills,
ability to prevent a relapse or handle it, do testing, determines emotional control and
cognitive behavioural change ability, dealing with cravings, etc..
Social worker: Determine and assess family background, social skills, developmental
problems, previous attempts to get help, utilization of resources, enabling, emotions,
conflict with family and friends, aftercare program, dealing with temptations, compiling recovery plan, role of the family, integration into aftercare groups, repairing
relationships and self-esteem, etc..
Medical: Perform physical examination, manage diseases and complications, do
brain scan, measure vitamine levels, test HIV status, prescribe medication for
withdrawal, keep patient alive, etc..
Nursing: History of drug use, types of drugs, diseases, medical history, blood or
urine testing, determine what type of drugs are in the body, etc..
Thorough evaluation by professionals ensures the best choices for treatment and
aftercare.
2. Emergency Treatment:
Many types of complications can be caused by drugs and alcohol and should be
treated during the phase of emergency intervention to keep the patient alive. The
more information available, the better for the team. Examples of complications are
convulsions, confusion, memory loss, sensory loss in the hands and feet, unsteadiness, tremor, bleeding in the brain, heart problems, ulcers in intestines and stomach, jaundice, liver cancer, pancreatitis, injuries, bleeding, alcohol poisoning, kidney failure, contraction of testicles, Fetal Alcohol Syndrome, coma, death.
Nicotine causes diseases like emphysema, cancer, heart problems, constricted
blood vessels, bronchitis, asthma, infection, etc..
Emergency treatment is a medical procedure and can only be done by doctors.
3. Preparation for change:
Give feedback to the patient and family about the phase where the patient is and
what complications need to be handled. Give information about the dangers of
detoxification and what medication will be used. Start building a therapeutic network
of treatment and aftercare.
4. Detoxification:
The brain and body's tolerances increase as more drugs and alcohol are consumed
and the brain and body get used to the drugs. Many dependents fear withdrawal
symptoms and feel it is not worth the suffering. Withdrawal can be life threatening
and must be done under medical supervision.
Detoxification is the process of withdrawal and deals with the physical and psychological symptoms. Some drugs are more addictive and toxic than others and affects
the brain faster. Heroin dependents getexperience an average of 4 painful withdrawal symptoms per day.
Patients should be 100% honest with the doctor about their use and the correct dose
of medication can be prescribed. Dependents should talk to successful patients who
have already been through the phases so that they are better motivated and know
exactly what lies ahead for them. Patients should be able to read about addiction
and drugs and do not believe any myths.
Preparation for detoxification is important in the treatment process so that the patient
knows what to expect. The patient must prepare himself physically and emotionally
and the family should be informed of the stages. The patient must visit the doctor for
a complete evaluation, he must take responsibility for change and has to stay focused and motivated. A support network has already started developing. The patient
must be healthy enough to eat and to treat other diseases. Strengthen believers'
faith and prayer life. Avoid other urgent matters and responsibilities during this phase
and focus on detoxification. Immediately respond to warning signs and let others
monitor your condition. Record pulse, anxiety attacks, mood changes, breathing and
blood pressure.Use prescribed medication exactly correctly and maintain contact
with the doctor.
Danger situations arise when a patient is suddenly expected to function without
drugs. eg. after admission to hospital or prison, when on tour or on holiday.
Different drugs are unique and there are differences in detoxification, warning signs
and symptoms.
Alcohol: Mortality risk is 20%, symptoms include sweating, tremor, nausea, vomiting,
diarrhea, anxiety, fever, insomnia, high blood pressure, etc.. Warning signs are hallucinations, convulsions, confusion nausea, abnormal movements, psychosis, etc..
Heroin and morphine: Withdrawal begins after 6 to 12 hours, the climax is between 2
to 3 days, suffering can take up to 2 weeks, body soon loses tolerance, overdose
possible with a relapse.
Sedatives: Slow and gradual withdrawal for several months.
Tik and cocaine: Very dangerous, often leads to death, withdrawal lasts 2 to 7 days,
no medication is really effective.
Nicotine: Withdrawal can take months, often causes depression, anxiety, irritability,
frustration, tension, restlessness, loss of sleep, increased appetite, anger, craving.
Marijuana: Few symptoms and warning signs.
5. Rehabilitation Program:
A new, sober, happy lifestyle must be learned. The goal of rehabilitation is restoration, abstinence and a normal life. Learn social skills as a sober person and strive for
good health, happy relationships and a healthy diet. Rebuild trust, honesty and family life. Deal with prejudice, distrust, fear, rejection, labeling and stigma. Be a winner
and be proud. Study addiction and substances and learn the correct answers to
tricky questions, eg. what is the difference between the brain of a dependent and a
social drinker.
A Rehabilitation Program is essential for recovery. Participation must be voluntary
and the patient must request it. The biggest advantage of in-patient treatment is that
the person is removed from the drug culture. Some centres are militaristic or ultraluxurious. Out-patient benefit is that the person must learn and exercise new behavior every day and must handle temptation. Choose a centre where the program has
been tested and registered and where minimum standards are maintained. The
choice is made easier with conversations with successful former patients. Discuss
different options and centres. Duration of treatment is 3 weeks to 2 years.
There are two main treatment models:
Minnesota: This model was developed in the 1950 `s in America, it is based on Alcoholics Anonymous`s 12 steps, duration is 3 to 4 weeks, dependence is accepted as
a brain disease, patient is responsible for recovery, key concepts are abstinence,
education, peer support, group therapy, aftercare, the family is included in treatment.
Therapeutic community: This model was developed in the 1960 `s and can last up to
2 years, it is holistic and can include fields like psychiatry, psychology, medicine,
occupational therapy, social work, nutrition, relaxation, exercise, family therapy,
groups, aftercare , religion. Key concepts are changes in lifestyle, personal growth,
abstinence, closed community, sharing tasks and responsibilities, earning privileges,
disciplinary action, family gets involved.
6. Abstinence and aftercare:
Each patient must follow a detailed recovery plan of continued treatment and there
must be an active, supportive network. There should be follow-up visits to professionals and attending meetings and group sessions. Learn to deal with temptations in
an effective way and thereby prevent a relapse. If a slip or relapse does occur, treat
it as a learning opportunity and start the whole process over again. A new, sober lifestyle requires a lot of practice and patience.
Treat ongoing complications and physical, financial, emotional, mental and social
problems immediately with new, more effective methods. The aftercare program is
lifelong, although it will become easier as the patient gets stronger and enjoys the
sober lifestyle. It is a great achievement to overcome dependence and the patient
will become stronger if he testifies about the salvation.
Medications
All medicines used during the phases of treatment must be prescribed by a doctor or
specialist, including anti-depressants and anti-psychotic drugs. All medicines consist
of chemicals that can be extremely dangerous if it is taken with alcohol or drugs,
even if the patient has a already stopped drinking or using.
Different medications are used for different types of withdrawal, eg. thiamine,
benzodiasipiene and multi-vitamins for alcohol and methadone or subutex for opiats.
For nicotine withdrawal Zyban or Bupropion can be used.
Summarised by Kobus Pienaar
CAD ORGANISER
Source:
Hitzeroth, V. and Kramer, L.: 2010. The end of addiction.