Chapter 17
Substance-Abuse Treatment:
Strategies for Change
Five Major Substances
of Abuse
Alcohol, opiates, marijuana/hashish, cocaine
and other stimulants account for almost all
cases (96%) of abusers seeking and receiving
treatment.
Source: SAMHSA
Designing Effective Substance-Abuse
Treatment Programs
Polydrug use is a common abuse or dependence
profile.
Others have co-existing mental health problems
Thus, effective treatment programs should address
polydrug abusers and include psychiatric care for
those with other mental disorders.
Many clients in substance-abuse treatment have cooccurring mental-health problems (co-morbidity).
These individuals are often referred to as dualdiagnosis clients.
The Biopsychosocial Model for
Substance-Abuse Treatment
Because many individuals experience problems
stemming from polydrug abuse, treatment programs
must consider common difficulties associated with
alcohol and a range of other drugs.
Chances of success in drug-abuse treatment can be
increased by looking at the combination of biological,
psychological, and social factors leading to drug abuse.
This is referred to as the biopsychosocial model.
The Biopsychosocial Model for
Substance-Abuse Treatment
NO program of treatment can succeed if the abuser
(addict/alcoholic) does not really want to get clean and
sober.
motivation is the most important ingredient in recovery
from addiction
e.g. hitting bottom
Figure 17.2
Intervention though Incarceration and
Other Punitive Measures
Federal laws since 1970 have established a
hierarchy of criminal penalties for drug trafficking,
depending on the schedule of the controlled
substance, the amounts of drugs that are involved,
and special circumstances under which violations
have been committed.
Drug related offenses and enforcement of drug laws
is generally considered to be the responsibility of
individual states; by far, most prosecution for drugrelated offenses occurs at the state level.
Intervention though
Incarceration and Other
Punitive Measures
In some cases, abusers of illicit drugs who are
arrested for violating drug-control laws are given
the option of entering a treatment program rather
than undergoing prosecution and imprisonment.
For those who are sentenced to a prison term, a
limited number of opportunities for drug treatment
exist within the prison system.
In the United States, most drug-related offenses are
prosecuted __________.
A. at the federal level
B. at the state level
C. at the municipal (city) level
D. at the county level
E. by ticked off landlords tired of having
addicts trash their places
Intervention though
Incarceration and Other
Punitive Measures
A growing number of drug courts, handling the
cases of adult, nonviolent drug offenders, operate
to adjudicate individual cases through supervised
treatment rather than incarceration.
The Personal Journey to
Treatment and Recovery
RECOVERY as five distinct “stages of change.”
1. pre-contemplation
recognition of a potential problem but no immediate
concern or intent to address it
2. contemplation
recognition that something should be done about
abuse problem, but not ready to take action
3. preparation
decision to take action has been made
The Personal Journey to
Treatment and Recovery
RECOVERY as five distinct “stages of change.”
4. action
cessation of use and treatment—the scary part
5. maintenance
clean and sober for at least six months, or beyond the
PAWS stage
continuing a drug free lifestyle
repeat
as
necessary
The Impact of Family Systems on
Treatment and Recovery
It is critical to examine the family dynamics
surrounding a drug abuser not only to understand
the situational problems that have developed but
also to anticipate and deal with the obstacles that
might derail treatment.
It is important to remember that slips are not
uncommon and do not signal failure; quitting a
recovery program is the only failure.
The Impact of Family Systems on
Treatment and Recovery
Family units typically pass through the following stages
denial
avoid shame, humiliation, responsibility, guilt
anger
fault-finding, assignment of blame
bargaining
“I’ll stop doing drugs if you’ll…”, or “Will you at least
just drink beer?”
feelings
helplessness, anxiety as dysfunction persists
acceptance
recognition and acceptance that help must be sought
The Impact of Family Systems on
Treatment and Recovery
Codependency can take many forms
Enabling behavior
family members assume the failed responsibilities of
the drug abuser
jeopardizes recovery of the user
The Impact of Family Systems on
Treatment and Recovery
avoiding and shielding
avoid seeing drug use, hide the problem
(“head in the sand”)
attempting to control
bribing or cajoling user
taking over responsibilities
paying bills, picking up the kids from school, etc.
rationalizing and accepting
“It’s not that bad.”
cooperation and collaboration
helping buy or use drugs, doing drugs with the abuser
Enabling behavior is a result of __________.
A. the family taking over responsibility
when the
abuser has not
B. a healthy pattern of interpersonal
relationships
C. the final portion of the maintenance
stage
D. overcoming the embarrassment and
shame of
drug abuse
The Impact of Family Systems on
Treatment and Recovery
Family support is crucial for success
Primary responsibility always remains with the
substance abuser
no program can work if the abuser does not
really want to quit
Al-Anon, Alateen, ACOA are all organizations to help
family members
substance abuse is a family disease
Finding the Right SubstanceAbuse Treatment Program
Consider the goals and objectives of a treatment
program to find the one best suited to the person
seeking help.
Inpatient or outpatient?
Format for treatment?
Length of treatment?
After-care, recovery houses?
It is also important to inspect the treatment facility
in person.
Finding the Right SubstanceAbuse Treatment Program
The treatment program should:
address the full range of individual needs
have diverse forms of treatment available
medical, psychiatric, counseling, behavioral
be licensed and/or accredited
Finding the Right SubstanceAbuse Treatment Program
outpatient
less costly, more like “real world” than is residential
residential is the treatment of choice when
outpatient has failed
facilities are a great distance from home
medical or psychiatric conditions demand inpatient
treatment
problems are severe enough to warrant separation of
the user from others
it is required by employer or licensing body (e.g. AMA)
Features of comprehensive treatment programs
Needing versus Receiving
Substance-Abuse Treatment
According to U.S. government estimates
more than 7 million people, aged twelve or older, need
treatment for an illicit drug problem;
approximately 19 million people need treatment for an
alcohol problem.
Only a small fraction of these people in need, however,
have received treatment in the past twelve months
Figure
17.5
Needing versus Receiving
Substance-Abuse Treatment
Of those individuals who have needed treatment for
problems with illicit drug or alcohol use but have not
received it, a very small proportion of them personally
felt the need to seek it out.
denial?
One reason for not seeking treatment, despite the
perceived need, is the lack of financial means to pay for
treatment services and inadequate health insurance
coverage.
Twelve-step programs have no fees.
Needing versus Receiving
Substance-Abuse Treatment
The Mental Health Parity and Addiction Equity Act
of 2008 allows individuals in substance-abuse
treatment to receive reimbursement on a par with
treatment for medical conditions.
Are you an alcoholic?
1. Do you lose time from work due to drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is your drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Have you ever got into financial difficulties as a result of drinking?
7. Do you turn to lower companions and an inferior environment when drinking?
8. Does your drinking make you careless of your family’s welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty in sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardizing your job or business?
15. Do you drink to escape from worries or trouble?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of drinking?
18. Has your physician ever treated you for drinking?
19. Do you drink to build up your self-confidence?
20. Have you ever been to a hospital or institution because of drinking?
Chronic Alcohol Abuse and
Alcoholism in the Workplace
Many corporations and other large organizations have
instituted Employee Assistance Programs (EAPs), and
unions have instituted Member Assistance Programs
(MAPs), to help workers with problems of alcohol abuse
or other forms of drug abuse.
e.g. Counseling and Wellness Center for UF
students
Approaches to Treatment
for Alcoholism
Approaches include behaviorally and psychologically
based treatments (e.g., cognitive behavioral
therapy, contingency management) and spiritually
based treatments (e.g., Alcoholics Anonymous).
It is curious to note that although AA embraces the
disease concept of alcoholism, it embraces a
spiritual rather than a scientific or medical approach
to its treatment.
Table 9.2
Approaches to Treatment for
Alcoholism
Objections to certain aspects of the AA philosophy
(e.g., spirituality, need for total abstinence, life-long
commitment) have promoted the growth of other
self-help organizations, such as Moderation
Management (MM) and Self-Management And
Recovery Training (SMART) Recovery.
Alcoholics Anonymous is based upon the idea of ______.
A. absolute devotion to its ideals
B. absolute abstinence
C. absolute commitment toward responsible drinking
D. absolute allegiance to one’s country
E. providing a safe place to drink where identities will
not be revealed
Approaches to Treatment for
Alcoholism
Moderation Management (MM)
secular, teaches that controlled drinking is possible
goal is reduction in alcohol consumption
9-step program
Attend meetings or on-line groups and learn about the
program of Moderation Management.
Abstain from alcoholic beverages for 30 days and
complete steps three through six during this time.
Examine how drinking has affected your life.
Approaches to Treatment for
Alcoholism
Moderation Management (MM), cont’d
1. Write down your life priorities.
2. Take a look at how much, how often, and under
what circumstances you had been drinking.
3. Learn the MM guidelines and limits for moderate
drinking.
4. Set moderate drinking limits and start weekly
"small steps" toward balance and moderation in
other areas of your life.
Approaches to Treatment for
Alcoholism
Moderation Management (MM), cont’d
5. Review your progress and update your goals.
6. Continue to make positive lifestyle changes and
attend meetings whenever you need ongoing
support or would like to help newcomers.
Approaches to Treatment for
Alcoholism
Self-Management And Recovery Training (SMART)
Recovery
secular and evidenced based
Four Points in the recovery process:
Building Motivation
Coping with Urges
Problem Solving
Lifestyle Balance
Approaches to Treatment for
Alcoholism
SMART Seven Stages of Change:
Precontemplation - At this stage, the participant may not
realize that they have a problem.
Contemplation - The participant evaluates the advantages
and disadvantages of the addiction by performing a
cost/benefit analysis.
Determination/Preparation - The participant completes a
Change Plan Worksheet.[
Approaches to Treatment for
Alcoholism
SMART seven stages of change (cont’d)
Action - The participant seeks out new ways of handling
their addiction behavior. This can include self-help, the
support of addiction help group or professional guidance.
Maintenance - After a few months, the participant's
behavior has been changed and now seeks to maintain
their gains.
Approaches to Treatment for
Alcoholism
SMART seven stages of change (cont’d)
Relapse - Although not inevitable, relapses are a normal
part of the change cycle and if handled well, can serve a
learning experience in overcoming an addiction.
Termination - Once a participant has sustained a long
period of change, they may choose to move on with their
lives and "graduate" from SMART Recovery.
Self-help groups __________.
A. should be considered as part of a multipronged
approach
B. are often very expensive
C. are always part of hospital care
D. are useful only in the action stage of change
Approaches to Treatment for
Alcoholism
Regardless of differences, all programs emphasize
the importance of learning life skills to enable the
alcoholic to cope with life without the use of alcohol.
Comparison of effectiveness is virtually impossible
given the different goals and criteria for success, the
anonymity of A.A. and the importance of motivation.
A Final Note: For Those Who
Need Help…
The most comprehensive source for information
about substance-abuse treatment in the United
States is the National Clearinghouse for Alcohol and
Drug Information (NCADI).
A Final Note: For Those Who
Need Help…
The following is informational only and is not a recommendation or endorsement of any
facility or program.
Treatment Centers in Gainesville
Florida Recovery Center, Shands & UF
http://floridarecoverycenter.ufandshands.org
352-265-4FRC (4372) Call for help.
Meridian Behavioral Healthcare, Inc.
http://www.mbhci.org/
352-374-5600
Drug Strategies
http://www.drugstrategies.org/Florida/Gainesville/
800-559-9503
A Final Note: For Those Who
Need Help…
The following is informational only and is not a recommendation or endorsement of any
facility or program.
Group Therapy (12-Step Programs) in Gainesville
North Central Florida Alcoholics Anonymous
www.northcentralflaa.org
352-372-8091 (24 hour hotline)
Narcotics Anonymous Meetings, Gainesville
http://www.drugstrategies.org/NA-Meetings/Florida/Gainesville/
North Florida Al-Anon and Alateen
http://www.northfloridaal-anon.org/
Adult Children of Alcoholics
Mondays, 7:00 p.m. 1521 N.W. 34th St. (Westminster Church, corner of 16th Avenue and 34th St.)
Directory for 12-step meetings across Florida
http://www.recovery-world.com/florida.html