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What actually happens in treatment programs |
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| Although treatment
programs differ, the basic ingredients of treatment are similar. Most
programs include many or all elements presented below. |
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| Assessment |
| All
treatment programs begin with a clinical assessment of a person’s
individual treatment needs. This assessment helps in the development of
an effective treatment plan. |
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| Medical Care |
| Programs
in hospitals can provide this care on site. Other outpatient or
residential programs may have doctors and nurses come to the program
site for a few days each week, or a person may be referred to other
places for medical care. Medical care typically includes screening and
treatment for HIV/AIDS, hepatitis, tuberculosis, and women’s health
issues. |
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| A Treatment Plan |
| The treatment team,
along with the person in treatment, develops a treatment plan based on
the assessment. A treatment plan is a written guide to treatment that
includes the person’s goals, treatment activities designed to help him
or her meet those goals, ways to tell whether a goal has been met, and a
timeframe for meeting goals.The treatment plan helps both the person in
treatment and treatment program staff stay focused and on track. The
treatment plan is adjusted over time to meet changing needs and ensure
that it stays relevant |
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| Group and
Individual Counseling |
| At first,
individual counseling generally focuses on motivating the person to stop
using drugs or alcohol. Treatment then shifts to helping the person stay
drug and alcohol free. |
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| The counselor
attempts to help the person |
- See the problem
and become motivated to change
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- Change his or
her behavior
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- Repair damaged
relationships with family and friends
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- Build new
friendships with people who don’t use alcohol or drugs
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- Create a
recovery lifestyle.
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| Group counseling is
different in each program, but group members usually support and try to
help one another cope with life without using drugs or alcohol. They
share their experiences, talk about their feelings and problems, and
find out that others have similar problems. Groups also may explore
spirituality and its role in recovery. |
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| Individual
Assignments |
| People
in treatment may be asked to read certain things (or listen to
audiotapes), to complete written assignments (or record them on
audiotapes), or to try new behaviors. |
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| Education about
Substance Use Disorders |
| People
learn about the symptoms and the effects of alcohol and drug use on
their brains and bodies. Education groups use videotapes or audiotapes,
lectures, or activities to help people learn about their illness and how
to manage it. |
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| Life Skills
Training |
| This training can
include learning and practicing employment skills, leisure activities,
social skills, communication skills, anger management, stress
management, goal setting, and money and time management |
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| Testing for
Alcohol or Drug Use |
| Program staff
members regularly take urine samples from people for drug testing. Some
programs are starting to test saliva instead of urine. They also may use
a Breathalyzer to test people for alcohol use. |
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| Relapse Prevention
Training |
| Relapse prevention
training teaches people how to identify their relapse triggers, how to
cope with cravings, how to develop plans for handling stressful
situations, and what to do if they relapse. A trigger is anything that
makes a person crave a drug. Triggers often are connected to the
person’s past use, such as a person he or she used drugs with, a time or
place, drug use paraphernalia (such as syringes, a pipe, or a bong), or
a particular situation or emotion. |
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| Orientation to
Self-Help Groups |
| Participants in
self-help groups support and encourage one another to become or stay
drug and alcohol free. Twelve-Step programs are perhaps the best known
of the self-help groups. These programs include; Alcoholics Anonymous
(AA), Narcotics Anonymous (NA), Cocaine Anonymous, and Marijuana
Anonymous. Other self-help groups include SMART (Self Management and
Recovery Training) Recovery7 and Women for Sobriety. |
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| Members themselves,
not treatment facilities, run self-help groups. In many places,
self-help groups offer meetings for people with particular needs. You
may find special meetings for young people; women; lesbian, gay, and
bisexual people; newcomers; and those who need meetings in languages
other than English. Internet chat groups and online meetings are also
available for some groups. |
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| Many treatment
programs recommend or require attendance at self-help groups. By
attending, many people make new friends who help them stay in recovery.
The number of meetings required varies by treatment program; many
programs require participants to attend “90 meetings in 90 days,” as AA
and NA recommend. Some treatment programs encourage people to find a
“sponsor,” that is, someone who has been in the group for a while and
can offer personal support and advice. |
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| Self-help groups
are very important in most people’s recovery. It is important to
understand, however, that these groups are not the same as
treatment. |
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| There are self-help
groups for family members, too, such as Al-Anon and Alateen (see the
“Just for You” section of this booklet). |
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| Treatment for
Mental Disorders |
| Many people with a
substance use disorder also have emotional problems such as depression,
anxiety, or posttraumatic stress disorder. Adolescents in treatment also
may have behavior problems, conduct disorder, or attention
deficit/hyperactivity disorder. |
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| Treating both the
substance use and mental disorders increases the chances that the person
will recover. Some counselors think people should be alcohol and drug
free for at least 3 to 4 weeks before a treatment professional can
identify emotional illness correctly. The program may provide mental
health care, or it may refer a person to other sites for this care.
Mental health care often includes the use of medications, such as
antidepressants. |
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| Family Education
and Counseling Services |
| This education can
help you understand the disease and its causes, effects, and treatment.
Programs provide this education in many ways: lectures, discussions,
activities, and group meetings. Some programs provide counseling for
families or couples. Family counseling is especially critical in
treatment for adolescents. Parents need to be involved in treatment
planning and follow up care decisions for the adolescent. Family members
also need to participate as fully as possible in the family counseling
the program offers. |
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| Medication |
| Many programs use
medications to help in the treatment process. Although no medications
cure dependence on drugs or alcohol, some do help people stay abstinent
and can be lifesaving. Medication is the primary focus of some programs,
such as the medication-assisted OTPs discussed earlier. Methadone is a
medication that prevents opioid withdrawal symptoms for about 24 hours,
so the person must take it daily. Taken as directed, it does not make a
person high but allows him or her to function normally. In fact,
methadone blocks the “high” a person gets from an opioid drug. |
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| Some people stay on
methadone for only 6 months to 1 year and then gradually stop taking it;
most of these people relapse and begin to use opioids again. However,
others stay on methadone for long periods of time or for life, which is
called methadone maintenance treatment. People receiving
this treatment often have good jobs and lead happy, productive lives. |
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| If your family
member is taking medications for HIV infection or AIDS or for any other
medical condition, it is important that OTP staff members know exactly
what he or she is taking. Mixing some medications with methadone or LAAM
may mean that your family member will need special medical supervision.
Buprenorphine is another medication that may be used to treat opioid
dependence and is sometimes used by OTPs. Buprenorphine recently was
approved for treatment by primary care doctors in their offices. A
doctor treating a patient with buprenorphine generally will provide or
refer the patient for counseling, also. |
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| Disulfiram
(Antabuse7)
is a medication that causes a bad reaction if people drink alcohol while
taking it. The reaction is flushing, nausea, vomiting and anxiety.
Because people know the medication will make them very ill if they drink
alcohol, it helps them not to drink it. Antabuse is taken daily |
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| Another medication,
naltrexone (ReVia7), reduces the craving for
alcohol. This medication can help keep people who drink a small
amount of alcohol from drinking more of it. Programs also sometimes use
naltrexone to treat heroin or other opioid dependence because it blocks
the drug’s effects. It is important for people who use heroin to go
through detox first, so they are heroin free before starting to take
naltrexone. |
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| Because it is very
difficult for a person to detoxify from opioid drugs, many people don’t
make it that far; buprenorphine is sometimes used to help people make
that transition. If a person does detoxify from opioids and begins to
take naltrexone, it still will not work well for this purpose unless a
person has a strong social support system, including someone who will
make sure that he or she continues to take the medication regularly.
When an adolescent is taking naltrexone to treat opioid dependence, it
is particularly important that parents provide strong support and
supervision |
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| Follow up Care
(Also Called Continuing Care) |
| Even when a person
has successfully completed a treatment program, the danger of returning
to alcohol or drug use (called a “slip” or relapse) remains. The longer
a person stays in treatment, including follow up, the more likely he or
she is to stay in recovery. Once a person has completed basic treatment,
a program will offer a follow up care program at the treatment facility
or will refer him or her to another site. Most programs recommend that a
person stay in follow up care for at least 1 year. Adolescents often
need follow up care for a longer period. |
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| Follow up care is
very important to successful treatment. Once a person is back in his or
her community, back in school, or back at work, he or she will
experience many temptations and cravings for alcohol or drugs. In follow
up care, your family member will meet periodically with a counselor or a
group to determine how he or she is coping and to help him or her deal
with the challenges of recovery. |
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| For some people,
particularly those who have been in residential treatment or prison
based programs, more intensive forms of follow up care may be helpful.
Halfway houses or sober houses are alcohol- and drug-free places
to live for people coming from a prison-based or residential program.
People usually stay from 3 months to 1 year, and counseling is provided
at the site or at an outpatient facility. |
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| Supportive
living or transitional
apartments provide small group living arrangements for those who
need a sober and drug-free living environment. The residents support one
another, and involvement in outpatient counseling and self-help groups
is expected. |
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