Drug rehabilitation :

Drug rehabilitation (often drug rehab or just rehab) is a term for the processes of medical and/or psycho therapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. Psychological dependency: Types of treatment: Pharmacotherapies: Criminal justice: Diseased person model: Counseling: Disease model and twelve-step programs: Client-centered approaches: Psychoanalytic approaches: Cognitive models of addiction recovery (Relapse prevention) Cognitive therapy of substance abuse: Emotion...

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Cognitive therapy of substance abuse

An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors....

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Cognitive models of addiction recovery (Relapse prevention)

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive  effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged...

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Psychoanalytic approaches

Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also offered an explanation of substance abuse. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesised specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which...

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Client-centered approaches

In his influential book, Client-Centered Therapy, in which he presented the client-centered approach  to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the therapeutic relationship could help an individual overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the two-factor theory to be...

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Disease model and twelve-step programs

The disease model of addiction  has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally...

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Counseling

Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Counselors help individuals identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it's more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. They are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It's very common to see them work also with family members who are affected by the addictions of the individual, or in a community in order to prevent addiction...

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Diseased person model

Some psychotherapists  question the validity of the "diseased person" model used within the drug rehabilitation environment. Instead, they state the individual person is entirely capable of rejecting previous behaviors. Further, they contend the use of the disease model of addiction  simply perpetuates the addicts' feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that could be resolved if the addict were to approach addiction as behavior that is no longer productive, the same as childhood tantru...

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Criminal justice

Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous  meetings. There are a number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U. S. Constitution, mandating separation of church and sta...

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Pharmacotherapies

Certain opioid medications such as methadone and more recently buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine  is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine.  Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new...

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Types of treatment

Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs. In a survey of treatment providers from three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring the treatment provider's responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics AA identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the...

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Psychological dependency

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.") Whether moderation is achievable by those with a history of abuse remains a controversial...

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Emotion regulation, mindfulness, and substance abuse

A growing literature is demonstrating the importance of emotion regulation  in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways,  an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused on negative reinforcement  as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. Currently, research is being conducted to determine the efficacy of mindfulness ...

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