What To Do When Your Child Is Using Drugs
C. Commonly Asked Questions
I. Drug Abuse and Drug Addiction
II. Signs and Symptoms Your Child Is Using Drugs
III. Confronting the Issue of Drug Use with Your Kids.
IV. Drug Treatment Defined
V. Drug Treatment Options
VI. Real-life Situations Concerning Drug Abuse and Treatment
I. Drug Abuse and Drug Addiction
A. What is drug abuse?
The use of illicit drugs or the abuse of prescription or over-the-counter drugs for purposes other than those for which they are indicated or in a manner or in quantities other than directed.
http://www.nlm.nih.gov/medlineplus/ency/article/001945.htm
B. What is drug addiction?
Drug dependence (addiction) is compulsive use of a substance despite negative consequences which can be severe; drug abuse is simply excessive use of a drug or use of a drug for purposes for which it was not medically intended.
Physical dependence on a substance (needing a drug to function) is not necessary or sufficient to define addiction. There are some substances which don't cause addiction but do cause physical dependence (for example, some blood pressure medications) and substances which cause addiction but not classic physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it is mainly characterized by depression).
http://www.nlm.nih.gov/medlineplus/ency/article/001522.htm
C. What is the difference between abuse and addiction?
Telling the difference between abuse and addiction is hard. Addiction begins as abuse, or usage of a substance like marijuana or cocaine. You can abuse a drug without having an addiction. For example, just because Sara smoked weed a few times doesn't mean that she has an addiction, but it does mean that she's abusing a drug - and that could lead to an addiction.
Addiction means having no control over whether to use a drug. A person who's addicted to cocaine has grown so used to the drug that he has to have it. Addiction can be physical, psychological, or both.
Physical addiction is when a person's body actually becomes dependent on a drug. It also means that a person builds tolerance to a drug, which means he needs a larger dose of that drug to get the same effects. When a person who is physically addicted stops using drugs, he may experience withdrawal symptoms. Withdrawal can be like having the flu - common symptoms are diarrhea, shaking, and generally feeling awful.
Psychological addiction may happen along with physical addiction or on its own. In this case, the cravings for a drug are psychological, or mental. People who are psychologically addicted feel overcome by the desire to have a drug. They may lie or steal to get it. An addicted person - whether it's a physical or psychological addiction or both - no longer has a choice.
An addiction is not just measured by how many times a person uses a drug. Some drugs, like crack or heroin, are so addictive that they may only be used once or twice before the user loses control. A person crosses the line between abuse and addiction when he's no longer trying the drug to have fun or get high, but because he's come to depend on it. His whole life centers around the need for the drug.
http://kidshealth.org/teen/your_mind/problems/addictions.html
II. Signs and Symptoms Your Child Is Using Drugs
A. What are the physical warning signs of drug use?
· Loss of appetite, increase in appetite, any changes in eating habits, unexplained weight loss or gain.
· Slowed or staggering walk; poor physical coordination.
· Inability to sleep, awake at unusual times, unusual laziness.
· Red, watery eyes; pupils larger or smaller than usual; blank stare.
· Cold, sweaty palms; shaking hands.
· Puffy face, blushing or paleness.
· Smell of substance on breath, body or clothes.
· Extreme hyperactivity; excessive talkativeness.
· Runny nose; hacking cough.
· Needle marks on lower arm, leg or bottom of feet.
· Nausea, vomiting or excessive sweating.
· Tremors or shakes of hands, feet or head.
· Irregular heartbeat.
http://www.acde.org/parent/signs.htm
B. What are the behavioral warning signs of drug use?
· Change in overall attitude/personality with no other identifiable cause.
· Changes in friends; new hang-outs; sudden avoidance of old crowd; doesn't want to talk about new friends; friends are known drug users.
· Change in activities or hobbies.
· Drop in grades at school or performance at work; skips school or is late for school.
· Change in habits at home; loss of interest in family and family activities.
· Difficulty in paying attention; forgetfulness.
· General lack of motivation, energy, self-esteem, "I don't care" attitude.
· Sudden oversensitivity, temper tantrums, or resentful behavior.
· Moodiness, irritability, or nervousness.
· Silliness or giddiness.
· Paranoia
· Excessive need for privacy; unreachable.
· Secretive or suspicious behavior.
· Car accidents.
· Chronic dishonesty.
· Unexplained need for money, stealing money or items.
· Change in personal grooming habits.
· Possession of drug paraphernalia.
http://www.acde.org/parent/signs.htm
C. What are some drug specific symptoms? (Make these buttons, please)
Marijuana: Glassy, red eyes; loud talking and inappropriate laughter followed by sleepiness; a sweet burnt scent; loss of interest, motivation; weight gain or loss.
Alcohol: Clumsiness; difficulty walking; slurred speech; sleepiness; poor judgment; dilated pupils; possession of a false ID card.
Depressants: (including barbiturates and tranquilizers) Seems drunk as if from alcohol but without the associated odor of alcohol; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness; and contracted pupils.
Stimulants: Hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; dilated pupils; weight loss; dry mouth and nose.
Inhalants: (Glues, aerosols, and vapors ) Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; an unusual number of spray cans in the trash.
Hallucinogens: Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
Heroin: Needle marks; sleeping at unusual times; sweating; vomiting; coughing and sniffling; twitching; loss of appetite; contracted pupils; no response of pupils to light.
Tobacco/Nicotine: Smell of tobacco; stained fingers or teeth.
http://www.acde.org/parent/signs.htm
III. Confronting the Issue of Drug Use with Your Kids
A. What do I do when my child is using drugs?
Talk to your child. If you need help with this, contact your doctor, a school social worker or clergy member, your local hospital, county medical health society, or family counselor. Professional intervention can help determine an appropriate course of action.
Keep in mind that the moment of disclosure is not just a moment to punish. It should open a conversation of understanding and bond by working together to solve the problem.
http://www.casacolumbia.org/info-url1940/info-url_show.htm?doc_id=20822
B. How do I help my child when he/she is abusing drugs?
If warning signs point to a child on drugs, it's time to take action. If you deal with possible drug use head-on, there's a very good chance your child can be helped. Don't spend time hiding from the problem. Spend your time helping your child. The faster you act, the faster your child can start to become well again.
Sit down with your child for an open discussion about Alcohol and drug use. Openly voice your suspicions to your child but avoid direct accusations. Do not have this conversation when your child is under the influence of alcohol or other drugs, and make sure you sound calm and rational. This may mean waiting a day if he comes home drunk from a party, or if her room smells like Marijuana . Ask your child what's been going on in her life. Discuss ways to avoid using alcohol and other drugs in the future. If you need help during this conversation, get another family member, your child's guidance counselor, or physician involved.
Remember to reinforce your no-drug policy during the conversation. Be firm and enforce whatever discipline you've laid out in the past for violation of house rules. You should discuss ways your child can regain your lost trust: calling in, spending evenings at home, or improving grades.
Just like many adults, many young people deny their alcohol and other drug use. If you have strong evidence that your child is lying, you may want to have her evaluated by a health professional experienced in diagnosing adolescents with alcohol- and drug-related problems. If you decide to go this route, remember that you're trying to help your child. Don't make the doctor's appointment seem like a threat or a punishment.
If your child has developed a pattern of drug use or an addiction, you will probably need to seek professional help. If you do not know about drug treatment programs in your area, call your doctor, local hospital, state or local substance abuse agencies, or county mental health society for a referral. Your school district should have a substance abuse coordinator or a counselor who can refer you to treatment programs, too. Parents whose children have been through treatment programs can also provide information.
Drug addiction is now understood to be a chronic, relapsing disease. It may require a number of attempts before your child can remain drug-free. Don't despair if your child's first try doesn't produce long-lasting results. Even if it's not apparent at the time, each step brings your child closer to a healthy life.
C. What is an intervention and how do I do it?
There are two ways to intervene with a substance abuser: an informal intervention (a personal discussion) or a structured intervention. The latter involves bringing together a group of people with the substance abuser to explore how the abuse has affected all their lives, and is used when the person has repeatedly declined to get help.
In any intervention, it's important to approach your loved one when he/she is not high or drunk (and when you are not acutely upset). Some additional hints:
Stay calm.
Couch your comments in concern.
Avoid labeling the person an "alcoholic" or "addict."
Cite specific incidents resulting from the person's substance abuse. ("You were recently arrested for DWI.")
Stick to what you know firsthand, not hearsay.
Talk in "I statements," explaining how the person's behavior has affected you. ("When you drive drunk, I don't sleep all night.")
Be prepared for denial and resentment.
Be supportive and hopeful about change.
The point of any intervention is to ask the person to take concrete steps to address the problem (i.e., go for a substance abuse evaluation, attend family counseling, enter inpatient treatment).
A structured intervention should be facilitated by a professional. The goal is to have the person begin treatment immediately.
Enlist a professional to help plan it.
Bring together the people most significant to the abuser (three to six is best, no children).
Decide who is going to say what.
Make all arrangements for the person to begin treatment immediately following the intervention.
Identify the objections you might hear from the substance abuser, and be prepared to answer each one.
Decide what consequences you're prepared to follow through with if the person refuses to enter treatment. (For a teenager, it might be, "We will file a petition with the court to have you placed in treatment." For a spouse: "I will no longer cover up for you," or even: "I won't remain in this relationship with you.")
Rehearse the intervention at least once.
http://www.pbs.org/wnet/closetohome/help-resc/html/intervention.html
IV. Drug Addiction Treatment Defined
A. What is drug addiction treatment?
There are many addictive drugs, and treatments for specific drugs can differ. Treatment also varies depending on the characteristics of the patient.
Problems associated with an individual's drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.
A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person's drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients. (See Treatment Section for more detail on types of treatment and treatment components.) The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.
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Drug addiction treatment can include behavioral therapy, medications, or their combination. |
Treatment medications, such as methadone, LAAM, and naltrexone, are available for individuals addicted to opiates. Nicotine preparations (patches, gum, nasal spray) and bupropion are available for individuals addicted to nicotine.
Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis.
Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment often is not sufficient. For many, treatment is a long-term process that involves multiple interventions and attempts at abstinence.
http://www.drugabuse.gov/PODAT/PODAT4.html
For more information, please visit:
http://www.drugabuse.gov/infofax/treatmeth.html
B. What are different approaches to treatment?
Drug addiction is a complex disorder that can involve virtually every aspect of an individual's functioningÑin the family, at work, and in the community. Because of addiction's complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual's drug use. Others, like employment training, focus on restoring the addicted individual to productive membership in the family and society.
Treatment for drug abuse and addiction is delivered in many different settings, using a variety of behavioral and pharmacological approaches. In the United States, more than 11,000 specialized drug treatment facilities provide rehabilitation, counseling, behavioral therapy, medication, case management, and other types of services to persons with drug use disorders.
Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of drug addiction and its medical consequences.
Drug abuse and addiction are treated in specialized treatment facilities and mental health clinics by a variety of providers, including certified drug abuse counselors, physicians, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting.
General Categories of Treatment Programs (make #’s into buttons, please)
Research studies on drug addiction treatment have typically classified treatment programs into several general types or modalities, which are described in the following text. Treatment approaches and individual programs continue to evolve, and many programs in existence today do not fit neatly into traditional drug addiction treatment classifications. Examples of specific research-based treatment components are described in the Approaches to Treatment Section.
- Agonist Maintenance Treatment for opiate addicts usually is conducted in outpatient settings, often called methadone treatment programs. These programs use a long-acting synthetic opiate medication, usually methadone or LAAM, administered orally for a sustained period at a dosage sufficient to prevent opiate withdrawal, block the effects of illicit opiate use, and decrease opiate craving. Patients stabilized on adequate, sustained dosages of methadone or LAAM can function normally. They can hold jobs, avoid the crime and violence of the street culture, and reduce their exposure to HIV by stopping or decreasing injection drug use and drug-related high-risk sexual behavior.
Patients stabilized on opiate agonists can engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation. The best, most effective opiate agonist maintenance programs include individual and/or group counseling, as well as provision of, or referral to, other needed medical, psychological, and social services.
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Patients stabilized on adequate sustained dosages of methadone or LAAM can function normally. |
2. Narcotic Antagonist Treatment Using Naltrexone for opiate addicts usually is conducted in outpatient settings although initiation of the medication often begins after medical detoxification in a residential setting. Naltrexone is a long-acting synthetic opiate antagonist with few side effects that is taken orally either daily or three times a week for a sustained period of time. Individuals must be medically detoxified and opiate-free for several days before naltrexone can be taken to prevent precipitating an opiate abstinence syndrome. When used this way, all the effects of self-administered opiates, including euphoria, are completely blocked. The theory behind this treatment is that the repeated lack of the desired opiate effects, as well as the perceived futility of using the opiate, will gradually over time result in breaking the habit of opiate addiction. Naltrexone itself has no subjective effects or potential for abuse and is not addicting. Patient noncompliance is a common problem. Therefore, a favorable treatment outcome requires that there also be a positive therapeutic relationship, effective counseling or therapy, and careful monitoring of medication compliance.
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Patients stabilized on naltrexone can hold jobs, avoid crime and violence, and reduce their exposure to HIV. |
Many experienced clinicians have found naltrexone most useful for highly motivated, recently detoxified patients who desire total abstinence because of external circumstances, including impaired professionals, parolees, probationers, and prisoners in work-release status. Patients stabilized on naltrexone can function normally. They can hold jobs, avoid the crime and violence of the street culture, and reduce their exposure to HIV by stopping injection drug use and drug-related high-risk sexual behavior.
3. Outpatient Drug-Free Treatment in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for individuals who are employed or who have extensive social supports. Low-intensity programs may offer little more than drug education and admonition. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient's characteristics and needs. In many outpatient programs, group counseling is emphasized. Some outpatient programs are designed to treat patients who have medical or mental health problems in addition to their drug disorder.
4. Long-Term Residential Treatment provides care 24 hours per day, generally in nonhospital settings. The best-known residential treatment model is the therapeutic community (TC), but residential treatment may also employ other models, such as cognitive-behavioral therapy.
TCs are residential programs with planned lengths of stay of 6 to 12 months. TCs focus on the "resocialization" of the individual and use the program's entire "community," including other residents, staff, and the social context, as active components of treatment. Addiction is viewed in the context of an individual's social and psychological deficits, and treatment focuses on developing personal accountability and responsibility and socially productive lives. Treatment is highly structured and can at times be confrontational, with activities designed to help residents examine damaging beliefs, self-concepts, and patterns of behavior and to adopt new, more harmonious and constructive ways to interact with others. Many TCs are quite comprehensive and can include employment training and other support services on site.
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Therapeutic communities focus on the "resocialization" of the individual and use the program's entire "community" as active components of treatment. |
Compared with patients in other forms of drug treatment, the typical TC resident has more severe problems, with more co-occurring mental health problems and more criminal involvement. Research shows that TCs can be modified to treat individuals with special needs, including adolescents, women, those with severe mental disorders, and individuals in the criminal justice system.
5. Short-Term Residential Programs provide intensive but relatively brief residential treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980's, many began to treat illicit drug abuse and addiction. The original residential treatment model consisted of a 3 to 6 week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as Alcoholics Anonymous. Reduced health care coverage for substance abuse treatment has resulted in a diminished number of these programs, and the average length of stay under managed care review is much shorter than in early programs.
6. Medical Detoxification is a process whereby individuals are systematically withdrawn from addicting drugs in an inpatient or outpatient setting, typically under the care of a physician. Detoxification is sometimes called a distinct treatment modality but is more appropriately considered a precursor of treatment, because it is designed to treat the acute physiological effects of stopping drug use. Medications are available for detoxification from opiates, nicotine, benzodiazepines, alcohol, barbiturates, and other sedatives. In some cases, particularly for the last three types of drugs, detoxification may be a medical necessity, and untreated withdrawal may be medically dangerous or even fatal.
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Detoxification is a precursor of treatment. |
Detoxification is not designed to address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification is most useful when it incorporates formal processes of assessment and referral to subsequent drug addiction treatment.
7. Prison-Based Treatment Programs.
Offenders with drug disorders may encounter a number of treatment options while incarcerated, including didactic drug education classes, self-help programs, and treatment based on therapeutic community or residential milieu therapy models. The TC model has been studied extensively and can be quite effective in reducing drug use and recidivism to criminal behavior. Those in treatment should be segregated from the general prison population, so that the "prison culture" does not overwhelm progress toward recovery. As might be expected, treatment gains can be lost if inmates are returned to the general prison population after treatment. Research shows that relapse to drug use and recidivism to crime are significantly lower if the drug offender continues treatment after returning to the community.
8. Community-Based Treatment for Criminal Justice Populations.
A number of criminal justice alternatives to incarceration have been tried with offenders who have drug disorders, including limited diversion programs, pretrial release conditional on entry into treatment, and conditional probation with sanctions. The drug court is a promising approach. Drug courts mandate and arrange for drug addiction treatment, actively monitor progress in treatment, and arrange for other services to drug-involved offenders. Federal support for planning, implementation, and enhancement of drug courts is provided under the U.S. Department of Justice Drug Courts Program Office.
As a well-studied example, the Treatment Accountability and Safer Communities (TASC) program provides an alternative to incarceration by addressing the multiple needs of drug-addicted offenders in a community-based setting. TASC programs typically include counseling, medical care, parenting instruction, family counseling, school and job training, and legal and employment services. The key features of TASC include (1) coordination of criminal justice and drug treatment; (2) early identification, assessment, and referral of drug-involved offenders; (3) monitoring offenders through drug testing; and (4) use of legal sanctions as inducements to remain in treatment.
http://www.drugabuse.gov/PODAT/PODAT7.html
C. Why can’t drug addicts quit on their own?
Nearly all addicted individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences, the defining characteristic of addiction.
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Long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. |
Understanding that addiction has such an important biological component may help explain an individual's difficulty in achieving and maintaining abstinence without treatment. Psychological stress from work or family problems, social cues (such as meeting individuals from one's drug-using past), or the environment (such as encountering streets, objects, or even smells associated with drug use) can interact with biological factors to hinder attainment of sustained abstinence and make relapse more likely. Research studies indicate that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.
http://www.drugabuse.gov/PODAT/PODAT4.html
D. How successful is drug addiction treatment?
In addition to stopping drug use, the goal of treatment is to return the individual to productive functioning in the family, workplace, and community. Measures of effectiveness typically include levels of criminal behavior, family functioning, employability, and medical condition. Overall, treatment of addiction is as successful as treatment of other chronic diseases, such as diabetes, hypertension, and asthma.
According to several studies, drug treatment reduces drug use by 40 to 60 percent and significantly decreases criminal activity during and after treatment. For example, a study of therapeutic community treatment for drug offenders demonstrated that arrests for violent and nonviolent criminal acts were reduced by 40 percent or more. Methadone treatment has been shown to decrease criminal behavior by as much as 50 percent. Research shows that drug addiction treatment reduces the risk of HIV infection and that interventions to prevent HIV are much less costly than treating HIV-related illnesses. Treatment can improve the prospects for employment, with gains of up to 40 percent after treatment.
Although these effectiveness rates hold in general, individual treatment outcomes depend on the extent and nature of the patient's presenting problems, the appropriateness of the treatment components and related services used to address those problems, and the degree of active engagement of the patient in the treatment process.
Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years. Many people who enter treatment drop out before receiving all the benefits that treatment can provide. Successful outcomes may require more than one treatment experience. Many addicted individuals have multiple episodes of treatment, often with a cumulative impact.
Drug addiction treatment is cost-effective in reducing drug use and its associated health and social costs. Treatment is less expensive than alternatives, such as not treating addicts or simply incarcerating addicts. For example, the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $18,400 per person.
According to several conservative estimates, every $1 invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.
http://www.drugabuse.gov/PODAT/PODAT5.html
E. Principles of Effective Treatment (please make #’s buttons that click for content with bold sentence as headings)
1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
2. Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.
4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs (see pages 11-49). Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community.
7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important.
8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.
9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.
10. Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.
11. Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.
12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior. Counseling also can help people who are already infected manage their illness.
13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.
http://www.drugabuse.gov/PODAT/PODAT1.html
F. How does the Criminal Justice System help in drug treatment programs?
Increasingly, research is demonstrating that treatment for drug-addicted offenders during and after incarceration can have a significant beneficial effect upon future drug use, criminal behavior, and social functioning. The case for integrating drug addiction treatment approaches with the criminal justice system is compelling. Combining prison- and community-based treatment for drug-addicted offenders reduces the risk of both recidivism to drug-related criminal behavior and relapse to drug use. For example, a recent study found that prisoners who participated in a therapeutic treatment program in the Delaware State Prison and continued to receive treatment in a work-release program after prison were 70 percent less likely than nonparticipants to return to drug use and incur re-arrest.
The majority of offenders involved with the criminal justice system are not in prison but are under community supervision. For those with known drug problems, drug addiction treatment may be recommended or mandated as a condition of probation. Research has demonstrated that individuals who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily.
The criminal justice system refers drug offenders into treatment through a variety of mechanisms, such as diverting nonviolent offenders to treatment, stipulating treatment as a condition of probation or pretrial release, and convening specialized courts that handle cases for offenses involving drugs. Drug courts, another model, are dedicated to drug offender cases. They mandate and arrange for treatment as an alternative to incarceration, actively monitor progress in treatment, and arrange for other services to drug-involved offenders.
The most effective models integrate criminal justice and drug treatment systems and services. Treatment and criminal justice personnel work together on plans and implementation of screening, placement, testing, monitoring, and supervision, as well as on the systematic use of sanctions and rewards for drug abusers in the criminal justice system. Treatment for incarcerated drug abusers must include continuing care, monitoring, and supervision after release and during parole.
http://www.drugabuse.gov/PODAT/PODAT6.html
G. What about self-help programs?
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model, and Smart Recovery®. Most drug addiction treatment programs encourage patients to participate in a self-help group during and after formal treatment.
http://www.drugabuse.gov/PODAT/PODAT6.html
TOUGHLOVE® International is a non-profit, self-help organization that provides ongoing education and active support to families, empowering parents and young people to accept responsibility for their actions. Our support network strives to make communities safe places to live.
We believe that drug and alcohol abuse, family violence, teen pregnancy, suicide, family dissolution, school drop-outs, and runaways are problems created and maintained by the culture in which we live. It is our goal to change the conditions of the culture by empowering people through TOUGHLOVE community-based self-help programs.
We do not:
· Advocate or support "throwing kids out."
· Advocate or support violence against kids or parents.
· Advocate or support verbal abuse.
· Offer an instant fix. Your situation took a long time to develop; it will take time to reverse
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H. How can family and friends help with drug treatment?
Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is important, especially for adolescents (See Approaches to Treatment Section). Involvement of a family member in an individual's treatment program can strengthen and extend the benefits of the program.
http://www.drugabuse.gov/PODAT/PODAT6.html
I. What type of behavioral changes should I expect?
Recovery from the disease of drug addiction is often a long-term process, involving multiple relapses before a patient achieves prolonged abstinence. Many behavioral therapies have been shown to help patients achieve initial abstinence and maintain prolonged abstinence. One frequently used therapy is cognitive behavioral relapse prevention in which patients are taught new ways of acting and thinking that will help them stay off drugs. For example, patients are urged to avoid situations that lead to drug use and to practice drug refusal skills. They also are taught to think of the occasional relapse as a "slip" rather than as a failure. Cognitive behavioral relapse prevention has proven to be a useful and lasting therapy for many drug addicted individuals.
One of the more well-developed behavioral techniques in drug abuse treatment is contingency management, a system of rewards and punishments to make abstinence attractive and drug use unattractive. Ultimately, the aim of contingency management programs is to make a drug-free, pro-social lifestyle more rewarding than a drug-using lifestyle. The community reinforcement approach is a comprehensive contingency management approach that has proven to be extremely helpful in promoting initial abstinence in cocaine addicts.
Once drug use is under control, education and job rehabilitation become crucial. Rewarding lifestyle options must be found for people in drug recovery to prevent their return to the old environment and way of life.
http://www.drugabuse.gov/infofax/behavchange.html
J. What medications are used in drug treatment programs?
Treatment for people who abuse drugs but are not yet addicted to them most often consists of behavioral therapies, such as psychotherapy, counseling, support groups, or family therapy. But treatment for drug-addicted people often involves a combination of behavioral therapies and medications. Medications, such as methadone or LAAM (levo-alpha-acetyl-methadol), are effective in suppressing the withdrawal symptoms and drug craving associated with narcotic addiction, thus reducing illicit drug use and improving the chances of the individual remaining in treatment.
The primary medically assisted withdrawal method for narcotic addiction is to switch the patient to a comparable drug that produces milder withdrawal symptoms, and then gradually taper off the substitute medication. The medication used most often is methadone, taken by mouth once a day. Patients are started on the lowest dose that prevents the more severe signs of withdrawal and then the dose is gradually reduced. Substitutes can be used also for withdrawal from sedatives. Patients can be switched to long-acting sedatives, such as diazepam or phenobarbital, which are then gradually reduced.
Once a patient goes through withdrawal, there is still considerable risk of relapse. Patients may return to taking drugs even though they no longer have physical withdrawal symptoms. A great deal of research is being done to find medications that can block drug craving and treat other factors that cause a return to drugs.
Patients who cannot continue abstaining from opiates are given maintenance therapy, usually with methadone. The maintenance dose of methadone, usually higher than that used for medically assisted withdrawal, prevents both withdrawal symptoms and heroin craving. It also prevents addicts from getting a high from heroin and, as a result, they stop using it. Research has shown that maintenance therapy reduces the spread of AIDS in the treated population. The overall death rate is also significantly reduced.
Within various methadone programs, those that provide higher doses of methadone (usually a minimum of 60 mg.) have better retention rates. Also, those that provide other services, such as counseling, therapy, and medical care, along with methadone generally get better results than the programs that provide minimal services.
Another drug recently approved for use in maintenance treatment is LAAM, which is administered three times a week rather than daily, as is the case with methadone. The drug naltrexone is also used to prevent relapse. Like methadone, LAAM and naltrexone prevent addicts from getting high from heroin. However, naltrexone does not eliminate the drug craving, so it has not been popular among addicts. Naltrexone works best with highly motivated patients.
There are currently no medications approved by the Food and Drug Administration (FDA) for treating addiction to cocaine, LSD, PCP, marijuana, methamphetamine and other stimulants, inhalants, or anabolic steroids. There are medications, however, for treating the adverse health effects of these drugs, such as seizures or psychotic reactions, and for overdoses from opiates. Currently, NIDA's top research priority is the development of a medication useful in treating cocaine addiction.
For information on hotlines or counseling services, please call the CSAT National Drug and Alcohol Treatment Routing Service at 1-800-662-4357.
http://www.drugabuse.gov/infofax/treatmed.html
V. Treatment Options
A. How do I find a program near me? (please insert facility locator, thanks)
http://findtreatment.samhsa.gov/faq.htm
B. Where can I find more information about drug treatment programs?
Alcohol and Drug Treatment
Al-Anon/Alateen Family Group Headquarters, Inc.
(For families and friends of alcoholics)
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
888-4AL-ANON
Alcoholics Anonymous World Services
P.O. Box 459
Grand Central Station
New York, NY 10163
212-870-3400
Department of Health and Human Services: The Substance Abuse and Mental Health Services Administration (SAMHSA)
Hazelden Foundation
P.O. Box 11-CO3
Center City, MN 55012-0011
1-800-257-7810
Narcotics Anonymous
P.O. Box 9999
Van Nuys, CA 91409
818-773-9999
Fax: 818-700-0700
Nar-Anon Family Groups
P.O. Box 2562
Palos Verdes Penninsula, CA 90274
310-547-5800
National Drug Information, Treatment and Referral Hotline:
1-800-662-HELP (662-4357)
The National Association for Children of Alcoholics
11426 Rockville Pike, Suite 100
Rockville, MD 2085
1-888-554-COAS
Online Recovery: Alcoholism and Drug Addiction
Parenting Resources
American Academy of Child & Adolescent Psychiatry: Facts for Families
P.O. Box 96106
Washington, DC 20090-6106
202-966-7300
www.aacap.org/info_families/index.htm
Parents: The AntiDrug
Children Now
1212 Broadway, 5th Floor
Oakland, CA 94612
510-763-2444
Fax: 510-763-1974
E-mail: children@childrennow.org
Department of Education Partnership for Family Involvement in Education
400 Maryland Avenue SW
Washington, DC 20202-8173
Email: partner@ed.gov
Mothers Against Drunk Driving (MADD)
P.O. Box 541688
Dallas, TX 75354-1688
214-744-6233
800-GET-MADD
Family Education Network
Teachers: The Anti-Drug Teacher's Guide
www.theantidrug.com/get_involved/learn.html
Leadership to Keep Children Alcohol Free
http://www.alcoholfreechildren.org/gs/leadership.htm
Media Literacy and Critical Viewing
The Family and Community Critical Viewing Project
www.pta.org/programs/tvoverview.htm
The Center for Media Education
2120 L Street NW, Suite 200
Washington, DC 20037
202-331-7833
Email: cme@cme.org
The Coalition for Quality Children's Media: Kids First!
112 West San Francisco Street, Suite 305A
Santa Fe, NM 87501
505-989-8076
Fax: 505-986-8477
www.cqcm.org/kidsfirst/index.shtml
The Media Literacy Online Project
interact.uoregon.edu/MediaLit/HomePage
http://www.pta.org/commonsense/6_help/62_gethelp.html
Interactive Module Stuff
1. Zeek Pop ups
1. Addiction means having no control over whether to use a drug. (I. C.)
2. A mental health professional or a caring and concerned adult may help a youngster successfully overcome a crisis and develop more effective coping skills. (II. A.)
3. Keep in mind that the moment of disclosure is not just a moment to punish.
(III. A)
4. If warning signs point to a child on drugs, it’s time to take action. (III. B.)
5. There are two ways to intervene with a substance abuser: an informal intervention or a structured intervention. (III. C.)
6. Problems associated with an individual’s drug addiction can vary significantly. (IV. A.)
7. Drug addiction is a treatable disorder. (IV. A.)
8. Short-term residential programs provide intensive but relatively brief residential treatment based on a modified 12-step approach. (IV. B.)
9. Agonist Maintenance Treatment for opiate addicts usually is conducted in outpatient setting, often called methadone treatment programs. (IV. B.)
10. Long-term residential treatment provides care 24 hours per day, generally in nonhospital settings. (IV. B.)
11. Long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. (IV. C.)
12. Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. (IV. D.)
13. Counseling and other behavioral therapies are critical components of effective treatment for addiction. (IV. D.)
14. TOUGHLOVE International is a non-profit, self-help organization that provides ongoing education and active support to families. (IV. F.)
15. Kids get into treatment because someone is coercing them or encouraging them to get into treatment. (VI. C)
16. Drug treatment is for life; it is about changing your whole lifestyle. (VI. C.)
E. Post-test
1. What is drug abuse?
a. compulsive use of substance despite negative consequences
b. use of illicit or abuse of prescription or over-the-counter drugs for purposes other than those for which they are directed
c. physical dependence on a substance
d. none of the above
* Found in I. A. What is drug abuse?
2. What are the warning signs your child is using drugs?
a. tremors or shakes
b. red, watery eyes
c. change in attitude
d. drop in grades
e. all of the above
*Found in II. A. and II. B. What are the physical warning signs of drug use and What are the behavioral warning signs of drug use?
3. How can you help your child when he/she is using drugs?
a. confront them while they are under the influence of drugs or alcohol
b. voice suspicions but avoid direct accusations
c. be firm and enforce whatever discipline you have laid out
d. both b and c
*Found in III. B. How do I help my child when he/she is abusing drugs?
4. Outpatient Drug-Free Treatment is more suitable for individuals who are employed or who have extensive social support.
True or False
*Found in IV. B. What are different approaches to treatment?
5. Drug addicts cannot quite on their own because long-term drug use results in significant changes in brain functions which create the compulsion to use drugs despite adverse consequences.
True or False
*Found in IV. C. Why can’t drug addicts quit on their own?
6. What are some typical measures of effectiveness of drug treatment?
a. levels of criminal behavior
b. family functioning
c. employability
d. all of the above
e. none of the above
*Found in IV. D. How successful is drug addiction treatment?
7. What are some self-help programs in the U.S.?
a. Alcoholics Anonymous
b. Narcotics Anonymous
c. Smart Recovery
d. ToughLove International
e. All of the Above
*Found in IV. F. What about self-help programs?
8. You can expect your child’s recovery from drug addiction to be a short-term, rapid process with few relapses.
True or False
*Found in IV. H. What type of behavioral changes should I expect?
9. What are some well-known drug treatment programs?
a. Betty Ford Center
b. Al-anon Family Group Headquarters
c. We Hate Drugs International
d. Both a and b
*Found in V. B. What are some nationally known programs?
10. There are many national and local resources that can help individuals find the best drug treatment programs available.
True or False
*Found in V. C. Where can I find more information about drug treatment programs?