An Informative Guide on Various Programs on Drug and Alcohol Addiction Treatment

Over the years, several programs for drug and alcohol addiction treatment have evolved. These treatment programs have various methods of working and they follow different principles. Even their purposes are different, because each of them target people with a different degree of addiction and different expectations from the addiction treatment program. However, it can be said that the different addiction treatment programs used in the US are largely progressive in nature. People can start out with a mild form of treatment, and if that doesn’t work for them, they can get themselves enrolled in a higher form of treatment. In this way, it can be said that there is a hierarchy of treatment programs in the US.

You will not find a similar hierarchy of treatment programs in most other countries of the world. There is a specific reason for that. In the US, the definition of addiction treatment is quite different than what it is in other parts of the world. For America, addiction treatment means getting a person completely out of the habit of using the substance of addiction. This is definitely a very difficult feat to achieve. Other parts of the world follow a simpler addiction treatment program. For example, in most parts of Europe, drug and alcohol addiction treatment means simply to manage the addiction to a lower level of dependency so that it is no longer as hazardous to the person’s health as it was before the treatment. Quite naturally, US treatment centers for drug and alcohol addiction have a longer and a much more elaborate program to follow.

This explains in part the need for having a hierarchical setup for the treatment program. The other reason is the need of the patient. Not all patients would be at the same level of addiction. Also, they may not be into the same kind of addiction. Depending on all these factors, their requirements for treatment will be different. This calls for different kinds of treatment programs of varying levels of severity, and this is what you will find when you are searching for options on addiction treatment in the US.

Let us see what different programs for addiction treatment exist in the US. This list arranges the treatment programs in an increasing order of their severity.

Outpatient Treatment Program – This is the mildest form of addiction treatment program in the US. This program does not focus much on detox treatment, though in some cases, there could be an outpatient detox provided. The outpatient treatment runs for about nine hours a week in most states, staggered into three or four sessions. The program is mainly designed for people who in mild to moderate stages of addiction and who are physically and mentally fit to undertake the program. Even people who have had a detox treatment can take this program as a method of aftercare.

Day Treatment Program – This is by far the most popular treatment program in most states, since it is a treatment option for moderate degrees of addiction and yet it does not isolate the patient from family. The person has to attend for this program in a treatment center for three to four hours a day, and the rest of the day is free for the patient. The patient can continue job or school, whichever the case may be. The program relies on both outpatient detox and counseling. It is usually a daily program.

Inpatient Treatment Program – As the name suggests, this program is carried out in an inpatient center. Detox is usually a part of this treatment in which the patient is made to abstain from the substance which makes the withdrawal effects make their appearance. Then the patient is provided a series of medication that helps them to overcome the withdrawal. Even after the detox treatment is completed, the patient continues to live in the treatment center to get counseled and for maintenance therapies. Some inpatient treatment centers in the US will just complete the detox treatment program and then will refer the patient to an outpatient treatment center for further treatment.

Dyadic Developmental Psychotherapy – An Evidence-Based Treatment For Disorders of Attachment

Dyadic Developmental Psychotherapy is an evidence-based and effective form of treatment for children with trauma and disorders of attachment . It is an evidence-based treatment, meaning that there has been empirical research published in peer-reviewed journals. Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a six level system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results DDP with other forms of treatment, ‘usual care’, 1 year after treatment ended.

It is important to note that over 80% of the children in the study had had over three prior episodes of treatment, but without any improvement in their symptoms and behavior. Episodes of treatment mean a course of therapy with other mental health providers at other clinics, consisting of at least five sessions. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of those studies would have resulted in DDP being classified as an evidence-based category 2, ‘Supported and probably efficacious’. There have been two related empirical studies comparing treatment outcomes of Dyadic Developmental Psychotherapy with a control group. This is the basis for the rating of category two. The criteria are:

1. The treatment has a sound theoretical basis in generally accepted psychological principles. Dyadic Developmental Psychotherapy is based in Attachment Theory (see texts cited below
2. A substantial clinical, anecdotal literature exists indicating the treatment’s efficacy with at-risk children and foster children. See reference list.
3. The treatment is generally accepted in clinical practice for at risk children and foster children. As demonstrated by the large number of practitioners of Dyadic Developmental Psychotherapy and it’s presentation as numerous international and national conferences over the last ten or fifteen years.
4. There is no clinical or empirical evidence or theoretical basis indicating – that the treatment constitutes a substantial risk of harm to those receiving it, compared to its likely benefits.
5. The treatment has a manual that clearly specifies the components and administration characteristics of the treatment that allows for implementation. Creating Capacity for Attachment, Building the Bonds of Attachment, and Attachment Focused Family Therapy constitute such material.
6. At least two studies utilizing some form of control without randomization (e.g., wait list, untreated group, placebo group) have established the treatment’s efficacy over the passage of time, efficacy over placebo, or found it to be comparable to or better than an already established treatment. See ref. list.
7. If multiple treatment outcome studies have been conducted, the overall weight of evidence supported the efficacy of the treatment.

These studies support several of O’Connor & Zeanah’s conclusions and recommendations concerning treatment. They state (p. 241), “treatments for children with attachment disorders should be promoted only when they are evidence-based.”

Dyadic Developmental Psychotherapy, as with any specialized treatment, must be provided by a competent, well-trained, licensed professional. Dyadic Developmental Psychotherapy is a family-focused treatment .

Dyadic Developmental Psychotherapy is the name for an approach and a set of principals that have proven to be effective in helping children with trauma and attachment disorders heal; that is, develop healthy, trusting, and secure relationships with caregivers. Treatment is based on five central principals.

Drug Addiction – Understanding the Nature of Addiction to Understand Cross Addiction

Early addiction recovery is a fragile thing. One of the most frequent contributing factors in relapse is something we call “cross-addiction”. Essentially what cross-addiction means, is that if you are alcoholic or addicted to other mood altering drugs, you a potentially addicted to all mood altering drugs.

To truly understand cross-addiction, you must appreciate the character of addiction and the nature of mood/mind altering drugs.

Addiction is a disease. It is frequently described as a primary, chronic, progressive, and relapsing disease.  Research in the last decade tells us that addiction is a brain disease.

People are often reluctant to acknowledge addiction as a disease because of voluntary first use of the chemical.  Although someone chooses to use alcohol or other drugs initially, the changes that occur in the brain over time do not reflect a deliberate choice.  Addiction changes the neuropathways of the mind.  These changes are suspected of creating the thinking and feeling distortions that lead to the compulsion to consume drugs despite the obvious negative consequences. Thus, the nature of addiction is that of compulsive drug use despite negative consequences.  This “compulsive use despite negative consequences” observation has become an part of an accepted definition of addiction.

Addiction induced brain changes are common to all drug addictions and some process addictions (e.g. compulsive behavioral addictions such as gambling addiction, compulsive overeating, sexual addiction). Addiction also involves a bio psychosocial combination of factors in the genesis, maintenance, and recovery.  It has been said in the addictions field for a long time that certain people are “hardwired” for addiction, due to biology (i.e., genetics), and become addicted with first use of any mood altering drug.

The nature of mood/mind altering drugs is that they drug your feelings, thoughts, and behavior. They distort your reality or they allow you to escape or ignore reality. Any mood/mind altering drug can be cross addictive.  It is the mood altering effects of drugs that people are addicted to.  You choose a particular drug for its unique pharmaceutic effects, based on your own individual needs.  As your needs change, your drug of choice may change.  The effects of the drug on your body can change over time as well.

Other variables are often involved in an addict’s choice of drug.  Consciously or unconsciously, other factors, like availability, ”social acceptability”, perceived lack of negative consequences, and cost may be part of the selection process.

Mood altering drugs operating in the altered brain neuropathways are self reinforcing in a number of ways. They meet specific individual needs (relaxation, feelings numbing, reducing behavioral inhibitions, etc.), which is self-reinforcing.  The altered neuropathways help maintain the compulsion. The specific drug(s) selected meets individual needs over time so that living skills to meet those same needs do not develop.  A common example is where a drug is chosen for its anxiety reduction properties because the addicted individual has few if any anxiety reduction skills.  When stress and anxiety levels exceed some threshold, relief will be sought.  Without skills to reduce the anxiety, a pharmaceutical solution will be sought, regardless of whether the drug is last drug of choice or a substitute.  This is one reason why it is so crucial to identify the roles that the chemicals have played in a recovering person’s life, and to develop the living skills with which to replace those roles.

When a person in recovery acknowledges the problems caused by the drug of choice and believes that s/he can safely use a different drug of choice, they are not taking into account the fact the “new drug”. like the ”old drug” will still operate in the brain in the same way(s).  When an addict substitutes one drug for another they are not abstinent.  His/her brain is still in an active state of addiction.  Thus, someone who is addicted to one mood altering drug is addicted to all mood altering drugs.

An addicted brain is qualitatively changed.  Changing drugs of choice does not return an addict to a non-addicted state.  An addicted person will continue to experience the same negative consequences of drug use.  You cannot regain persistent control over drug use by changing drugs.

Many people, in the process of trying to regain control over their life, chase an “illusion of control”, believing that the latest attempt at control (switching drugs) has, and will have a lasting effect and that control is once again re-established. It has not. It is only a matter of time, usually a short amount of time.