Substance Abuse - Research Paper Example

? "Substance Abuse" Substance abuse encompasses dependence of an individual on various mood altering agents like drugs such as marijuana, alcohol, opioids, stimulating agents, narcotic agents, depressants, inhalants and hallucinogenic agents. Addiction to these agents causes serious health implications, affects individual's personal as well as social life and also results in the family issues. Although occasional drinking may not turn out to be injurious, but if it happens on a regular basis to relieve stress, it becomes detrimental. Dealing with the substance abuse cases is complicated. Individuals involved in substance abuse may deliberately or innocently bring numerous situations of predicament for themselves and also for those who are associated with them. The present research article deals with the evidence-based practice for the treatment approach. The article highlights the history, overview related to substance abuse and also the critique of the treatment modality whereby prominence of substance abuse in terms of its pros and cons could be selected. Introduction History of Substance Abuse Since the dawn of human civilization, use of drugs has become an inevitable part of life to relieve sufferings and have a contented and happy life. Tracing the history, substance abuse started around 6000 B.C. Human beings possess a craving for good food items which not only generate a good feeling but also act as a stimulant. This was pertinent to making them look for substances which alleviate d their mood. Discovery of fermentation served as a landmark which paved the way for alcohol production. With time, alcohol production has taken new paradigms and has become a part of culture as social drink and for some it has become an addiction. History reveals that besides alcohol, other various home remedies were also followed, such as use of herbs, roots and fungi to relieve pain, some provided relief by rubbing them on skin while others were inhaled or drunk. Consumption of these substances was not harmful in its natural form, but due to human temperament to enhance the potency of the compound, the natural flavor and potency was altered and things started taking a new shape and composition to provide alteration of mood and to divert the feelings of stress and anxiety towards good emotions. Gradually this process took a large form, and now people consume these substances on a regular basis and therefore, once beneficial in altering the situation of melancholy and dissatisfaction for individuals to feel a new life, the substance gradually becomes part of their routine forming habit. High consumption is deleterious to health, and so the individual becomes victim of the substance and the substance turns to be "an abuse" (History of Drug & Alcohol Abuse). Origin of Modalities Substance abuse treatment has always been a great subject of research and, therefore, much research has been carried out and still ongoing to deal with the substance abuse. Various modalities were studied over the years encompassing inpatient, residential, outpatient free of drugs and outpatient with drugs to understand the efficacy of the modalities along with their cost-effectiveness (Mojtabai & Zivin, 2003). Findings of Mojtabai and Zivin (2003) highlight the fact that outpatient drug-free was the most cost-effective modality for the treatment of substance abuse. Besides these, other treatment modalities encompassed Mental Health or Psychiatric Stabilization, Inpatient, Detoxification, Adolescent Treatment, Private Therapy or self help to overcome the consequences of substance abuse (Treatment Modalities). Overview of the Philosophy of the Modality Various methods or modalities have been experimented and researched to understand the requirement of the patient as well as to identify the kind of modality that will work for the patient. Some patients need emotional support to deal with the situation while others are found themselves to be unfit to meet the growing competition in education, degrees, job, career and social front. It becomes essential for the physician to deal with the patient as an individual case and not to mingle the treatment with others. A stereotype approach or one method for all cannot be implemented in dealing with substance abuse cases. Therefore, a physician must have a thorough understanding of the treatment modalities and must know how to interpret the kind of modality to be applied on the case. Besides, other governing factors such as diagnosis of the problem, age of the patient, support of the family, constraints involving monetary matters, choices and preferences of the patient, ability to cope with and tackle stress, the degree of stress tolerance and patient's ability to interpret and react with the situation are some of the factors which play a vital role in treating substance abuse cases. The present epoch witnesses tremendous research in medicine and social norms. Growing awareness as well as education of the patient also highlights their expectations from the physicians who should have knowledge to decide and establish the treatment procedure along with the minimum expenditure. This trust and belief placed on healthcare professionals portray a fiduciary duty (Roberts & Yeager, 2004). Evidence-based practice accentuates the physician's or practitioner's ability to implement scientifically authorized appraisal, involvement as well as assessment procedures and critical thinking while dealing with substance abuse cases. According to Roberts and Yeager (2004), practice-based research serves as a spring board for the development of evidence-based practice. Accordingly, the evidence-based practice suggests that every case must be tackled with precision and should not overlap while approaching similar issues. It is, therefore, important to have three different kinds of sources, systematic reviews, practice guidelines as well as consensus guidelines of experts. Although evidence-based practice is a challenging issue since it involves a wide range of unpredictability in precision as well as efficacy, practitioners have to be logical in determining the application of the modality. Classification of schemes have been developed by the American Public Human Services Association (2005), The National Crime Victims Research and Treatment Center, funded by the Office of Victims of Crime (OVC) (Saunders, Berliner, & Hanson, 2004), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (2006). All the regulations are set to formulate criteria for evidence-based practices to guide the review of programs, involving psychosocial managements devised by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures (Lonigan, Elbert, & Johnson, 1998). Based on all these parameters, the current article deals with the psychological modality as the main frame to handle cases involving substance abuse. Description of Modality: Psychotherapy Psychotherapy encompasses all the techniques and processes that are related to the treatment of mental health and emotional well-being of an individual. Psychotherapy empowers the individual to understand oneself, find out reasons that are responsible for inducing positivity and enable the patients to realize their strengths and accept their weaknesses. Realization is the most imperative component of the psychotherapy; an understanding of this coping mechanism enables them to deal with substance abuse. Psychoanalysis is performed to understand the behavior and emotions of the individual. These factors remain hidden in the unconscious mind and generate gloom. All these affect the self esteem of the individual; hence, there is a need to undergo psychoanalytic treatment and psychotherapy for the substance abuse treatment. Psychotherapy determines the chronological basis of the problem, changes that took place at some point in time and empowers an individual to deal with the truth. Medilexicon's medical dictionary defines psychotherapy as "Treatment of emotional, behavioral, personality and psychiatric disorders based primarily on verbal or nonverbal communication and interventions with the patient in contrast to treatments using chemical and physical measures". Psychotherapy, thus, intends to assuage psychological distress by means of conversation as compared to drugs (Corey, 2005). As psychotherapy refers to talking treatment, a good communication skill is required. The psychotherapist must be an expert in communicating with the patient, narrating stories, drama and artwork. The true psychotherapy began in the 19th century with psychoanalysis. Psychotherapy is generally utilized to deal with psychological issues and is applicable in the case of substance abuse. In certain cases, psychological issues take a long time to accrue. A bond of trust and faith between the patient and the psychotherapist is the most essential consideration for psychotherapy as psychological treatment can prolong for a greater length of time starting from months and may last for years. The therapy requires one-to-one treatment, where the individual has to deal with the therapist directly (Corey, 2005). Interactions and mutual co-ordination in psychotherapy encompass treatment of cataleptic factors encumbering relationships, work performance, mood alterations and their impact on self esteem. The method is based on the verbal procedures. The sole motive of psychotherapy is to resolve the issues related with psychological problems by conveying cataleptic clashes to the cognizant mind where they may be tackled and determined. The focus is on basic approaches of practicing concerns and being judgmental on them as compared to the focus on behavior. Psychotherapy, therefore, focuses on altering the personality of the individual in a complete manner in contrast to bringing alteration only in behavior. Intervention methods are devised to fortify self-image, enhance attentiveness, alertness and to gain control over emotions so as to avoid emotional distress. It is a slow but continuous process and may take years to be accomplished. A psychotherapist plays an inert role and guides the individual but, unlike teacher, the psychotherapist cannot teach. It is imperative that the psychotherapist should understand the emotional confrontation of the individual; it then becomes essential to bring the issue to the aching consciousness. A psychotherapist reveals the derivation of the poignant confrontation. In order to make the therapy an effective method, it becomes highly essential for the individual to deal with the concerns and resolve them rather than running away or ignoring the cause. To accomplish the task in an appropriate manner, various theories have been postulated to enhance the person's prudence of well being, improve the mental health of the individual and to establish congenial relationship with the others, both at the personal, family relationship and at the professional front and to treat the substance abuse (Models of Understanding Human Behavior). Sigmund Freud was the pioneer in developing Psychotherapy Theory stating that personality of an individual is shaped by diverse factors that enable the individual to react with the situation and respond to the world. The theory suggests that every individual is born with an identity and personality of the individual revolves around this identity, facilitating growth as it expresses the congregation of basic needs and how well they are met (Models of Understanding Human Behavior). Other theories that were proposed involve: I. Adler's theory given by Alfred Adler states that every individual is responsible for creating one's own destiny. According to Adler, individuals should provide their lives with a motive, a goal to accomplish and sort out the directions to accomplish the goal. Lack of appropriate goals makes the life meaningless (Fassino, Amianto, & Ferrero, 2008). To deal with cases of substance abuse, individuals are directed and motivated towards the set objectives or goals. It involves social interest to march ahead and accomplish objectives and to deal with the obstacles that hinder the accomplishment of the set goals, and a person tends to adopt addiction to keep one’s thoughts away from reality. The motivation involves realizing one's positive attitude, abilities and strengths, to co-operate with every other person in the society. Co-operation with everyone in the society inculcates a feeling of self-worth and generates an atmosphere of trust. This approach minimizes stress in everyday life. As a result, a person feels good and gradually overcomes the issue of indulgence in substance abuse. It is, therefore, imperative that early years of development should be constructive and devoid of complications (Fassino et al., 2008). Pros of Adlerian therapy: Adlerian theory involves harmony of personality, it provides a new outlook to the individual regarding perception towards the society, to possess an individual viewpoint. The theory highlights the importance of set objectives and the inspiration to achieve the set objectives; it emphasizes the importance and pre-eminence, mounting a distinctive survival and, thereby, motivates an individual to overcome substance abuse. The therapy is to motivate the patients in realizing their strengths and in changing the lifestyle accordingly. Goals of therapy & Therapeutic relationship: goals of the therapy encompass presenting an objective for the patient, encouraging individuals to set goals that are socially productive to develop the feeling of belongingness to the society (Corey, 2005). A bond of trust must be present if the goals are found to be defective. Alterations could be made to modify lifestyle in order to lead a happy life. Critiques and Cons: the theory is weak as it lacks accuracy, testability, and pragmatic strength and is liable to generalize some gross issues encompassing substance abuse that had a significant impact on the life of the individual (Corey, 2005). II. Person-centered therapy was given by Carl Rogers, the father of the humanistic movement in psychotherapy. According to this theory, humans are positive beings and apt to be efficient and purposeful. The theory offers an approach to realize the potentials that an individual possesses and to drive an individual towards enhancing alertness, faith, impulsiveness, self-belief and inner consciousness. All these aid in enhancing self-worth and overcome the substance abuse. Key concepts: the patient of substance abuse possesses a temperament towards generating awareness to resolve issues and problems. Firmness and faith are highly placed and serve as a means for self-governance. Here, mental health becomes imperative and provides wisdom to discriminate ideal self and real self, which is very important to face the reality rather than adopting means such as substance abuse to escape from the truth. Any kind of maladjustment culminates into incongruity between what one wanted to achieve or would like to achieve and what one gets in hand (Enguidanos, Coulourides, Keefe, Geron, & Katz, 2011). Pros: the therapy is solely concerned with the individual and provides encouraging environment for self-exploration in order to understand what one can choose and witness growth and progress. It aims at providing a stress free and safe atmosphere to the individual for holistic development. The theory encourages the individual to display openness, honesty, superior conviction in self, enthusiasm as well as enhanced impulsiveness and liveliness. Therapeutic Relationship: it is desired that the patient recognize the characters of self and also of the therapist, a bond of empathy must co-exist between the two, whereby integrating legality, compassion, accurate, reverential, as well as non-judgmental communication are established between the patient and the psychotherapist. An understanding that is built in this relationship is transmitted to other relationships and enables an individual to realize self-worth and generates willingness to overcome self-negligence (Corey, 2005). Critics and Cons: in certain cases, a feeling of insecurity is observed where a patient may feel jeopardy from the psychotherapist, who may stay passive or inactive, restraining answers to manifestations. Patients may display a need for larger directives towards the structures and techniques to continue with the process of psychotherapy, especially when the patient demands greater care to deal with the critical situations. Functional to personage psychotherapy, a few cultural assemblages require more counseling. The theory displays the rigidness of thoughts and, therefore, it should be reevaluated with an approach to incorporate the situations of current scenario and introduce flexibility in thoughts (Corey, 2005). III. Cognitive Behavior therapy (CBT): CBT encompasses psychotherapeutic approach by means of communication. The theory is designed to resolve issues related with dysfunctional sentiments related to conduct and cognition all the way through a targeted-oriented, methodical process as it is an amalgamation of behavioral as well as cognitive theory (Olatunji, Cisler, & Deacon, 2010). The theory is widely accepted and finds its application in dealing with varied situations encompassing temper, apprehensions, persona, eating deeds, substance abuse as well as psychotic turmoil (Butler, Chapman, Forman, & Beck, 2006; Olatunji et al., 2010). According to the studies carried out by Butler et al. (2006), CBT finds a wider range of application, especially in treating unipolar depression, anxiety and panic disorders, social phobia, posttraumatic stress disorder as well as anxiety related childhood disorders, childhood somatic disorders as well as to deal with the situations of chronic pain and involvement of the individual in addictive habits. The study carried out by Butler et al. (2006) also indicates that CBT is highly effective for dealing with nuptial distress and annoyance. CBT was found to be advanced as compared to antidepressants used to treat adult depression and, therefore, it also finds application in dealing with behavior related disorders. The Basic Philosophies: CBT enables individuals to evade negative thoughts that are responsible for faulty thoughts causing emotional and behavioral distress as it is established that cognitions are the chief determinants of individual feelings; therefore, CBT emphasizes behavior and cognition. Consequently, CBT has emerged as a psycho-educational model incorporating learning procedure and innovative skills to cope with various issues (Butler et al., 2006). Pros: it is observed that certain psychological issues are seeded in the childhood itself, and hence, the cause of anxiety could be the individual beliefs. Essentially, internal dialogue plays an imperative role in formulating behavior (Corey, 2005). CBT is directed towards removal of defective supposition and misapprehensions with effectual values. Changing thoughts is the most imperative method of the CBT, and hence, it is found to be effective in dealing with substance abuse cases. CBT involves A-B-C model of altering cognitions and is associated with collaborative relationships. The psychotherapist encourages remedial understandings leading to learning innovative skills (Corey, 2005). Limitation or cons: the CBT theory aims at altering emotions without attending the deep rooted reasons of conflicts in sub-conscious minds, and therefore, premature termination of therapy is observed (Corey, 2005). References American Public Human Services Association. (2005). Guide for child Welfare administrators on evidence based practice. Retrieved from http://www.aphsa.org/home/doc/Guide-for-Evidence-Based-Practice.pdf Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 26(1), 17-31. Enguidanos, S., Coulourides, K. A., Keefe, B., Geron, S. M., & Katz, L. (2011). Patient-centered approach to building problem solving skills among older primary care patients: problems identified and resolved. J Gerontol Soc Work. 54(3), 276-91. Fassino, S., Amianto, F., & Ferrero, A. (2008). Brief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators. Panminerva Med. 50(2), 165-75. History of Drug & Alcohol Abuse. (n.d.) Retrieved from http://forcon.ca/learning/drug_abuse.html Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th ed.). Belmont, CA. Brooks/Cole. Lonigan, C. J., Elbert, J.C., & Johnson, S.B. (1998). Empirically supported psychosocial interventions for children: An overview. Journal of Clinical Child Psychology. 27(2), 138-145. Models of Understanding Human Behavior. (n.d.). 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Charleston, SC: National Crime Victims Research and Treatment Center. Substance Abuse and Mental Health Services Administration. (2006). Retrieved from http://www.modelprograms.samhsa.gov/ Treatment Modalities. (n.d.). Retrieved from http://www.treatment-resources.com/430_treatment.asp Read More