Drug Treatment

1. Drug Treatment Lecture 11

2. What to Expect in This Lecture • Historical overview of drug treatment efforts • Description of major treatment modalities • Effectiveness of drug treatment • Some contemporary issues in treatment

3. History of Drug Treatment • Must be told in two stories: • Alcohol • All other drugs • Both stories begin with moralistic premises • Both research and treatment efforts diverge largely because of agency separation in the federal government • Alcohol – National Institute on Alcohol Abuse and Alcoholism (NIAAA) • Other drugs – National Institute on Drug Abuse (NIDA)

4. History of Alcohol Treatment • Benjamin Rush—an early advocate of alcohol treatment • Alcoholics Anonymous—1935 • Bill W(ilson) and Dr. Bob (Smith) • Two ideological bases for treatment • Medical model – recognizing alcoholism as a disease • Christian-based spiritual model—alcoholism a manifestation of power of sin, requiring confession • Yale Research Group—1940-1960’s • E.M. Jellinek • Heavily promoted the disease concept of alcoholism • Identified 4 types of alcoholism: alpha, beta, gamma and delta • Disease model endorsed by WHO in 1951 and by AMA in 1956

5. History of Drug Treatment (Non-Alcohol) • Early treatment efforts were rather rudimentary, involving primarily detoxification • Federal “Narcotics Farms”—1930’s • Lexington, KY and Fort Worth, TX • Primarily used for narcotics addicts in the federal prisons (but accepted walk-ins) • Used gradually decreasing dosages of morphine • Therapeutic Community (1950’s) • Chuck Dederich and “Synanon” • 24-hour residential treatment • Became very popular, but also controversial • Methadone Maintenance (1960’s) • Vincent Dole and Marie Nyswander • Initially used methadone as means to gradually detoxify • Later, methadone became a form of maintenance • Recent Treatment Efforts (post 1960’s) • Focus on recognizing differences among addicts (esp. males and females) • Focus on application to different types of drugs

6. Treatment Modalities • “Modalities” refer to broad, general approaches to treatment • The major modalities typically bring fundamentally different ideologies and assumptions regarding addictions • Four major modalities: • Medical/Pharmacological Approaches • Residential Drug-Free Approaches • Out-Patient Drug-Free Approaches • Self-Help Approaches

7. Medical/Pharmacological Approaches: Methadone Maintenance • Uses the synthetic, legal narcotic methadone to stabilize the addict • Methadone is a long-acting narcotic with dosages effective 24-36 hours • Specific programs guided by one of two philosophies: • Metabolic model • Psychotherapeutic model • Structure of programs vary depending on funding source, philosophy, etc. • MM is the most widespread form of treatment used for narcotics addicts • Recently two new drugs have been developed are being considered as replacements for methadone (Subutex and Subuzone)

8. Medical/Pharmacological Approaches: Chemical Antagonists • Either block effects of addictive drugs, or produce unpleasant side effects • Narcotics antagonists (cyclazocine and naltrexone) induce withdrawal symptoms • Alcohol antagonist (Antabuse) produces heightened sensitivity to alcohol and extremely uncomfortable side effects

9. Residential Programs:Therapeutic Communities • The “TC” is grounded in the philosophy of Synanon • Relatively long-term programs • Usually at least 15 months involving 3 phases: • Residential – 24-hour care where addicts are confronted with their way of life; usually lasts about 12 months • Re-entry – involves spending time outside of the program, typically working; often addict returns to program at night or on weekends • Aftercare – addict has formally “graduated” but may come back for occasional counseling sessions or make use of facility resources • Involves a radical resocialization process

10. Residential Programs:Minnesota Model • Based on two early (1940s) programs in Minnesota—Pioneer House and Hazelden. • Built upon principles of AA as the core, with various counseling activities by both professional and non-professional staff • Initial detoxification • Group Therapy • Spiritual Meditation • Much shorter duration than TC—about 30 days • Numerous well-known programs using the Minnesota Model—most notably the Betty Ford Center in Rancho Mirage, CA Hazelden Campus Center City, MN

11. Out-Patient Drug-Free Programs • Refers to a host of treatment programs that do not involve any residential time. • Initial strategy almost always involves detoxification • Other treatment strategies vary, depending on resources and philosophy of facilities: • Individual counseling • Group therapy • Family therapy • Vocational training • Referral services • Crisis centers • Out-patient programs tend to be either “change oriented” or “adaptive” • Change oriented – seeks to bring about radical change of lifestyle • Adaptive – seeks to help individual lessen dependence so that they can function more effectively

12. Self-Help Programs • Most are modeled after AA • Addiction is regarded as a disease that has physical, psychological and spiritual dimensions • Utilizes peers as an accountability mechanism • Central feature of these programs is the “12 steps” • Program has been replicated for numerous types of addiction, including: • Narcotics Anonymous • Cocaine Anonymous • Overeaters Anonymous • Sex Addicts Anonymous

13. Employment Effectiveness of Drug Treatment Crime • How do we know if treatment is successful? • Researchers use one or more of three indicators: • Reduced drug use • Reduced crime • Employment (or other conventional activity such as enrolling in school) • Three major sources of information on drug treatment effectiveness • Drug Abuse Reporting Program (DARP) • Treatment Outcomes Prospective Study (TOPS) • Drug Abuse Treatment Outcomes Studies (DATOS)