PRESENTATION OVERVIEW

1. EFFECTIVE Treatment for substance use disordersCARL M. DAWSON , M.S. , MAC , LPCTHE FOREST INSTITUTE OF PROFESSIONAL PSYCHOLOGY Springfield , missouriNATIONAL DRUG COURT INSTITUTE ( NDCI )WASHINGTON , DC

2. PRESENTATION OVERVIEW • ADOLESCENCE AND ADULT TREATMENT DIFFERENCES . • GENDER DIFFERENCES AND SUBSTANCE ABUSE TREATMENT . • CLINICAL POINTS OF REFERENCE “ TREATMENT “ ISSUES . • THIRTEEN ( 13 ) NECESSARY COMPONENTS OF AN EFFECTIVE SUBSTANCE ABUSE TREATMENT PROGRAM . • THE FUTURE USE OF MEDICATION ( INTERVENTION ) POSSIBILITIES IN TREATMENT .

3. KEEPING PERSPECTIVE Remember : Our initial goal during the early months of recovery is not to focus on the idea of long term sobriety, but to keep the person from relapsing . Relapse is and will always be our enemy . During early recovery, focus on teaching the individual(s) how not to relapse and what it will take for them to stay drug free long enough until they feel confident about not using, and experienced enough time to reestablish a new life without the use mood altering substances .

4. POINTS OF REFERENCEEVERY INDIVIDUAL THAT ENTERS INTO THE PROCESS OF RECOVERY IS CURSED WITH KNOWING THAT THEY POSSESS ONE MORE RELAPSE . . . WHAT THEY DON’T KNOW IS HOW MANY MORE OPPORTUNITES , IF EVER , THEY WILL HAVE TO RECOVER !

5. Maslow’s Needs • Individuals in recovery may need to re-experience and redefine each stage of emotional development before their healing is complete .

6. POINTS OF REFERENCE • NINETY ( 90 % ) OF SUCCESSFUL RECOVERY OCCURS AFTER THE INDIVIDUAL COMPLETES FORMAL TREATMENT . • NETWORKTHERAPIES : INVOLVING AFTERCARE COUNSELING , SELF - HELP GROUPS , SPONSERSHIP , AND CONTINUED INVOLVEMENT IN RECOVERY ORIENTED ACTIVITIES FOR A PERIOD OF THREE ( 3 ) TO FIVE ( 5 ) YEARS HAVE BEEN FOUND TO BE MOST EFFECTIVE WITH REGARDS TO ESTABLISHING A LONG TERM RECOVERY AND RELAPSE PREVENTION PROGRAM . • MOST RESEARCH ESTIMATES THAT MORE THAN NINETY ( 90% ) RELAPSE ONE TIME BEFORE GAINING SOLID RECOVERY .

7. GENDER DIFFERENCES AND SUBSTANCE ABUSE TREATMENT • WOMEN ( GIRLS ) IN TREATMENT , BLAME “ STRESS “ AS THEIR MOST COMMON REASON FOR USING DRUGS . • MEN ( BOYS ) IN TREATMENT ROUTINELY STATE THAT “ PEER PRESSURE “ WAS THEIR INITIAL REASON FOR THEIR USE OF DRUGS .

8. GENDER DIFFERENCES • WOMEN ( GIRLS ) IN TREATMENT ARE MORE FREQUENTLY IDENTIFIED AS HAVING HAD A PRE – EXISTING “ MOOD “ DISORDER PRIOR TO THEIR USE OF DRUGS . • MEN ( BOYS ) IN TREATMENT , ARE FREQUENTLY FOUND TO HAVE AQUIRED A “ MOOD “ DISORDER AFTER THEIR INITIAL INTRODUCTION AND USE OF DRUGS .

9. GENDER DIFFERENCES • WOMEN ( GIRLS ) IN GENERAL ARE TWICE ( 2 X’s ) AS LIKELY TO STRUGGLE WITH DEPRESSION AND ANXIETY RELATED MOOD DISORDERS THEN MEN . • AS A CONSEQUENCE . . . THEY ARE ALSO MORE LIKELY TO BE ATTRACTED TO ILLICIT DRUGS THAT POSSESS : “ ANTI – DEPRESSANT “ PROPERITIES , LIKE AMPHETAMINES , METHAMPHETAMINE AND COCAINE AND . . . PERSCRIPTION “ ANTI – ANXIETY “ MEDICATIONS LIKE XANAX OR SEDATIVE – HYPNOTIC SUBSTANCES “ SLEEP – AIDS “ .

10. GENDER DIFFERENCES • WOMEN SUBSTANCE ABUSERS REPORT STRUGGLING MORE WITH “ SHAME ” OR . . . “ WHAT’S WRONG WITH ME ! ” • MEN SUBSTANCE ABUSERS REPORT STRUGGLING MORE WITH FEELINGS OF “ GUILT ” OR . . . “ I KNOW I DID SOMETHING WRONG ! ”

11. GENDER DIFFERENCES • WOMEN ( GIRLS ) IN TREATMENT , ARE FOUND TO RESPOND MORE EFFECTIVELY TO A “ LESS – CONFRONTATIONAL “ THERAPEUTIC COMMUNITY , . . . THAT EMPHASIZES AND REWARDS . . . • POSITIVE SELF - GROWTH , • ESTEEM BUILDING AND DEVELOPMENT , • PERSONAL EMPOWERMENT .

12. GENDER DIFFERENCES • MEN ( BOYS ) IN TREATMENT , ARE FOUND TO RESPOND MORE POSITIVELY TO TRADITIONAL TREATMENT CONCEPTS INVOLVING A . . . 1. MORE DIRECT “ CONFRONTATIONAL “ THERAPEUTIC APPROACH . 2. SELF – HELP GROUPS, ( A. A. / N. A. ) . . . 3. ISSUES SURROUNDING “ POWERLESSNESS “ , “ LIFE UNMANAGIBILITY “ .

13. GENDER DIFFERENCES • RESEARCH ON WOMEN ( GIRLS ) AND STIMULANT DRUG USAGE , FINDS THE FOLLOWING : • WOMEN ( GIRLS ) ARE LIKELY TO DEVELOP A DEPENDENCY ON METHAMPHETAMINE AND COCAINE SOONER THEN MEN , • THEY ARE PRONE TO USE STIMULANT DRUGS MORE IMPULSIVELY THAN MEN ( BOYS ) AND , • EXPERENCE A HIGHER RATE OF DRUG RELAPSE THAN MEN ( BOYS ) .

14. DAWSON’S HYPOTHESIS OF CHANGE A PERSON WILL RARELY SEEK TO CHANGE THEIR BEHAVIOR(S) UNTIL . . . THEY EXPERIENCE THAT MOMENT OF REALITY . . . WHEN THEY REALIZE , THEY . . . ARE THE ONLY ONE TRULY RESPONSIBLE FOR THEIR PRESENT SUFFERING ! ! !

15. CLINICAL POINTS OF REFERENCE “ TREATMENT “ ISSUES “ COMPLETE ABSTINENCE FROM THE USE OF ALL MOOD ALTERING SUBSTANCES , INCLUDING THE INDIVIDUALS “ LEAST “ DRUG OF CHOICE , SHOULD BE THE FUNDAMENTAL PHILOSOPHY AND GOAL OF EVERY EFFECTIVE TREATMENT PROGRAM .

16. REMEMBER : CURRENT THERAPEUTIC APPROACHES ONLY IMPACT APPROXIMATELY 1 BILLION OF THE 100 BILLION NEURONS IN THE HUMAN BRAIN .

17. “ TREATMENT “ ISSUES • GROUP DIRECTED TREATMENT HAS BEEN FOUND TO BE MORE EFFECTIVE WHEN TREATING ADDICTION DISORDERS THAN INDIVIDUALLY DIRECTED TREATMENT . • “ CULTURAL “ SPECIFIC TREATMENT HAS BEEN FOUND TO BE MORE EFFECTIVE THAN “ GENERIC “ ORIENTED TREATMENT . • FAMILY THERAPY AND FAMILY INVOLVEMENT IS THE “ MISSING LINK “ AND KEY FACTOR IN ALL EFFECTIVE SUBSTANCE USE TREATMENT .

18. “ TREATMENT “ ISSUES • “ RESIDENTIAL “ DRUG TREATMENT HAS BEEN FOUND TO BE MORE EFFECTIVE THAN “ OUTPATIENT “ DRUG TREATMENT WHEN ADDRESSING ADOLESCENT ADDICTION ISSUES . • “ PERSONALLY “ AND “ PROFESSIONALLY “ , I WILL NOT REFER TO A TREATMENT PROGRAM THAT DOES NOT EMPHASIZE THE PRIMARY PRINCIPLES AND PHILOSOPHIES OF THE ALCOHOLICS ANONMYOUS ( A .A .) PROGRAM .

19. “ TREATMENT “ ISSUES • WHAT AGE DID THE INDIVIDUAL FIRST BEGAN USING DRUGS ? • THAT IS THE EMOTIONAL AGE OF THE INDIVIDUAL . . . AND EMOTIONALLY THAT IS WHERE DRUG TREATMENT SHOULD BEGAN . • REMEMBER : FOR DRUG TREATMENT TO BE EFFECTIVE , YOU MUST BEGAN WHERE THE INDIVIDUAL IS . . . NOT WHERE YOU WANT THEM TO BE !!!

20. “ TREATMENT “ ISSUES • FOR ADDICTION TREATMENT TO BE EFFECTIVE . . . THE INDIVIDUAL MUST BE WILLING OR FORCED TO CHANGE : PLAY - GROUNDS , ( Bars , Clubs, Parties ) PLAY - MATES , ( Using friends ) PLAY - THINGS ,( Drug paraphernalia )

21. THIRTEEN ( 13 ) NECESSARY COMPONENTS OF AN EFFECTIVE DRUG AND ALCOHOL TREATMENT PROGRAM

22. ( 1 ) NO SINGLE TREATMENT IS APPROPRIATE FOR ALL INDIVIDUALS • PROPER IDENTIFICATION AND PLACEMENT IS CRUCIAL IN DETERMINING CLIENT - TREATMENT COMPLIANCE AND SUCCESS . • RESEARCH CONDUCTED BY CSAT AT UCLA CONCLUDED : THE MATRIX MODEL APPLIED TO A DRUG COURT PHILOSOPHY WAS MORE EFFECTIVE THAN TREATMENT AS USUAL .

23. ( 2 ) TREATMENT NEEDS TO BE READILY AVAILABLE • STRIKE WHILE THE IRON IS HOT ! • POTENTIAL TREATMENT APPLICANTS CAN BE LOST IF TREATMENT IS NOT IMMEDIATELY AVAILABLE OR IS NOT READILY ACCESSIBLE .

24. ( 3 ) EFFECTIVE TREATMENT ATTENDS TO THE MULTIPLE NEEDS OF THE INDIVIDUAL . . . NOT JUST THEIR DRUG USE • IN ORDER FOR TREATMENT TO BE EFFECTIVE A TREATMENT PROGRAM MUST BE ABLE TO ADDRESS THE INDIVIDUALS DRUG USE . . . AND OTHER MEDICAL , PSYCHOLOGICAL , VOCATIONAL , SOCIAL , AND LEGAL PROBLEMS .

25. ( 4 ) A CLIENTS TREATMENT PLAN NEEDS TO BE PERIODICALLY REVIEWED TO ENSURE THAT THE PLAN IS MEETING THE CLIENTS CHANGING NEEDS • A CLIENT THAT REQUIRES MULTIPLE COMBINATIONS OF ASSISTANCE WILL REQUIRE MORE TIME AND ATTENTION TO ENSURE SUCCESSFUL COMPLIANCE AND PARTICIPATION IN TREATMENT .

26. ( 5 ) THE LENGTH OF TIME IN TREATMENT IS CRITICAL FOR OVERALL TREATMENT EFFECTIVENES • MOST RESEARCH INDICATES THAT A MINIMUM OF THREE ( 3 ) MONTHS OF CONTINUOUS TREATMENT IS NECESSARY FOR A SUCCESSFUL TREATMENT OUTCOME . • THE RESEARCH ALSO INDICATES THAT THE LONGER A PERSON REMAINS IN CONTINUOUS TREATMENT ( from 3 T0 14 mo. ) THE RELAPSE POTENTIAL RATE DROPS SIGNIFICIANTLY .

27. ( 6 ) COGNATIVE – BEHAVIORAL THERAPIES ARE MOST EFFECTIVE IN TREATING ADDICTION DISORDERS • ( MULTI – DISCIPLINARY TREATMENT ) INVOLVING GROUP THERAPIES , INFORMATIONAL LECTURES , DIDACTIC DISCUSSIONS , PEER INTERACTION ( A.A. OR N.A ) , PROBLEM SOLVING AND SKILL’S BUILDING , MARTIAL COUNSELING AND FAMILY INVOLVEMENT IS MOST EFFECTIVE IN SUBSTANCE ABUSE TREATMENT .

28. ( 7 ) EFFECTIVE TREATMENT PROGRAMS SHOULD BE CAUTIOUS BUT WILLING TO CONSIDER THE USE OF APPROPRIATE MEDICATIONS • PSYCHO - PHARMACOLOGICAL INTERVENTION IS PROVING TO BE AN IMPORTANT AND SOMETIMES NECESSARY ADDITION TO TRADITIONAL SUBSTANCE ABUSE TREATMENT . ( PLEASE . . .DON’T KILL THE MESSENGER ! )

29. ( 8 ) CO – EXISTING ( SUBSTANCE ABUSE AND PSYCHIATRIC DISORDERS ) NEED TO BE ADDRESSED IN AN EFFECTIVE TREATMENT PROGRAM • SUICIDE : FOUR ( 4 ) OUT OF FIVE ( 5 ) . • MOODDISORDERS : Bi – Polar : ( 20 % to 60 % ) . Depression : ( 98 % ) . • ANXIETYDISORDERS : ( 23 %) . • STRESS -TRAUMADISORDERS : ( 60% TO 80%) . • PERSONALITYDISORDERS : ( 40% ) . • PSYCHOTICDISORDERS : ( 14% TO 47 % ) .

30. ( 9 ) MEDICAL DETOXIFICATION AND INTERVENTION IS ONLY THE “ FIRST “ STAGE OF TREATMENT • MEDICAL INTERVENTION , IDENTIFICATION , DIAGNOSIS AND DETOXIFICATION ARE CRITICAL FIRST STEPS IN EFFECTIVE SUBSTANCE ABUSE TREATMENT .

31. ( 10 ) TREATMENT DOES NOT HAVE TO BE VOLUNTARY TO BE EFFECTIVE • REMEMBER : DAWSON’S HYPOTHESIS OF CHANGE ! ! ! • SANCTIONS AND BEING FORCED TO BE RESPONSIBLE , RELIABLE , DEPENDABLE , AND CONSISTANT . . . HAS BEEN FOUND TO BE A STRONG MOTIVATION TO ATTEND , PARTICIPATE , AND COMPLETE TREATMENT .

32. ( 11 ) POSSIBLE DRUG USE DURING TREATMENT MUST BE MONITORED CONTINUOUSLY • DRUG MONITORING HOLDS THE CLIENT RESPONSBILE TO THEIR COMMITMENTS . • DRUG MONITORING PERMITS THE TREATMENT TEAM TO ADJUSTED AN INDIVIDUALS TREATMENT PLAN ACCORDING TO THE NEEDS OF THE INDIVIDUAL .

33. ( 12 ) EFFECTIVE TREATMENT PROGRAMS SHOULD HAVE AVAILABLE . . . OR ACCESS TO . . . ASSESSMENT AND COUNSELING SERVICES FOR HIV - AIDS , HEPATITIS “ B ” AND “ C “, TUBERCULOSIS AND OTHER INFECTIOUS DISEASES THAT PLACE THEM OR OTHERS AT RISK OF INFECTION .

34. ( 13 ) TREATMENT AND RECOVERY IS LONG TERM PROCESS . . . PRONE TO EPISODES OF RELAPSE AND MULTIPLE TREATMENT ATTEMPTS • REMEMBER: TREATMENT AND RECOVERY FROM ALCOHOL AND DRUGS IS A PROCESS . . . NOT AN EVENT !

35. USING MEDICATIONS IN TREATMENT CURRENTLY THERE ARE EFFECTIVE MEDICATIONS THAT ASSIST HEALTH CARE PROFESSIONALS IN TREATING PSYCHIATRIC DISORDERS , SLEEP DISORDERS , NEUROLOGICAL DISORDERS , AND PHYSICAL – MEDICAL DISEASES . WE ARE IN PART AN “ CHEMICAL “ ORGANISM . CONSIDER THAT IN THE FUTURE , TREATMENT OF CHEMICAL DEPENDENCY DISORDERS WILL AND SHOULD INCLUDE THE PROPER BALANCE OF THERAPEUTIC INTERVENTIONS THAT INCLUDE , CONVENTIONAL COUNSELING TECHNIQUES , EDUCATION , PREVENTION , SELF – HELP GROUPS , PSYCHOLOGY , MEDICINE , SPIRITUALITY AND CHEMISTRY .

36. CURRENT AND FUTURE “ CRAVING “ MEDICATIONS ALCOHOL : DISULFRAM “ANTABUSE “ . ACAMPROSATE“CAMPARAL ‘’ . NALTREXONE“ VIVITROL “ . GABAPENTIN “ NEURONTIN “ : IMPACT THE GABA SYSTEM . BACLOFEN : AN ANTI – ANXIETY AGENT THAT IMPACTS THE GABA SYSTEM . TOPIRAMATE “ TOPAMAX “ : IMPACTS THE GABA AND THE GLUTAMATE SYSTEM .

37. COCAINE AND METHAMPHETAMINE ( S ) : ANTI–DEPRESSANTS “ SSRI’S “ , “SNRI’S “ . MEDICATIONS TARGETING THE INSULAR CORTEX OF THE BRAIN . A COCAINE VACCINE DEVELOPED DR. THOMAS KOSTEN , BAYLOR COLLEGE OF MEDICINE .

38. THE INSULAR REGIONS THE BRAIN ALSO ASSOCIATED WITH “ CRAVINGS “

39. MARIJUANA : RIMONABANT “ ACOMPLIA “ IMPACTS THE ENDOCANNABINOID SYSTEM . • TOBACCO : VARENICLINE “CHANTIX “ . ANTI – DEPRESSANTS “ WELLBUTRIN “ . A NICOTINEVACCINE INVENTED BY NABI BIOPHARM , MARYLAND . • OPIATES : METHADONE , NALOXONE , NALTREXONE , BUPRENORPHINE .

40. CONTACT INFORMATION :CARL M. DAWSON , M.S. MAC , LPC1320 E. KINGSLEY SUITE “ A “SPRINGFIELD, MO . 65804e – mail : cdawson1028@YAHOO.COM

41. Recommend Readings • U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment TREATMENT IMPROVEMENT PROTOCOL (TIP) SERIES Rockwall II, 5600 Fishers Lane Rockville, MD 20857

42. References and Recommended Readings • American Psychiatric Association (2000). The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, The American Psychiatric Association. • Cooper, J., F. Bloom, and R. Roth. The Biochemical Basis of Neuropharmacology, 8th ed. Oxford, U.K.: Oxford University Press, 2003. • Kandel, E.,J.Schwartz, and T. Jessell. The Foundations of Neural Science, 4th ed. Boston, MA: McGraw Hill, 2000.

43. Ray, O., Ksir, C. :Drugs Society, and Human Behavior, 7th ed., Mosby Publishing Co. (1996). • Squire, L. : Memory and Brain, Oxford, U.K.: Oxford University Press, (1987). • Whishaw. Il, and B. Kolb. Fundmentals of Human Neuropsychology, 5th ed. New York: Worth Books, (2003).