Promising new medical treatment options for drug addiction!!!

October 17th, 2011

Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.

• These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
  
• By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.

What else is new aside from medications?

There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!

Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.

I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…

I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.

citations:
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2) A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.

Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?

Posted in:  Drugs, Drugs, Education, Medications, Treatment Tags: Buprenorphine, cocaine, contingency management, drug treatment, Drugs, heroin, medical treatment, medication, residential treatment

Addiction treatment in Vietnam – Beatings and forced labor

September 8th, 2011

You’ll never think of Cashews in the same way after reading the first few pages of this recent report by the Human Rights Watch group that looked into the abuses in Vietnamese “drug treatment” centers.

The detainees in these facilities, whether they checked themselves in voluntarily or were committed after being arrested for using or possessing drugs, describe terrible conditions, hard forced labor, and extensions to sentences that make their experience seem much more like jail than any form of drug treatment. Indeed the report states that “no one who had been detained described any form of scientifically or medically appropriate drug dependency treatment within a center. Psychosocial counseling involved lectures on the evils of drug use and morning exercises while chanting slogans such as ‘Healthy! Healthy! Healthy!’ .”

It should be pretty obvious that relapse rates are extremely high since, as we’ve talked about numerous times here on A3, at least part of addiction involves compulsive behavior affected by biology and early experiences and therefore punishment alone will simply not work for true addicts… And still we put all of our addicts in jails and prisons with little actual drug treatment in our own country – I guess at least we don’t have forced labor.

Read this thing  by the Human Rights Watch group – it’ll leave you just a little speechless.

Posted in:  Education, Treatment Tags: addicts, drug, drug treatment, forced, forced labor, human rights, human rights watch, treatment, treatments, vietnam, vietnamese

Family Addiction – A Tough Nut to Crack

August 3rd, 2011

Guest author – Lisa Fredriksen from breakingthecycles.com:

I was 49 years old when one of my loved ones entered a residential alcohol treatment program and I found myself plunged into a whole other world – a world that included terms and concepts like codependency, adult children of alcoholics, 12-step programs, co-addictions, dual diagnosis and the role a family member has in the denial that protects a loved one’s drinking. The family addiction world was a world I found confusing and overwhelming as I learned just how many of my loved ones had an alcohol problem and what that had meant in my life.

True to my nature, I began my quest for deeper understanding in the same way I’d approached my six other published nonfiction books and numerous articles. I immersed myself in research, intent on learning as much as I could about the subject – in this case alcoholism and treatment programs – and then all of the other issues that emerged as I tried to understand why a loved one drinks too much and why someone like myself puts up with it for so long. I started attending Al- Anon meetings, doubled my individual therapy sessions and attended family-help group sessions at the treatment center, as well.

My book, If You Loved Me, You’d Stop! What You Really Need To Know When A Loved One Drinks Too Much, and my blog, www.breakingthecycles.com, are the culmination and continuation of my discoveries. I hope that by sharing what I have learned, others – whether a parent, friend, sibling, spouse or child – will find the tools they need to live their lives.

I share this information because I wish I had known it, that it had been openly and freely talked about, long before I’d spent decades grappling with my various loved ones’ drinking. I try keep my shares (including my book) very short and simple. I know, myself, that when I first started looking for information, I was frustrated with the variety and depth of the books and research on what I was striving to understand – excessive drinking (alcohol abuse), alcoholism, co-addictions, adult children of alcoholics, codependency, dual diagnosis, how to help the alcoholic stop drinking, how to heal the family, how to talk to your children, family in recovery – and the list went on and on.

For now, I’d like to leave you with my top key discoveries:

1. Alcoholism is one of the diseases of addiction – a chronic relapsing disease. Check out www.hbo.com/addiction for a wealth of information. It’s produced by HBO, NIAAA, NIDA and The Robert Wood Johnson Foundation.
2. To begin treating addiction, the substance of abuse must be stopped in its entirety in order to allow the structural and chemical changes in the brain to change and recover.

These first two discoveries freed me from my continued efforts to try control my loved ones’ drinking and thus stop my nagging, raging, deal-making and shaming – the behaviors I’d been using in order to “help” them stop [hence the title of my book, If You Loved Me, You'd Stop!...]. They also allowed me to respect the person but hate the disease and know that until that person came to grips with the power of addiction, they would/will continue to drink, no matter how hard they try to control their drinking.

3. Other family members need help, too, in order to change some of the behaviors they’ve adopted in order to survive but that are actually getting in the way of their living healthy, happy, fulfilling lives, regardless of whether their loved one stops drinking or not.
4. Alcoholism is a young person’s disease. Due to brain imaging technologies of the past fifteen years or so, neuroscientists have been studying how the brain develops. According to NIAAA, half of alcoholics were addicted by age 21 and two-thirds were addicted by age 25. Click here to better understand why.
5. Having a dual diagnoses (a mental illness, such as depression, bipolar, ADHD or PTSD) and an addiction (to alcohol or drugs) is common. Click here for information.

Posted in:  Drugs, Education, Opinions, Treatment Tags: 12 step, addiction, alcoholism, codependency, dual-diagnosis, family addiction, NIAAA, NIDA, residential, young

Antisocial personality disorder – Drug policy and court mandated addiction treatment

June 13th, 2011

A recent study conducted by a group at the University of Maryland found that court-mandated addiction treatment is especially helpful for those with Antisocial personality disorder (ASPD).

Using 236 men, it was found the overall success for participants without ASPD was high (85%) whether the treatment was court mandated or not. However, for those with ASPD, a whopping 94% remained in court-mandated treatment, though only 63% stayed in voluntary programs!

ASPD is relatively rare in the general population, but it’s estimated that its prevalence is relatively high (some estimate the prevalence as high as 50%) among addicts in drug treatment programs. I personally doubt that ASPD prevalence is that high even among treated addicts but it is certainly higher.

The Maryland team’s findings have two important implications for substance abusers with ASPD that should be noted:

1. Judicial mandates offer a way to keep them in addiction treatment programs.
2. Voluntary participants may require special interventions to keep them actively engaged in therapy.

Recently, a colleague shared with me some great insight about research into the effectiveness of mandated treatment: Mandated treatment can be effective if implemented well, which may sound simple but isn’t within a system that is used to putting down prisoners and not building them up. However, without aftercare, even the best mandated treatment loses its impact quickly. When it comes to aftercare, when trying to determine the best form of it (outpatient, residential , intensive, medical, etc.) the best thing to do is to ask the released client – if the match between the client’s desires and the treatment provided is high, the results are significantly better.

Citation:

The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout. Journal of Substance Abuse Treatment 34(2):157-164, 2008

Posted in:  Drugs, Education, For others, Tips, Treatment Tags: abuse treatment, antisocial, antisocial personality, antisocial personality disorder, ASPD, court, court mandated, drug policy, jail, mandated, mandated treatment, substance abuse treatment, treatment, Treatment

Convincing yourself to quit smoking – The influence of personal beliefs on smoking

June 5th, 2011

A study published in Addictive Behaviors showed that thinking actively about quitting smoking cigarettes allows people to smoke less!!!

In the experiment, participants from one group of smokers were asked to think about reasons to quit smoking and write them down on a piece of paper. Participants from a second group of smokers were asked to read pre-written anti-smoking arguments.

Both groups of participants were then asked to wait up to 30 minutes while the experimenter prepared a task unrelated to the actual experiment. Individuals who generated their own arguments against smoking abstained from smoking cigarettes longer than those who read pre-written anti-smoking arguments.

The results of this experiment suggest that self-generated information has a greater influence on smoking behavior (at least in the short-term) than information that is simply read.

Many anti-smoking campaigns try to “educate” people out of smoking cigarettes. They provide a great deal of information on the potential health hazards of smoking and try to convince smokers to quit. This approach can be dangerous as smokers might feel as though they are being attacked and react defensively. The truth is, many smokers already understand the consequences of tobacco use. If anti-smoking campaigns could find a way to develop personal beliefs against smoking, smokers might have an easier time not lighting up.

Citation:

Müller, B., van Baaren, R.B., Ritter, S.M. (2009) Tell me why…the influence of self-involvement on short term smoking behavior, Addictive Behaviors, 34(5)

Posted in:  Drugs, Education, Tips, Treatment Tags: abstain, addictive behaviors, anti, anti smoking arguments, anti smoking campaigns, anti-smoking, beliefs, cigarettes, feelings, group smokers, on smoking, quit smoking, quitting, smokers, smoking, smoking cigarettes

Two Million Dollars a piece – The cost of drug use and violence

May 25th, 2011

The average cost to society of a lifelong criminal = About $2 million

I’ll get into more of this in later posts (I already talked about the cost of addiction prevention versus treatment versus enforcement), but if that cost of drug use and violence doesn’t cry out for a better application of money to prevention and addiction treatment, I don’t know what does.

At that cost, even if a treatment method costs $10k per client, it only needs to work for 1 out of 200 people to break even, and benefit society while doing so. In reality, our success rates are much higher than .5% (1/200) and closer to 15%-25%. When you take into account the fact that average cost of a month in addiction treatment (residential, outpatient treatment is much cheaper) is indeed about $7000-$10,000, it seems silly not to avoid the cost of crime by greatly reducing drug use, and hence criminal behavior.

NIDA, the government’s top agency for drug and alcohol abuse research recommends three months of treatment, but even then, success rates as low as 2% would leave us with a profit by providing treatment. Screw it, even a whole year of treatment would save us money if it succeeded but I can tell you that funding for that kind of addiction treatment length is almost non-existent, especially when compared to the actual need.

So with success rates about 20 to 30 times higher than our break-even point, we would literally benefit, and I’m talking financially, from helping people with treatment as expensive as $100,000 or more (as long as it worked). One of the things I’ve learned in all my work has been that while some individuals are actually interested in helping people, yes, even if they’ve been dirty drug addicts who have commited crimes, almost everyone cares about money. So forget for a second about all the social justice arguments to be made for helping addicts and think about the cost savings to our society… It makes sense.

True, true, not all drug users who would enter treatment would become lifelong offender, but if you’re still keeping tabs, even if only 1/20 or so do, we’re more than breaking even here. In fact, with our prison populations exploding as more and more drug users enter the system, I bet we’re in for some real savings.

Citation:

Dodge, K. A. (2008) Framing public policy and prevention of chronic violence in American youths. America Psychologist, 63, 573-590.

Posted in:  Education, Opinions, Treatment Tags: addiction, average cost, cost, criminal, drug, drug use, enforcement, helping, helping people, million, money, policy, prevention, success rates, treatment, violence

Rehabing Rehab – How we can fix America’s addiction treatment system

April 3rd, 2011

When Charlie Sheen finally entered rehab, it wasn’t terribly shocking news. But what most people did find surprising was that instead of checking into a swanky Malibu addiction treatment center as he has done in the past, Sheen opted to receive in-home rehab. Immediately the media began criticizing his choice and questioning his commitment to getting sober.

There are undoubtedly certain challenges related to in-home rehab, but are you really guaranteed better care if you check into a treatment center?

Absolutely not, thanks to the lack of standardization in our current rehab system.

Seeking addiction treatment in The U.S.

Each year, about three million Americans seek help from a seemingly endless list of addiction treatment facilities. But who is ensuring these treatment centers are qualified to effectively treat them?

With a lax application process for state licensure and certification, there is little accountability placed on facilities, or their ownership, to ensure proper treatment is being offered. With more than 12,000 rehab centers in the country, the odds of finding the one that best fits your needs are next to impossible.

When treatment fails, which it often does, it is then assumed to be the addict who failed, when in reality it was often the addict who was failed by a flawed system.

This leads to a vicious cycle of relapse — a story all too familiar to families struggling with addiction, not to mention one we’ve seen repeatedly played out by Hollywood stars.

It is true that some don’t take advantage of their treatment and fail at sobriety on their own, but others simply weren’t given a chance to succeed.

The whole story is made worse by the fact that most rehab clinics market themselves as “all inclusive” — able to treat any type of addiction disorder — which most are certainly not. Addicts and their families are often so desperate to get help that they select a rehab clinic based on cost and availability, without understanding whether or not the care providers are properly certified in the type of addiction that affects them or are qualified to fulfill any additional needs they might have (including mental health needs).

This is especially true of first-timers (over 60 percent of those seeking addiction treatment are doing so for the first time). They don’t know what questions to ask or even what they are looking for out of a treatment center, making it nearly impossible to find the right option for their individual needs.

How to set standards for addiction treatment

We need to try and get some measure of standardization into the addiction treatment system so that we are able to match those looking for treatment with providers that fit their needs. Currently, there is essentially no oversight regarding the services addiction treatment providers report and their actual capabilities for providing those services.

In the place of a centralized federal or state-level vetting system, there are some private groups that provide directories. But it is not easy to tell how well these directories actually vet the treatment centers listed. It is critical for treatment candidates to know exactly what type of credentialed treatment services are provided. This should be provided by the public health departments, but until that happens, it’s basically “every man for himself.” (Here All About Addiction, we recently launched our own “rehab finder,” to provide a vetting system we think can help.)

We believe this is a crucial element for successful treatment; especially when you consider that more than 50 percent of addicts suffer from mental health issues, meaning they need special care by a trained professional. And while some may promise this, there is no verification process to ensure they are able to deliver on their promise.

In fact, a huge survey of the addiction treatment industry found that more than 20 percent of addicts entering treatment were missing crucial mental health services that they needed. (About 50 percent were missing other necessary medical services.)

Rehab is a business — a booming one, at that — and right now it is too easy to sell the idea of recovery. Because there is no model of care to follow, the system is compromised with clinics that don’t know how to do things better, some that limit their treatment due to dogma and other centers that are actually trying to “game” the system.

The bottom line is, without some level of standardization, treatment becomes nothing more than a crapshoot. You are left at the mercy of a broken system and never know what kind of treatment you are going to receive until it is too late.

Right now, you could easily check into rehab facility and find they offer nothing more than an expensive 12-step program. This is unacceptable. We have tools, like cognitive behavioral therapy and motivational enhancement therapy, which we know are effective, we just need to ensure they are part of the treatment model being offered to patients.

Add to that some very effective, if poorly utilized, medications and it’s clear we’re handicapping our patients, pun and all.

However, there is hope, and a better way of doing things, but it will require us to adopt a more progressive model of treatment.

Our society has too readily accepted the supposed “fact” that recidivism rates are high, and will always be high, for addicts. The fact of the matter is that the treatment process itself is deeply flawed and until we fix the model of care for recovering addicts, we will never be able to truthfully tell how many of them can recover. Addiction isn’t a death sentence. It is a treatable disease; we need to acknowledge that the way we are doing things doesn’t work and do something to change it.

After many years of trial and error, researchers and doctors have finally begun to grasp what works and what doesn’t in terms of treating addiction.

It is now our job and our responsibility to start developing a system that gets the proper treatment to the people who need it.

Any doctor will tell you, there are no guarantees with addiction. All we can do is give people the best shot at treatment, and sadly, right now, our system is failing at that.

Posted in:  Education, Treatment Tags: addiction, addicts, mental health, rehab, seeking addiction treatment, treatment, treatment center