Understanding Substance Abuse Treatment...

TREATMENT

Substance Abuse treatment is effective!

Patients who decide to stop drinking can find the treatment and support needed to quit, remain sober, and regain their lives. Like all treatments, having a full understanding of the options is important to making good, informed choices.

PHASES OF TREATMENT

There are FOUR PHASES to treatment.

Assessment and Evaluation:

Of symptoms life problems, treatment choices and plan development.

Detoxification:

Stopping use

Active treatment:

Consists of any and all of the following – Residential programs, therapeutic communities, intensive and regular outpatient treatment, medications for alcohol craving reduction, medications to discourage alcohol use, medications to treat comorbid mental health issues, 12-step programs, other self-help/mutual-help groups.

Maintaining sobriety and relapse prevention:

Ongoing outpatient treatment, 12-step programs, other self-help/mutual-help groups.

Assessment and Evaluation:

Step one is for the Alcoholic to overcome denial and distorted thinking. This is followed by the desire to begin treatment. At this point, the alcohol dependent individual must get help from someone knowledgeable and competent in the treatment of this disorder.

At this stage in the illness, some individuals have lost most control over their alcohol use they may be able to make immediate decisions only. The most basic goal is to quit drinking. You may be able to develop a detailed plan but you may also need to wait until the patient is post-detoxification.

The issues encountered with this stage center around DENIAL. This denial may be almost universal, or the individual may show some level of insight into their problem.

Your treatment plan should be developed based on the level of insight and the amount of the denial an individual exhibits. This is the point where a trained addiction specialist is absolutely necessary to assist the patient.

Detoxification

This phase of treatment involves quitting use. Sometimes called “Cold Turkey.” It can be done on an inpatient setting or in an outpatient setting. Regardless of the setting medical evaluation and treatment are very important at this stage. Many alcohol dependent individuals will develop dangerous withdrawal symptoms that need medical management in a hospital or in an outpatient setting. Simply removing the alcohol does not automatically produce positive, complete outcomes.

Medical Management of Withdrawal Symptoms

Abrupt cessation of drinking, as well as simply “cutting back” may produce a number of specific withdraw symptoms when an individual is physically dependent. These symptoms include:

Sweating                        Rapid heartbeat

Hypertension                 Tremors

Anorexia                        Insomnia

Agitation                        Anxiety

Nausea                           Vomiting.

Delirium tremens:

Is a central nervous system symptom of alcohol withdrawal that may occur in the first 96 hours of quitting alcohol. It is often seen in chronic alcoholism. Symptoms include:

Uncontrollable trembling                        Hallucinations

Severe anxiety                                         Sweating

Sudden feelings of terror.

The Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) is a symptom-triggered, 10-item scale that quantifies the risk and severity of alcohol withdrawal. This instrument can be found in Appendix A.

Often, withdrawal symptoms are treated with benzodiazepines. This class of drug reduces related anxiety, restlessness, insomnia, tremors, DT, and withdrawal seizures.

However, both short-acting and long- acting benzodiazepines have their problems. The long-acting benzodiazepines can decrease rebound symptoms and work for long periods of time, but intramuscular absorption can be very erratic. Short-acting benzodiazepines have less risk of over sedation. Yet, breakthrough symptoms can and do occur, and risk of seizure is imminent.

Patients undergoing withdrawal are generally treated with diazepam or chlordiazepoxide. If intramuscular administration is necessary, Lorazepam is the drug of choice.

Anticonvulsants are also used for safe withdrawal. The cannot be abused and there is almost no risk of seizures. Their problems can be dangerous. They do not help with the symptoms of delirium and they can have some liver toxicity.

Detoxification is only one of many steps in the treatment process, and the beginning of a lifelong process.

ACTIVE TREATMENT

The first decision for active treatment is acute hospitalization vs. inpatient detoxification. While hospitalization can be cost-effective, it is not always available..

Inpatient hospitalization is indicated for the following:

acute withdrawal symptoms                                   

failed outpatient detoxification

appears depressed                                                

unstable home situation

possibility of family disruption or job loss

If in doubt, call a physician who specialized in alcohol treatment of error on the side of caution and attempt to secure inpatient hospitalization.

This first three to six months is a period characterized by mood changes, anxiety, depression, insomnia, physiological changes and sleep problems.

This time frame is critical for sobriety. Active support is constantly necessary.

The second phase of active treatment can last for 6 months to many years. Here is where the patient gains the motivation and skills to stay sober. They are in the process of building the support systems they need in order to cope with the daily issues they avoided through their alcohol use.

During this phase, a treatment professional is very important. A professional can help them understand how alcohol has affected their life and can help them develop goals and plans to maintain sobriety.

Some proven medications are available to help with alcohol craving and to discourage alcohol use and will be discussed in detail later in this course.

This stage is where some medications and treatments are most effective. It is also the stage where other medications can be used to treat co-morbid psychiatric conditions including depression and anxiety.

All of our research indicates the longer a patient maintains sobriety, the longer they stay in treatment, the more active and involved their commitment is, the greater the chance to remain sober.

This is a time when support groups, especially AA can help achieve and maintain sobriety.

Maintaining Sobriety and relapse Prevention

The dividing line between active treatment and the maintenance phase of recovery is very blurry. Sometimes, almost impossible to establish.

During the active phase, the patient learns what is needed to stay sober and they develop skills to avoid relapsing. During the maintenance phase the person is using the skills learned to handle the curve-balls life throws at them. Many patient attribute their ongoing sobriety to support group participation. These groups range from AA to NA to Women for Sobriety.