Domestic Relapse Case Study

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Domestic Relapse Case Study



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Many programs emphasize that recovery is an ongoing 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 misuse remains a controversial point. The brain's chemical structure is impacted by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process. Some rehab centers offer age- and gender-specific programs.

Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like methadone and buprenorphine can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs.

Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use. Research has shown that most patients need at least three months of treatment and longer durations are associated with better outcomes. It affects people from all walks of life and can be a devastatingly destructive force.. Certain opioid medications such as methadone and more buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone.

Methadone and buprenorphine are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use , and the risks associated with it, such as disease, arrest, incarceration , and death, in line with the philosophy of harm reduction. Both drugs may be used as maintenance medications taken for an indefinite period of time , or used as detoxification aids.

According to the National Institute on Drug Abuse NIDA , patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and Hepatitis C by stopping or reducing injection drug use and drug-related high risk sexual behavior. Naltrexone is a long-acting opioid antagonist with few side effects. It is usually prescribed in outpatient medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Ibogaine is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine.

To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome. The drug is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered tend to have little oversight and range from motel rooms to one moderately-sized rehabilitation center.

These medications include bupropion and nortriptyline. Acamprosate , disulfiram and topiramate a novel anticonvulsant sulphonated sugar are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them to maintain abstinence for several weeks, even months. It is more effective for patients with high motivation and some addicts use it only for high-risk situations. Nitrous oxide , also sometimes known as laughing gas, is a legally available gas used for anesthesia during certain dental and surgical procedures, in food preparation, and for the fueling of rocket and racing engines. People who use substances also sometimes use the gas as an inhalant.

Like all other inhalants, it is popular because it provides consciousness-altering effects while allowing users to avoid some of the legal issues surrounding illicit substances. Misuse of nitrous oxide can produce significant short-term and long-term damage to human health, including a form of oxygen starvation called hypoxia , brain damage and a serious vitamin B12 deficiency that can lead to nerve damage. Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions.

In-patient residential treatment for people with an alcohol use disorder is usually quite expensive without insurance. The length is based solely upon providers' experience. During the s, clients stayed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. Patients with severe opioid addiction are being given brain implants to help reduce their cravings, in the first trial of its kind in the US. Treatment starts with a series of brain scans. Surgery follows with doctors making a small hole in the skull to insert a tiny 1mm electrode in the specific area of the brain that regulates impulses such as addiction and self-control.

It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies. The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. 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 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.

Constitution, mandating separation of church and state. In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act. Counselors help individuals with 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.

Counselors 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 also work with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her. This process begins with a professionals' first goal: breaking down denial of the person with the addiction. Denial implies a lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, instead of continuing the destructive behavior.

Once this has been achieved, the counselor coordinates with the addict's family to support them in getting the individual to drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family. One approach with limited applicability is the sober coach. In this approach, the client is serviced by the provider s in his or her home and workplace—for any efficacy, around-the-clock—who functions much like a nanny to guide or control the patient's behavior.

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displays 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 being 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 that can help them remain sober.

Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in Opponents also contend that it lacks valid scientific evidence for claims of efficacy. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. This is considered to be similar to other self-help groups who work within mutual aid concepts. 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 but not limited to alcohol use disorder. To this end, a study [52] 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 the most effective, it actually proved to be deleterious in the outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques.

A variation of Rogers' approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Psychoanalysis , a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also explained substance use. 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 hypothesized 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 hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural, and political factors, encapsulation, traumatophobia, and masturbation as a form of self-soothing. Additionally, homosexual content is not implicated as a necessary feature in addiction. An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt's Relapse Prevention approach.

Self-efficacy refers to one's ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancy refers 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. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in a consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual can employ successful coping strategies , such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk PATH 1 and heighten his efficacy for future abstinence.

If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings PATH 2 —then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. An additional cognitively-based model of substance use recovery has been offered by Aaron Beck , the father of cognitive therapy and championed in his book Cognitive Therapy of Substance Abuse. 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. The cognitive therapist's job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunction. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment. A growing literature is demonstrating the importance of emotion regulation in the treatment of substance use.

Considering that nicotine and other psychoactive substances such as cocaine activate similar psycho-pharmacological pathways, [59] an emotion regulation approach may be applicable to a wide array of substance use. 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. People who are diagnosed with a mental health disorder and a simultaneous substance use disorder are known as having a dual diagnosis. For example, someone with bipolar disorder who also has an alcohol use disorder would have dual diagnosis.

On such occasions, two treatment plans are needed with the mental health disorder requiring treatment first. Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exist for both working with the person using the substance community reinforcement approach and their family community reinforcement approach and family training. Both these models have had considerable research success for both efficacy and effectiveness. Barriers to accessing drug treatment may worsen negative health outcomes and further exacerbate health inequalities in the United States. Stigmatization of drug use , the War on Drugs and criminalization, and the social determinants of health should all be considered when discussing access to drug treatment and potential barriers.

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