TREATMENT OF SUBSTANCE ABUSES.   Term Paper ID:29908 Click to get this paper

Essay Subject: Discusses various therapeutic models for alcohol, cocaine & other drugs & cigarette abuse.... More...

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Paper Abstract: Discusses various therapeutic models for alcohol, cocaine & other drugs & cigarette abuse. Compares group therapy for substance abuses in an outpatient setting to other forms of drug therapy (12-Step program of AA, "network" therapy, short-term psychodynamic approach, behavioral therapy & other models). Recommends comgination of group therapy & self-help groups as most effective. Paper Introduction: Comparing Group Therapy Approaches in an Outpatient Setting for Treating Substance Abusers Introduction Substance abuse is a major problem in the United States, and many other countries. Currently, alcoholism directly affects approximately 14 million people in this country, while also impacting their families, friends, and coworkers (Knapp, 1999). In 1997, the Centers for Disease Control and Prevention reported that there were more than 18,000 alcohol-induced deaths and nearly 15,000 drug-related death in 1996. Further, there were 142,164 cocaine-related emergency room episodes in 1995 (Petersen, 1999). There is no single factor that can be pointed to as d Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. The glass half empty. However, substanceabuse treatment has long neglected mental health issues, andpsychotherapists have often been ignorant of the role of substance abuse increating or sustaining their clients' problems. If individuals are uncertain of the confidentiality ofgroups, they are unlikely to commit to them, or to talk about sensitivematters - both of these automatically reduce the effectiveness of thegroups. 91999). (1998) foundthat CBT was significantly more effective than 12-step facilitation intreating cocaine abuse. Longabaugh, R., Wirtz, P.W., Sweben, A., and Stout, R.L. Managed Healthcare, 9(6), 4 -42.2 Pressman, M.A. Further,there were 142,164 cocaine-related emergency room episodes in 1995(Petersen, 1999). Currently, alcoholism directly affects approximately 14million people in this country, while also impacting their families,friends, and coworkers (Knapp, 1999). Foote, J., DeLuca, A., Magura, S., Warner, A., Grand, A., Rosenblum,A. Also, the focus was not specifically on ensuringabstinence from substance use and maintenance of sobriety. (1999). ment. In 1997, the Centers for DiseaseControl and Prevention reported that there were more than 18, alcohol-induced deaths and nearly 15, drug-related death in 1996. Galanter and Kleber (1999) provide a useful compendium thatlooks at all of these issues, including neurobiology and the variousmethods of group therapy, along with 12-step programs. These elements are feedback, responsibility,advice, menu of options, empathy, and self-efficacy. Roback, H.B., Moore, R.F., Waterhouse, G.J., martin, P.R. There wasalso a 4 percent decrease in inpatient bed days in the year followingintake. Apparently,they needed the ongoing connection and reinforcement encouraged by TSF.This group was much more likely to be involved in AA and that involvementmay have been the real difference in the effectiveness of the programmodels. The authors concluded that the multicomponentbehavioral approach was a superior intervention both for keepingoutpatients in treatment and attaining and maintaining cocaine abstinence.Combining group therapy and self-help groups A common model currently in use for patients who graduate frominpatient facilities is to combine outpatient aftercare groups withattendance at self-help AA groups. Influence ofoutpatient treatment and 12-step group involvement on one-year substanceabuse treatment outcomes. Journal of Group Psychotherapy, 49(4), 486-512. Journal of Studies on Alcohol, 59(5), 513-522. Conclusion In reviewing the literature, it becomes immediately apparent thatthere are a number of unresolved questions about substance abuse, includingthe differing roles of biology and environment, and the appropriatetreatment for different individuals or groups. The researchers indicate that it has shownconsiderable promise in working with this group of individuals who often donot have some of the same type of problems as long-term alcoholics, forexample. They were randomly assigned either to standard group counseling orindividualized relapse prevention aftercare in order to determine which wasmost effective in maintaining sobriety and preventing relapse. Network therapy for alcohol and drug abuse: Anew approach in practice. For example, in onestudy of substance abusers at the one-year treatment mark, the researcherscould only include that encouraging substance abuse patients to regularlyattend both outpatient aftercare groups and self-help groups may improvelong-term outcomes (Ouimettte, Moos, and Finney, 1998). In reporting about thetherapists, or facilitators, of these substance abuse treatment groups, 27percent of respondents indicated that they had been subpoenaed to testifyabout a group member. Resultsindicated that subjects in the CBT group were significantly more likely toachieve abstinence than participants in the 12 step facilitation group, butthat there was some support for treatment matching hypotheses. and Silvan, M. The American Journal of Psychiatry, 153(1 ), 125 Schuckit, M.A. Another model for this was provided by Sloan and Rowe (1998) whodevised an outpatient dual-diagnosis treatment program for substance abuseand psychiatric illness. Treatment included three separate elements, although urine drugscreening does not seem to qualify as treatment. In a somewhat different mode, Galanter (1993) proposed a model ofoutpatient therapy that involved a group, but did not follow traditionalmodels of group therapy. He or she is notlikely to have a peer group sharing the addiction, special bars oractivities. There is no single factor that can be pointed to as definitelycausal, although both inheritance and environment have been implicated ashaving roles in developing a substance abuse disorder (Schuckit, 1999).Besides alcohol, drugs, cigarettes, and others substances can be a sourceof misuse, or abuse. Group counseling versus individualized relapse prevention aftercarefollowing intensive outpatient treatment for cocaine dependence: Initialresults. and Finney, J.W. Because of concerns about their records beingsubpoenaed, 65 percent of the respondents indicated that they were verycareful about what they put in their records so that important disclosureswould not be put in writing and have to be revealed in court or otherproceedings (Roback et al., 1997). Some newly-designedprograms, however, attempt to work with both substance abuse and mentalhealth issues. What seems clear is that aone-size-fits-all approach is an inadequate approach, although AA hascertainly promoted that in its movement and had a great deal of success.Still, there are millions of people suffering from active substance abusewho either will not join 12-step programs or have not succeeded in becomingabstinent through their use. Instead, the addiction is likely to be characterized by evenmore than the ordinary shame, isolation, and secrecy of the average addict. The unauthorized identification of a group member to a person outside thegroup was the most frequent type of violation. Nonetheless, theycombined this with group therapy using an educational model, along withcrisis intervention. (1999). This led them to some preliminary conclusions: namely, that themotivational processes were affected by the GMI and that the patientsperceived the GMI environment and leader as more "autonomy supportive" thanother treatment modalities. Psychiatric Quarterly, 7 (2), 123-135. If the individual does not attend or contribute, the group cannotwork.Comprehensive treatment Although the focus of this study has been on group therapyapproaches, the treatment of substance abusers often seems to require acombination of approaches. This is not the only problem, however. The researchers randomly assigned 8 6clients from five clinical research units to one of three differentindividual treatment models, which also included Cognitive BehavioralTherapy. American Journal of Drug and Alcohol Abuse,24(4), 589-6 1. Group psychotherapy is another model with much to offer, but muchunresolved. (1999). Again, the problem is that this is a new model with one randomizedclinical trial supporting its efficacy. There have been a plethora of group therapy models developed bypractitioners during the 199 s as AA has been challenged and as managedcare has searched for brief care models for treatment. American Journal of Psychiatry, 15 (5), 763-769. Kaminer, Y., Burleson, J.A., Blitz, C., Sussman, J., and Rounsaville,B.J. Obviously this study has problems since there are so many offeringsavailable to adolescents at the same time that there is no way ofdetermining what permutation of offerings, or what interaction ofadolescent characteristics and group elements, contribute to positivebehavioral change. Certainly cognitive-behavioral therapy has promise and some ofthe other newer models described in this paper might prove effective. Lash, S.J. Instead, it seemsmore fruitful to offer an array of alternatives - if possible - as wasreported by Pressman and Brooks (1999) in their work with adolescents.Certainly the Maude-Griffin et al. In order to test this, 32 dually diagnosed adolescents were randomlyplaced into two 12-week manual-guided outpatient group psychotherapies,either of CBT or IT. (1993). Galanter, M. and Brook, D.W. Journal of Substance AbuseTreatment, 16(1), 55-6 . Achieving cocaine abstinence with a behavioralapproach. While this is a special case, since physician credibility wouldpresumably be even more impacted than other members of the community shouldknowledge of their substance abuse disorder and/or behaviors become knownwithin the larger community, the issue of group confidentiality is animportant one in looking at the effectiveness of both group therapy andself-help groups. That would be one criticism of the book. In Massachusetts, the focus is on just that combination of problems(McNaught, 1999). Journal of Consulting and Clinical Psychology, 66(5), 832-837. and Kleber, H.D. In addition, in thebehavioral treatment group 68 percent and 42 percent achieved abstinence of8 or 16 weeks respectively compared to 11 percent and 5 percent for thedrug abuse counseling group. They feared revelation by other members of thegroup and by the facilitators of the group. This is the same problem with a model described by Khantzian et al.(199 ). This is a promising model, but the problem with this discussion isthat it is the author himself who is reporting on its effectiveness. The median time of treatment was 217 days. However, attendance rates for aftercare therapy tend tobe low, with those who have attended inpatient substance abuse treatmentprograms not as willing to consider the group therapy process on anoutpatient basis. However, research has not yet established that there is significantand definite advantage to this for substance abusers. Another study compared different psychotherapies for dually-diagnosedsubstance abusers to see if the most effective treatment could be chosenbased on their psychopathology. (1998). This model is an intensive aftercareapproach designed to reinforce what clients have learned in inpatientprograms and to establish good patterns for them on the outside. The focus was strictly behavioral, looking for clues as to thelikelihood of renewed drinking. (199 ), the focus isspecifically on cocaine abusers. (1999). Another method showing promise, but needing more studies to verifyfindings is the Group Motivational Intervention (GMI), which is a groupprocess model using motivational elements that are usually associated withindividual treatment. Atpresent, however, it would not be possible to recommend a specific grouptherapy model for all groups in any outpatient setting. Therapists must gain the trustof group members, starting from a non-judgmental stance that allows thepatient to feel diminished isolation and shame (Fayne and Silvan, 1999).Special problems in group therapy There are not only issues involving special populations in grouptherapy - such as the dually-diagnosed - there are issues about grouptherapy itself which make it problematic for some substance abusers. It is a modified dynamic group therapymodel that is described as a short-term, supportive-expressivepsychodynamic approach. NY: Guilford. If able to overcometheir fear of connection, and their resentment at being ordered into thetherapy group for the most part, physicians can be successful because thegroup psychotherapy setting provides them with the safety to explorepersonal issues and the opportunity to gain feelings of attachment andaffiliation with a group of peers. Journal of Consulting and Clinical Psychology, 65(5), 778-788. NY: Basic Books. As Fayne and Silvan (1999) noted, the substance abusingphysician is probably the most isolated of addicts. (1998). (1997). In this way, clients begin to understandthe interaction of their problems and how they can begin to gain controlover their lives. (1998). The authorsrandomly assigned 38 patients in outpatient treatment to either amulticomponent behavioral treatment or drug abuse counseling based on thedisease model of dependence and recovery. The researchers attempted to explore the usefulness of this grouptherapy model by conducting a randomized clinical trial on an outpatientbasis. (1993) were claiming success forstrictly behavioral models in working with cocaine abusers. (1997) created astudy in which 98 male cocaine-dependent patients who had finished theiroutpatient treatment programs were assigned to one of two groups for follow-up. However, work-relatedincidents and illegal activities were less likely to be disclosed nor didviolators often disclose to other professionals information about a co-members substance abuse problem. One model that has more support in the literature for efficacy indealing with substance abusers and some types of behavioral disorders isthe cognitive-behavioral therapy model. Psychotherapies for adolescent substance abusers: A pilotstudy. Also looking at aftercare programming, McKay et al. Patients in the behavioralgroup received incentives for turning in drug-free urine samples. Alcoholics Anonymous and long-term matchingeffects. Thus, patients with externalizingdisorders were hypothesized to be more likely to succeed with cognitive-behavioral group treatment (CBT), while those with internalizing disorderswere hypothesized to be more likely to succeed with interactional grouptreatment (IT) (Kaminer et al., 1998). Instead, approaches that utilize inpatient oroutpatient treatment, plus AA, plus individual or group therapy, plusconceivably medication for the substance abuse disorder or the mentalhealth problem might be the most effective. The GMI model usesthese elements plus elements from self-determination theory with its focuson motivation as either internal and autonomous or external and controlled. In working with physicians, as withother groups, safety is a paramount issue. (1999). New York Times Magazine,6, 19:2. As a whole, the program wassuccessful, the researchers concluded, in promoting participantcohesiveness, communication skills, and hopefulness (Pressman and Brook,1997). The model used both operant andconditioning aspects of behavioral therapy for increased effectiveness. Substance abuse and psychiatricillness: Treatment experience. Comparing Group Therapy Approaches in an Outpatient Setting for Treating Substance Abusers Introduction Substance abuse is a major problem in the United States, and manyother countries. Their subjects were 118 consecutive admissions tothe Seattle Veterans Affairs Medical CenterÕs dual disorders program fromJune 1992 to August 31, 1994. Ouimette, P.C., Moos, R.H. Resultsindicated that at least initially the individualized relapse preventionaftercare follow-up was more effective. To focus only on group therapy is probably tofail, in most instances. McKay, J.R., Alterman, A.I., Cacciola, J.S., rutherford, M.J. Ideal substance abuse treatment still open todebate. and Rowe, G. Yet,there is controversy about their effectiveness, and their appropriatenessfor all clients. He termed this "network" therapy for alcohol anddrug abuse and it followed a behavioral model designed to prevent relapse.Galanter indicated that it was only designed for those with moderatedependency problems who were able to put together a group of family andfriends willing to work with them on a regular basis for relapseprevention. They were assessed at baseline ad at Weeks4, 8, 12, and 26, with treatment itself lasting for 12 weeks. Lash and Blosser (1999) indicated that while adherencecontracts and orientation to aftercare group therapy when the individual isparticipating in an inpatient program tend to improve aftercare attendance,participation levels still remain low. and Blosser, S.L. Physicians. Khantzian, E.J., Halliday, K.S., and McAuliffe, W.E. Theeffectiveness of any kind of group was impacted by the physicians' concernsabout confidentiality. Dis., 186(11), 684-69 . While the newfocus is on the genetic and the neurobiological, this simply adds to whatwe already know, not replacing information about family issues and the roleof other mental illnesses. The state has attempted to ensure that some of the mostintractable members of the population of substance abusers receivesadequate treatment for both sets of problems. Essentially, they developed the model in response to evidenceindicating that people will gain and maintain behaviors for longer periodsof time if they perceive that they are internally motivated to do so,rather than externally driven (Foote et al., 1999). In other words,adolescents were exposed to a multiplicity of experiences, any of whichcould have contributed to changed behavior. This was a randomized, controlled trial using 128 participants in twodifferent treatment conditions. This is a goodbeginning in working with a problem that is, indeed, cunning, baffling, andpowerful in many instances. Resultsindicated that the patients receiving behavioral treatment completed agreater length of treatment, with 58 percent finishing 24 weeks compared toonly 11 percent from the drug counseling group. There are individuals who have dual disorders, dealingwith both mental health and substance abuse issues. Nonetheless, at a minimum, the researchers needto study a wider population base and carry their research out over a longerperiod of tie to see if positive behavior changes indeed result and arecarried forth through time. (1999). These fears were notgroundless, since the researchers indicated that the 51 respondentsreported knowledge of a total of 3 3 incidents of violations ofconfidentiality perpetrated by co-members of groups of addicted physicians. Resultsseemed promising for this group, with 6 percent of subjects going withouta positive drug screening during the entire treatment phase. Dual disorders. One of the problems that substance abuseprofessionals, and psychotherapists, face is that substance abusers mayhave other problems. Higgins, S.T., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F.,and Badger, G. (1997) discussed the issue of confidentiality inregard to physicians diagnosed with substance abuse disorders. (1999). In otherwords, both psychotherapies may be differentially effective for specifictarget populations. (1998).Network support for drinking. (1993). Trends in functioning in family, school, peer-socialrelationships, legal problems, and psychiatric severity all showed afavorable direction for CBT in comparison to IT (Kaminer et al, 1998). Int. Journal of Substance Abuse Treatment, 17(3), 181-192. This is a complex probleminvolving both neurobiological and psychosocial elements. There are other issues to overcome, including the tendency ofphysicians to think of themselves as healers, rather than as patients, andthe general isolation that has been reinforced by their professional role.Fayne and Silvan (1999) indicated, however, that group psychotherapy withthis group can be surprisingly successful, since it allows members to gaininterpersonal connections that they have been lacking. Petersen, C. This seems to indicate that a significant percentage of subjectsbenefited from the different elements of the treatment process, sustainingboth sobriety and stability for longer periods of time than was customaryfor this group. (1998). Sloan, K.L. It seems as though themodel might be so adapted to a specific subset of substance abusers as toonly be relevant for that group. In the model described by Khantzian et al. This approach allowed adolescents to attend concurrenteducational programs, including a high school on site, while attending anyor all of the groups including the Substance Abuse Group, using the 12-stepmodel, the Health Group, the Psychotherapy Group, the Leisure Time Group,the Self-Awareness Group, and the Multiple Family Group. More research is needed to learn if it isequally applicable to other substance abusers. They worked through a day-treatment program using a multifaceted approach to treating comorbidadolescents. What they learned during this longitudinal study was that TSF wasmore effective than MET in certain circumstances, particularly with clientswho had networks which were highly supportive of drinking. Treatment issues in the grouppsychotherapy of addicted physicians. This is an interesting study, because it works with two specialpopulations, the dually diagnosed and adolescents. The intention in this paper is toexamine and compare group therapy treatment for substance abusers in anoutpatient setting. Addiction, 93(9), 1313-1333. The best place to begin is with a comprehensiveexploration of the person's background - if possible - gaining all theinformation that is usable is devising an appropriate, tailored, treatmentapproach. (1999). Certainly it builds well on theoryand obtained good results. References Fayne, M. If not possible, the best choice is the group therapy modelmost congruent with the therapist's training and the target population'scharacteristics and needs. Increasing adherence tosubstance abuse aftercare group therapy. Whether in inpatient oroutpatient setting, mental health psychotherapy is included as part ofsubstance abuse treatment, and substance abuse information is included inmental health treatment programs. Yet, clearly there were those who did well with either MET or CBT;they were less likely to be in AA and less likely to come from, or be partof, social networks highly supportive of drinking (Longabaugh, 1998). It also showed resultsdiffering from those expected by the researchers and highly supportive of aCBT intervention. (1998) study leant support to the ideathat different psychotherapies may be differentially effective for specificpopulations, or subgroups of populations. There is nothing in the literature to lead me to conclude thatany one model is significantly better than all other models, or canguarantee high percentage success rates with all populations of substanceabusers. Since prevention of the problem is not yet a possibility, the focushas been on intervention and treatment. The American PsychiatricAssociation. Maude-Griffin et al. (199 ).Addiction and the vulnerable self: Modified dynamic group therapy forsubstance abusers. The authors describe the development of the GMI,which is a four-session, manual-driven group approach that uses sixmotivational elements. (1996).Confidentiality dilemmas in group psychotherapy with substance-dependentphysicians. J. The results werenot definitive.Special Populations Adolescents. In one study, for example, researchers attempted to compare theeffectiveness of the Twelve Step Facilitation Therapy Model withMotivational Enhancement Therapy for those clients who were alcoholdependent and members of social networks that were highly supportive ofdrinking (Longabaugh et al., 1998). A group motivational treatment for chemicaldependency. Superior efficacy of cognitive-behavioral therapy for urban crack cocaine abusers: Main and matchingeffects. The American Psychiatry PressTextbook of Substance Abuse Treatment. A multiple grouppsychotherapy approach to adolescents with psychiatric and substance abusecomorbidity. The depressed individual drinks to alleviate depression, butthe long-term effect is only a more severe depression. nerv. Group Therapy Approaches The Alcoholics Anonymous program, as well as the other 12-stepprograms, have been variously described as self-help groups, mutual helpgroups, and as a form of group therapy not mediated by a facilitator. There is also support for the increased effectiveness of substanceabuse treatment that is gained through attendance in aftercare grouptherapy programs. Knapp, C. However, not allhave the research backing to unequivocally support their usefulness. Another surprisingly troubled population is thephysician-addict. The Boston Phoenix, January25, 1999. However, these were justpreliminary results and the authors intended to continue their follow-up(McKay et al., 1997). Even earlier, Higgins et al. Pressman and Brook (1997) reported on a treatmentmodality which combined even more group options in treating dually-diagnosed adolescents on an outpatient basis. and Stahl, S. New findings in the genetics of alcoholism.JAMA, 281(2 ), 1875-1876. Galanter, M. Often one exacerbatesthe other. Forexample, Roback et al. Maude-Griffin, P.M., Hohenstein, J.M., Humfleet, G.L., Reilly, P.M.,Tusel, D.J., and Hall, S.M. At a 3-month follow-up, there were no patient-treatment matching effects identified, but adolescents assigned to CBTshowed a significant reduction in substance abuse severity in comparison tothose assigned to IT. Thereneed to be additional studies using the network therapy approach to learnmore about his effectiveness in comparison to AA, cognitive-behavioralgroup therapy, and other approaches. More research is needed toexplore that concept, focusing on matching methods, includingpsychotherapies, to specific populations and then to subgroups of thosepopulations. McNaught, S. Theyare, in any event, probably the form of group work that most outpatientsubstance abusers are most familiar with, and most likely to use. Double jeopardy. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.

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