Options for the improvement of Substance abuse programs
This article will outline most of the best known substance abuse programs currently available. The programs will be given a position regarding the quality of their success. Substance abuse is a multi-dynamic problem and so too can be the treatment of it. The most current treatments of today will be covered in this report.
The improvement of substance abuse treatment programs and possible variations for their implementation and the evaluation of their success is the purpose of this article.
Of course one of the most difficult parts of addressing substance abuse is that it is a subject which deals with people and people are subject to circumstances wherefore the issue of addiction and abuse is relevant to the circumstances of whether there is a problem of abuse. If one is having some type of problem in their life due to the use or abuse of alcohol and or drugs such as legal problems, marital problems, family problems, problems at work or other types of problems then there is little to question as to whether there is a problem with the persons use or abuse of alcohol and or drugs. According to (Van Voorhis et al., 2009), there are different types of treatment for addicts who admit they have a problem apposed to those who are in denial. Also most recovery programs expect participants to abstain from addictive substances while others allow for controlled drinking or methadone maintenance. Furthermore, most forms of treatment can be applied to both or either drugs or alcohol as it is the addiction which is being targeted as the problem and not the particular substance.
The federal government has done a lot over the years to improve public safety and some of the work involved substance abuse treatment programs. For example, per (Van Voorhis et al., 2009), around the 1970’s the federal government instituted what was called the Treatment Accountability for Safer Communities and in the 1990’s they implemented the Residential Substance Abuse Treatment programs. Furthermore; additional agencies have been created to deal with substance abuse treatment. According to the National Criminal Justice Treatment Practices Survey, (Taxman, Perdoni & Harrison, 2007), there have been a few unfavorable findings. From those surveys they found that low intensity treatment programs and educational programs whether exercised in or out of custody are not very affective. Next, very few who actually really need treatment receive it per the above cited survey.
There are many different techniques used in the treatment of substance abuse. Per (Van Voorhis et al., 2009), here are the most commonly used or well known forms of substance abuse treatment: Psychodynamic therapy focuses on the acceptance of the client admitting they have a problem and then goes on to address those issues. Radical Behavioral Approaches are forms of classical or operant conditioning and consist of such things as token economies, stimulus control and community reinforcement. Classical conditioning consists of such things as drug induced nausea or foul odors or electric shock to stop alcohol or drug usage. Covert sensitization uses imagery that induces negative thoughts towards the desired subject towards which the conditioning is aimed. Operant conditioning consists of reinforcement of good behavior in various forms. Community reinforcement approach is when drinking is given negative feedback while sobriety is complimented. Social learning or Cognitive Behavioral Approaches use role models such as the AA or NA groups use sponsors who offer how to beat the addictive behavior. Therapeutic Communities are where addicts live in a treatment facility with other recovering or recovered addicts for 3 months to a year and learn how to beat their addictions and cope with life. Coping and Social Skills Training is taught in order to help addicts cope with their desires to use. This type of treatment seems to be good in that it teaches how to cope in a variety of social situations which seems conducive to successful abstinence and or rehabilitation.
Relapse Prevention is another technique that is used after or in conjunction with other therapeutic options and teaches how to maintain sobriety in high risk situations. In relation to Relapse Prevention is a theory called Self-Efficacy which was invented by Albert Bandura and it teaches how to cope with high risk situations and is complimentary to many Relapse Prevention techniques. In addition to the above mentioned Relapse Prevention techniques is Abstinence Violation Effect also known as (AVE). Thus when a situation of a lapse but not a relapse occurs and the risk of relapse is increased as a result of reduced self-efficacy or demoralization. Family Therapy Approaches of which there are several different types hold one core belief in common and that being the identified patient is most often not the only one in the family in need of therapy.
There are 5 different types of family therapy mentioned by (Van Voorhis et al., 2009). Psychodynamic Family Therapies, Behavioral Family Therapies, Family Systems Models, Communications Therapy and Multisystemic Family Therapy and all are in the class of Family Therapy Approaches and do a good job at combating substance abuse. Self-help groups and support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are very important parts of recovery yet are run by members and must remain non-professional. While these meetings can be an addicts only means of substance abuse treatment sometimes persons educated in social and behavioral sciences can help were (AA) & (NA) fall short. Most programs that tend to work the best for offender populations usually adhere to the general responsivity of its clients. Specific responsivity addresses a client’s particular need. Continuity of care is when offenders are continuously evaluated through their different stages of incarceration and their substance abuse treatment is adjusted to their needs using evidence-based research.
According to (Kinlock, T. et al., 2008), Opioid-agonist therapy used mostly for methadone maintenance has been proven to work very well in reducing addiction and crime and the spreading of HIV. Also, the New York City methadone-maintenance program called (KEEP) Key Extended Entry Program which treated jail inmates and was studied for 11 years showed positive affects for post release treatment entry and reductions in reincarceration rates. There have also been other successful methadone-maintenance programs in Australia.
Per (Marlowe, D. 2009), drug courts have been shown to significantly reduce crime and drug abuse. However, drug courts are not considered substance abuse treatment in themselves but they do assist in monitoring and directing offender’s attendance to such programs. According to (Pearson, F. & Lipton, D., 1999), of the boot camp programs, therapeutic communities and group-counseling all but therapeutic communities were more affective at reducing recidivism than were treatment as usual groups.
While the treatment options mentioned above are all good programs and have been used successfully there are a few that are known to currently be the best in use. According to (Van Voorhis et al., 2009), these programs consist of, Behavioral & Cognitive-Behavioral Approaches. Social Skills training, Community reinforcement, Behavior contracting, Relapse prevention & Motivational enhancement.
Furthermore; it is my position that the most favorable, cost effective and successful options are a combination any of the above mentioned programs to be used in conjunction with self help groups such as AA or NA. The latter is free of charge and really a vital key in long term sobriety although no surveys or research have been done on the later because they maintain anonymity this is still my position. According to (Van Voorhis et al., 2009, p. 293), “It is equally apparent that no agency should be providing a single ‘one size fits all’ approach to substance abuse, given the myriad pathways to abuse and the different stages in the therapeutic process.” I concur with Van Voorhis in that the best programs are those that custom fit their clients.
Kinlock, T., Gordon, M., Schwartz, R., & Grady, K. (2008). A study of methadone maintenance for male prisoners.
Marlowe, D. (2009). Evidence-based sentencing for drug offenders: An analysis of prognostic risks and criminogenic needs.
Pearson, F. & Lipton, D. (1999). A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse.
Taxman, F., M. Perdoni & L. Harrrison (2007). Drug treatment services for adult offenders: The state of the state. Journal of substance abuse treatment, 32, 239-254.
Van Voorhis, P., Braswell, M., Lester, D. (2009). Correctional counseling & rehabilitation. 7th Edition.