About 4 million people a year get treatment in the US
That's only 1 out of every 5 who need it
Among those who get help, only half receive it from a licensed or certified facility
Treatment is cost-effective
For every $1 spent on treatment, costs associated with crime decrease by $4-$7
If you add in healthcare-related costs, we gain $12 for every $1 spent on treatment
Effective treatments
Recognize that many users are polydrug users
Recognize that there are often underlying mental health issues that need to be addressed
Known as dual-diagnosis patients , who often self-medicate
the Biopsychosocial Model
A perspective on treatment that recognizes the underlying biological, physiological, and social factors that contribute to drug use, and that encourages an integrated approach in designing individualized treatments
Recognizes that there are multiple pathw
Effective treatments
While there are some substance-specific treatment options (e.g. Antabuse for alcohol), many approaches can be generalized to multiple substances
Makes sense since we know there are common neurochemical mechanisms at play
E.g. naltrexone can treat both opi
Treatment history
Historically, substance abuse has been viewed through a punitive perspective in which incarceration was the only "treatment." It was believed that this was necessary in order to:
Protect society
Reduce the likelihood that individuals would use substances
drug trafficking
Unauthorized manufacture, distribution by sale or gift, or possession (With intent to distribute) or any controlled substance
Current law enforcement
The 1970 Drug Abuse Prevention and Control Act not only classified drugs into schedules based on risk of abuse and reduce access, but also established criminal penalties
Focuses on both possession and drug trafficking
Law sets specific minimum and maximum
Until the 2010 fair sentencing act
, the ratio of powder cocaine to crack cocaine that would lead to equivalent sentencing was 100:!. Today it is 18:1
Current law enforcement 2
Penalties for simple possession of small amounts are lower, regardless of type of drug
First offense: Maximum of 1 year in prison and a fine of $1000-$5000
Second offense: Minimum of 15 days to maximum of 2 years in prison; fine up to $10,000
Notably, mos
Current law enforcement 3
Strict drug laws have resulted in an overpopulated, overwhelmed prison population in the US
More than half (51%) of all prisoners in federal jails are there for drug offenses
Most (82%) were there for possession
Current law enforcement 4
Prison-alternative treatment programs offer an alternative to incarceration
Mandate supervised treatment in lieu of jail time
CA and AZ require drug court alternatives be offered for first 2 offenses
In AZ, shown to be highly effective, with 75% of those
Drug courts
More than 3,000 currently operate in all 50 states
Handle nonviolent drug offenders with no previous felonies
Require mandatory, supervised treatment in lieu of jail time
Treatment programs last at least a year
Include probation, drug testing, treatment,
Prison-based treatment programs
Estimated that half of all prisoners meet the criteria for substance use disorders
Fewer than 20% get treatment
Those who do often lose services once released, a time when the risk of relapse is especially high
Face stigma, housing issues, lack of employm
Individual treatment options
The decision to seek treatment often follows an acute crisis
Risk of job loss, relationship dissolution, overdose of self or friend, arrest, etc.
Most enter with a great deal of fear, embarrassment, and/or denial
Three goals of treatment
To repair the physical and psychosocial damage that's been caused by substance use
To stop the use of all psychoactive substances
To rebuild or create from scratch a lifestyle that is substance-free
Stages of change
Pre completion stage
contemplation stage
preparation stage
action stage
maintenance stage
Stages are not always linear...more often a loop with many cycles
Precontemplation stage
individual may want to change, but either lacks serious intention to do so in the foreseeable future or is unaware of how serious the problem has become
Abuser still feels committed to the positive aspects of substance use
Goal is to change that
Contemplation stage
individual is aware that a problem exists and is thinking about overcoming it, but hasn't yet made a commitment to take action
Struggle with the amount of effort sobriety would take
Goal is to increase awareness of the negative aspects of substance use, t
Preparation stage
when an individual who has not taken action to change in past year seriously considers taking action to change within the next 30 days
May set a "quite date" or a date to enter a treatment facility
Counselors can work with these individuals to assist in p
Action stage
when an individual actually modifies behavior and the environment in an effort to overcome the problem
Drug use has stopped, but the risk of relapse is high
Counselors should reinforce abstinence even if there is a relapse
Important to let the abuser know
Maintenance stage
occurs after maintaining sobriety for at least 6 months, and when new skills have been developed to reduce the possibility of relapse
Important to acknowledge success while reinforcing the message that SUDs are a life-long disorder
Stage continues indefin
Denial
helps family avoid feelings of shame, guilt. Often rationalize that their family is no different than others. May look outside of family for assurance that nothing is abnormal.
Anger
strategy for avoiding blame, avoiding other family members. The abuser may cause fights to get out of the house where he/she is able to use more easily
Bargaining
often follows a crisis... denial no longer possible. Family members make bargains about what they'll do if the substance use stops; abusers may bargain to continue use
Feeling
pervasive anxiety and obsessiveness toward the situation occur when earlier reactions no longer work. Family members may cry easily or enter a deep depression or stte of anxiety.
Acceptance
occurs after other strategies don't work and family is forced to seek help. The family recognizes that they have a problem and takes steps to fix it. This is when contemplation and preparation for change begin
Enabling behaviors
Family members try to cushion the consequences of substance abuse by taking on responsibilities themselves, thus enabling the abuse to continue. Takes several forms:
Avoiding and shielding
make excuses to avoid social situations or to avoid going home
Attempting to control
try to stop the use from occurring. (e.g., by throwing out substances, threatening to hurt themselves if the use continues)
Taking over responsibilities:
may ensure the abuser gets to work, take another job to pay bills, etc.
Rationalizing and accepting
may claim that things aren't really so bad or that substance abuse is necessary or even positive
Cooperation and collaborating
may assist in making drinks, preparing drugs; giving the abuser money to get drugs, etc.
Chief enabler
often a spouse or eldest child who performs the tasks of the enabler.
Family hero
child who tries to compensate for family dysfunction by personal achievement. The model child who is successful but often feels like a fraud who doesn't deserve success or happiness
Family scapegoat
tries to divert attention away from the substance use by engaging in antisocial behavior
The lost child
child who disengages with the family, becomes emotionally and physically disconnected in an effort to avoid the pain and suffering within the family
Family mascot
tries to divert attention away from the problem through humor and self-disparaging behavior.
Families and treatment
All of these things make it difficult for families to seek treatment, but family support is a large part of the recovery process
Important to stress to family members that they are not responsible for the substance abuse itself or whether the abuser seeks
3 general treatment recommendations
Outpatient treatment is preferable because less expensive and teaches the user to remain sober in the real world
Inpatient should be considered if: 1) outpatient treatment has failed; 2) medical or psychiatric problems necessitate hospitalization; 3) near
NIDA's Principles to maximize treatment success
Substance abuse is a treatable disease that alters the brain's structure and function. Thus, relapse is possible even after long periods of sobriety.
No single treatment works best for every individual. Finding the right treatment can be difficult; doing
Nida's Principles to maximize treatment success 2
Effective treatment attends to multiple needs of the individual, not just substance use. Medical, psychological, social, vocational, legal problems must be treated as well
Treatment length must be adequate (at least 3 months, preferably 6-12+)
Individual
NIDA's Principles to maximize treatment success 3
Treatment and service plans should be continually assessed and modified when necessary
Many substance-abuse problems are accompanied by ongoing mental health disorders. Effective treatment must address comorbidity
Medically-assisted detoxification is only
NIDA's Principles to maximize treatment success 4
Treatment does not need to be voluntary to be effective; sanctions or enticements from family, employers, or the criminal justice system can increase success rates
Drug use treatment must be monitored continuously, as lapses during treatment do occur. Mon
Needing versus receiving treatment
According to U.S. government estimates, more than 7 million people, aged twelve or older, needed treatment for an illicit drug problem; approximately 17 million people needed treatment for an alcohol problem.
Only a small fraction of the people in need, h