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Posts Tagged ‘rehab’

The best addiction treatment option

May 5th, 2012

I get asked which addiction treatment option is the best all the time. The short answer? Whichever one ends up working for the client.

I don’t like being stuck in the corner, having to pick a “best of” option just because I’m asked. For some clients Moderation Management will work, others need intense day-treatment or an in-hospital residential treatment program before moving into a more traditional residential place for a year or more. Some clients feel suffocated by such a structured environment and can’t manage it – outpatient treatment options can be a better fit there.

Sometimes we ask ourselves questions in a way that forces us to make bad choices: Which is better, chocolate or vanilla ice-cream? I reject the premise.

It’s about time we all faced the fact that only rare occasions allow for two-word answers that are absolutely true. The world is full of nuance and if we don’t start allowing some gray into our conceptualization of questions and answers we are going to keep repeating the past mistakes of polarized opposition to a small number of camps that are all equally wrong.

Brain research supports the notion that they way in which questions are posed can affect the sort of answers we look for – our brain pays attention to the stimuli it expects to find. So if you think that all you have to pick from are two or three options, your brain will calculate costs and benefits and spit out an answer – 42. It’s what happens when you ask the wrong question – you get a nonsensical answer.

So I don’t answer question like “which treatment is best?” or “which is more important, biology, the environment, or personality?” The way I see it the pieces are all so interconnected that the separation is false. The question is moot. And that’s true whether you’re picking addiction treatment or a your favorite cone.


Posted in:  Education
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Treating alcohol withdrawal with benzodiazepines – Safe if mindful

February 27th, 2012

Alcohol withdrawal can lead to some pretty horrible side effects

Contributing co-author: Andrew Chen

Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.

Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.

Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.

The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)

The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).

Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.

In short

Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.

Citations:

1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115

2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87


Posted in:  Alcohol, Education, For addicts, For others, Medications, Tips, Treatment
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New drug testing technology? Cocaine and saliva

October 30th, 2011

A recent development (check it out here) might lead the way to a quicker, more easily administered drug test. Instead of the lab analysis of urine, blood, or other fluids, this recent technology might allow first responders, such as EMTs, to assess a person’s exposure to drugs (prescription and otherwise) by simply dipping this device (think pregnancy test) into their saliva.

As of right now, the researchers have been able to demonstrate the success of the technology with cocaine, but it shouldn’t be too long before they can provide similar devices for many different drugs.

Now, it’s true that I usually focus on abused drugs in this blog, but this technology could help medical professionals identify dangerous drug interactions common to many prescribed, properly taken, medications. Given the huge increases in prescription medication abuse in the United States, that could be extremely useful and might save some of the 12,000 lives annually lost to accidental overdoses.

Maybe when these devices get cheap enough they can be used in addiction treatment centers to provide more immediate testing results.

Who knows, one day, the technology might be widespread enough to make home drug-testing a simple reality. Whether that’s a good or bad thing should probably be left to another post…


Posted in:  Education
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Addiction stories: Hellish Heroin – Bambi’s heroin addiction story

May 14th, 2011

Opiate Addiction can be a horrible thing whether it's to heroin, hydrocodone, oxycontin, or any one of a number of available opiates. This is only the first in a series of addiction stories we will have on the site.Addiction stories seem to have an impact that objective research can never have. This is another in a series of addiction stories submitted by our readers. I hope that everyone will benefit from learning about others’ experiences. There’s no doubt that Bambi’s experience of escalation in use from what seemed initially innocent is a common one. If you, or someone you know, needs help with their opiate addiction, try our rehab-finder for the best way to get reliable, verified, rehab recommendations.

A harrowing tale of heroin addiction:

When most people hear the word heroin, some things come to mind. Those of you who have never even thought of doing a drug like heroin, would never understand. And for those of you who you know who you are, whether you have found your way out, or are slowly still slipping away… Believe me, if you know who you are, then you know how it is. Realizing you’re addicted to something doesn’t hit you, until you mentally find your way out by accepting what has happened and letting go with only one hell of a memory. Read the rest of this entry »


Posted in:  Addiction Stories, Drugs, Opiates
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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
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Don’t walk this road alone – Tips for those still struggling

February 14th, 2011

Trying to quit an addiction can be challenging for many reasons. One of the biggest problems, especially at first, is the faulty learning that has taken place while using (or engaging in addictive behavior). For this reason, finding a long term residential addiction treatment option is ideal for people with severe and long addiction problems. And yet, for many, this solution is simply impractical.

If you can’t remove yourself from your everyday life for long enough to change your now addictive patterns, make sure to enlist the help of others around you.

Be honest with people who are close to you and are not using (at least not abusively) and ask them if they’d be willing to act as de-facto chaperons (or sober buddies). I’ve talked about it on here before, but if you’re anything like me, your addiction permeates your life. Make sure that you have planned activities that fill up your free time with those who are willing to help you. Read my treatment-related posts for specific ideas on things to fill up your time with (exercise, reading, gardening, etc.).

While you may have forgotten what going to the movies when not stoned feels like, trust me, it all comes back in time. Just make sure you have someone there to help you along the way in the beginning…

Like so much else, the biggest first step is asking for that help. Once that’s done, so much of the rest gets easier!


Posted in:  Education, For addicts, Tips
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About Alfred Adler – One psychoanalytic view of alcohol and drug addiction

November 16th, 2010

In a previous post (see A Million Ways to Treat an Addict) I had mentioned that there are many ways to approach the treatment of addiction to drugs and alcohol. I mentioned methods such as cognitive behavioral therapy (CBT), motivational interviewing (MI), and a growing number of medications (like Vivitrol) and possibly some preventative measures (like an upcoming nicotine vaccine). The reason its important to know about the options for addiction treatment is that even if one treatment doesn’t work, there’s nothing to indicate that another will not and I believe that it’s the duty of those who treat alcohol and drug addiction to be aware, and make use, of multiple therapies to give their clients the best chance at treatment success. However, even within specific categories of treatment methods, like psychoanalysis, there are several schools that approach the individual problem differently.Here I think that an individual therapist’s discretion is the best tool we have in terms of therapy selection, at least for now.

Alfred Adler and addiction

While he was part of the group that started the school of psychoanalysis along with Sigmund Freud, Alfred Adler had his own ideas about psychology. I’ll let you read more about the man and his history on your own time, but I want to point out his emphasis on family structure, dynamic, rank, and power structure as a main source for later psychopathology.

adlerHis concept of ‘inferiority complex‘ is one that is especially familiar to addicts. Feeling somehow incompetent, many addicts compensate by attempting to prove their worth at every possible chance. The overcompensation can make them seem cold, competitive, and insensitive. This often alienates them more, straining relationships and making them withdraw further. This is at least one of the reasons for the necessity of ‘drug buddies’ or ‘using friends’ to make up for the loss of many other social relationships.

Adler stressed equality as important for the prevention of pathology. Adlerian therapy establishes equality from the start with a therapist-client relationship that is collaborative rather than one in which the therapist is a teacher or master. Some clients will find this method more suitable, while other will need a more confrontational therapy, which we will address soon.

Overall, Adler’s approach seems very much in line with motivational interviewing methods whereby the therapist and client move together to find appropriate solutions that come from the client’s own resolution of ambiguity and indecision. I personally believe that such non-confrontational methods are important for many clients as they avoid the accusations, finger pointing, and blaming that normally goes along with trying to direct addicts to treatment. Still, there are many options out there, and being aware of what is available allows clients, and their loved ones, find the right treatment and produce much better choices.

Drug, alcohol, and other addiction help from All About Addiction

If you need help finding treatment for your own, or a loved one’s sex addiction, make sure to give our Rehab-Finder a try: It’s the only evidence-based, scientifically created, tool for finding rehab anywhere in the United States!


Posted in:  Education, For addicts, For others, Tips, Treatment
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