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.

***************************************************