Traditional Treatment Approaches: Medical Model Opioid Dependence

INTRODUCTION
This unit examines the current traditional medical model approaches used to treat addiction, including the use of self-help. Scientifically based treatment includes the use of behavioral and medication therapies designed to help motivate and sustain changes in addictive behaviors.
Addictions-treatment professionals typically subscribe to the belief that patients with an alcohol or drug dependence disorder can learn how to maintain abstinence and to integrate a nondrug-centered lifestyle as the new norm. Much like individuals with other chronic medical conditions, such as heart disease, respiratory conditions, or other health problems, the addicted person does not eliminate the underlying disorder but can learn how to manage dependence or addictive factors.
As described by the National Institute on Drug Abuse (1999), effective treatment must include various combinations of core treatment elements:
• Intake processing or assessment.
• Treatment planning.
• Substance abuse monitoring.
• Clinical case management.
• Behavior or cognitive therapy.
• Pharmacotherapy.
• Self-help or peer support groups.
• Continuing care.
The National Institute on Drug Abuse (1999) also indicates that treatment must take place within a context that addresses the underlying social, familial, multicultural, financial, and housing, child care, legal, and educational obstacles, HIV and AIDS issues, medical and mental health treatment, and vocational challenges often faced by the person in recovery for substance abuse or addiction (p. 14). Failure to address factors that have been historically linked to the person’s pattern of addiction are associated with higher rates of relapse (Stevens, 2001a).
Individual treatment for substance abuse begins with detoxification from the abused substances. Depending on the severity of symptoms associated with the withdrawal process, medical intervention may be required in the form of inpatient hospitalization. This intervention could include frequent monitoring of co-occurring medical conditions and potentially life-threatening withdrawal symptoms.
To reduce the risk for severe medical reactions and adverse outcomes from withdrawal, medication may be used to mimic some of the neurological effects of the abused substance. For example, buprenorphine may be used for opiate addiction withdrawal or management. According to Stevens (2001a), methadone may be prescribed due to its properties to mimic “the production of endorphins in the body, producing a feeling of satisfaction without the high of heroin” (p. 185). There is some disagreement in the professional treatment community about the pros and cons of this strategy—why mimic the effects of one drug of dependence for another? In spite of these varying perspectives, individuals on methadone maintenance may remain on this medication for a year or longer (National Institute on Drug Abuse, 1999).
The debate regarding some forms of treatment continues. However, there is ample evidence that combinations of 30-, 60-, or 90-day inpatient programs and participation in self-help community-based programs hold promise for positive recovery outcomes. The programs that have acquired the most recognition as self-help methods to achieve and maintain abstinence are 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. According to Stevens (2001b), “The cornerstone of the AA model is the paradoxical belief that to gain control of one’s life, one must give up control to a Higher Power” (p. 283). As with many approaches to substance abuse treatment, this foundational belief is open to debate among treatment professionals as well as potential patients. For those who make a commitment to the AA model, however, the outcome can be a lasting form of recovery linked to others who share a similar belief system.
References
National Institute on Drug Abuse. (1999, October). Principles of drug addiction treatment: A research-based guide (NIH Publication No. 99-4180). Retrieved March 18, 2009, from http://www.nida.nih.gov/PDF/PODAT/PODAT.pdf
Stevens, P. (2001a). Individual and group treatment. In P. Stevens & R. L. Smith, Substance abuse counseling: Theory and practice (2nd ed., pp. 179–200). Upper Saddle River, NJ: Merrill Prentice Hall.
Stevens, P. (2001b). Maintaining behavior change: Relapse prevention strategies. In P. Stevens & R. L. Smith, Substance abuse counseling: Theory and practice (2nd ed.). Upper Saddle River, NJ: Merrill Prentice Hall.

OBJECTIVES
To successfully complete this learning unit, you will be expected to:
1. Describe the behavioral and pharmacological therapies used to treat addiction.
2. Explain the role of self-help in treating addiction.
3. Analyze the application of these approaches in community-based settings.
Learning Activities
Studies 1

• Use your Concepts of Chemical Dependency textbook, the Capella library, and your coursepack to complete the following:
• Read Chapter 32, “Pharmacological Interventions for Substance Use Disorders,” pages 467–477. This chapter discusses pharmacological treatments of different types of substance abuse.
• Read Chapter 34, “Support Groups to Promote and Sustain Recovery,” pages 514–526. This chapter discusses AA.
• Read Ronel, Gueta, Abramsohn, Caspi, and Adelson’s 2011 article, “Can a 12-Step Program Work in Methadone Maintenance Treatment?,” from International Journal of Offender Therapy and Comparative Criminology, volume 55, issue 7, pages 1135–1153.
• Read the Brown and Flynn article, “The Federal Role in Drug Abuse Technology Transfer: A History and Perspective.”

Web Sites
Visit and explore the following Web sites in preparation for an upcoming discussion:
• American Association for the Treatment of Opioid Dependence (AATOD).
• Narcotics Anonymous (NA).
• Alcoholics Anonymous (AA).

Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Methadone Availability
American Association for the Treatment of Opioid Dependence (AATOD).
Narcotics Anonymous (NA).
Alcoholics Anonymous (AA).
Visit and explore the American Association for the Treatment of Opioid Dependence (AATOD) and the Narcotics Anonymous (NA) Web sites.
Although methadone is a controlled substance and an extremely effective treatment for heroin addiction, it can be administered only by federally sanctioned treatment clinics. Because methadone, like heroin, is a narcotic, some people have criticized this treatment as simply replacing one drug with another drug. For this discussion:
• Examine the arguments made in favor or against making methadone more available to people with heroin addictions.
• Provide your opinion about deregulating how methadone is administered in an effort to increase its availability.
• Discuss how a methadone user would integrate treatment with the tenets of Narcotics Anonymous.

 

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