- Amber Pegg
Does NKY have the Most Effective Treatments Available?
A Review of the Literature
Drugs and alcohol have increased in acceptability over the years in the United States. Individuals use these drugs for mood alterations and medicinal purposes. Society is surprisingly very unaware of the epidemic that is occurring right under their noses. Annually, illicit drug abuse cost in average $181 billion dollars. (Office of National Drug Policy, 2010)
Addiction and dependency both play an extreme role in the increase of use and both are extremely misunderstood. During the year 2013 21.6 million individuals were classified with Substance Dependence/Addiction (Administration, 2013). With addiction on the rise in North America it has been recognized as a public health crisis that is extremely multidimensional and complex. (Larkin, 2006)
Drug addiction is classified as an actual disorder according to the medical association. Studies have began to show that genetics may indeed be a part of addiction. These studies are showing genetics may cause susceptibility to addiction in an individual. (Erickson, 2001) Drug addiction is classified into three groups; the first being preoccupation and anticipation, the second being binge and intoxication, and finally the third is withdrawal and negative effect. Those stages are described as, preoccupation with using the substance, constant cravings, using more than necessary, and experiencing tolerance. Addiction is having a severe craving for a substance. This generally also implies that a great deal of attention is devoted to the activity and interferes with the individual’s daily routine. Frank Tallis writes “At first, addiction is maintained by pleasure. But the intensity of this pleasure gradually diminishes and the addiction is then maintained by the avoidance of pain.”
Dependency is said to be the compulsion to use drugs to experience psychological or physical effects. To be considered drug dependent you must have three characteristics; First they must exhibit tolerance, which happens after the body becomes familiarized to the drug, second they must show habituation, this is continuing to have the desire to use the drug after the physical need has ended, and lastly addiction this normally means a great deal of attention is devoted to this activity. In both addiction and dependence the primary goal of an individual suffering from these is simply to attain and use the substance.
Commonly used drugs are often categorized into six groups, opioids, sedative-hypnotic, stimulant, hallucinogens, cannabis, and inhalants. In the Northern Kentucky area there are certain drugs that are more prone than others. These include but are not limited to, stimulants, opioids, cannabis and hallucinogens. Opioids include heroine and methadone. Heroin was introduced in 1898 as a cough suppressant, which depresses neural functioning. Heroin use has shifted within populations; literature shows that it was mostly low income minorities as to now where middle class Caucasians are the most prevalent users. (Cleero, 2014) The majority of opiates reduce anxiety and pain for a short period of time. Most heroin users will have the need for larger amount to get the “fix” but for some, overdose occur and death is the ultimate price. In 2011 heroin alone accounted for 16% of all admissions to treatment facilities. (services, 2012) The most common stimulant abused is known as cocaine. Cocaine is a crystallized white powder, convenient for snorting. Stimulants increase alertness, decrease the need for sleep and often suppress the feeling of being hungry. This makes it very marketable to college students. Cannabis is often described as a natural drug and is often in debate as to whether it should be classified as something addictive. Marijuana has been cultivated for over 5000 years. THC can produce several effects Marijuana has the effect of relaxation and could give someone the perception of slowing time.
What Are the Varying Types of Treatments available?
Across the United States there are several treatment types available to those who suffer from substance abuse. Addiction treatments vary due to the complexity of the disease. Individuals may benefit from rapid treatments or they may need treatments that in other terms work to “cure” and take longer amounts of time and effort. (Riessman).”In the last 30 years, there has been significant progress in the development and validation of psychosocial treatments for substance abuse and dependence, with a predominant focus on the validation of cognitive behavioral treatments” (Dutra Lissa & Stathopoulou, 2008)
The office of Drug and Crime reported in 2012, “ expressed in monetary terms, some $200-250 billion dollars would be needed to cover all cost related to drug treatment worldwide; less than 1 in 5 that need treatment will actually receive it. (Publication, 2012). Factors such as treatment length and intensity of individuals play a role into the success of treatment but studies have proven that there is a link between the two. (Finny, 1996) The following information will focus on the most dominant and relevant to NKY.
With medically assisted treatment on the rise it has quickly become one of the most popular and user “friendly” though controversy over drug substitution has arisen within the treatment community (Kleber, 2008). Mattick wrote “Medically assisted treatments are more appealing than typical drug free approaches.” (Mattick, 2009) With the up rise in heroin and opioid use these treatments will continue to grow. Medically assisted treatments normally consist of one of three drugs to help intervene within the withdrawal and detox phase; Methadone, Suboxone, and Buprenorphine. Each of the three are considered to be moderately effective. There are drop in clinics that will supply the medication and are considerably accessible to communities. Medically assisted treatments can potentially cause addictiveness to the treatment itself. According to the SAMHSA data collected more than 300,000 individuals received medically assisted treatment in 2011. (Treatments for Substance Abuse Disorders, 2014)
The National Institution on Drug Abuse classifies Detoxification and Withdrawal as the most common process. (NIDA, 2009)”Detoxification is the allowance of the body to rid itself of a drug while managing the symptoms of withdrawal.” (NIDA, 2009) Each treatment process must begin with the detoxification and withdrawal stages. An often misconception of these two are that while they are processes within each treatment they alone are not considered treatment, one must have follow up.
There are several forms of counseling and therapy available to those in need. This ranges from individual, group, psychotherapy, couples, family, open and closed meetings. These sessions are available through insurances and some are right in an individual’s own community. These groups and sessions are great means for resources, networking and general support. Literature reads that cognitive behavioral therapy for substance abuse has been deemed effective; both in combination treatment and monotherapy. (Center for Alcohol and Addiction Studies, 2009). Cognitive and Behavioral treatment programs are focused on a short term approach. Motivational Interviewing and CBT are both evidence based treatments that continue to make strides in the treatment industry, (McHugh, 2010)
Lastly, Inpatient and Outpatient rehabilitation. These facilities are structured similarly yet have extreme differences. While an individual is attending an inpatient center they are at the center 24 hours a day, each day. They will see therapist and doctors routinely for a minimum of 28 days. Outpatient facilities still routinely have therapist and doctors with their clients but they are able to return home in the evenings and be part of their normal routine. This also keeps them accessible to whatever the addiction may be. These programs allow individuals to use self autonomy in which treatment facility they feel would best suit them. Many would argue that outpatient is less affective when in fact studies have shown that there is little to no difference in outcomes between the two. (Moos, 1995) Steven Gifford included in his description of inpatient and outpatient unsettling statistics from NIDA; 23.2 billion individuals required treatment for substance abuse in 2013, only 2.4 billion were treated by some sort of drug rehabilitation. (NIDA, 2009)
Gaps Included in the Literature
The amount of literature readily assessable in regards to drug abuse and treatments available is incredible. There is an abundance of knowledge about the topic with reasonable resources at ones fingertips. We know that individuals who suffer from substance abuse are likely to choose a treatment that fits best to their needs and addiction but also at the convenience to themselves and their families. Finances and insurance can also impact ones decision to certain treatment programs. As to the question, Does NKY have the most effective treatments available the literature does not go into depth enough in geographical terms. There are many treatment options available but whether they are geographically reasonable to the rural and lower income are that is left unanswered. The statistics and information in very broad to the general. Though we know there are treatments in NKY area the question of are they the most effective continues to go unanswered.
Administration, S. A. (2013). Retrieved March 15, from www.drugwarfacts.com: http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/NationalFindin…#sthash.snuPjFav.dpuf
Center for Alcohol and Addiction Studies. (2009). Cognitive Behavioral Treatment with Adult alcohol and Illicit drug users. Journal of Studies on Alcohol and Drugs , 516-527.
Cleero, T. E. (2014). The changing Face of Heroin. Journal of the American Medical Association , 71 (17), 821-826.
Dutra Lissa, P., & Stathopoulou, G. (2008). A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorder. The American Journal of Psychiatry , 179-187.
Erickson, S. W.-M. (2001). Drug abuse and addiction Research. Journal of the American Pharmacist Association , 41 (1).
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Kleber, H. D. (2008). Methadone Maintenance 4 decades later. American Medical Association , 2303-2305.
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Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 2009, Issue 3.
McHugh, R. a. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America , 511-525.
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NIDA. (2009). Treatment. Retrieved March 30, 2015, from NIDA: http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
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Riessman, F. C. (n.d.). Social Policy. 27 (2), pp. 36-46.
services, N. A. (2012). Center for behavioral health statistics and quality. Retrieved 4 5, 15, from http://www.samhsa.gov/treatment
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