Thursday, July 30, 2009

What is treatment and rehabilitation?

WHAT IS TREATMENT AND REHABILITATION?





Abdullah Baniyameen
baniyameen@aol.com
July 30, 2009





PRINCIPLES OF EFFECTIVE TREATMENT:
  • No single treatment is appropriate for all individuals.

  • Treatment services must be readily available.

  • Effective treatment attends to multiple needs of the individual, not just his / her drug use.

  • An individual’s treatment plan must be developed as assessed periodically and modified as necessary to ensure that the plan meets the person’s changing needs.

  • Retaining client in treatment for adequate period of time is critical for treatment effectiveness.

  • Counseling (Individual / Group) and other behavioral therapies are critical component of effective treatment for addiction.

  • Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

  • Addicted or drug abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.

  • Medical detoxification is only the first stage of addiction treatment and by itself does little to change long term drug use.

  • Treatment does not need to be voluntary to be effective.

  • Possible drug use during treatment must be monitored continuously.

  • Treatment programs should provide assessment for HIV/AIDS, Hepatitis B&C, Tuberculosis, and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection.

  • Recovery from drug addiction can be a long term process and frequently requires multiple episodes of treatment.

  • Engaging the family while the addicted client is in treatment should be a component of treatment.

  • Treatment must be clearly define to meet the challenges ahead by the service providers, significant others and clientele.

DEVELOPMENT MODEL OF RECOVERY:

  • The development model recognizes that recovery is a progressive process of growth which includes the mastery of a series of emotional, psychological, social and recovery related tasks. These development tasks, which begin as basic and become more complex, serve as the building blocks for recovery.

  • Recovery is then defined as the ongoing process of improving level of functioning while striving to maintain abstinence from mood – altering chemicals.

PRE TREATMENT PHASE:

PRE TREATMENT:

POTENTIAL SYMPTOMS OF ACUTE WITHDRAWAL (AWS):

  • Medical Complications.

  • Physiological Discomforts.

ENROLLMENT IN A PROGRAM OF CHANGE:

  • H & I Meeting.
  • Pre Treatment Counseling.

UNDERSTAND RECOVERY & RELAPSE IS A PROCESS:

  • Initial Recovery Plan.

EXPERIENCE UNPLEASANT CONSEQUENCES AND HAVE BEEN UNABLE TO MAINTAIN CONTROL OVER THEIR LIFE AS A RESULT OF THEIR SUBSTANCE USE.

DEVELOP AWARENESS THAT THEIR PROBLEMS ARE RELATED TO THEIR SUBSTANCE USE.

EXPERIENCE SOME LEVEL OF EMOTIONAL PAIN WHICH MOTIVATES THEM.

MAKE A DECISION AT SOME LEVEL TO CONSIDER THE POSSIBILITY OF ENGAGING IN THE TREATMENT PROCESS.
INITIAL STABILIZATION:

PATTERN OF USE INTERRUPTED.

PERIOD OF ABSTINENCE WHICH ALLOWS FOR RECOVERY FROM WITHDRAWAL.

DETOX FROM OTHER IMPULSIVE BEHAVIORS.
STABILIZATION:

  • Abstinence is a Prerequisite.
  • Post Acute Withdrawal Symptoms (PAWS)

EARLY PHASE RECOVERY:

EARLY RECOVERY:

ASSESSMENT OF TREATMENT NEEDS:

  • Hours of counseling,
  • Group therapy et cetera.

EARLY INTERVENTION VERSES ADVERSE CONSEQUENCES:

  • Reemergence of warning signs.
  • Early termination.

DAILY, WEEKLY INITIAL RECOVERY PLANNING:

  • Diary.
  • Worksheet.

EARLY PHASE RECOVERY I:

  • Struggles with acceptance and understanding of addiction.
  • Recognizes triggers.
  • Begins to learn skills which promote personal development, i.e., problem solving, impulse control.
  • Assumes personal responsibility for choices, decisions, and behaviors.
  • Recognizes and verbalizes feelings.
  • Familiarizes self with concept of treatment models.

EARLY PHASE RECOVERY II:

  • Verbalize struggle with ambivalence.
  • Begins to manage triggers and drug hunger.
  • Embraces recovery – integrates principles of recovery.
  • Begins to develop a drug – free image.
  • Acknowledge the need to make lifestyle changes.
  • Period incident of use.

EARLY PHASE RECOVERY III:

  • Address the Issues which Predated Use.
  • Tries on new behavior and attempts to apply skills they have learned.
  • Experiences hope based on small successes.
  • Tests and affirms what they have learned in treatment.
  • Struggles with family issues.

MIDDLE PHASE RECOVERY:

  • UNDERSTANDING AND LEARNING OF HIGH RISK SITUATION.
  • INTERNAL CAUSES OF RETURNING TO CHEMICAL USE.
  • EXTERNAL CAUSES OF RELAPSE.
  • COMBINED CAUSES OF RELAPSE.

IDENTIFYING WARNING SIGNS:

  • Degree of frequency.
  • Early warning signs.
  • Critical warning signs.
  • Managing and coping warning signs to interrupt any potential return to chemical use.
  • EXPERIENCES RESOLUTION OF AMBIVALENCE.
  • NEW BEHAVIORS ARE INTEGRATED INTO NEW SELF – CONCEPT.
  • EXPERIENCES A COMMITMENT TO RECOVERY.
  • PROVE TO THEM THAT THEY CAN THRIVE.
  • FACES AND DEALS WITH “LIFE” PROBLEMS.
  • BECOMES COMFORTABLE WITH FEELING STATE.
  • BEGINS CATCHING UP ON DEVELOPMENT LAGS.
  • BECOMES AWARE OF NEED FOR SPIRITUAL GROWTH.
  • CONTINUES TO STRUGGLE WITH FAMILY ISSUES.
  • COMFORTABLE WITH LIFESTYLE CHANGES.
  • SEEK HELP ON ADDRESSING CLINICAL ISSUES WHICH PREDATED USE.

ADVANCE PHASE RECOVERY:

  • DEVELOPED A RELAPSE PREVENTION STRATEGY.
  • ESTABLISHING RECOVERY NETWORK.
  • ENROLLED IN A FELLOWSHIP THAT PROMOTES A CONTINUITY OF RECOVERY CARE.
  • PLAN FOR A DAILY, WEEKLY INVENTORY.
  • BEGIN DEVELOPMENT OF A SPIRITUAL PROGRAM.
  • LEARN COPING MECHANISMS FOR DEALING WITH FAMILY.
  • BROADENS SCOPE OF LIFE, BEGINS FULFILLING POTENTIAL.
  • DEVELOPS HEALTHY RELATIONSHIP WITH OTHERS.
  • DEVELOPS INDEPENDENCE FROM TREATMENT CENTER.
  • DEVELOPS BALANCE IN LIFE.
  • EXPERIENCE AGE APPROPRIATE RESOLUTION TO DEVELOPMENTAL TRAUMA.
  • EXPERIENCE ACCEPTANCE WITH IDENTITY AS A RECOVERY PERSON.

MAINTENANCE PHASE RECOVERY:

  • CONTINUES PERSONAL GROWTH.
  • RECOVERY IS PART OF THEIR LIFE BUT NOT THEIR ENTIRE LIFE.
  • FOCUSES ON SPIRITUAL DEVELOPMENT.
  • POST INDEPENDENCE FROM TREATMENT CENTRE.
  • REENTRY READINESS.

MAINTENANCE:

  • Service.
  • Have fun.

MODELS OF CHEMICAL DEPENDENCY:

MORAL MODEL:

ORIGIN:

  • Substance Abuse Results because one has Weak, Bad, or Evil Character.

TREATMENT GOAL:

  • Increase One’s Will Power.

TREATMENT STRATEGY:

  • Reliance on GOD through Religious Counseling.

MEDICAL/DISEASE MODEL:

ORIGIN:

  • Substance abuse unknown, genetic / biological factors important.

TREATMENT GOAL:

  • Complete abstinence.

TREATMENT STRATEGY:

  • Focus on substance abuse primary problem, rather than lacking will power of self control.

LEARNING MODEL:

ORIGIN:

  • Substance abuse results from learning maladaptive habits.

TREATMENT GOAL:

  • Teach new behaviors and cognitions.

TREATMENT STRATEGY:

  • Education through therapy, teaching new coping skills and cognitive restructuring.

SELF MEDICATION MODEL:

ORIGIN:

  • Substance Abuse Occurs as Symptoms of another Primary Disorder.

TREATMENT GOAL:

  • To Improve Mental Functioning.

TREATMENT STRATEGY:

  • Psychotherapy and Pharmacotherapy of Underlying Disorder.

INTEGRATED MODEL:

ORIGIN:

  • Substance Abuse Results from Complex Bio – Psych – Social Health.

TREATMENT GOAL:

  • Enhance Bio – Psych – Social Health.

TREATMENT STRATEGY:

  • A Combination of Electric Approaches in Relations to Achieve a Holistic Recovery.

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Saturday, July 18, 2009

Twelve core functions of the alcohol and other drug abuse counselor

TWELVE CORE FUNCTIONS OF THE ALCOHOL AND OTHER DRUG ABUSE COUNSELOR



Abdullah Baniyameen
baniyameen@aol.com
July 18, 2009





THE CASE PRESENTATION METHOD IS BASED ON TWELVE CORE FUNCTIONS. SCORES ON THE CPM ARE BASED ON THE GLOBAL CRITERIA FOR EACH CORE FUNCTION. THE COUNSELOR MUST BE ABLE TO DEMONSTRATE COMPETENCE BY ACHIEVING A PASSING SCORE ON THE GLOBAL CRITERIA IN ORDER TO BE CERTIFIED. ALTHOUGH THE CORE FUNCTIONS MAY OVERLAP, DEPENDING ON THE NATURE OF THE COUNSELOR’S PRACTICE, EACH REPRESENTS A SPECIFIC ENTITY. GIVE SPECIFICS THROUGHOUT AND DO NOT SUPPLY ORIGINAL DEFINITIONS.

SCREENING:
The process by which the client is determined appropriate and eligible for admission to a particular program.

GLOBAL CRITERIA:
۩ Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse.
۩ Determine the client’s appropriateness for admission or referral.
۩ Determine the client’s eligibility for admission or referral.
۩ Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate need for additional professional assessment and/or services.
۩ Adhere to applicable laws, regulations and agency policies governing alcohol and other drug abuse services.
EXPLANATION:
This function requires that the counselor consider a variety of factors before deciding whether or not to admit the potential client for treatment.
It is imperative that the counselor use appropriate diagnostic criteria to determine whether the applicant’s alcohol or other drug use constitutes abuse. All counselors must be able to describe the criteria they use and demonstrate their competence by presenting specific examples of how the use of alcohol and other drugs has become dysfunctional for a particular client.
The determination of a particular client’s appropriateness for a program requires the counselor’s judgment and skill and is influenced by the program’s environment and modality (i.e., inpatient, outpatient, residential, pharmacotherepy, detoxification, or day care). Important factors include the nature of the substance abuse, the physical condition of the client, the psychological functioning of the client, outside supports/resources, previous treatment efforts, motivation and philosophy of the program.
The eligibility criteria are generally determined by the focus, target population and funding requirements of the counselor’s program or agency. Many of the criteria are easily ascertained. These may include the client’s age, gender, place of residence, legal status, veteran status, income level and the referral source. Allusion to following agency policy is a minimally acceptable statement
If the applicant is found ineligible or inappropriate for this program, the counselor should be able to suggest an alternative
INTAKE:
The administrative and initial assessment procedures for admission to a program.
GLOBAL CRITERIA:
۩ Complete required documents for admission to the program.
۩ Complete required documents for program eligibility and appropriateness.
۩ Obtain appropriately signed consents when soliciting from or providing information to outside sources to protect client confidentiality and rights.

EXPLANATION:
The intake usually becomes an extension of the screening, when the decision to admit is formally made and documented. Much of the intake process includes the completion of various forms. Typically, the client and counselor fill out an admission or intake sheet, document the initial assessment, complete appropriate releases of information, collect financial data, sign consent for treatment and assign the primary counselor.
ORIENTATION:
Describing to the client the following: general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
GLOBAL CRITERIA:
۩ Provide an overview to the client by describing program goals and objectives for client care.
۩ Provide an overview to the client by describing program rules, and client obligations and rights.
۩ Provide an overview to the client of program operations.
EXPLANATION:
The orientation may be provided before, during and/or after the client’s screening and intake. It can be conducted in an individual, group, or family context.
Portions of the orientation may include other personnel for certain specific aspects of the treatment, such as medication.
ASSESSMENT:
The procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems and needs for the development of a treatment plan.
GLOBAL CRITERIA:
۩ Gather relevant history from client including but not limited to alcohol and other drug abuse using appropriate interview techniques.
۩ Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding client’s alcohol and other drug abuse and psycho-social history.
۩ Identify appropriate assessment tools.
۩ Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding.
۩ Develop a diagnostic evaluation of the client’s substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client’s strengths, weaknesses, and identified problems and needs.
EXPLANATION:
Although assessment is a continuing process, it is generally emphasized early intreatment. It usually results from a combination of focused interviews, testing and/or record reviews.
The counselor evaluates major life area (i.e., physical health, vocational development, social adaptation, legal involvement and psychological functioning) and assesses the extent to which alcohol or drug use has interfered with the client’s functioning in each of these areas. The result of this assessment should suggest the focus of treatment.
TREATMENT PLANNING:
Process by which the counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized.
GLOBAL CRITERIA:
۩ Explain assessment results to client in an understandable manner.
۩ Identify and rank problems based on individual client needs in the written treatment plan.
۩ Formulate agreed upon immediate and long-term goals using behavioral terms in the written treatment plan.
۩ Identify the treatment methods and resources to be utilized as appropriate for the individual client.
EXPLANATION:
The treatment contract is based on the assessment and is a product of a negotiation between the client and the counselor to assure that the plan is tailored to the individual’s needs. The language of the problem, goal, and strategy statements should be specific, intelligible to the client and expressed in behavioral terms. The statement of the problem concisely elaborates on a client’s need identified previously. The goal statements refer specifically to the identified problem and may include on objective of a set of objectives ultimately intended to resolve or mitigate the problem. The goals must be expressed in behavioral terms in order for the counselor and client to determine progress in treatment. Both immediate and long-term goals should be established. The plan or strategy is a specific activity that links the problem with the goal. It describes the services, who will perform them, when they will be provided, and at what frequency. Treatment planning is a dynamic process and the contracts must be regularly reviewed and modified as appropriate.
COUNSELING:
(Individual, Group, and Significant Others): The utilization of special skills to assist individuals, families or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision-making.
GLOBAL CRITERIA:
۩ Select the counseling theory (ies) that apply (ies).
۩ Apply technique(s) to assist the client, group, and/or family in exploring problems and ramifications.
۩ Apply technique(s) to assist the client, group, and/or family in examining the client’s behavior, attitudes, and/or feelings if appropriate in the treatment setting.
۩ Individualize counseling in accordance with cultural, gender, and lifestyle differences.
۩ Interact with the client in an appropriate therapeutic manner.
۩ Elicit solutions and decisions from the client.
۩ Implement the treatment plan.
EXPLANATION:
Counseling is basically a relationship in which the counselor helps the client mobilize resources to resolve his or her problem and/or modify attitudes and values. The counselor must be able to demonstrate a working knowledge of various counseling approaches. These methods may include Reality Therapy, Transactional Analysis, Strategic Family Therapy, Client Centered Therapy, etc. Further, the counselor must be able to explain the rationale for using a specific approach for the particular client. For example, a behavioral approach might be suggested for clients who are resistant and manipulative or have difficulty anticipating consequences and regulating impulses. On the other hand, a cognitive approach may be appropriate for a client who is depressed, yet insightful and articulate.
Also, the counselor should explain his or her rationale for choosing a counseling approach in an individual, group or significant other context. Finally, the counselor should be able to explain why a counseling approach or context changed during treatment.
CASE MANAGEMENT:
Activities which bring services, agencies, resource, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts.
GLOBAL CRITERIA:
۩ Coordinate services for client care.
۩ Explain the rationale of case management activities to the client.
EXPLANATION:
Case management is the coordination of a multiple services plan. Case management decisions must be explained to the client. By the time many alcohol and other drug abusers enter treatment they tend to manifest dysfunction in a variety of areas. For example, a heroin addict may have hepatitis, lack job skills and have a pending criminal charge. In this case, the counselor might monitor his medical treatment, make a referral to a vocational rehabilitation program and communicate with representatives of the criminal justice system.
The client may also be receiving other treatment services such as family therapy and pharmacotherapy, within the same agency. These activities must be integrated into the treatment plan and communication must be maintained with the appropriate personnel
CRISIS INTERVENTION:
Those services which respond to an alcohol and/or other drug abuser’s needs during acute emotional and/or physical distress.
GLOBAL CRITERIA:
۩ Recognize the elements of the client crisis.
۩ Implement an immediate course of action appropriate to the crisis.
۩ Enhance overall treatment by utilizing crisis events.
EXPLANATION:
A crisis is a decisive, crucial event in the course of treatment that threatens to compromise or destroy the rehabilitation effort. These crises may be directly related to alcohol or drug use (i.e., overdose or relapse) or indirectly related. The latter might include the death of a significant other, separation/divorce, arrest, suicide gestures, a psychotic episode or outside pressure to terminate treatment. If no specific crisis is presented in the Written Case, rely on and describe a past experience with a client. Describe the overall picture-before, during, and after the crisis.
It is imperative that the counselor be able to identify the crises when they surface, attempt to mitigate or resolve the immediate problem and use negative events to enhance the treatment efforts, if possible.
CLIENT EDUCATION:
Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.
GLOBAL CRITERIA:
۩ Present relevant alcohol and other drug use/abuse information to the client through formal and/or informal processes.
۩ Present information about available alcohol and other drug services and resources.
EXPLANATION:
Client education is provided in a variety of ways. In certain inpatient and residential programs, for example, a sequence of formal classes may be conducted using a didactic format with reading materials and films. On the other hand, an outpatient counselor may provide relevant information to the client individually or informally. In addition to alcohol and drug information, client education may include a description of self-help groups and other resources that are available to the clients and their families. The applicant must be competent in providing specific examples of the type of education provided to the client and the relevance to the case.
REFERRAL:
Identifying the needs of a client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
GLOBAL CRITERIA:
۩ Identify need(s) and/or problem(s) that the agency and/or counselor cannot meet.
۩ Explain the rationale for the referral to the client.
۩ Match client needs and/or problems to appropriate resources.
۩ Adhere to applicable laws, regulations and agency policies governing procedures related to the protection of the client’s confidentiality.
۩ Assist the client in utilizing the support systems and community resources available.
EXPLANATION:
In order to be competent in this function, the counselor must be familiar with community resources, both alcohol and drug and others, and should be aware of the limitations of each service and if the limitations could adversely impact the client. In addition, the counselor must be able to demonstrate a working knowledge of the referral process, including confidentiality requirements and outcomes of the referral.
Referral is obviously closely related to case management when integrated into the initial and on-going treatment plan. It also includes, however, aftercare or discharge planning referrals that take into account the continuum of care.

REPORT AND RECORD KEEPING:
Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data.
GLOBAL CRITERIA:
۩ Prepare reports and relevant records integrating available information to facilitate the continuum of care.
۩ Chart pertinent ongoing information pertaining to the client.
۩ Utilize relevant information from written documents for client care.
EXPLANATION:
The report and record keeping function is important. It benefits the counselor by documenting the client’s progress in achieving his or her goals. It facilitates adequate communication between co-workers. It assists the counselor’s supervisor in providing timely feedback. It is valuable to other programs that may provide services to the client at a later date. It can enhance the accountability of the program to its licensing/funding sources. Ultimately, if performed properly, it enhances the client’s entire treatment experience. The applicant must prove personal action in regard to the report and record keeping function.
CONSULTATION WITH OTHER PROFESSIONALS IN REGARD TO CLIENT TREATMENT/SERVICES:
Relating with in-house staff or outside professionals to assure comprehensive, quality care for the client.
GLOBAL CRITERIA:
۩ Recognize issues that are beyond the counselor’s base of knowledge and/or skill.
۩ Consult with appropriate resources to ensure the provision of effective treatment services.
۩ Adhere to applicable laws, regulations and agency policies governing the disclosure of client-identifying data.
۩ Explain the rationale for the consultation to the client, if appropriate.
EXPLANATION:
Consultations are meetings for discussion, decision-making and planning. The most common consultation is the regular in-house staffing in which client cases are reviewed with other members of the treatment team. Consultations may also be conducted in individual sessions with the supervisor, other counselors, psychologists, physicians, probation officers, and other service providers connected to the client’s case.


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Saturday, July 4, 2009

What is chemical dependency or addiction?

WHAT IS CHEMICAL DEPENDENCY OR ADDICTION?



Abdullah Baniyameen
baniyameen@aol.com
July 4, 2009





CHEMICAL DEPENDENCY IS A DISEASE CAUSED BY THE USE OF ALCOHOL AND/OR DRUGS, CAUSING CHANGES IN A PERSON'S BODY, MIND, AND BEHAVIOR. AS A RESULT OF THE DISEASE OF CHEMICAL DEPENDENCY, PEOPLE ARE UNABLE TO CONTROL THE USE OF ALCOHOL AND/OR DRUGS, DESPITE THE BAD THINGS THAT HAPPEN WHEN THEY USE. CHEMICAL DEPENDENCY OCCURS MOST FREQUENTLY IN PEOPLE WHO HAVE A FAMILY HISTORY OF THE DISEASE. AS THE DISEASE PROCESS PROGRESSES, RECOVERY BECOMES MORE DIFFICULT. CHEMICAL DEPENDENCY MAY CAUSE DEATH IF THE PERSON DOES NOT COMPLETELY ABSTAIN FROM USING ALCOHOL AND OTHER MOOD‑ALTERING DRUGS.

EFFECTS:

The problems of chemical dependency that affect people when they use alcohol or drugs, and even after they have stopped using, include the following.

MALNUTRITION AND METABOLIC DYSFUNCTION:

The addict's ability to fnction normally is damaged by the effects of alcohol and/or drugs on the brain and body. Only after a period of proper diet and taking supplements can normal body chemistry is restored. This process affects the way the addict thinks, feels, and acts.

LIVER DISEASE AND OTHER MEDICAL COMPLICATIONS:

The addict's liver enzymes may be far above normal. This can cause poisonous effects within the body and may lead to infections and illnesses that need to be treated before normal functioning can resume.

BRAIN DYSFUNCTION:

Alcohol and drugs damage brain cells interrupt the production of certain brain chemicals called neurotransmitters, and alter the way the brain functions. Some of these changes may be permanent.

ADDICTIVE PREOCCUPATION:

A chemically dependent person's thinking patterns are altered by chemical dependency as the disease progresses. These changes cause the person to have strong thoughts, desires, and physical cravings for alcohol or drugs. These processes also change the way the person sees the world. They lead the person to believe that using is better than not using, despite the bad things that result from using.

SOCIAL CONSEQUENCES:

As the physical and psychological problems identified above get worse, the person's behavior becomes more antisocial and self‑destructive. Frequent social consequences of addiction are job loss, money problems, car accidents, domestic violence, criminal behaviors, illness, and death.

CRIMINAL BEHAVIORS:

Chemical dependency can cause a person to commit crimes. People who are chemically dependent commit crimes related to their use of alcohol or drugs (drunk driving, public drunkenness, assault, etc.), the support of their addiction (selling drugs, committing crimes to get drugs or money for drugs, etc.), and secondary consequences of drug or alcohol use (not paying child support or court fines, failing to follow through with probation requirements, etc.). Some people do not commit crimes until they become chemically dependent. Others have personality problems that initiate their criminal behavior. Most of those who have personality problems either become chemically dependent on or abusive of alcohol and drugs. Any relapse into behavior that leads to criminal actions is likely to cause a relapse into the use of alcohol or drugs. Any relapse into chemical use is likely to cause a relapse into criminal behavior.

The conditions just described combine and interfere with the ability to think clearly, control feelings, and regulate behaviors, especially under stress. Alcohol and drug dependency damages the basic personality traits that are formed before the addictive use of alcohol or drugs.

Dependency on alcohol or other drugs systemically destroys meaning and purpose in life as the addiction gets worse and worse.

TREATMENT:

Because dependency on alcohol or other drugs creates problems in a person's physical, psychological, and social functioning, treatment must be designed to work in all three areas. The worse the damage in each area, the greater the chance of relapse and return to old behaviors (criminal actions and/or the use of alcohol or drugs). Total abstinence (not using any alcohol and drugs) plus personality and lifestyle changes are essential for full recovery. The type and intensity of treatment depend on the patient's:

۩ Current physical, psychological and social problems,
۩ Stage and type of addiction(s),
۩ Stage of recovery,
۩ Personality traits and social skills before the onset of addiction,
۩ Other factors in life that cause stress.

Chemical dependency is a chronic condition that has a tendency toward relapse. Abstinence from alcohol and other mood‑altering drugs is essential in the treatment of chemical dependency. It is also an important part of relapse prevention therapy. There is no convincing evidence that controlled drinking or drug use is a practical treatment goal for people who have been physically dependent on alcohol or drugs.

Many chemically dependent people who exhibit criminal behaviors were raised in families that did not provide proper support, guidance, and values. This caused them to develop self‑defeating personality styles that interfere with their ability to recover. Personality is the habitual way of thinking, feeling, acting, and relating to others that develops in childhood and continues in adult life. Personality develops as a result of an interaction between genetically inherited traits and family environment.

Growing up in a dysfunctional family causes a person to have a distorted view of the world. He or she learns coping methods that may be unacceptable in society. In addition, the family may not have been able to provide guidance or foster the development of social and occupational skills that allow the person to fully participate in society. This lack of skills and distorted personality functioning may cause addictive behaviors to occur. These problems may also contribute to a more rapid progression of the addiction, make it difficult to recognize and seek treatment during the early stages of the addiction, and make it hard to benefit from treatment.

There are four goals in the primary treatment of dependency on alcohol and other drugs:

  • Recognition that chemical dependency is a bio/psycho/social disease,
  • Recognition of the need for life‑long abstinence from all mind‑altering drugs,
  • Development and use of an ongoing recovery program to maintain abstinence,
  • Diagnosis and treatment of other problems or conditions that can interfere with recovery.

Traditional treatment has taken one of two general approaches:

1. THE MEDICAL MODEL:

This approach tries to help the patient meet the first three goals listed above.

2. THE SOCIAL/BEHAVIORAL MODEL:

This approach focuses on the fourth goal listed above.

The lack of a model that includes all of the components has led to high relapse rates, especially in criminal justice populations. Relapse prevention therapy is a model that uses an approach that works with all four components.



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Process of addiction

PROCESS OF ADDICTION





Abdullah Baniyameen
baniyameen@aol.com
July 4, 2009





EARLY ADDICTION:

۩ Experimental drug use.
۩ Use is pleasurable, rewarding.
۩ Uses drug when offered.
۩ Uses drug to escape boredom.
۩ Many friends are non-users.

INTERMEDIATE ADDICTION:

۩ Begins to buy drugs.
۩ More time is spent finding drugs.
۩ Dosage/usage increases.
۩ Mood swings/defensiveness.
۩ Using to reduce feelings.
۩ Change in appearance.
۩ Truancy, school or work performance drops.
۩ Increased problems at home/work place.
۩ Denial and constant lying.
۩ Most friends are drug users.
۩ Isolation.
۩ Loss of control over drugs.
۩ Using to feel good about self.
۩ Friends and family becomes aware.

ADVANCED ADDICTION:

۩ Uses drug to feel and function normally.
۩ Uses in isolation.
۩ Most friends are drug users.
۩ Failed attempts to control use.
۩ Drug hunger drives behaviour.
۩ Drug related physical injuries.
۩ Blaming others for problems.
۩ Problems with authority.
۩ Neglecting priorities in life.


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Wednesday, July 1, 2009

System and procedures

SYSTEM AND PROCEDURES
“MANAGING TREATMENT AND REHABILITATION”




Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009




TREATMENT PROTOCOL:
QUALITY IS NEVER AN ACCIDENT. IT IS ALWAYS THE RESULT OF CAREFUL PLANNING, TEAM WORK, AND A COMMITMENT TO EXCELLENCE.
HAPHAZARD AND UNPLANNED GROWTH IN THE FIELD:
  • Lack of understanding of the magnitude of the problem.
  • Lack of awareness of the need to provide multi disciplinary care.
  • Absence of documented literature on the nature of services to be offered.
  • Lack of training, hence, no professionalism in the field.

MINIMUM STANDARD OF CARE:

  • Continuum of care gets focused which in turn, ensures effective service delivery.
  • Ensures optimum utilization of services through networking and convergence.
  • Helps in planned growth and provides opportunities for evaluation.
  • Availability of documented literature providing guidelines which can be replicated.

ADDICTION MANAGEMENT:

  • No single treatment is appropriate for all individuals. There is a need to offer a range of treatment services based on individual needs.
  • Treatment needs to be readily available.
  • Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
  • Treatment does not need to be voluntary to be effective.
  • Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
  • Drug abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
  • Counseling (individual and/or group/ family) and other behavioral therapies are critical components of effective treatment for addiction.
  • An individual’s treatment and service plan must be assessed continually and modified as necessary to ensure that the plan meets the person’s changing needs.
  • Possible drug use during treatment must be monitored continuously.
  • Treatment programs should include assessment for HIV-AIDS, Hepatitis B and C, Tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk or infection.
  • Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.

PRINCIPLE OF EFFECTIVE TREATMENT:

  • Comprehensive program by a multi disciplinary team addressing the varied needs of the client.
  • Detoxification services to make withdrawal safe and comfortable.
  • Repeated assessment and treatment to address the changing needs of the client medical and psychiatric.
  • Psycho social treatment for the total recovery of the client through proven methods like counseling, group therapy and re-educative sessions.
  • Exposure to self-help groups.
  • Exclusive psycho social care to families to improve their quality of lives.
  • Availability of culturally relevant vocational training, by utilizing local resources.
  • Identification and networking with other existing facilities for reintegration into society.
  • A clearly defined long-term after care program focusing on 'whole person recovery' which includes relapse prevention.

TREATMENT PROCESS:

  • Identification and early intervention.
  • Detoxification and managing co morbid medical and psychiatric problems.
  • Psycho social management of dependency.
  • Therapy program for families.
  • Extended care program/after care program including vocational rehabilitation.

TREATMENT ISSUES:

  • Access, availability and admission criteria.
  • Assessment.
  • Early intervention.
  • Treatment content.
  • Aftercare and referral.
  • Documentation and evaluation.

ACCESS, AVAILABILITY AND ADMISSION CRITERIA:

  • Adequate number of service agencies available to cover the affected population.
  • Services easily accessible with regard to location and transportation.
  • Treatment available without delay since it may lead to worsening of the condition.
  • A range of treatment services and options available to address the individual needs of the clients – in – patient, out-patient, day care program.
  • Services available irrespective of the kind of drug abused, legal status of the drug involved HIV status of the client or history of prior treatment.
  • Services available irrespective of age or gender, religion, caste or political beliefs.
  • Services available irrespective of the patient's, socioeconomic or employment status or his ability to pay.
  • Services available in custodial settings like prisons and police cells.
  • The period of treatment to be adequate (either out-patient or in-patient) in order to make the program effective.

ASSESSMENT:

  • Assessment of physical and psychiatric disorders in order to plan intervention.
  • Access to laboratory for assessing medical problems and other facilities for identification of drugs through body fluid.
  • Assessment of the social circumstances of the clients which includes family, employment, financial and legal position.
  • Psychological instruments for assessment of psycho social functioning.
  • Maintenance of records from entry of the client into the service till termination.

EARLY INTERVENTION:

  • Routine self - assessment questioning to screen for drug dependence available in general health facilities, work places, educational institutions etc.
  • Active promotion of early intervention for drug related problems with special emphasis on specific population groups like children of addicts, street children, pregnant women etc.
  • Information about assessment procedures and treatment resources made available to individuals who are initial contact points for potential patients - medical practitioners, nurses, social workers etc.
  • Staff of health care services, teachers in schools, police, and social workers is trained during their education in the recognition, basic management and referral of individuals with drug related problems.
  • Procedures exist for counseling family members, employers, and other service agencies who seek assistance in initiating drug users into treatmen

MEDICAL AND PSYCHIATRIC MANAGEMENT:

  • Minimizing withdrawal symptoms.
  • Providing essential medicines to deal with withdrawal related emergencies.
  • Providing medical and psychiatric help to deal with drug related problems.
  • Ensuring availability of essential equipment like ECG, Oxygen cylinder, suction apparatus etc.
  • Ensuring ready accessibility to laboratory facilities.
  • Availability of links between the treatment program and other services to facilitate intervention for other co-morbid conditions.

PSYCHOSOCIAL MANAGEMENT:

  • Availability of services on a continuum of care basis.
  • Availability of services to strengthen motivation.
  • Adequate provision of individual counseling, group therapy and re-educative sessions.

AFTERCARE AND REFERRALS:

  • Criteria for discharge of clients determined by the recovery status.
  • Attention paid to further treatment and support which may be required based on the client's condition/problems diagnosed, lack of resources and other requirements.
  • Alternative pathways in case of partial or complete failure of treatment.
  • Regular links with other agencies for referrals and criteria for admission.
  • Aftercare services, in-patient, out-patient and day care to sustain the recovery of clients and families.
  • Specific programs to identify and deal with relapses and improve the quality of life.
  • Opportunities to get vocational training through networking.
  • Services to reach out to unmotivated clients through home visits.

RESIDENTS BILL OF RIGHTS:

  • Protecting the human rights of clients.
  • Maintaining confidentiality – not divulging any information about the client to individuals or authorities without the client’s consent.
  • Informing clients and their family members about the nature and content of the treatment as well as the risks and benefits to be expected.
  • Obtaining prior consent from the client regarding the conditions and restrictions of treatment agencies.
  • Allowing the client to interact with and visits from family and others.
  • Strictly avoiding physical restraint to detain or restrain clients who are legally competent to leave.
  • Setting defined criteria for the expulsion of clients due to violation of rules, violence, continued use of drugs etc.
  • Ensuring that a documented complaint procedure exists and is made known to clients and their relatives.

TREATMENT SETTING AND INFRASTRUCTURE:

  • The physical environment designed to protect the well being of clients ensuring hygiene, safety and protection.
  • Availability of privacy for in-patient/ residential clients.
  • Availability of privacy for conducting group therapy/individual counseling sessions.
  • Access to recreational facilities for in-patient/day care clients.
  • Provision to store records of clients to ensure confidentiality and a system of easy retrieval.

DOCUMENTATION:

  • A RECORD OF PATIENT MANAGEMENT, PROGRESS AND ONWARD REFERRAL TO BE KEPT AND UPDATED ON A REGULAR BASIS.
  • MEDICAL CASE SHEET:
    Data to be collected - History of addiction, medical history and associated medical and psychiatric problems and medications prescribed.
  • CASE HISTORY FORM:
    Data to be collected - Case history of the client – Background information, family history, childhood issues, occupational history, financial history, marital history, etc.
  • FOLLOW UP CARD:
    Data to be collected - The recovery of the client – abstinence and improvements in every area of life and the efforts taken by him to stay abstinent. The measures taken by the center to provide care to the client and his family members.
  • MEDICAL MANUAL:
    Covers medical management of addiction, treatment for other co-existing psychiatric problems, dealing with medical emergencies related to addiction.
  • NURSING MANUAL:
    Has to cover the role of nurses, admission procedure, nursing care to be provided during detoxify, delirium emergencies, methodology of dispensing medicines and records to be maintained.
  • THERAPY MANUAL:
    Has to cover the role of counselors, different therapy to be used, and basic information regarding addiction and recovery, guidelines for conducting group therapy, issues to be dealt during counseling.
  • FAMILY MANUAL:
    The need for family program, issues to be dealt during counseling sessions, information to be provided during re-educative sessions and topics for group therapy.
  • AFTERCARE SERVICES MANUAL:
    The importance of after care services, types of services needed and issues to be dealt during follow-up / after care.
  • NETWORK DIRECTORY:
    Names, addresses and other vital information about agencies who are working with allied fields like hospitals, HIV treatment agencies, laboratories, job placement agencies, vocational training centers.

PROGRAM EVALUATION:

  • Diligent investigation of a programs characteristics and merits, to optimize the outcome, efficiency and quality of service delivery.
  • Measuring the effectiveness of components of the program – individual counseling, relapse program and vocational training.

EFFICACY OF TREATMENT:

  • Abstinence from alcohol or other drugs.
  • Improvements in physical and emotional health, interpersonal relationships and vocational and financial functioning.
  • Client’s satisfaction with regard to treatment.
  • Feedback from referral.

PROGRAM PROCEDURES' REVIEW:

  • Periodic meetings of program administrators and staff to make decisions about continuing or changing certain aspects of services.
  • Outside monitors to determine that appropriate services, which meet acceptable standards are being provided.
  • Funding sources to ensure that money is being spent appropriately.

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What is recovery?

WHAT IS RECOVERY?
"RECOVERY IS A PROCESS THAT TAKES PLACE OVER TIME, IN SPECIFIC STAGES"


Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009


A COMPREHENSIVE MODEL OF CHEMICAL DEPENDENCY TREATMENT EFFECTIVELY COMBINES THE BEST OF THE MEDICAL AND SOCIAL/BEHAVIORAL TREATMENT MODELS. IT IS BASED ON THE IDEA THAT RECOVERY IS A PROCESS THAT TAKES PLACE OVER TIME, IN SPECIFIC STAGES. EACH STAGE HAS TASKS TO BE ACCOMPLISHED AND SKILLS TO BE DEVELOPED. IF A RECOVERING PERSON IS UNAWARE OF THIS PROGRESSION, UNABLE TO ACCOMPLISH THE TASKS AND GAIN THE SKILLS OR LACKS ADEQUATE TREATMENT, HE OR SHE WILL RELAPSE.
THE FOLLOWING IS A DESCRIPTION OF THIS COMPREHENSIVE MODEL. IT IS CALLED THE DEVELOPMENTAL MODEL OF RECOVERY (DMR).
THE DEVELOPMENTAL MODEL OF RECOVERY:
The DMR has been devised to help recovering people and treatment professionals identify appropriate recovery plans, set treatment goals, and measure progress. The DMR describes six stages or periods of recovery.
TRANSITION STAGE:
The transition stage begins the first time a person experiences an alcohol or drug related problem. As a person's addiction progresses, he or she tries a series of strategies designed to control use. This ends with recognition by the person that safe use of alcohol and/or drugs is no longer possible.
The struggle for control is a symptom of a fundamental conflict over personal identity. Alcoholics and drug addicts enter this phase of recovery believing they are normal drinkers and drug users capable of controlled use. As the progression of addiction causes more severe loss of control, they must face the fact that they are addictive users who are not capable of controlled use.
During the transition stage, chemically dependent people typically attempt to control their use or stop using. They are usually trying to prove to themselves and others that they can use safely. This never works for very long. Controlled use is especially tough for people who are participating in criminal behavior because the high level of alcohol and drug use among their peers makes their lifestyle and use seem normal.
The major cause of inability to abstain during the transition stage is the belief that there is a way to control use.
STABILIZATION PERIOD:
During the stabilization period, chemically dependent people experience physical withdrawal and other medical problems, learn how to break the psychological conditioning causing the urge to use, stabilize the crisis that motivated them to seek treatment, and learn to identify and manage symptoms of brain dysfunction. This prepares them for the long‑term processes of rehabilitation.
TRADITIONAL TREATMENT OFTEN UNDERESTIMATES THE NEED FOR MANAGEMENT OF THESE ISSUES, FOCUSING INSTEAD ON DETOXIFICATION:
Patients find themselves unable to cope with the stress and pressure of the symptoms of brain dysfunction and physical cravings that follow detoxification. Many have difficulty gaining much from treatment and feel they are incapable of recovery.
EARLY RECOVERY PERIOD:
Early recovery is marked by the need to establish a chemical‑free lifestyle. The recovering person must learn about the addiction and recovery process. He or she must separate from friends who use and build relationships that support long‑term recovery. This may be a very difficult time for criminal justice patients who have never associated with people with sobriety‑based lifestyles.
They also need to learn how to develop recovery‑based values, thinking, feelings, and behaviors to replace the ones formed in addiction. The thoughts, feelings, and behaviors developed by people with criminal lifestyles complicate and hinder their involvement in appropriate support programs during this period. Major intervention to teach the patient these skills is necessary if he or she is to succeed. This period lasts about 1B2 years.
The primary cause of relapse during the early recovery period is the lack of effective social and recovery skills necessary to build a sobriety‑based lifestyle.
The lack of a supportive environment for recovery that many criminal offenders experience adds stress and undermines their attempts to stabilize these symptoms. They often use alcohol and drugs to relieve such distress. It takes between 6 weeks and 6 months for a patient to learn to master these symptoms with the correct therapy.
The major cause of inability to abstain during the stabilization period is the lack of stabilization management skills.
MIDDLE RECOVERY PERIOD:
Middle recovery is marked by the development of a balanced lifestyle. During this stage, recovering people learn to repair past damage done to their lives.
The recovery program is modified to allow time to reestablish relationships with family, set new vocational goals, and expand social outlets. The patient moves out of the protected environment of a recovery support group to assume a more mainstream and normal lifestyle. This is a time of stress as a person begins applying basic recovery skills to real‑life problems.
The major cause of relapse during the middle recovery period is the stress of real‑life problems.
LATE RECOVERY PERIOD:
During late recovery, a person makes changes in ongoing personality issues that have continued to interfere with life satisfaction. In traditional psychotherapy, this is referred to as self‑actualization. It is a process of examining the values and goals that one has adopted from family, peers, and culture. Conscious choices are then made about keeping these values or discarding them and forming new ones. In normal growth and development, this process occurs in a person's mid‑twenties. Among people in recovery, it does not usually occur until 3B5 years into the recovery process, no matter when recovery begins.
For criminal offenders, this is the time when they learn to change self‑defeating behaviors that may trigger a return to alcohol or drug use. These self‑defeating behaviors often come from psychological issues starting in childhood, such as childhood physical or sexual abuse, abandonment, or cultural barriers to personal growth.
The major cause of relapse during the late recovery period is either the inability to cope with the stress of unresolved childhood issues or an evasion of the need to develop a functional personality style.

MAINTENANCE STAGE:
The maintenance stage is the life‑long process of continued growth and development, coping with adult life transitions, managing routine life problems, and guarding against relapse. The physiology of addiction lasts for the rest of a person's life. Any use of alcohol or drugs will reactivate physiological, psychological, and social progression of the disease.
The major causes of relapse during the maintenance stage are the failure to maintain a recovery program and encountering major life transitions.
STUCK POINTS IN RECOVERY:
Although some patients progress through the stages of recovery without complications, most chemically dependent people do not. They typically get stuck somewhere. A stuck point" can occur during any period of recovery. Usually it is caused either by lack of skills or lack of confidence in one's ability to complete a recovery task. Other problems occur when the recovering person encounters a problem (physical, psychological, or social) that interferes with his or her ability to use recovery supports.
When recovering people encounter stuck points, they either recognize they have a problem and take action, or they lapse into the familiar coping skill of denial that a problem exists. Without specific relapse prevention skills to identify and interrupt denial, stress begins to build. Eventually, the stress will cause the patient to cope less and less well. This will result in relapse.
THE DEVELOPMENTAL MODEL OF RECOVERY COMPARED WITH TRADITIONAL MODELS:
TRADITIONAL MODELS OF TREATMENT ARE BASED ON THE IDEA THAT ONCE A PERSON IS DETOXIFIED, HE OR SHE CAN FULLY PARTICIPATE IN THE TREATMENT PROCESS.
Although this is true for many patients in the early stages of addiction who have had functional lives before their addiction progressed, it is not true for most of the criminal justice population. In addition, most traditional programs have a program format that is applied to all people regardless of their education, personality, or social skills. Patients whose needs fit within the program usually do well. But those, whose needs do not fit, such as criminal justice patients, generally do not do well.
The DMR recognizes that there are abstinence‑based symptoms of addiction that persist well into the recovery process. These symptoms are physical and psychological effects of the disease of chemical dependency. In the DMR, these symptoms must be stabilized and the patient must be taught how to manage them before general rehabilitation can take place. This model identifies the specific symptoms that a patient needs to overcome.
This model also contains methods and techniques that recognize the learning needs, psychological problems, and social skills of the patient.
POST ACUTE WITHDRAWAL:
Some of the symptoms of withdrawal from alcohol or drugs are the result of the toxic effects of these chemicals on the brain. These symptoms are called Post Acute Withdrawal (PAW). PAW is more severe for some patients than it is for others. Other factors cause stress that aggravates PAW. Below is a list of conditions affecting the criminal justice population that tends to worsen the damage and aggravate PAW.
PHYSICAL CONDITIONS THAT WORSEN PAW THROUGH INCREASED BRAIN DAMAGE OR DISRUPTED BRAIN FUNCTION:
  • Combined use of alcohol and drugs or different types of drugs,
  • Regular use of alcohol or drugs before age 15 or abusive use for a period of more than 15 years,
  • History of head trauma (from car accidents, fights, falling, etc.),
  • Parental use of alcohol or drugs during pregnancy,
  • Personal or family history of metabolic disease such as diabetes or hypoglycemia,
  • Personal history of malnutrition, usually due to chemical dependence,
  • Physical illness or chronic pain.

PSYCHOLOGICAL AND SOCIAL CONDITIONS THAT WORSEN PAW:

  • Childhood or adult history of psychological trauma (participant in or victim of sexual or physical violence),
  • Mental illness or severe personality disorder,
  • High stress lifestyle or personality,
  • High stress social environment.

ADDICTIVE PREOCCUPATION:

The other major area of abstinence‑based symptoms is addictive preoccupation. This consists of the obsessive thought patterns, compulsive behaviors, and physical cravings caused or aggravated by the addiction. These behaviors become programmed into the patient's psychological processes by the addiction. They are automatic and can cause the recovering patient to return to use unless he or she has specific training to identify and interrupt them.

Addictive preoccupations are activated by high‑risk situations and stress. Because of the environment surrounding most criminal justice patients, they often experience high‑risk situations and stress. These situations and stresses can include:

  • Exposure to alcohol or drugs or associated paraphernalia,
  • Exposure to places where alcohol or drugs are used,
  • Exposure to people with whom the patient has used in the past or people the patient knows who are actively using,
  • Lack of a stable home environment,
  • Lack of a stable social environment,
  • Lack of stable employment.

TRADITIONAL TREATMENT focuses on either detoxification alone or detoxification with movement into a rehabilitation program aimed at changing the patient's lifestyle. Programs are similar for all patients. Many programs omit teaching the specific stabilization skills that are necessary before lifestyle rehabilitation can take place.

The DMR first stabilizes patients so that they can take advantage of lifestyle rehabilitation. It then places the patient into a group that contains patients in similar stages of recovery and works on tasks and skills for that stage of recovery. Specific skills are taught to identify and manage relapse warning signs.


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Drugs and kids

DRUGS AND KIDS
LET THEM BE WHO THEY ARE… BUT WATCH WHAT THEY DO!





Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009




From The Complete Book of Baby & Child Care

LET THEM BE WHO THEY ARE… BUT WATCH WHAT THEY DO!
Keeping an eye on your kid is not taking away their freedom; it’s actually the best way to keep them away from Drugs.
Talk >> Know >> Ask >> Keep an eye on them… PARENTS, the anti-drug
DRUG-PROOFING YOUR HOME:
Drug abuse is so widespread in our culture that you cannot expect to isolate your child from exposure to it. You can, however, take specific steps to reduce the likelihood of contact with drugs and build your child’s immunity to using them. These measures should be ongoing, deliberate and proactive.

MODEL GOOD BEHAVIOR:
When it comes to drugs, two adages are worth noting: "Children learn what they live" and "What parents allow in moderation their children will do in excess." While not absolute truths, these maxims reflect the reality that kids look to their parents for cues as to what is acceptable behavior while at the same time they are developing the discernment required to understand moderation. If you smoke, your offspring will probably do likewise. But it’s never too late to quit, and your decision to give up cigarettes will make an important statement to all the members of your family.
If you consume alcohol at home, what role does it play in your life? Do you need to drink to unwind at the end of the day? Is it a necessary ingredient at every party or family get-together? If so, your children will get the picture that alcohol is a tension reliever and the life of the party, and they will likely use it in a similar fashion.
If you drink modestly — an occasional glass of wine with dinner or a beer every other week — think carefully about alcohol’s role in your family. Many parents decide to abstain while rearing their children in order to send an unambiguous message to steer clear of it. Others feel that modeling modest, nonintoxicated use of alcohol equips children and teenagers to make sensible decisions later in life. Each family must weigh the options carefully and set its own standards.
What about the medicine cabinet? If you are stressed, upset or uncomfortable, are drugs the way you spell relief? Have you accumulated prescription narcotics and tranquilizers that you use freely when the going gets tough? Kids aren’t blind. If they see the adults around them frequently taking "legitimate" drugs to dull their pain, why won’t they use their own drugs of choice to do the same?
BUILD DRUG-RESISTANT ATTITUDES:
THIS IS AN ONGOING PROJECT, BEGINNING DURING THE FIRST YEARS OF YOUR CHILD’S LIFE. SPECIFICALLY:

۩ Create an environment that consistently balances love and limits. Kids who know they are loved unconditionally are less likely to seek "pain relief" through drugs, and those who have learned to live within appropriate boundaries will have better impulse control and self-discipline.
۩ Instill respect and awe for the God-given gift of a body and mind—even one that isn’t perfect.
۩ Help your children become students of consequences, not only in connection with drugs but with other behaviors as well. Talk about good and bad choices and the logic behind them. "Just say no" is an appropriate motto for kids to learn, but understanding why it is wrong to use harmful substances will build more solid resistance.
۩ Build a positive sense of identity with your family. This means not only openly affirming and appreciating each member but putting forth the time and effort for shared experiences that are meaningful and fun. A strong feeling of belonging to a loving family builds accountability and helps prevent loneliness.
۩ Encourage mosque-related activities that build a meaningful personal faith. Reliance on God is the cornerstone of drug treatment programs, and it makes no sense to leave the spiritual dimension out of the prevention process. A vibrant faith reinforces the concept that the future is worth protecting, stabilizes the emotions during turbulent years, and provides a healthy response to the aches and pains of life.

BEGIN TALKING EARLY:

Because experimentation with drugs and alcohol commonly begins during the grade-school years, start appropriate countermeasures in very young children. A 5-year-old boy may not be ready for a lecture about the physiology of cocaine addiction, but you should be ready to offer commentary when you and your child see someone smoking or drinking, whether in real life or a movie.

KEEP TALKING:

Make an effort to stay one step ahead of your child’s knowledge of the drug scene. If you hear about an athlete, rock star or celebrity who uses drugs, be certain that everyone in the family understands that no amount of fame or fortune excuses this behavior.
Be aware of current trends in your community and look for local meetings or lectures where abuse problems are being discussed. Find out what’s going on—not only from the experts but from your kids and their friends.
All this assumes that you are available to have these conversations. Be careful, because the time when you may be the busiest with career or other responsibilities may also be the time your adolescents at home most need your input.

FIND TRUSTWORTHY ADULTS:

Don’t blindly assume that the presence of a grown-up guarantees a safe environment. Get to know the parents of your kids’ friends. Make certain your child knows you will pick him up anytime, anywhere—no questions asked—if he finds himself in a situation where drugs or alcohol are being used. And be sure to praise him for a wise decision if he does so.

COURAGE TO CONFRONT:

The epidemic of drug abuse spreads from person to person. Whether a recent acquaintance or a long-term friend, if one (or more) of your teenager’s friends is known to be actively using alcohol and/or drugs, you must put restrictions on the relationship.
Even with these limits in place, you will need to keep track of who is influencing whom. If your family is reaching out to a troubled adolescent and helping to move him toward healthier decisions, keep up the good work. But if there is any sign that the drug-using friend is pulling your teenager toward his lifestyle, declare quarantine immediately.

CREATE CONSEQUENCES:

Teenagers may not be scared off by facts, figures and gory details. Even the most ominous warnings may not override an adolescent’s belief in his or her own immortality, especially when other compelling emotions — such as the need for peer acceptance — are operating at full throttle.
You may improve the odds by making it clear that you consider the use of cigarettes, alcohol or illegal drugs a very serious matter. If your adolescent confesses that he tried a cigarette or a beer at a party and expresses an appropriate resolve to avoid a repeat performance, a heart-to-heart conversation would be more appropriate than grounding him for six months.
But if your warnings repeatedly go unheeded, you will need to establish and enforce some meaningful consequences. Loss of driving, dating or even phone privileges for an extended period of time may be in order.

PRE-EXISTING PROBLEMS:

Even in families that hold strong values and practice ongoing drug-proofing, there are no guarantees that substance abuse won’t affect one or more of your children. As you begin to cope with the chemical intruder(s) in your home, keep the following principles in mind:
  • Don’t deny or ignore the problem. If you do, it is likely to continue to worsen until your family life is turned inside out.
  • Don’t wallow in false guilt. Most parents assume a great deal of self-blame when a drug problem erupts in their home. If you do carry some responsibility for what has happened, face up to it, confess it to God and your family, and then get on with the task of helping your child.
PREPARING YOUTH FOR PEER PRESSURE:
TALKING WITH YOUR TEEN;
Peer pressure—it’s more than just a phase that young people go through. Whether it leads to pink hair or body piercing, peer pressure is a powerful reality and many adults do not realize its effects. It can be a negative force in the lives of children and adolescents, often resulting in their experimentation with tobacco, alcohol, and illegal drugs.
Parents often believe that their children do not value their opinions.
In reality, studies suggest that parents have tremendous influence over their children, especially teenagers. No matter the age of their children, parents and caregivers should never feel helpless about countering the negative effects of peer pressure. Here’s what parents and caregivers can do:

۩ TEACH YOUNG PEOPLE HOW TO REFUSE OFFERS for cigarettes, alcohol and drugs. Making children comfortable with what they can say goes a long way. For instance, shy children and adolescents might be more comfortable saying, “no thanks,” or “I have to go,” while those who are more outgoing might saying something like, “forget it!” or “no way!” No matter what approach parents choose, it is important for them to role-play peer-pressure situations with their children.
۩ TALK TO YOUNG PEOPLE ABOUT HOW TO AVOID UNDESIRABLE SITUATIONS OR PEOPLE who break the rules. Children and adolescents who are not in situations where they feel pressure to do negative actions are far less likely to do them. Likewise, those who choose friends who do not smoke, drink, use drugs, steal, and lie to their parents are far less likely to do these things as well.

۩ REMIND CHILDREN THAT THERE IS STRENGTH IN NUMBERS. When young people can anticipate stressful peer pressure situations, it might be helpful if they bring friends for support.
۩ LET YOUNG PEOPLE KNOW THAT IT IS OKAY TO SEEK AN ADULT’S ADVICE. While it would be ideal if children sought the advice of their parents, other trusted adults can usually help them avoid most difficult situations, such as offers to smoke, drink, or use drugs.
۩ NURTURE STRONG SELF-ESTEEM. Strong self-esteem helps children and adolescents make decisions and follow them, even if their friends do not think some choices are “cool.” Some ways parents can do this include being generous with praise, teaching children how to perceive themselves in positive ways, and avoiding criticism of children that takes the form of ridicule or shame.

DRUG USE: ALCOHOL
TALKING WITH YOUR TEEN ABOUT ALCOHOL;
For many parents, bringing up the subject of alcohol is no easy matter. Your young teen may try to dodge the discussion, and you yourself may feel unsure about how to proceed. To boost your chances for a productive conversation, take some time to think through the issues you want to discuss before you talk with your child. Also, think about how your child might react and ways you might respond to your youngster’s questions and feelings. Then choose a time to talk when both you and your child have some “down time” and are feeling relaxed.
Keep in mind, too, that you don’t need to cover everything at once. In fact, you’re likely to have a greater impact on your child’s drinking by having a number of talks about alcohol use throughout his or her adolescence. Think of this discussion with your child as the first part of an ongoing conversation.
And remember; do make it a conversation, not a lecture! Following are some topics for discussion:

YOUR CHILD’S VIEWS ABOUT ALCOHOL:
Ask your young teen what he or she knows about alcohol and what he or she thinks about teen drinking. Ask your child why he or she thinks kids drink. Listen carefully without interrupting. Not only will this approach help your child to feel heard and respected, but it can serve as a natural “lead-in” to discussing alcohol topics.
Important Facts About Alcohol. Although many kids believe they already know everything about alcohol, myths and misinformation abound. Here are some important facts to share:
Alcohol is a powerful drug that slows down the body and mind. It impairs coordination; slows reaction time; and impairs vision, clear thinking, and judgment.

BEER AND WINE ARE NOT “SAFER” THAN HARD LIQUOR:
A 12-ounce can of beer, a 5-ounce glass of wine, and 1.5 ounces of hard liquor all contain the same amount of alcohol and have the same effects on the body and mind.
On average, it takes 2 to 3 hours for a single drink to leave the body’s system. Nothing can speed up this process, including drinking coffee, taking a cold shower, or “walking it off.”
People tend to be very bad at judging how seriously alcohol has affected them. That means many individuals who drive after drinking think they can control a car—but actually cannot.
Anyone can develop a serious alcohol problem, including a teenager. The “Magic Potion” Myth. The media’s glamorous portrayal of alcohol encourages many teens to believe that drinking will make them popular, attractive, happy, and “cool.” Research shows that teens who expect such positive effects are more likely to drink at early ages.
However, you can help to combat these dangerous myths by watching TV shows and movie videos with your child and discussing how alcohol is portrayed in them. For example, television advertisements for beer often show young people having an uproariously good time, as though drinking always puts people in a terrific mood.
Watching such a commercial with your child can be an opportunity to discuss the many ways that alcohol can affect people—in some cases bringing on feelings of sadness or anger rather than carefree high spirits.
GOOD REASONS NOT TO DRINK:
In talking with your child about reasons to avoid alcohol, stay away from scare tactics. Most young teens are aware that many people drink without problems, so it is important to discuss the consequences of alcohol use without overstating the case. For example, you can talk about the dangers of riding in a car with a driver who has been drinking without insisting that “all kids who ride with drinkers get into crashes.” Some good reasons that teens shouldn’t drink:
۩ YOU WANT YOUR CHILD TO AVOID ALCOHOL: Be sure to clearly state your own expectations regarding your child’s drinking and to establish consequences for breaking rules. Your values and attitudes count with your child, even though he or she may not always show it.
۩ TO MAINTAIN SELF-RESPECT: In a series of focus groups, teens reported that the best way to persuade them to avoid alcohol is to appeal to their self-respect—letting them know that they are too smart and have too much going for them to need the crutch of alcohol. Teens also pay attention to ways in which alcohol might cause them to do something embarrassing that might damage their self-respect and important relationships.
۩ DRINKING IS ILLEGAL: Because alcohol use under the age of 21 is illegal, getting caught may mean trouble with the authorities. Even if getting caught doesn’t lead to police action, the parents of your child’s friends may no longer permit them to associate with your child. If drinking occurs on school grounds, your child could be suspended.
۩ DRINKING CAN BE DANGEROUS: One of the leading causes of teen deaths is motor vehicle crashes involving alcohol. Drinking also makes a young person more vulnerable to sexual assault and unprotected sex. And while your teen may believe he or she wouldn’t engage in hazardous activities after drinking, point out that because alcohol impairs judgment, a drinker is very likely to think such activities won’t be dangerous.
۩ YOU HAVE A FAMILY HISTORY OF ALCOHOLISM: If one or more members of your immediate or extended family has suffered from alcoholism, your child may be somewhat more vulnerable to developing a drinking problem. Your child needs to know that for him or her, drinking may carry special risks.

DRUG USE: ALCOHOL
HOW TO HANDLE ALCOHOL AND PEER PRESSURE;
It’s not enough to tell your young teen that he or she should avoid alcohol—you also need to help your child figure out how. What can your daughter say when she goes to a party and a friend offers her a beer? (See “Six Ways to Say No to a Drink.”) Or what should your son do if he finds himself in a home where kids are passing around a bottle of wine and parents are nowhere in sight? What should their response be if they are offered a ride home with an older friend who has been drinking?
Brainstorm with your teen for ways that he or she might handle these and other difficult situations, and make clear how you are willing to support your child. An example: “If you find yourself at a home where kids are drinking, call me and I’ll pick you up—and there will be no scolding or punishment.” The more prepared your child is, the better able he or she will be to handle high-pressure situations that involve drinking.
At some point, your child will be offered alcohol. To resist such pressure, teens say they prefer quick “one-liners” that allow them to dodge a drink without making a big scene. It will probably work best for your teen to take the lead in thinking up comebacks to drink offers so that he or she will feel comfortable saying them. But to get the brainstorming started, here are some simple pressure-busters—from the mildest to the most assertive.
SIX WAYS TO SAY 'NO!’:
  1. No thanks.
  2. I don’t feel like it—do you have any soda?
  3. Alcohol’s NOT my thing.
  4. Are you talking to me? FORGET it.
  5. Why do you keep pressuring me when I’ve said NO?
  6. Back off!

DRUG USE: ALCOHOL

COULD YOUR TEEN DEVELOP A DRINKING PROBLEM?

Certain children are more likely than others to drink heavily and encounter alcohol-related difficulties, including health, school, legal, family, and emotional problems. Kids at highest risk for alcohol-related problems are those who:

  • Begin using alcohol or other drugs before the age of 15.
  • Have a parent who is a problem drinker or an alcoholic.
  • Have close friends who use alcohol and/or other drugs.
  • Have been aggressive, antisocial, or hard to control from an early age.
  • Have experienced childhood abuse and/or other major traumas.
  • Have current behavioral problems and/or are failing at school.
  • Have parents who do not support them, do not communicate openly with them, and do not keep track of their behavior or whereabouts.
  • Experience ongoing hostility or rejection from parents and/or harsh, inconsistent discipline.

The more of these experiences a child has had, the greater the chances that he or she will develop problems with alcohol. Having one or more risk factors does not mean that your child definitely will develop a drinking problem. It does suggest, however, that you may need to act now to help protect your youngster from later problems.

For example, if you have not been openly communicating with your child, it will be important to develop new ways of talking and listening to each other. Or, if your child has serious behavioral difficulties, you may want to seek help from your child’s school counselor, physician, and/or a mental health professional.

FROM ELEMENTARY TO MIDDLE SCHOOL BIG CHANGES THAT COULD INCREASE YOU’RE PRETEEN'S RISK FOR DRUG USE:

WHAT PARENTS SHOULD KNOW?

Just months ago he was the master of his universe, the envy of his younger schoolmates, so confident now that he was finally at the top of the elementary school totem pole. But that was then -- this is now. Now, the same child who thought he knew it all is learning his way around a new school, mixing with older kids, facing puberty, and, most likely, confronting decisions about drug use for the first time.

The truth is when kids make the leap from elementary school to junior high, their exposure to drugs increases dramatically. Recent studies show that one in 13 sixth graders have smoked marijuana. That figure jumps to an even more alarming one in five by the seventh grade -- an increase of nearly 300 percent.

What does this mean for parents of budding teens? Many parents have had "the talk" with their children. Others have yet to discuss the dangers of drugs with their child. Do it now. As parents, you do make a difference in your child's decision about whether to use drugs. Love, trust and recurring conversations about drugs and alcohol will help your child make the right choices in his or her new school and throughout the teen years.

Here are some specific tips for parents who want to help their children stay drug-free, courtesy of the National Youth Anti-Drug Media Campaign:

  • Make clear rules for your kids and enforce them consistently.
  • Tell your kids you don't want those using drugs - ever.
  • Know where your children are at all times: who they're spending time with, how to reach them, and when they'll be home.
  • Praise their positive behavior.
  • Help your child learn ways to say no to drugs, so that when drugs are offered they'll know how to reject them.
  • Spend some quality time with each child individually at least once a week.
  • Open an ongoing dialogue about the risks of drug abuse, and the benefits of living a drug-free life.
  • Let your kids know the immediate effects of drug use, such as doing poorly in school or disappointing the family.
  • Model the behavior you want your kids to learn. Your kids pay as much attention to your actions as they do to your words. Your own drug use, including alcohol and tobacco, has an impact on your kids.

PEER PRESSURE:

Children, especially during adolescence, begin to spend a lot more time with their friends, and less time with their family. This makes them more susceptible to the influences of their peers. It is important to remember that teenage friends can have a positive influence on your children; you should therefore help them find friends that have similar interests and views as those you are trying to develop in your children, including doing well in school, having respect for others and avoiding drug use, smoking and drinking, etc.

During adolescence, children practice risk taking behaviors as they are trying to find their own identity and become more independent. This makes them very vulnerable to experimenting or becoming addicted to using drugs and drinking, especially if there is peer pressure to do so. Children who use drugs are also more likely to practice unprotected sex at an earlier age, have low self esteem, behavior problems, school performance problems, and depression.

It is very important to communicate with your child to help minimize their being susceptible to negative influences and prevent them from picking up bad habits. Teenagers whose parents talk to them regularly are at much less risk for experimenting with cigarettes, drinking and drugs.

Teach them how to avoid situations where drug use, drinking, or smokings are present and to minimize negative influences by choosing friends who also choose not to use these substances. You have a lot more positive influence over your children's choices, even when you are not physically around, then you think.

Other ways to minimize the influences of negative peer influences is to help her to have high self esteem, confidence, a sense of self worth, and to feel needed and loved by her friends and family.
A lot of the peer pressure that your adolescent children will be exposed to and be influenced by relates to external things, such as clothing and hair styles, taste in music, etc. It is not always important to insist that your child conform to your own ways of thinking, especially when it relates to these less important issues.

If your children are doing well in school, are not using drugs, drinking, or smoking and you are not having serious behavior problems, then it may be worthwhile to ignore some of these less important issues as your child tries to find her own identity. Creating power struggles over these issues are unlikely to change their attitudes and will likely create more problems.

There are other negative influences on your children, including the Internet, television, movies, video games, books, etc. You should monitor very closely what your adolescents are exposed to, to minimize the negative influences these things may have on them.

You should talk with your child if you think she is being negatively influenced by her peers to drink, smoke or experiment with drug use. Or you can set up an appointment with a medical professional with experience in dealing with adolescents with this problem. This professional can be your Pediatrician, a psychologist, counselor or someone else that your child can build a relationship with to talk about her problems.

PRETEENS AND PEER PRESSURE:

When your preteen first starts middle school they may be facing real peer pressure for the first time. Experimenting does happen at this age as these recently elementary school graduates want to fit in with the older crowd. Here are some things you can do to help your preteen be prepared for when they are asked to do something that they normally wouldn't.

BE THE FIRST TO SAY SOMETHING:

If you haven't talked to your preteen about drugs, smoking or anything else they could be facing because they haven't had to face that problem yet, TALK TO THEM! Don't avoid it until it becomes a problem, or you start to see "signs". Be proactive with your preteen.

ROLE PLAY:

Let your preteen be the one who offers you a cigarette. This will be an eye opening experience. Say no and keep saying no. When you preteen says, "I couldn't say that", ask them what they could say or do.

BEING 'RUDE' IS SOMETIMES OK:

Let them know it is ok to avoid people who are trying to get them to do something they do not want to do, even if it is an old friend.

LET THEM MAKE YOU THE SCAPE-GOAT:

Tell your preteen that there is nothing wrong with using you as an excuse. Saying, "My mom would be so mad!" to a friend who is trying to get them to smoke is a perfectly good enough excuse to get out of the situation.

BE AVAILABLE:

Be ready and available should they need to come to you with questions, thoughts on a situation, even. Even if your teen didn't make the right choices, you can help them with the next time the situation arises.

WARNING SIGNS OF TEENAGE DRUG ABUSE:

Please note that even though some of these warning signs of drug abuse may be present in your teen, it does not mean that they are definitely abusing drugs. There are other causes for some of these behaviors. Even the lifestage of adolescence is a valid reason for many of them to exist.

On the flip side of that, do not ignore the warning signs of teenage drug abuse. If six of these signs, (not all in the same category), are present for a period of time, you should talk to your teen and seek some professional help.

SIGNS IN THE HOME:

  • Loss of interest in family activities,
  • Disrespect for family rules,
  • Withdrawal from responsibilities,
  • Verbally or physically abusive,
  • Sudden increase or decrease in appetite,
  • Disappearance of valuable items or money,
  • Not coming home on time,
  • Not telling you where they are going,
  • Constant excuses for behaviour,
  • Spending a lot of time in their rooms,
  • Lies about activities,
  • Finding the following: cigarette rolling papers, pipes, roach clips, small glass vials, plastic baggies, remnants of drugs (seeds, etc).

SIGNS AT SCHOOL:

  • Sudden drop in grades,
  • Truancy,
  • Loss of interest in learning,
  • Sleeping in class,
  • Poor work performance,
  • Not doing homework,
  • Defiant of authority,
  • Poor attitude towards sports or other extracurricular activities,
  • Reduced memory and attention span,
  • Not informing you of teacher meetings, open houses, etc.

PHYSICAL AND EMOTIONAL SIGNS:

  • Changes friends,
  • Smell of alcohol or marijuana on breath or body,
  • Unexplainable mood swings and behavior,
  • Negative, argumentative, paranoid or confused, destructive, anxious,
  • Over-reacts to criticism acts rebellious,
  • Sharing few if any of their personal problems,
  • Doesn't seem as happy as they used to be,
  • Overly tired or hyperactive,
  • Drastic weight loss or gain,
  • Unhappy and depressed,
  • Cheats, steals,
  • Always needs money, or has excessive amounts of money,
  • Sloppiness in appearance.

STAYING INVOLVED IS WHAT YOU DO BEST WAY TO KEEP KIDS OFF DRUGS. TURN OFF THE TV, UNPLUG THE PHONE, TALK POLITICS, AND SHARE SOME SECRETS…
TELL THEM YOU LOVE THEM…
THEY’LL BE A LOT LESS LIKELY TO GET HIGH TODAY…
HONESTY: THE ANTI – DRUG:

Your kids ask if you ever used drugs. What do you say? You want to be honest because you love them and respect their intelligence.

It’s a very difficult question. But remember, the issue isn’t your past. The issue is their present and future. How you respond is entirely up to you (Perhaps tell them when they’re older.)
What’s important is that your kids understand that you don’t want them to use drugs.

Studies show that parents who give their kids clear rules and reward for good behavior are far more effective in keeping their kids off drugs than those who don’t.

THC IN MARIJUANA:

This where THC comes from; THC is the active ingredient in marijuana. It looks the same today as it did in 1960. The difference is how much of it is in marijuana today. Pot today is often grown hydroponically and can be genetically altered to produce more THC in each plant. The production of marijuana is a commercial industry that in many ways has created a drug much different than it was in the 1970’s.

SMOKING MARIJUANA IS HARMFUL:

The younger you are, the more harmful it is;
Research has shown that people who smoke marijuana before the age of 15 are 7 times more likely to use other drugs than people who don’t smoke marijuana. Studies also show that people who did not smoke marijuana by the time they were 21 were more likely to never smoke marijuana.


-Office of National Drug Control Policy Partnership for a Drug-Free America-

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