Ablative Surgery Becomes Popular In China And Issues Emerge
The study of Gao et al. published in 2003 attracted wide attention in the neurosurgery field. The reported clinical benefits of NAc ablation to the opiate-addicted patients were generally modest and progressively diminished over the follow-ups. The results of NAc ablative surgery in treating addiction still encouraged the neurosurgeons in psychosurgery and brought hope for patients who suffered from intractable drug addiction. However, some private hospitals driven by financial interests used this procedure as a medical service mostly for economic profit. Conceivably, some patients believed that, finally and fortunately, an effective, easy, novel treatment for drug addiction was available. Ablative surgery became rapidly and widely adopted as a suitable treatment approach to opiate addiction in China between 2003 and 2004, despite the lack of solid clinical data. In December 2004, at least 1000 registered patients had received ablative surgery for opiate addiction .
Using Medication To Treat Addiction
Two of the biggest challenges in addiction treatment are the withdrawal process as the persons body reacts to the loss of the substance use and the continued cravings that occur both during and after treatment. These are both major contributors to the individuals risk of relapse, as evidenced partly by an article from Alcoholism: Clinical and Experimental Research. As a result, researchers have increasingly tried to find medications that can help to ease the uncomfortable symptoms of withdrawal and curb the destructive cravings that can cause a person to return to substance use. In the case of dangerous withdrawal syndromes, such as for alcohol, this can also decrease the chance of a lethal withdrawal reaction.
Some of the medications provided during substance abuse treatment are simple, over-the-counter products that ease physical discomforts that are typical of the withdrawal period. However, certain medications are also provided to directly affect the brain systems involved in the addiction response, in the hopes that they can deter the persons desire to start using again.
Another use of medication during addiction treatment is to manage co-occurring disorders that can contribute to substance abuse. For example, individuals who self-medicate depression by drinking alcohol may find it easier to stop alcohol abuse if they take medications to treat depression.
Pharmacotherapy And The Role Of Social Workers
Social workers who have knowledge of the benefits of pharmacotherapy for SUD can be of significant help to their clients with substance use problems. Social workers are often on the front line of health care. For example, social workers often see clients in their home and are the health care workers who most often work directly with family members. In this capacity social workers observe events and obtain information regarding substance abuse unavailable to other clinicians. Social workers can literally save lives by educating clients about the importance of receiving medication for withdrawal from alcohol and benzodiazepine dependence. Similarly social workers are in a critical position to inform clients who need treatment for alcohol and opioid dependence about the potential benefits of naltrexone and acamprosate for alcohol dependence and naltrexone, buprenorphine, and methadone for opioid dependence.
We provide two illustrations below of specific examples where social workers can help their clients by using their knowledge of how medications are therapeutic in the treatment of substance use disorders.
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Are Interventions Helpful To Get People Into Treatment
In the addiction world, “intervention” is a technique of confrontation intended to drive a person into treatment for addiction. Typically, a family member or someone close to the substance user arranges a surprise gathering of family and friends, along with a representative of an addiction treatment facility or program, to persuade the user to immediately enter treatmentor risk losing the support of and contact with those near and dear. Those who promote interventions contend that only such a dramatic event can pierce the denial of harmful consequences that is presumed to be perpetuating the addiction. The drama inherent in interventions has made them fodder for reality television.
In real life, however well-meaning they are, interventions are humiliating and often backfire. Even if they succeed in getting people into treatment, data show that they dont ensure that people stay in treatment one major problem is that they nullify the internal motivation need to quit.
How Are Medications And Devices Used In Drug Addiction Treatment
Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.
Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself “treatment,” but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications . In November 2017, the Food and Drug Administration granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Also, in May 2018, the FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.
Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid , tobacco , and alcohol addiction. Scientists are developing other medications to treat stimulant and cannabis addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.
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Build A Meaningful Drug
You can support your drug treatment and protect yourself from relapse by having activities and interests that provide meaning to your life. It’s important to be involved in things that you enjoy, that make you feel needed, and add meaning to your life. When your life is filled with rewarding activities and a sense of purpose, your addiction will lose its appeal.
Pick up an old hobby or try a new one. Do things that challenge your creativity and spark your imaginationsomething you’ve always wanted to try. Learn a musical instrument, a foreign language, or try a new sport.
Adopt a pet. Yes, pets are a responsibility, but caring for an animal makes you feel loved and needed. Pets can also get you out of the house for exercise.
Spend time in nature. Take a scenic hike, go fishing or camping, or enjoy regular walks in a park.
Enjoy the arts. Visit a museum, go to a concert or a play, take an art class or write a memoir.
Get involved in your community. Replace your addiction with drug-free groups and activities. Volunteer, become active in your church or faith community, or join a local club or neighborhood group.
Set meaningful goals. Having goals to work toward and something to look forward to can be powerful antidotes to drug addiction. It doesn’t matter what the goals are, just that they are important to you.
Types Of Substance Abuse Treatment Facilities
On the road to recovery, treatment of substance abuse disorders involves varying levels of care with different psychosocial and sometimes physiological approaches according to a 2013 study on the Continuing Care Model of substance use treatment.
Below are three of the most common treatment facilities for substance abuse.
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Types Of Drug Treatment Programs
- Residential treatment Residential treatment involves living at a facility and getting away from work, school, family, friends, and addiction triggers while undergoing intensive treatment. Residential treatment can last from a few days to several months.
- Day treatment/Partial hospitalization Partial hospitalization is for people who require ongoing medical monitoring but wish to still live at home and have a stable living environment. These treatment programs usually meet at a treatment center for 7 to 8 hours during the day, then you return home at night.
- Outpatient treatment Not a live-in treatment program, these outpatient programs can be scheduled around work or school. You’re treated during the day or evening but don’t stay overnight. The major focus is relapse prevention.
- Sober living communities Living in a sober house normally follows an intensive treatment program such as residential treatment. You live with other recovering addicts in a safe, supportive, and drug-free environment. Sober living facilities are useful if you have nowhere to go or you’re worried that returning home too soon will lead to relapse.
The Three Basic Steps Of Urge Surfing:
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What Is The First Step To Addiction Recovery
People who experience adverse effects due to substance abuse must recognize that they might have an addiction. Acknowledging the problem is the first step of the recovery process.
Once people accept the problem, they can seek treatment. The treatment type or types will depend on their unique needs and situation.
No one substance use treatment is the best for everyone. What may work for you may not work for another person. Some people may even need a combination of treatment options.
Residential Inpatient Alcohol Treatment
Inpatient/residential alcohol treatment centers are able to provide 24-hour rehabilitation and care, while giving patients access to on-call medical and psychiatric services during their stay. Residential facilities vary in amenities and services, but all incorporate a variety of recovery programming such as individual and group counseling, coping skills education, and relapse prevention classes.
Most residential treatment facilities offer 30- to 90-day programs in order to allow patients to focus solely on their recovery without the distractions of their everyday lives. Research indicates that remaining in treatment for an adequate amount of timebased on the severity of addiction and other individual needscan be critical to recovery.5 Research supports at least 90 days in treatment to optimize treatment outcomes.5
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What Happens During Addiction Treatment
When a person enters addiction treatment, the intensity of care and time frame of such care will vary depending on individual needs. The American Society for Addiction Medicine outlines a continuum of several levels of addiction treatment care, including the following levels:5
- Outpatient services
- Residential/inpatient services
- Medically managed intensive inpatient services
Keeping such levels of care in mind, treatment providers may recommend an appropriate plan for care based on a multifactorial assessment of individual risks, supports, and various other treatment needs.5 During treatment, a number of approaches may be taken, including medication, individual and/or group therapies, or a combination of these approaches.3
Future Directions In Dbs Treatment For Addiction
Several areas of progress in DBS treatment for addiction may be identified. First, as alluded to earlier, randomizedcontrolled studies are urgently needed to evaluate the efficacy and safety of DBS treatment for addiction. Also, uncertainty still exists about the best target and stimulation parameters for DBS addiction treatment. Although the NAc seems to be one of the most relevant and widely used targets, DBS of the NAc combined with the ventral internal capsule or DBS of other mechanistically informed targets, such as the subthalamic nucleus, lateral habenula, medial forebrain bundle or bed nucleus of the stria terminalis, could also be valuable targets . In fact, even with the use of NAc or ventral internal capsule targets, it remains unclear which white-matter bundles are associated with the greatest clinical benefits to the patients. In addition, it is unknown whether different targets and stimulation parameters may be more effective for patients who are addicted to a certain kind of substance.
DBS and ablative-surgery targets in the management of addiction. The targets that have been used for neurosurgical treatment for addiction mainly include: ACC, NAc, STN, NAc and the neighboring ALIC, NAc and the neighboring BNST, and VMH. Among them, the ACC and NAc targets have been both used for DBS and ablative surgery. The STN, NAc and the neighboring ALIC, NAc and the neighboring BNST targets were only used for DBS surgery.
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What Is Detoxification
When you ask what is the first step in treating addiction in the facility, a lot of rehabilitation centers will begin talking about detoxification as their primary goal with a new patient. It is common that patients come into the facility with drugs or alcohol still in their system, which makes it difficult to treat their addiction as their brain and bodys chemistry is not at their baseline.
those with a substance use disorder deserve treatment to address their addiction.
NYTimes
The withdrawal process is difficult for many patients, which typically leads them to seeking out their addicted substance again to avoid the feelings of the crash as many describe it.
Withdrawing from the substance may lead to cravings, cold sweats, anger, or other symptoms that change based on the substance they are addicted to. Detoxification is an important step in the rehab facility.
Because the patient can be monitored to ensure their safety with access to medical staff if necessary, detoxification is safe in a rehab setting, allowing the individual to take what many describe as one of the hardest steps towards sobriety.
How Do I Find Help
Finding help can be daunting, especially in a crisis. Its important to know what the many treatment options are and at least as challenging to know which would be best fit for any individual, to say nothing of figuring out how to pay for it.
One of the most comprehensive sources of help is SAMSA, the Substance Abuse and Mental Health Administration, an agency of the of the U.S. Department of Health and Human Services, which maintains a 24-hour helpline and website. The website features a list of treatment facilities searchable by zip code.
The Psychology Today website features an extensive registry of treatment centers, programs, expert clinicians, and support groups specializing in addiction recovery. The directory not only covers the full spectrum of care possibilities but provides detailed descriptions of each one. The website is searchable by city name and zip code.
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How Do Behavioral Therapies Treat Drug Addiction
Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use. As a result, patients are able to handle stressful situations and various triggers that might cause another relapse. Behavioral therapies can also enhance the effectiveness of medications and help people remain in treatment longer.
- Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they’re most likely to use drugs.
- Contingency management uses positive reinforcement such as providing rewards or privileges for remaining drugfree, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
- Motivational enhancement therapy uses strategies to make the most of people’s readiness to change their behavior and enter treatment.
- Family therapy helps people with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning.
- Twelve-step facilitation is an individual therapy typically delivered in 12 weekly session to prepare people to become engaged in 12-step mutual support programs. 12-step programs, like Alcoholic Anonymous, are not medical treatments, but provide social and complementary support to those treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.
Ablative Surgery For Addiction
Since the 1920s, animal studies have disclosed an intimate structural and functional relationship between the frontal lobes and the limbic system, particularly in emotional states of fear, rage, sexual excitement, aggression and pleasure . In primates, loss of fear or social indifference emerged following bilateral removal of the anterior cingulate gyrus . Subsequently, based on the assumption that lesioning cingulate fibers might benefit mentally ill persons, cingulotomy was used for the treatment of various psychiatric illnesses, including mood disorders, anxiety disorders and OCD. This initial ablative-therapy study, however, yielded variable results . One factor that probably has contributed to the mixed results is related to technical aspects of the neurosurgical procedure used. Although the neurosurgical procedure used targeted the cingulum bundle, it is now known that this procedure is not always precise and can also impact the adjacent cortex, which might be linked to the therapeutic effect .
In conclusion, these early ablative-therapy studies provide putative evidence that cingulumotomy, but not hypothalamotomy, could be an effective and tolerable treatment for some addicted patients. However, this conclusion should be questioned because the availability of clinical data is scarce. Well-controlled clinical trials are required to evaluate the utility and role of ablative surgery in addiction treatment.
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