drug rehabilitation essay

Drug and Alcohol Rehabilitation Essay

Introduction.

According to MacLean, Cameron, Harney and Lee (2012), volatile substance use is one of the main problems that make it hard to attain a desirable social fabric.

With most people turning into substance abuse, the question that is asked is how the psychosocial institutions can reduce the number of new abusers of drugs and alcohol and the way the drug and alcohol addicts can be rehabilitated and incorporated back in the society effectively.

Research shows that a substantial number of rehabilitation institutions have been established to facilitate the recovery of drug and alcohol addicts. However, further research reiterates the resounding role of social networks of the addicts in fostering full recovery and rehabilitation of the addicts.

Therefore, the development of interpersonal relations that foster the development of social networks and social identity is critical in the rehabilitation of the drug and alcohol addicts. More often than not, the rehabilitation process is halted only by paying attention to the social workers and psychological professionals, addicts, health care professionals, and the families of the addicts.

This leaves out the issue of interpersonal relations among addicts, yet is vital in rehabilitation. The main question that this paper seeks to answer is: what role do interpersonal relations play in drug and alcohol rehabilitation?

This paper argues that the policies governing the rehabilitation of drug and alcohol addicts should pay attention to interpersonal relations of the people under rehabilitation because they are the main determinants of complete rehabilitation.

In presenting the arguments, the paper begins by bringing out the essence of interpersonal relations of the subjects in drug and alcohol rehabilitation programs. This is followed by an intense discussion about the modalities of incorporating interpersonal factors in the road to recovery and rehabilitation of drug and alcohol addicts.

The discussion focuses on the exploration of studies that expand on drug and alcohol rehabilitation, before drawing conclusions and recommendations that can help in explaining how interpersonal relations should be factored in rehabilitation.

The essence of Interpersonal relations in drug and alcohol rehabilitation

As observed in the introduction, the rate of alcohol and substance abuse in quite high. Thus, substance abuse rehabilitation centres have been established to help volatile substance users regain their status and social position in the society.

However, as these centres continue to work, it is evident that they leave out important steps that are critical in offering complete therapy for the alcohol and drug abusers. Research ascertains the importance of groups in rehabilitative counselling and the administration of recovery medications for drug and alcohol abuse addicts (O’Farrell & Fals-Stewart, 2008).

Borrowing from this, it can be argued that drug and alcohol abuse is a habit that occurs in the social space. According to Morgenstern and Longabaugh (2000), the cognitive behaviours of individuals who engage in drug and substance abuse are largely shaped by the environment in which they dwell.

Therefore, the full recovery and complete rehabilitation of the drug and alcohol addicts can only be achieved when they are placed within the environments that influence their behaviour. Failure to do so implies a vacuum in the rehabilitation therapy. This is denoted by the separation of the people, physically or psychologically, from the environment in which they are supposed to dwell in for their entire lifetime (Klimas, 2010).

According to Klimas (2010), there is a close relationship between relationships and the recovery of drug and substance abusers. Therefore, the process of therapeutic change that is embraced by rehabilitation institutions needs to foster the interaction of individuals within the recovery group and the nature of relations that are embraced by individuals outside the recovery groups.

This argument is invigorated by the tendency of most addicts within the institutions to portray positive characters, denoting recovery as a way of speeding up the completion of the recovery process. These people often revert back to the earlier habits once they are out of the rehabilitation centres and out of monitoring institutions.

According to the Center for Substance Abuse Treatment (2005), group therapy is highly favoured when it comes to the active phase of rehabilitation where the behaviour and actions of individuals and their close associates play a great role in enhancing behaviour change.

In a similar sense, the long-term recovery plans for the addicts have to consider the placement and consideration of all people who associate with the addicts within the wider social realm.

Most of the institutions that deal with the rehabilitation of drug and alcohol addicts only focus on the formal groups that are established therapeutically while ignoring the other interactions that are embraced by the addicts outside these groups.

Relationships in the cycle of addiction change as the stage of addiction progresses from one level to another. This is an important consideration in the rehabilitation process because changes in relationships also occur during the recovery phase of individuals who are undergoing rehabilitation (Klimas, 2010).

It is important to note that interpersonal relations play out differently in the recovery phase. In some cases, the recovering addicts may come from equally addicted families. In such situations, relations become more complex, but they are simple when it comes to the elimination of incidences of drug use.

Close ties between the addicts denote a high level of ties. These ties are depicted in acts of sympathy and excessive care and concern. In most cases, individuals may find themselves helping people they have close relations within the wrong way because of the high level of attachment and feelings that they have for the addicts.

This is common in cases where an addict enters a drug and alcohol recovery therapy as an individual. In situations where couples enter therapy together, they might also break some rules of recovery because of the mutual feelings they may have (Simmons, 2006). Therefore, consideration should also be paid to cases where relationships can be hindrances in the recovery of drug and alcohol addicts.

Interpersonal considerations in drug and alcohol rehabilitation

Klimas (2010) observes that the modern concept of group therapy in drug and substance abuse rehabilitation considers the extended issue of interpersonal relationships in attaining full recovery of the addicts.

This is based on the classification of the recovery therapy in two: group therapy, which applies during the early stages of recovery for the volatile substance use addicts and the outside group therapy that comes in the advanced stages of recovery.

Here, the question of the nature of relationships that should be embraced by the psychiatric and counsellors comes out. Individuals undergoing therapy undergo psychosocial problems during the entire process of recovery. These problems can only be sorted out by the kinds and levels of interactions that are fostered and who the addicts interact with (Klimas, 2010).

According to Price and Simmel (2002), people who are undergoing rehabilitation face psychological problems like trauma. The problems emanate from the changes in their lifestyles that are characterized by addiction. Such problems become much more complex when the addicts are confronting the health-related conditions caused by excessive drug use and alcoholism.

According to the research that was conducted by Price and Simmel (2002) to ascertain the role of partners in the addiction and recovery of addicted women, the researchers observed that the formation of partnerships is critical in solving the psychologically associated problems. Addicts can hardly recover in isolation. However, the other important thing to note is that addicts can only recover fully when right partnerships are formed.

According to UNDOC and WHO (2008), effective interventions for drug and alcohol addicts require the development of networked systems.

These systems are wide in the sense that they involve a wide range of partners, among them the civil society, labour, welfare, and the criminal justice, among others. Avoiding drug and alcohol abuse is attained when individuals understand the dangers of drugs and the essence of living a drug-free life.

Therefore, the involvement of a large number of players is critical in the dissemination of knowledge and the reduction of the rate at which drugs and alcohol are made available to people in the society. The importance of social welfare departments is reiterated, especially when it comes to the coordination of recovery for the addicts due to the nature of drug use in the society.

A substantial number of people who engage in drug abuse are people who are placed within highly interactive environments, for instance students. Therefore, interpersonal relationships cannot be easily avoided in the recovery of the individuals.

This is why the WHO and UNDOC insist on the involvement of the social welfare departments in the recovery of drug addicts and alcohol addicts. The greater involvement of the social welfare is to help in developing the modalities on which the relationships of the addicts under recovery can be monitored (UNDOC & WHO, 2008).

In their research about the importance of social support for drug addicts who are undergoing recovery therapy, Dobkin, De Civita, Paraherakis and Gill (2002) found out that high social support that comes from the encouragement of the recovering addicts to foster relations with people outside the rehabilitation process highly promotes quick recovery.

By further conducting a regression analysis based on hierarchy, Dobkin, De Civita, Paraherakis and Gill (2002) further observed that the pace of recovery is higher for patients who are allowed to embrace relations than inpatients or recovering addicts. This reiterates the value of social support, which is necessitated by the development of relationships with the recovering addicts in the course of their recovery.

This is supported by the research by Beattie and Longabaugh (1997), who insisted on the value of social relationships in the realms of drug and alcohol addiction and recovery.

The subjective well-being of alcohol addicts depends on the patterns of interactions that are fostered by the addicts and the kind of discussions that they engage in. Positive relationships, which in this case mean engaging in constructive group activities, help in stabilizing the mental and emotional status of the recovering addicts.

Granfield and Cloud (2001) brought about the issue of social capital gathered by the addicts in helping the addicts in complete recovery. Therefore, any policies that are developed to help with drug and alcohol recovery have to pay attention to natural recovery, which is largely pegged on social capital.

Social capital in this sense means the relationships, norms, and institutions that are available in the society. At the centre of the development of social capital entails the relationships that are developed by individuals because human beings are social beings and interaction plays a great role in the psychosocial development of people.

Relations within the lives of the addicts together with the actual resources that they possess is critical in cushioning the recovering addicts from the social and psychological forces that engulf their lives because of the changes that take place in their lives during recovery (Granfield & Cloud, 2001).

Challenges of embracing partnership and relationships in the recovery of drug and alcohol addicts

Partners can be engaged in the recovery of addicts in different ways. One of the common ways of engaging partners and embracing relations in the recovery of addicts is the choice of partners who can give assurance of recovery to the addicts.

Relationships are part of the extended care for the addicts and can facilitate complete recovery or bring about hindrances in the recovery of individuals. There are prospects of change that need to be observed and given full attention by the people who are monitoring the progress of recovery during recovery.

Taking an example from the Tekuma Recovery Group in Israel where the addicts are attached to role models to help in shaping the changes in their cognitive behaviours, it can be argued that the patient-therapist model of addiction recovery has to be expanded to include more people.

It is easy to encourage the participants to be fully responsible for their compulsive behaviours through the linkage of the addicts who are undergoing recovery with partners or allowing them to choose partners outside the inside recovery groups (Tekuma Recovery Group, n.d.).

Interpersonal distress is one of the main causes of drug use in the society. This distress comes from the kinds of relations and behaviours that are common in the environment in which a person dwells. Therefore, rehabilitating the severe cases of addiction needs to focus on the individual and the larger environment in which a person dwells.

Taking an example from the case study by Klimas (2010), one addict confessed that the behaviour of his mother forced him to start using drugs as a consolation. He always came home from work and found her mother completely drunk; therefore, he had to get some drugs to cope psychologically with the situation and handle the embarrassment and agony.

This means that a given form of complexity presents itself here. The main aim of running recovery programs is to reinstate the consciousness of the addicts so that they are fit to join the society. However, the same society might still be having the sources of distress that resulted in the addictive trends in the persons who have undergone full recovery.

According to Beattie and Longabaugh (1997), it is important to comprehend the roles that are played by social relationships in the course of recovery, treatment, or relapse of the addicts. This is very helpful, more so in the clarification of the way clients can make use of interpersonal relationships in an effective way, thereby maximizing the impact of the recovery and rehabilitation therapy.

Therefore, rehabilitating individuals should go far much deeper than dealing with the individuals alone into unearthing all forms of relationships that are fostered by the rehabilitated individuals and how they might contribute to the well-being of the individual.

For instance, in the case of an individual who started engaging in drugs because of the behaviour of her mother, people responsible for the recovery of the individual should go further and rehabilitate the mother if possible (Klimas, 2010).

According to Andjelokvic (2012), encouraging the clients in the rehabilitation centres to link with the community enables them to create intense levels of interaction. This is critical in the positive shaping of their emotional content. An example is the linkage of the clients to the spiritual mentors as part of the therapy.

The development of strong relationships with the spiritually inclined people enables the clients to mould their behaviours in line with the spiritual content. This is a form of counter-transference in drug and alcohol rehabilitation (Andjelokvic, 2012).

According to Klimas (2010), another issue that is common among the recovering addicts is that they often become allergic to developing and embracing social relationships.

This emanates from the changes that take place in the interpersonal functioning of an individual during the entire period the individual undergoes the recovery therapy. However, the question that comes out here is how these behaviours impact on the positive functioning of an individual in the society in the long term basis.

Koehn (2007) presented a framework on which relationships can be modelled in drug and alcohol abuse. Known as the relationship sculpture, this framework can help people who are experiencing drug addiction problems to explore the changes in their interpersonal relationships, especially the intimate relationships.

It is critical to assess the changes in the relations’ landscape of the addicts throughout the entire process of recovery as set by the facilitators of recovery in order to experience changes in their lives.

The discussion conducted in the paper reiterates the importance of broadening the angle at which interpersonal relationships are developed and fostered by the recovering addicts. Most of the points presented in the paper denote that interpersonal relationships play a dual role when it comes to drug and alcohol use and recovery from drugs.

Just as interpersonal relationships can cause drug addiction, such relationships can also play a critical role in the full recovery of drug and alcohol addicts.

However, this depends on the level at which the professionals dealing with the clients in drug and alcohol rehabilitation programs understand the interplay between interpersonal networks and relationships in the recovery process.

It is important for the professionals who are working with the addicts to know most of the conflicting priorities that can prevent the addicts from developing and maintaining relationships with the social networks established within the formal recovery groups and outside the formal groups.

The discussion also points to the need for counsellors and psychologists, as well as other healthcare professionals working with substance abusers to broaden their scope regarding the issue of interpersonal relationships because they often take the centre stage in addiction and recovery.

Andjelokvic, B. B. (2012). P-1131 – Some experiences of group psychotherapy in Orthodox community of rehabilitation of drug addicts. European Psychiatry, 271 . doi:10.1016/S0924-9338(12)75298-7

Beattie, M. C., & Longabaugh, R. (1997). Interpersonal factors and post‐treatment drinking and subjective well-being. Addiction, 92 (11), 1507-1521.

Center for Substance Abuse Treatment. (2005). Substance abuse treatment: Group therapy , (Treatment Improvement Protocol (TIP) Series, No. 41.) . Web.

Dobkin, P. L., De Civita, M., Paraherakis, A., & Gill, K. (2002). The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers. Addiction, 97 (3), 347-356.

Granfield, R., & Cloud, W. (2001). Social context and “natural recovery”: The role of social capital in the resolution of drug-associated problems. Substance Use & Misuse, 36 (11), 1543-1570.

Klimas, J. (2010). Interpersonal relationships during addiction and recovery: A qualitative exploration of the views of clients in therapeutic community . Web.

Koehn, C. V. (2007). Experiential work group treatment for alcohol and other drug problems: the relationship sculpture. Alcoholism Treatment Quarterly , 25(3), 99-111.

MacLean, S., Cameron, J., Harney, A., & Lee, N. K. (2012). Psychosocial therapeutic interventions for volatile substance use: a systematic review. Addiction, 107 (2), 278-288.

Morgenstern, J., & Longabaugh, R. (2000). Cognitive–behavioral treatment for alcohol dependence: A review of evidence for its hypothesized mechanisms of action. Addiction, 95 (10), 1475-1490.

O’Farrell, T. J., & Fals-Stewart, W. (2008). Behavioral couples therapy for alcoholism and other drug abuse. Alcoholism Treatment Quarterly, 26 (1/2), 195-219.

Price, A., & Simmel, C. (2002). Partners’ influence on women’s addiction and recovery: The connection between substance abuse, trauma, and intimate Relationships . Berkeley, CA: National Abandoned Infants Assistance Resource Center, University of California at Berkeley.

Simmons, J. (2006). The interplay between interpersonal dynamics, treatment barriers, and larger social forces: an exploratory study of drug-using couples in Hartford, CT. Substance Abuse Treatment, Prevention, and Policy, 1 (12), 1-13.

Tekuma Recovery Group. Tekuma recovery at a glance . Web.

UNDOC & WHO. (2008). Principles of drug dependence treatment . Discussion Paper . Web.

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Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery

Can addiction be treated successfully.

Yes, addiction is a treatable disorder. Research on the science of addiction and the treatment of substance use disorders has led to the development of research-based methods that help people to stop using drugs and resume productive lives, also known as being in recovery.

Can addiction be cured?

Like treatment for other chronic diseases such as heart disease or asthma, addiction treatment is not a cure, but a way of managing the condition. Treatment enables people to counteract addiction's disruptive effects on their brain and behavior and regain control of their lives.

Does relapse to drug use mean treatment has failed?

No. The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process, but newer treatments are designed to help with relapse prevention. Relapse rates for drug use are similar to rates for other chronic medical illnesses. If people stop following their medical treatment plan, they are likely to relapse.

Treatment of chronic diseases involves changing deeply rooted behaviors, and relapse doesn’t mean treatment has failed. When a person recovering from an addiction relapses, it indicates that the person needs to speak with their doctor to resume treatment, modify it, or try another treatment. 52

While relapse is a normal part of recovery, for some drugs, it can be very dangerous—even deadly. If a person uses as much of the drug as they did before quitting, they can easily overdose because their bodies are no longer adapted to their previous level of drug exposure. An overdose happens when the person uses enough of a drug to produce uncomfortable feelings, life-threatening symptoms, or death.

What are the principles of effective treatment?

Research shows that when treating addictions to opioids (prescription pain relievers or drugs like heroin or fentanyl), medication should be the first line of treatment, usually combined with some form of behavioral therapy or counseling. Medications are also available to help treat addiction to alcohol and nicotine.

Additionally, medications are used to help people detoxify from drugs, although detoxification is not the same as treatment and is not sufficient to help a person recover. Detoxification alone without subsequent treatment generally leads to resumption of drug use.

For people with addictions to drugs like stimulants or cannabis, no medications are currently available to assist in treatment, so treatment consists of behavioral therapies. Treatment should be tailored to address each patient's drug use patterns and drug-related medical, mental, and social problems.

What medications and devices help treat drug addiction?

Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse.

• Treating withdrawal. When patients first stop using drugs, they can experience various physical and emotional symptoms, including restlessness or sleeplessness, as well as depression, anxiety, and other mental health conditions. Certain treatment medications and devices reduce these symptoms, which makes it easier to stop the drug use.
• Staying in treatment. Some treatment medications and mobile applications are used to help the brain adapt gradually to the absence of the drug. These treatments act slowly to help prevent drug cravings and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment.
• Preventing relapse. Science has taught us that stress cues linked to the drug use (such as people, places, things, and moods), and contact with drugs are the most common triggers for relapse. Scientists have been developing therapies to interfere with these triggers to help patients stay in recovery.

Common medications used to treat drug addiction and withdrawal

• Buprenorphine
• Extended-release naltrexone
• Nicotine replacement therapies (available as a patch, inhaler, or gum)
• Varenicline
• Acamprosate

How do behavioral therapies treat drug addiction?

Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use. As a result, patients are able to handle stressful situations and various triggers that might cause another relapse. Behavioral therapies can also enhance the effectiveness of medications and help people remain in treatment longer.

• Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they're most likely to use drugs.
• Contingency management uses positive reinforcement such as providing rewards or privileges for remaining drugfree, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
• Motivational enhancement therapy uses strategies to make the most of people's readiness to change their behavior and enter treatment.
• Family therapy helps people (especially young people) with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning.
• Twelve-step facilitation (TSF) is an individual therapy typically delivered in 12 weekly session to prepare people to become engaged in 12-step mutual support programs. 12-step programs, like Alcoholic Anonymous, are not medical treatments, but provide social and complementary support to those treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.

How do the best treatment programs help patients recover from addiction?

Stopping drug use is just one part of a long and complex recovery process. When people enter treatment, addiction has often caused serious consequences in their lives, possibly disrupting their health and how they function in their family lives, at work, and in the community.

Because addiction can affect so many aspects of a person's life, treatment should address the needs of the whole person to be successful. Counselors may select from a menu of services that meet the specific medical, mental, social, occupational, family, and legal needs of their patients to help in their recovery.

For more information on drug treatment , see Principles of Drug Addiction Treatment: A Research-Based Guide , and Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide .

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Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety

Redonna k. chandler.

1 Services Research Branch, National Institute on Drug Abuse, Bethesda, Maryland

Bennett W. Fletcher

Nora d. volkow.

2 National Institute on Drug Abuse, Bethesda, Maryland

Despite increasing evidence that addiction is a treatable disease of the brain, most individuals do not receive treatment. Involvement in the criminal justice system often results from illegal drug-seeking behavior and participation in illegal activities that reflect, in part, disrupted behavior ensuing from brain changes triggered by repeated drug use. Treating drug-involved offenders provides a unique opportunity to decrease substance abuse and reduce associated criminal behavior. Emerging neuroscience has the potential to transform traditional sanction-oriented public safety approaches by providing new therapeutic strategies against addiction that could be used in the criminal justice system. We summarize relevant neuroscientific findings and evidence-based principles of addiction treatment that, if implemented in the criminal justice system, could help improve public heath and reduce criminal behavior.

The past 20 years have seen significant increases in the numbers of individuals incarcerated or under other forms of criminal justice supervision in the United States. These numbers are staggering—approximately 7.1 million adults in the United States are under some form of criminal justice supervision. 1 The large increase in the criminal justice population reflects in part tougher laws and penalties for drug offenses. 2 An estimated one-half of all prisoners (including some sentenced for other than drug offenses) meet the criteria for diagnosis of drug abuse or dependence ( Table 1 ). 3 , 4

Inmate Drug Use, Abuse/Dependence, and Treatment

During the past 20 years, fundamental advances in the neurobiology of addiction have been made. Molecular and imaging studies have revealed addiction as a brain disorder with a strong genetic component, and this has galvanized research on new pharmacological treatments. However, a large disconnect remains between addiction research and the treatment of addiction in general, particularly within the criminal justice system. This is evidenced in that most prisoners (80%–85%) who could benefit from drug abuse treatment do not receive it. 3 , 4 In addition, drug-using offenders are at high risk for infectious diseases such as human immunodeficiency virus (HIV) and hepatitis C 5 and frequently have co-morbid psychiatric disorders, 6 , 7 which further highlights the dire treatment needs of this population.

Not treating a drug-abusing offender is a missed opportunity to simultaneously improve both public health and safety. Integrating treatment into the criminal justice system would provide treatment to individuals who otherwise would not receive it, improving their medical outcomes and decreasing their rates of reincarceration. 8

Recidivism in the Drug-Abusing Offender

The inadequacy of incarceration by itself in addressing drug abuse or addiction is evident in the statistics. A review of recidivism in 15 states found that one-quarter of individuals released returned to prison within 3 years for technical violations that included, among other things, testing positive for drug use. 9 Illicit drugs are used in jails and prisons despite their highly structured, controlled environments, 10 but even enforced abstinence can mislead criminal justice professionals as well as addicted persons to underestimate the vulnerability to relapse postincarceration. On release from prison or jail, addicted persons will experience challenges to their sobriety through multiple stressors that increase their risk of relapsing to drug use. These include the stigma associated with being labeled an ex-offender, the need for housing and legitimate employment, stresses in re-unifying with family, and multiple requirements for criminal justice supervision. 11 , 12

Returning to neighborhoods associated with preincarceration drug use places the addicted individual in an environment rich in drug cues. As discussed below, these conditioned cues automatically activate the reward/motivational neurocircuitry and can trigger an intense desire to consume drugs (craving). 13 The molecular and neurobiological adaptations resulting from chronic drug use persist for months after drug discontinuation, 14 and evidence exists that compulsive seeking of drugs when addicted individuals are reexposed to drug cues progressively increases after drug withdrawal. 15 This could explain why many drug-addicted individuals rapidly return to drug use following long periods of abstinence during incarceration and highlights the need for ongoing treatment following release.

Drug Abuse Treatment Effectiveness in the Criminal Justice System

Research over the last 2 decades has consistently reported the beneficial effects of treatment for the drug abuser in the criminal justice system. 16 , 17 These interventions include therapeutic alternatives to incarceration, treatment merged with judicial oversight in drug courts, prison- and jail-based treatments, and reentry programs intended to help offenders transition from incarceration back into the community. 8 , 18 Through monitoring, supervision, and threat of legal sanctions, the justice system can provide leverage to encourage drug abusers to enter and remain in treatment.

Behavioral treatments are the most commonly used interventions for addressing substance use disorders. Evidence-based behavioral interventions include cognitive therapies that teach coping and decision-making skills, contingency management therapies that reinforce behavioral changes associated with abstinence, and motivational therapies that enhance the motivation to participate in treatment and in non–drug-related activities. 19 , 20 Many residential treatment programs rely on the creation of a “therapeutic community” based on a social learning model. 21 Medications such as methadone, buprenorphine, and naltrexone are beneficial for the treatment of heroin addiction and naltrexone and topiramate for the treatment of alcoholism. 22 – 24 Self-help programs such as Alcoholics Anonymous or SMART Recovery can be valuable adjuncts to formal drug treatment. 25

Research has consistently shown that community-based drug abuse treatment can reduce drug use and drug-related criminal behavior. 26 A meta-analysis of 78 comparison-group community-based drug treatment studies found treatment to be up to 1.8 times better in reducing drug use than the usual alternatives. 20 In a meta-analysis of 66 incarceration-based treatment evaluations, therapeutic community and counseling approaches were respectively 1.4 and 1.5 times more likely to reduce reoffending. 27 Drug courts combine judicial supervision with drug treatment as an alternative to incarceration; their graduates have rearrest rates about half those of matched comparison samples and much lower than those of drug court dropouts. 28 Individuals who participated in prison-based treatment followed by a community-based program postincarceration were 7 times more likely to be drug free and 3 times less likely to be arrested for criminal behavior than those not receiving treatment. 29 , 30

The benefits of medications for drug treatment were shown in a recent randomized trial in which heroin-dependent inmates began methadone treatment in prison prior to release and continued in the community postrelease. At 1-, 3-, and 6-month follow-up, patients who received methadone plus counseling were significantly less likely to use heroin or engage in criminal activity than those who received only counseling. 31 – 33 The potential exists for immediate adoption of methadone maintenance for incarcerated persons with opioid addictions, but most prison systems have not been receptive to this approach. 34

Economic analyses highlight the cost-effectiveness of treating drug-involved offenders. 35 On average, in- carceration in the United States costs approximately $22 000 per month, 36 and there is little evidence that this strategy reduces drug use or drug-related re-incarceration rates for nonviolent drug offenders. By contrast, the average cost of methadone is $4000 per month, 37 and treatment with methadone has demonstrated effectiveness in reducing drug use and criminal activity following release. 31 Alternatives to incarceration can also defray job productivity losses and the separation from family and social support systems.

The cost of integrating volunteer-led self-help organizations such as Alcoholics Anonymous and Narcotics Anonymous into criminal justice settings is nominal and could provide support to the recovery efforts of addicted persons in the criminal justice system. One dollar spent on drug courts is estimated to save approximately $4 in avoided costs of incarceration and health care, 38 and prison-based treatment saves between $2 to $6. 39 These economic benefits in part reflect reductions in criminal behavior. 40 , 41

Access to Treatment

Drug education—not drug treatment—is the most common service provided to prisoners with drug abuse or addiction problems. 4 , 42 More than one-quarter of state inmates and 1 in 5 federal inmates meeting abuse/dependence criteria participate in self-help groups such as Alcoholics Anonymous while in prison. 4 However, though treatment during and after incarceration has been shown to significantly reduce drug use and drug-related crime, less than 20% of inmates with drug abuse or dependence receive formal treatment ( Table 1 ). 3 , 4

In a recent survey of correctional programs and organizations across the United States, 42 most correctional agencies reported providing sometype of drug abuse treatment services;however, the median percentage of offenders who had access to those services at any given time was low, usually less than 10% ( Table 2 ). 42 Even if a correctional institution does provide treatment, the continuity of treatment postincarceration, which is essential to recovery, 16 is often lacking when the drug-involved offender transitions from incarceration to community supervision. 43 Failure to receive treatment on release increases the risk not only of relapse but also of mortality from drug overdose and other causes. 44

Access to Health, Mental Health, and Substance Abuse Treatment Services in Correctional Facilities a

Abbreviations: HIV, human immunodeficiency virus; NA, not applicable.

Infectious diseases such as HIV and hepatitis C are associated with illicit drug use and occur at higher rates in correctional populations than in the general population, 5 but treatment for these conditions appears to fall short of need. 45 , 46 It is feasible to implement screening and treatment in correctional settings for HIV 47 , 48 and hepatitis C. 49 , 50 Continuity of treatment for released offenders with infectious disease is crucial not only for the individual’s health 51 , 52 but also for the health of the community. 45 , 53

There are many barriers to treatment for the drug-involved offender, including lack of the resources, infrastructure, and treatment staff (including physicians knowledgeable about addiction medicine) required to meet the drug treatment needs of individuals under their supervision. Addiction remains a stigmatized disease not often regarded by the criminal justice system as a medical condition; as a consequence, treatment is not constitutionally guaranteed as is the treatment of other medical conditions.

Neurobiology of Addiction

Addiction is a chronic brain disease for which genetic factors are believed to contribute 40% to 60% of the vulnerability. 54 Repeated drug exposure in individuals who are vulnerable (because of genetics, or developmental or environmental factors) trigger neuroadaptations in the brain that result in the compulsive drug use and loss of control over drug-related behaviors that characterizes addiction. Molecular and neuroimaging studies have helped illuminate how genes may affect vulnerability to addiction and how repeated use of addictive drugs causes long-lasting disruptions to the structure and function of the brain. 55 Among the genes identified to contribute to the vulnerability for addiction are those that participate in the neuroplastic changes associated with learning. 56 Imaging studies have identified multiple brain circuits that are disrupted in addicted persons 57 ; these include circuits involved in reward and motivation, learning and memory, cognitive control, mood, and interoception (awareness of physiological body signals) ( Figure ). Disruption of these circuits impairs the addicted person’s ability to inhibit intentional actions or to control strong emotions and desires and also increases the likelihood that the individual will have difficulties making adaptive decisions. 60 , 61

Circuits work together and change with experience. Each is linked to an important concept: reward (saliency), motivation (drive), memory (learning associations), inhibitory control (conflict resolution), mood (well-being), 58 and interoception (internal awareness). 59 Size of circuit ovals indicates influence in determining behavioral outcomes. Thicker line weights indicate greater influence on regulation of the circuit. A, In a nonaddicted person the decision to consume a drug (same process pertains for natural rewards) is a function of the balance between the expected pleasure (based on past experience or memory), alternative stimuli (this includes internal states such as mood and interoception but also alternative external rewards), and potential negative outcomes that oppose the motivation to take the drug (inhibitory control exerted by prefrontal cortex) and stop the drug use. B, During addiction, the enhanced value of the drug in the reward, motivation, and memory circuits overcomes the inhibitory control exerted by the prefrontal cortex, thereby favoring a positive feedback loop initiated by the consumption of the drug and perpetuated by enhanced activation of the motivation/drive and memory circuits. Decreased sensitivity to rewards also raises the hedonic threshold, disrupting mood and increasing the saliency values of drugs and behaviors temporarily associated with relief from the dysphoria. Learning and conditioning result in an enhanced interoceptive awareness of discomfort and the associated desire for the drug (craving). Absence of lines from inhibitory control circuit to reward and motivation circuits indicates loss of regulation.

Addiction also decreases sensitivity in the reward and the motivational circuits, which modulate response to positive as well as negative reinforcers. Practically, this suggests that an addicted individual may experience less motivation to pursue activities likely to result in beneficial outcomes and to avoid those that could result in punishment. One can also predict that dysfunction in this neurocircuitry would reduce an addicted person’s motivation to abstain from drug use because alternative reinforcers (natural stimuli) are comparatively weaker and negative consequences (eg, incarceration) are less salient. 62

In parallel, the repeated use of drugs leads to the formation of new linked memories that condition the addicted individual to expect pleasurable responses—not only when exposed to a drug but also when exposed to stimuli associated with the drug. These stimuli trigger automatic responses that frequently drive relapse, even in individuals motivated to stop taking drugs. 63 The enhanced sensitivity to drugs as rewards and the conditioning to associated drug cues increase the interoceptive awareness of discomfort (anxiety and tension) that occurs when the individual is exposed to drug cues and increase the desire to consume the drug. 64 Additionally, repeated drug use also affects brain regions implicated in mood and anxiety, which could explain the high rate of addiction comorbid with dysphoria, depression, or both and the vulnerability of the addicted person to relapse when exposed to social stressors. 65 , 66

Impairment of the neural substrates affected by addiction—particularly those concerned with behavioral inhibition, control of emotions and desires, and decision-making—increase the likelihood that addicted individuals will make choices that appear impulsive. 67 , 68 This idea is supported by research in the emerging area of behavioral economics, which has found that addicted individuals differ from those who do not use drugs in how they make decisions. Addicted individuals tend to have higher levels of temporal discounting than those who do not use drugs; ie, they tend to choose immediate, smaller rewards over future, larger rewards. 69 High temporal discounting is also associated with impulsivity—the inability to delay immediate gratification and to recognize the potential for negative consequences. 70

Many of the neurobiological changes associated with repeated drug use persist for long periods after drug discontinuation. 71 This helps explain why addicted individuals who have ceased drug use are at high risk of relapse and provides neurobiological support for the recognition of addiction as a chronic relapsing disease. 72

What are the implications of neuroscience research for how society and clinicians might regard the addicted offender? There are at least 3 implications for how this emerging knowledge about the neurologic basis of addictive behavior is important.

First, of most importance, neuroscience’s uncovering of new molecular targets implicated in the responses to drugs and of new knowledge on the function of the human brain provides new targets for medication development and behavioral interventions in addiction. Although many of the neurobiological changes associated with repeated drug use persist for long periods after drug discontinuation, 71 research suggests that the impaired brain can regain some of the functions damaged by use of illicit drugs over time. 73

Second, neuroscience establishes a biological framework for understanding aspects of addictive behavior that otherwise seem to defy rational explanation. In the absence of known biological determinants, these behaviors often have been attributed to “moral weakness.” 74 Identifying the neurologic factors underlying addictive behavior can place these moral arguments into a more reasoned context. Addiction does not absolve one of responsibility for use of illicit drugs or for criminal behavior, but understanding how addictive drugs affect behavior through brain mechanisms can inform decisions to provide treatment to addicted individuals. For example, mandated treatment may be useful for drug-involved offenders who would otherwise not engage in the treatment process or make progress toward recovery. The persistence of neurologic deficits provides support for the recognition of addiction as a chronic disease and highlights the need for the same continuity of care so important in treatment of other chronic diseases (eg, asthma, hypertension). 72 It also suggests that agonist medications such as methadone are important treatments for addiction, even for individuals who have been under enforced abstinence during incarceration.

Third, neuroscience may help addicted individuals to better understand their own addiction. Such individuals may become frustrated when their efforts to control their own drug use are unsuccessful, and even with treatment many become frustrated with what is often a slow and tenuous recovery process. The neurobiology of the brain can help the addicted individual put this disease into a more understandable context and thereby facilitate effective treatment. Little research has been conducted in the field of addiction on whether knowing more about the substance use disorder is useful in helping to sustain recovery, and more research is needed. However, the concept of the “expert patient” who serves as his or her own best health advocate in a recovery management paradigm has been promoted for chronic disorders. As with these other illnesses, addiction must be managed by the individual over time to sustain recovery.

Principles of Drug Abuse Treatment for Offenders

Principles of Drug Abuse Treatment for Criminal Justice Populations , 75 published by the National Institute on Drug Abuse, synthesizes research on drug abuse treatment for drug abusers in the criminal justice system. It is intended as a resource for criminal justice professionals and the treatment community working with drug abusers involved with the system. The publication summarizes 20 years of research to provide guidance on evidence-based practices and identifies general principles on how to effectively address the drug abuse problems of populations involved with the criminal justice system ( Box ). 75

Box. NIDA Principles of Drug Abuse Treatment for Criminal Justice Populations

Drug addiction is a chronic brain disease that affects behavior

Recovery from drug addiction requires effective treatment, followed by continued care

Duration of treatment should be sufficiently long to produce stable behavioral changes

Assessment is the first step in treatment

Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations

Drug use during treatment should be carefully monitored

Treatment should target factors associated with criminal behavior

Criminal justice supervision should incorporate treatment planning for drug-abusing offenders, and treatment providers should be aware of correctional supervision requirements

Continuity of care is essential for drug abusers reentering the community

A balance of rewards and sanctions encourages prosocial behavior and treatment participation

Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach

Medications are an important part of treatment for many drug-abusing offenders

Treatment planning for drug-abusing offenders living in or reentering the community should include strategies to prevent and treat serious, chronic medical conditions such as human immunodeficiency virus/AIDS, hepatitis B and C, and tuberculosis

NIDA indicates National Institute on Drug Abuse. Principles adapted from Fletcher and Chandler. 75

Implementing the Principles

Effective interventions depend on a coordinated response between criminal justice agencies, drug abuse treatment providers, mental health and physical health care organizations, and social service agencies. Each type of criminal justice agency (eg, jail, drug court, probation, prison) has its own role in sanctioning and supervision and lends itself to specific intervention opportunities. Table 3 provides a simplified overview of the criminal justice system and identifies the points at which intervention is possible.

Intervention Opportunities in Criminal Justice Systems

Abbreviations: FBI, Federal Bureau of Investigation; NA, not applicable; TASC, Treatment Accountability for Safer Communities.

Effective integration of drug treatment interventions into criminal justice settings requires matching the intervention to the organization. For example, since jail stays are usually brief, the interventions best suited to jails may be screening for drug and alcohol abuse, other mental illnesses, and medical conditions (eg, HIV, hepatitis B or C), with referral to community-based treatment providers. Implementing these principles throughout the criminal justice and drug abuse treatment systems also requires that these systems work together to address the addicted individual’s drug use, comorbid mental disorders and medical conditions, if present, and criminal behavior. Treatment professionals should understand the criminal justice process and the supervision requirements of their patients. In addition to addressing drug use behaviors, treatment outcomes improve when antisocial and criminal behaviors are targets of clinical intervention. 76 Criminal justice professionals must develop an understanding of addiction—signs and symptoms, treatment, and relapse—and their role in facilitating recovery.

Substance Abuse Treatment Research in Criminal Justice Settings

Prison environments are inherently coercive, 77 and special safeguards have been developed to ensure that prisoners can choose freely whether to participate in biomedical research without fear of consequence. Beyond mere equipoise, clinical trials must be designed so the research is of benefit to the prisoner participant regardless of the assigned study group. Within these constraints, it is important to conduct research to help improve substance abuse treatment and to assist in the successful transition of the substance abuser to the community. To facilitate research in this area, the National Institute on Drug Abuse created the Criminal Justice Drug Abuse Treatment Studies research cooperative, 78 a network of correctional agencies linked with treatment research centers and community treatment programs.

Opiate agonist medications used for the treatment of heroin addiction such as methadone and buprenorphine are underused in correctional populations. Naltrexone, an opiate antagonist, was developed to treat heroin addiction but also has been approved for treating alcoholism. Naltrexone is likely to be more acceptable in the criminal justice setting than agonist medications. However, the poor compliance with naltrexone has limited its use in the treatment of heroin addiction. The recent development of a long-lasting depot formulation for naltrexone 79 , 80 obviates this limitation, and a multisite clinical trial ( {"type":"clinical-trial","attrs":{"text":"NCT00781898","term_id":"NCT00781898"}} NCT00781898 ) is currently evaluating its effectiveness in heroin-addicted probationers. Another area of research intended to reduce relapse in addicted offenders is the development of vaccines against cocaine, methamphetamine, or heroin.

Several avenues currently exist for providing drug abuse treatment as an alternative to incarceration. Drug courts were intended to provide a bridge between drug treatment and adjudication; from the first drug court established in Miami in 1989, drug courts have increased in number to nearly 2000 today. States such as Arizona, California, and New York have created treatment alternatives to incarceration for first-time drug offenders, juvenile offenders, and others. Many states are coming under political pressure to reduce the costs associated with incarceration by diverting nonviolent drug offenders to treatment.

Conclusions

Punishment alone is a futile and ineffective response to drug abuse, 2 failing as a public safety intervention for offenders whose criminal behavior is directly related to drug use. 81 Addiction is a chronic brain disease with a strong genetic component that in most instances requires treatment. The increase in the number of drug-abusing offenders highlights the urgency to institute treatments for populations involved in the criminal justice system. It also provides a unique opportunity to intervene for individuals who would otherwise not seek treatment.

The challenge of delivering treatment in a criminal setting requires the cooperation and coordination of 2 disparate cultures: the criminal justice system organized to punish the offender and protect society and the drug abuse treatment systems organized to help the addicted individual. Addressing addiction as a disease does not remove the responsibility of the individual, which is the argument frequently used to resist recognizing and treating addiction as an illness. Rather it highlights the personal responsibility of the addicted person to seek and adhere to drug treatment and that of society to ensure that such treatment is available and based on scientific evidence. Only a small percentage of those requiring treatment for drug addiction seek help voluntarily; in light of this, the criminal justice system provides a unique opportunity to intervene and disrupt the cycle of drug use and crime in a cost-effective manner.

Acknowledgments

Funding/Support: This article was written by staff from the National Institute on Drug Abuse and there was no external funding for this work.

Author Contributions: Study concept and design: Chandler, Fletcher, Volkow.

Financial Disclosures: None reported.

Publisher's Disclaimer: Disclaimer: The statements in this article are those of the authors and not necessarily those of the National Institute on Drug Abuse.

Additional Contributions: We thank Faye S. Taxman, PhD, and Matthew Perdoni, MS, both of George Mason University, for data on physical/medical, mental health, and substance use services ( Table 2 ) from the NIDA National Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) National Criminal Justice Treatment Practices Survey. Neither of these individuals received compensation for their contributions.

Analysis and interpretation of data: Fletcher.

Drafting of the manuscript: Chandler, Fletcher.

Critical revision of the manuscript for important intellectual content: Chandler, Fletcher, Volkow.

Administrative, technical, or material support: Chandler, Fletcher, Volkow.

Home / Essay Samples / Health / Rehabilitation Programs / The Process of Drug Rehabilitation: Steps and Strategies

The Process of Drug Rehabilitation: Steps and Strategies

• Category: Health
• Topic: Drugs , Rehabilitation Programs

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The Drug Rehabilitation Process

• What drugs are you currently taking?
• When was your last dose?
• Are you mixing drugs with other drugs?
• Are you mixing drugs with alcohol?
• How long have you been taking drugs?

Detoxification

• How long has the patient been taking drugs?
• Were drugs and alcohol being mixed?
• What types of drugs are being taken? (Opioids can have severe symptoms)
• How long has the patient been addicted to drugs?
• Are there any mental disorders to consider? (Anxiety, depression, PTSD)

Inpatient and Outpatient Treatment

A typical day in rehab, choosing the right substance abuse treatments centers, know the cost of drug rehabilitation.

• Will the patient need inpatient or outpatient treatment? (Outpatient costs less)
• If inpatient, how long will the patient be staying?
• Is medical detox needed? (If detox isn’t need, the cost will decrease)
• What sort of amenities does the facility offer? (Some facilities are more luxurious and offer swimming pools, tennis course, award-winning chefs, large patient room, massages, acupuncture, etc. Some drug rehab centers used by the rich and famous cost tens of thousands a month.

Nonprofit and State-Funded Rehabs

Treatment cost breakdown, inpatient rehab, outpatient rehab, medications.

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