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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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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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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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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