Substance Abuse Treatment Programs

Substance abuse is the repeated use of drugs such as cocaine, heroin and prescription drugs. There are many reasons that contribute to such addictions, such as ineffective parenting, poor social coping skills, association with deviant peer group and peer pressure.

There are various symptoms too, such as forgetfulness, aggressiveness, irritability and getting drunk on a regular basis that can be seen frequently in an individual. If you notice any of the symptoms, it is imperative to approach a drug rehab center otherwise these can have deadly consequences if not treated at the right time. Treating the drug or alcohol abuse at an early stage is the best way to get rid of this habit.

Essentially treatment is a behavior modification therapy that helps drugs and alcohol addicts to come out of this habit and lead a healthy and stress free life. The drug prevention programs made available by the rehab center are offered after analyzing the person’s characteristics and knowing the type of substance being consumed.

The substance abuse treatment programs are carried out by specially trained staff members who are certified or licensed as substance abuse counselors. These substance abuse counselors or specialists identify the individual’s negative behavioral traits and take necessary steps with a positive approach.

Substance abuse counseling plays a crucial role in the psychological recovery of the patient. With this counseling session, addicts are motivated to develop basic problem-solving skills, achieve a balanced lifestyle, improve relationships, find a higher meaning in life and eventually lead a productive and happy life.

There are residential programs, outpatient programs and executive rehab programs also made available to patients by specialists helping in the recovery process. Partial hospitalization and methadone clinics are other amenities provided to individual suffering from alcohol or drug abuse. To ensure long time recovery, there are residential substance abuse programs made available by drug rehab centers. Get more information.

Anger Management, a Neglected Topic in Substance Abuse Intervention

A long standing issue

Problems managing anger has always been a concern for patients suffering from addictive disorders. Pioneering research by my mentor, Dr. Sidney Cohen at the UCLA Neuropsychiatric Institute demonstrated the relationship between, anger, violence and the use of alcohol and or cocaine. One of the most popular articles written by Dr. Cohen, was entitled, “Alcohol, the most dangerous drug known to man”. In this and other publications, Dr. Cohen systematically demonstrated the causal relationship between cocaine and alcohol abuse and aggression. Much of this research was done in the 70s and 80s.

Anger has always been a factor in substance abuse intervention. Unfortunately, until recently, it has been overlooked or treated as an after thought by substance abuse programs nationwide. Substance use and abuse often coexist with anger, aggressive behavior and person-directed violence. Data from the Substance Abuse and Mental Health Administration’s National Household Survey on Drug Abuse indicated that 40 % of frequent cocaine users reported engaging in some form of violence or aggressive behavior. Anger and aggression often can have a causal role in the initiation of drug and alcohol use and can also be a consequence associated with substance abuse. Persons who experience traumatic events, for example, often experience anger and act violently, as well as abuse drugs or alcohol. This is currently occurring with recently returned combat veterans from Iraq.

ANGER AND SUBSTANCE ABUSE

Substance abuse and dependence has grown beyond even the bleakest predictions of the past. In the United States alone, there are an estimated 23 million people who are struggling (on a daily basis) with some form of substance abuse or dependence. The toll it is having on our society is dramatically increased when we factor in the number of families who suffer the consequences of living with a person with an addiction, such as:

o Job loss

o Incarceration

o Loss of child Custody

o DUI’s

o Domestic Violence/Aggression

o Marital problems/divorce

o Accidents/injuries

o Financial problems

o Depression/anxiety/chronic anger

Unfortunately, most substance abusers may not even be aware that they have an underlying anger problem and do not “connect” their anger problem to their alcoholism, drug addiction and substance abuse. Therefore, they do not seek (or get) help for their anger problem. But more often than not, their anger is the underlying source of their disorder.
Anger precedes the use of cocaine and alcohol for many alcohol and cocaine dependent individuals. Anger is an emotional and mental form of “suffering” that occurs whenever our desires and expectations of life, others or self are thwarted or unfulfilled. Addictive behavior and substance abuse is an addict’s way of relieving themselves of the agony of their anger by “numbing” themselves with drugs, alcohol and so on. This is not “managing their anger”, but self medication.

When we do not know how to manage our anger appropriately, we try to keep the anger inside ourselves. Over time, it festers and often gives rise to even more painful emotions, such as depression and anxiety. Thus, the individual has now created an additional problem for themselves besides their substance abuse, and must be treated with an additional disorder. Several clinical studies have demonstrated that anger management intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.

Medical research has found that alcohol, cocaine and methamphetamine dependence are medical diseases associated with biochemical changes in the brain. Traditional treatment approaches for drug and alcohol dependency focus mainly on group therapy and cognitive behavior modification, which very often does not deal with either the anger or the “physiological” components underlying the addictive behavior.

Anger precedes the use of cocaine for many cocaine-dependent individuals; thus, cocaine-dependent individuals who experience frequent and intense episodes of anger may be more likely to relapse to cocaine use than individuals who can control their anger effectively. Several clinical trials have demonstrated that cognitive-behavioral interventions for the treatment of mood and anxiety disorders can be used to help individuals with anger control problems reduce the frequency and intensity with which they experience anger.

Although studies have indirectly examined anger management group treatments in populations with a high prevalence of substance abuse, few studies have directly examined the efficacy of an anger management treatment for cocaine-dependent individuals. A number of studies demonstrating the effectiveness of an anger management treatment in a sample of participants who had a primary diagnosis of post-traumatic stress disorder have been conducted by the Department of Veterans Affairs. Although many participants in these studies had a history of drug or alcohol dependence, the sample was not selected based on inclusion criteria for a substance dependence disorder, such as cocaine dependence. Considering the possible mediating role of anger for substance abuse, a study examining the efficacy of anger management treatment in a sample of cocaine-dependent patients would be informative.

Anger management as an after thought

In spite of the information available to all professional substance abuse treatment providers, anger management has not received the attention which is deserved and needed for successful substance abuse treatment. Many if not most substance abuse programs claim to offer anger management as one of the topics in its treatment yet few substance abuse counseling programs include anger certification for these counselors.

Typically, new substance abuse counselors are simply told that they will need to teach a certain numbers of hours or sessions on anger management and then left to find there own anger management information and teaching material. These counselors tend to piece together whatever they can find and present it as anger management.

Despite the connection of anger and violence to substance abuse, few substance abuse providers have attempted to either connect the two or provide intervention for both. In the Los Angeles area, a number of primarily upscale residential rehab programs for drug and alcohol treatment have contracted with Certified Anger Management Providers to offer anger management either in groups on an individual basis for inpatient substance abuse clients. Malibu based Promises (which caters to the stars) has contracted with Certified Providers to offer anger management on an individual coaching bases.

It may also be of interest to note that SAMSHA has published an excellent client workbook along with teacher’s manual entitled, Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual [and] Participant Workbook.
This publication free and any program can order as many copies as needed without cost. There is simply no excuse for shortchanging substance abuse clients by not providing real anger management classes.

Limited anger management research

What has been offered as anger management in substance abuse programs has lacked integrity. The Canadian Bureau of Prisons has conducted a 15 year longitudinal study on the effectiveness of anger management classes for incarcerated defendants whose original crime included substance abuse, aggression and violence. One of first findings was that in order to be useful, the anger management model used must have integrity. Integrity is defined as using a client workbook containing all of the material needed for an anger management class, consistency among trainers in terms of how the material is taught and a pre and post test to document change made by clients who complete the class.
It is not possible to determine the effective of anger management which is fragmented and not based on any particular structure of theoretical base.

Anger management training is rarely integrated into substance abuse treatment
At the present time, anger management is rarely integrated into any model of substance abuse intervention. Rather, it is simply filler tacked on to a standard twelve step program,

Trends in anger management and substance abuse treatment.

Several years ago, the California state legislature established statewide guidelines for all state and locally supported substance abuse programs. This legislation is included in what is commonly referred to as proposition 36. As a result of this legislation, all substance abuse counselors must have documented training in anger management facilitator certification. This training requires 40 hours of core training plus 16 hours of continuing anger management education of a yearly basis.

What is Anger Management?

Anger management is rapidly becoming the most requested intervention in human services. It may be worthwhile to define what anger management is and is not. According to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological condition therefore; it is not listed as a defined illness in the Diagnostic and Statistical Manual of Nervous and Mental Disorders. Rather, anger is considered a lifestyle issue. This means that psychotherapy or psychotropic medication is not an appropriate intervention for teaching skills for managing anger.

The American Association of Anger Management Providers defines anger management as a skill enhancement course which teaches skills in recognizing and managing anger, stress, assertive communication and emotional intelligence. Anger is seen a normal human emotion which is a problem when it occurs too frequently, lasts too long, is too intense, is harmful to self or others or leads to person or property directed aggression.

The Anderson & Anderson anger management curriculum is currently the most widely used model of anger management in the world. This model includes an assessment at intake which is designed to determine the client’s level of functioning in the following four areas, anger, stress, communication and emotional intelligence. The intervention/classes which are provided teach skills in these four areas. Post test are administered after course completion to determine the success or lack thereof of the program.

In Summary

All anger management programs should conduct an assessment at intake for substance abuse and psychopathology and all substance abuse programs should assess all participants for the current level of functioning in recognizing anger, stress, assertive communication and emotional intelligence.

All substance abuse programs should have their intervention staff certified in anger management facilitation.

Guidelines should be established to determine the number of hours/sessions that each client will receive in teaching skill enhancement in anger management, stress management, communication and emotional intelligence.

Mental Health and Substance Abuse Programs: Holistic Coping Methods

Peer support specialists are important members to the faculty of mental health, addiction and substance abuse services. Peer support specialists relate to patients in a way that they can understand. The most important factor between peer supports and clients is trust. After going through rough times in life, trust can be especially hard to establish.

A wellness center can often offer a spectrum of individual and group activity based on need. Peer specialists often run these centers. A peer specialist provide their own experiences with the given circumstance to help achieve a level of recovery by being a role models for others.

A wellness center focuses on holistic health approaches. These methods allow individuals to provide stories, to learn and share coping mechanisms. The intent is to establish a sense of self worth, confidence, and balance in their lives through psycho-educational groups.

Below are examples holistic focused wellness classes:
1. Wellness recovery action plan: developed by Mary Ellen Copeland, is an evidence-based program that presents day-to-day coping and wellness strategies for those experiencing/experienced mental health difficulties
2. Personal action toward health: developed by Stanford University to help those with chronic diseases: mental health, substance abuse, cardiac problems, or lung disorders
3. Writing groups: expression through writing as a coping method
4. Art classes: use visual creativity to express feelings and to cope

One-on-one services have been proven to help individuals, but so do group settings. Utilizing peers, those who have gone through similar experiences, makes one feel less alone. A support system is beneficial. I would suggest searching local areas for peer support groups for help during times of struggle.

One outcome of wellness centers, or support groups, is the self-confidence to find a job and maintain employment. Specialists help individuals identify strengths, skills and interests, and offer a plan to find the right job, whether full time or part time. Specialists help develop a resume, train for interviews, and help fill out applications. In addition, transportation that may have been an issue, no long will be.

Maintaining the job requires on-site coaching and training, a follow-up from a peer supporter and maintaining communication with management.

It is difficult to overcome mental illnesses or substance abuse. Peer specialists are there for help. If you know someone struggling with getting back on to stable ground, connect with the community for outreach programs, group support systems or counseling for obtaining and maintaining jobs.

Substance Abuse and Learning Disabilities

The National Institute of Health estimates that about one in five people have a learning disability severe enough to interfere significantly with academic accomplishments.  Yet, other research estimates that only about one in four of these individuals with a learning disability receive proper treatment.  Since we know that learning disabilities are usually genetic, parents may fail to seek help for the very condition that impacted them.  Unfortunately, adolescents who are unaware of their learning disabilities are more likely to become involved in substance abuse, which only exacerbates their problems in school.  There is a higher incidence of substance abuse in the learning disabled population than there is in the general population.  No one is exactly sure of the nature of the relationship between the two, but there are logical hypotheses that are being researched.

Do drugs cause school failure or does school failure cause drug use?  It would be an interesting debate, but the bottom line is the two are in some way very much connected.  Yet, not everyone with learning disabilities is involved with drugs.  There has to be a reason.  For those who do fall victim to substance abuse, proper treatment is an important element of recovery. Durazzo et al, 2008;43(6):683-691,  2008

Oxford University Press, discovered that alcohol abusers with processing deficits were 14.2 times more likely to relapse with alcohol than alcoholics with normal processing. This presents a very compelling reason to test for such learning disabilities.

For any substance abuse program or treatment center to be truly effective the underlying issues of substance abuse must be clearly identified and re-mediated.  Dual diagnosis should not only include substance abuse and psychological problems but, given the high incidence of substance abuse with learning disabilities, should also include learning problems.  This, in essence, creates a triple diagnosis program.  Sobriety always comes first since, as those in the addiction field often tout, “You can’t do therapy on a drug.”  The cloud and fog need to go away before any serious work can be done.

As children and adolescents we spend almost half of each weekday in school and doing homework.  When there are learning disabilities, including processing problems, school becomes a battleground of failure.  Failure breeds low self-esteem, anxiety, depression, and, often, normal peer rejection.  Pain is a great motivator.  Make no mistake about it.  While creating other problems, drugs DO numb the pain.  This is called self-medication.  Then, the person has a built-in peer group with which to socialize … other drug users.

Again, while not every person with learning disabilities turns to drug use, there is enough evidence to suggest those with learning disabilities who go untreated are much more likely to become involved with substance abuse than those who are treated.

Children and adolescents with untreated learning disabilities and substance abuse issues grow up to be adults with learning disabilities and substance abuse issues.  While the physiological effects of drugs on the developing body and brain are more severe, the life effects on an adult can often be much worse.

With proper standard psycho-educational assessments and such modern technologies as the DESA (Digital EEG Spectral Analysis), fMRI (functional Magnetic Resonance Imaging), and SPECT (Single Photon Emission Computed Tomography) scans, the learning disabilities and processing problems can be clearly identified.  Once identified, the individual’s treatment regimen must include the remediation of the problems if it is to have any chances of sustained success.  Substance abuse and learning disabilities create psychological problems.  It is a three-headed monster.  When only two of the three are slain, it is still very much alive and capable of inflicting great harm.  Certainly, identifying the problems early in childhood and adolescence is the ideal, but it is never too late.  Adults with learning disabilities can benefit from proper diagnosis as well.

Copyright 2009 Yellen & Associates All rights reserved.