Outline of Treatment Approaches

Outline of Treatment Approaches

Team C

BSHS/455

Outline of Treatment Approaches

When working with an individual struggling with a substance abuse problem, the professional first assesses the client and provides a diagnosis. After these first steps, the professional and client work together to discover the type of treatment the client needs. Professionals must have knowledge of multiple treatment options to provide their clients with the option that will work best for each individual. This Outline of Treatment Approaches will provide information about five major treatment options that help reduce dependency on substances. The outline will also provide information about how treatment approaches may be modified for special populations. The approaches included in the outline are detoxification, residential treatment, intensive treatment, medication, and Outpatient Services.

I.Detoxification

A.Briefest step in the recovery process

1.Clients often need service if discontinued use of drugs or alcohol result in withdrawal symptoms

2.Some people with mild symptoms are able to detox on their own

3.The severity of the symptoms will determine the type of treatment necessary

a.Inpatient

b.Out patient

4.Medical hospital detoxification

a.Come for detoxification

b.Come in as an emergency overdose and land in the drug treatment facility

5.Medical nonhospital detoxification

a.Inpatient community-based detoxification center

b. Federal comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Hughes Act of 1970

c.Referred by

1.Police

2.Probation or parole officers,

3.Self-referred

4.Brought by a friend or relative

5.Health department staff

6.Clergy

7.Social agency personnel

d.If clients wait too long to arrive at the detox center to receive medical attention to get them through the worst withdrawal symptoms such as seizures or DT’s, they may need to be transferred to the hospital (McNeece&DiNitto, 2012)

e.More is usually done to link the client to additional services needed for recovery

f.Counseling for family members

g.Patients served in community detox programs often have limited financial resources. May charge on a sliding scale.

h.Detox occurs in a hospital or in a community program observe the patient and assess the severity of withdrawal symptoms to determine the regimen needed (McNeece&DiNitto, 2012)

i.Treatment – including the type and amount of medication, if any, will depend on if the patient’s withdrawal symptoms are mild , moderate or severe (McNeece&DiNitto, 2012)

j.When medication is not warranted respond with encouragement

k.Each drug produces different withdrawal symptoms and the length of the detox

l.Beds are in high demand, patient or outpatient treatment program, halfway house, the Salvation Army, as soon as withdrawal dangers have passed (McNeece&DiNitto, 2012)

6.Outpatient detoxification

a.An economical alternative when withdrawal can be managed at home

b.Contingent on patient social and psychological states.

B.Effectiveness of detoxification services

1.Community detox centers are very successful and much cheaper than hospitals but a longer wait to get into.

a.No medical attention

2.Mild to moderate alcohol withdrawal can be done successfully through an outpatient program

3.Small numbers of alcoholics and addicts continue in treatment following detox (McNeece&DiNitto, 2012)

Intensive Treatment

Intensive impatient care

28-30 days

When a patient is unlikely to stay alcohol or drug free in their home environment (Mcneece&DiNitto, 2012)

Locations

General hospital

Psychiatric impatient facility

Privately owned for –profit

Private non-for profit public facilities

Minnesota model

“absence oriented, comprehensive, multi-professional approach to the treatment of the addiction, based upon the principles of Alcoholics Anonymous” (Mcneece&DiNitto, pg.125, 2012)

Intensive outpatient care

Now a preferred option for single parents, those who cannot miss work, and lack of insurance will not cover inpatient services.

Four evenings a week over a 10-12 week period.

Matrix model is a longer-term intensive outpatient treatment for those on stimulant drugs (Mcneece&DiNitto, 2012).

master’s level therapist serves as primary treatment agent

First phase 6 months individual treatment

Stabilization group

Twelve-step meetings

Breath and urine testing, relapse prevention groups

Family intervention groups

And couples counseling

Second phase 6 months

Weekly support groups

12 step program

Day treatment

20 hours per week

May last longer than other forms of intensive treatment

Appropriate for clients that are not able to function at jobs or take care of families

Patients have dual diagnoses of both psychiatric disorders and drug abuse or cognitive impairments from drug abuse (Mcneece&DiNitto, 2012)

Need additional time to learn relapse prevention

Communication

Vocational

Independent living skills

For individuals waiting for residential treatment

VA hospital programs

Effectiveness of Intensive Treatment

Minnesota model has a 2/3 success rate with its patients after 1 year after treatment.

No difference is shown between inpatient and outpatient care

Hospital treatment for alcoholics produce better results than community treatments (Mcneece&DiNitto, 2012)

Patients with psychiatric, medical and social disadvantages need residential care

Medication

Disulfiram – for Alcoholism

Antabuse – approved in 1951

Neither an agonist or an antagonist

Will become violently ill if they drink

Interferes with the normal metabolism of alcohol

Symptoms

flushing

increase pulse and respirations

decreased bp

severe head ache

vomiting

confusion

heart failure

death

Patients must fully be aware of consequences before taking medication (Mcneece&DiNitto, 2012)

Once a day

Carry a card that states they take this med

Many Alcoholics have taken this medication successfully

Also an interest in using to treat cocaine dependence (Mcneece&DiNitto, pg 144, 2012)

Methadone – Heroin

Synthetic narcotic antagonist

Detoxification and long-term chemical dependency treatment for opioids (Mcneece&DiNitto, 2012)

Approved in 1972

Blocks opiate euphoric and sedating effects

Relieves cravings that leads to relapse

Relieves opiate withdrawal symptoms

Some use it for a short time before completely with drawling

Some use it indefinitely

Daily dose

Symptoms

Weight gain

Insomnia

Patients may start to use other substances and this must be addressed in treatment.

Methadone maintenance is monitored through urinalysis

The methadone clinics only provide one dose daily unless tested clean for two years then they may take 31 doses home

Buprenorphine – Opiates

Angelic drug related to morphine related to morphine but much stronger.

Approved 2002

Combines antagonist and agonist properties

Acts on the same brain receptors as the opiates but blocks the euphoric effects

Low physical dependence and a mild withdrawal syndrome

Sublingual tablets

Trade name Saboxone

Naltrexone, Acamprosate and Nalmefene – opioids

Reverse the effects of opioids

May also help alcoholics and those dependent on cocaine

Blocks opioid receptors and makes it less pleasurable

Approved in 2004

Reduces withdrawal symptoms

III. Residential Treatment

1.Residential treatment facilities are shared living environments intended to increase an individual’s likeliness to remain sober during the beginning of the recovery process (McNeece&DiNitto, 2012). Examples of residential treatment facilities include halfway houses, missions, shelters, therapeutic environments, and domiciliary (McNeece et al, 2012).

2. There are several factors that must be considered when recommending residential treatment. These factors include, loneliness, the type of addiction and homelessness.

3. Residential facilities often have specific rules that individuals must follow to remain in the facility. For example, halfway houses not only require individuals to maintain their sobriety, but often times residents must also abide by a curfew.

4. Therapeutic environments carefully monitor residents on a regular basis. This helps the facility to maintain the attitude, conduct, emotions and values of the residents.

5. A domiciliary program assists individuals severe mental and physical problems stemming from drug and alcohol abuse.

6. Shelters and mission help by providing religious programs that help and encourage individuals (McNeece et al, 2012).

7. Professionals must consider the client’s ability to maintain rules when recommending a residential treatment program.

8. Different considerations may also be taken for special populations. For example, how comfortable a certain individual will be in a facility. It may be easier for them to be in a facility that caters to their personal and cultural beliefs.

IV. Outpatient Services

Outpatient Detoxification

Manages withdrawal from alcohol or drug addiction.

Offered in chemical dependency treatment or doctors’ offices.

Services provided are counseling, alcohol and drug education, and referral services.

Intensive Outpatient Care

For individuals who are chemically dependent and unable to afford intensive inpatient care.

Individuals with short term treatment needs receive services over a number of weeks, a few days a week, and at least an hour each day.

Individuals with long term treatment will receive services in 2 different phases for a number of 6 months each.

Services provided are individual treatment, breath and urine testing, twelve step meetings, relapse prevention groups, and weekly support groups.

In conclusion, each of these treatment approaches are very important and help service clients in the best way possible. After assessing the client and identifying the diagnoses, the client and the professional work together to find ways to overcome the situation that they are in. We identified and explained five different treatment approaches as to which a professional could use when working with an individual dealing with substance abuse.

Reference

McNeece, C. A., &DiNitto, D. M. (2012). Chemical dependency: A systems approach (4th ed.).

Boston, MA: Pearson.