Is it abuse? Is it addiction?
Substance abuse or addiction is the chronic or habitual use of any chemical substance—alcohol, drugs, tobacco, prescription medication-used with the intention of altering states of body or mind for other than medically warranted purposes. This maladaptive pattern can be identified by the presence of three (or more) of the following unique behavioral patterns occurring at any time in the same 12-month period:
• The
substance is often taken in larger amounts or over a longer period than
intended;
• Persistent desire and/or unsuccessful efforts to cut down or control
substance use;
• A great deal of time is spent in activities necessary to obtain the substance
(e.g., visiting multiple doctors or driving long distances), use the substance
(e.g., chain smoking), or recover from its effects;
• Important social, occupational, or recreational activities are given up
or reduced because of time and/or energy and/or money involved in using substance;
• Continued substance use despite knowledge of having a persistent or recurrent
psychological, or physical problem that is caused or exacerbated by use of the
substance;
• Tolerance for the substance becomes defined by either:
1. Need for greater amounts of the substance in order to achieve intoxication
or desired effect; or
2. Markedly diminished effect with continued use of the same amount.
• Withdrawal from the substance is manifested by either:
1. Characteristic withdrawal syndrome for the substance; or
2. The same (or closely related) substance is taken to relieve or avoid withdrawal
symptoms. |
What Helps People Stay In Drug Rehab?
Since successful outcomes often depend upon retaining the person long
enough to gain the full benefits of treatment, strategies for keeping
an individual in the program are critical. Whether a patient stays in
rehab depends on factors associated with both the individual and the
program. Individual factors related to engagement and retention include
motivation to change drug -using behavior, degree of support from family
and friends, and whether there is pressure to stay in treatment from
the criminal justice system, child protection services, employers, or
the family. Within the rehab program, successful counselors are able
to establish a positive, therapeutic relationship with the patient. The
counselor should ensure that a treatment plan is established and followed
so that the individual knows what to expect during treatment. Medical,
psychiatric, and social services should be available.
Since some individual problems (such as serious mental illness, severe
cocaine or crack use, and criminal involvement) increase the likelihood
of a patient dropping out, intensive treatment with a range of components
may be required to retain patients who have these problems. The provider
then should ensure a transition to continuing care or "aftercare" following
the patient’s completion of formal treatment.
Source: www.4therapy.com
Effective Options for Treating Alcohol Dependence
The medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management, according to results from "Combining Medications and Behavioral Interventions for Alcoholism" (The COMBINE Study). Results from the National Institutes of Health-supported study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management (MM), an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone. Effect of Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence appears in the current issue of the Journal of the American Medical Association, Volume 295, Number 17, pages 2003-2017.
NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA) launched COMBINE in 2001 to identify the most effective current treatments and treatment combinations for alcohol dependence. The largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence, COMBINE was carried out at 11 academic sites that recruited and randomly assigned 1383 recently abstinent, alcohol-dependent patients to one of nine treatment groups (COMBINE Study Design).
Eight treatment groups received MM; four of these received naltrexone (100 milligrams a day), acamprosate (3 grams a day), both naltrexone and acamprosate, or placebo pills. The other four groups received in addition specialized alcohol counseling. Termed Combined Behavioral Intervention (CBI), the counseling integrated cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation - all treatments shown in earlier studies to be beneficial. Patients assigned to the specialized alcohol counseling could receive up to twenty 50-minute sessions in addition to medical management; the median number received was 10 sessions. To test for any effects of pill taking (placebo), the researchers assigned some patients to a ninth group that received specialized alcohol counseling, but no pills, and no more than four visits with a health professional for general medical advice.
During the 16 weeks of treatment and 1 year after the treatment, the researchers assessed the patients for the percentage of days abstinent from alcohol and time to the first heavy drinking day, defined as 4 or more drinks per day for women and 5 or more drinks per day for men. They also assessed the odds of good clinical outcome, defined as abstinence or moderate drinking without alcohol-related problems. As in other large clinical trials, the researchers found that most patients showed substantial improvement during treatment and that both the overall level of improvement and the differences between treatment groups diminished during the follow-up period. In the COMBINE study, however, naltrexone continued to show a small advantage for preventing relapse at 1 year after the end of active treatment. Specific findings from the COMBINE study are summarized at (COMBINE Findings: Highlights).
"These results demonstrate that either naltrexone or specialized alcohol counseling - with structured medical management - is an effective option for treating alcohol dependence," said Mark L. Willenbring, M.D., Director, Division of Treatment and Recovery Research, NIAAA. "Although MM is somewhat more intensive than the alcohol dependence interventions offered in most of today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus. MM's application in primary care and general mental health care settings would expand access to effective treatment dramatically, while offering patients greater choice." To expand its application, NIAAA will develop an abbreviated version of MM to be available in early summer. Print copies of the treatment manuals used in COMBINE are available by order from http://www.niaaa.nih.gov/Publications/EducationTrainingMaterials.
"The COMBINE results provide guidance for applying today's treatment tools. NIAAA continues to explore new treatment tools in more than 50 current medication trials, in studies to better understand the mechanisms of action in behavioral treatments, and in our search for new molecular targets and novel compounds for clinical testing," according to Raye Z. Litten, Ph.D., COMBINE's government director and co-leader of NIAAA medications development team.
Source: National Institute on Alcohol Abuse and Alcoholism
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One in Three Alcoholics in Recovery, Study Says
Despite a scarcity of formal addiction treatment, more than one in three people who have been dependent on alcohol in their lifetime are now in recovery, WedMD reported Jan. 19.
Researchers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) drew their conclusions from a review of data on 43,000 American adults who took part in the National Epidemiological Survey on Alcohol and Related Conditions, conducted in 2001-2002. "Many people can and do recover from alcoholism," says NIAAA director Ting-Kai Li, M.D.
NIAAA researcher Deborah Dawson and colleagues looked at survey participants who had met the criteria for alcohol dependence and found that 35.9 percent were either completely abstinent or had become "low-risk" drinkers as defined by the American Psychological Association. About 18 percent were completely abstinent.
One in four people surveyed remained dependent on alcohol, while about a third were in "partial remission," still showing signs of alcohol misuse or dependence.
Only about one in four survey participants had ever received formal treatment for their drinking, but abstainers were the most likely (49 percent) to have received treatment. Most of the study group had started drinking between the ages of 18 and 24. |
