Management of Addictions: What could be the Most Effective Approach?
Addiction has become a major public health problem. It is a condition that makes an individual tolerant and dependent to a substance or object, which results in maladaptive behaviours, conflicts in relationships and impairs cognition. As a result, addiction rates have been rising significantly over the past few years in the developed countries as well as in the developing countries like Pakistan. According to the Drug Use in Pakistan 2013 Report, an estimated 6% or 6.7 million people aged 15-64 years are suffering from substance abuse.
Despite this massive health problem, only a fraction of people seek the treatment they need. People with addiction require different treatment approaches that are integrated and coordinated to provide the best outcome and prevent relapse. There are many treatment options available in treating addiction that includes pharmacotherapy, psychotherapy, meditation and mindfulness training (Angres, 2008). According to the Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines (2008) psychotherapy is thought to be the foundation of addiction treatment, especially for substances where pharmacotherapy has not been beneficial.
American psychological association (2012) defined psychotherapy as “a practice designed to provide symptom relief and personality change, reduce future symptomatic episodes, promote adaptive functioning in work/school and increase the likelihood of making healthy life choices”. A wide range of psychological treatment options is available that vary in their approach depending on the goals of treatment. However, I will highlight four different psychological approaches that have been proved to be effective in treating addiction, and relapse prevention.
Starting with Motivational Enhancement Therapy (MET); it is an organized approach for evoking change in people with addiction especially alcoholism. It is derived from the transtheoretical model of change proposed by James Prochaska. This model consists of five sequential stages of change that are used to describe the process of ceasing drug abuse. (Prochaska et al, 2013). Thus, the MET approach assists the client in moving through the stages toward successful sustained change.
Next is Contingency Management (CM). Proposed by Skinner, it is based on the theory of operant conditioning, in which consequences (i.e. Reinforcement and punishment) are used to lessen substance use. (Dutra et al., 2008). For example, in maintaining compliance and attendance in treatment sessions a client might receive positive regards and prizes to reinforce that behaviour. On the other hand, if the client shows less desirable behaviour such as missing out treatment sessions, he or she might receive the punishment to decrease that behaviour. CM approaches are widely used in increasing drug abstinence. (Barnett et al., 2011).
Another is Twelve-step facilitation therapy. It is rooted from the Minnesota Model of addiction treatment. The basic idea behind this model was that alcoholism is treated as a disease and its treatment should include physical, social, and, spiritual dimensions. (Huebner & Kantor, 2011). TSF consists of structured approaches based on the cognitive, behavioral and spiritual principles. The three key ideas that predominate include acceptance, surrender and active participation in 12-step meetings and associated activities as discussed in the above scenario (Nowinski, 2003).
There are many other psychological approaches that include family in accomplishing successful treatment. One of them is Multidimensional Family Therapy (MDFT). It is a family-focused therapy specializing in the treatment of youth drug abuse. (Liddle et al., 2013). The central principle of MDFT is family engagement, which is essential in creating a new adaptive lifestyle alternatives for adolescents. The approach has four interventional domains: adolescents, parent, family and extra familial social system.
Discussed above are some psychological approaches that have proved to be effective in dealing with addiction. These therapies are performed by a trained psychologist, but other health care members can also play a key role in alleviating addiction. It is essential to establish and maintain therapeutic relationship with patients in order to identify patient needs, offer emotional support and help in promotion and recovery of patients in every aspect of life.
Moreover, health care professionals should collaborate with hospitals and community institutions and take participation in awareness programs and rehabilitation of addicted patients. It is also recommended that the government and private sector universities should launch training programs and courses on psychotherapy to fulfil the requirement of trained staff. In addition, monitoring and evaluative research should be conducted to evaluate the effectiveness of psychological interventions and outcomes.
In conclusion, addiction constitutes a major health problem. However, many addicts are still left untreated. There are many psychological therapies available that are effective in treating an addiction, i.e., MET, CM, TSF and MDFT.. In my opinion, by utilizing health awareness programs in hospitals as well as in community settings, we as health care professionals can change people’s perceptions and replace stigma with a new understanding of addiction as a treatable disease.
American Psychological Association. (2012). Recognition of Psychotherapy Effectiveness.Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx
Angres, D., &Angres, K. B. (2008). The Disease of Addiction: Origins, Treatment, and Recovery. Disease-a-Month, 54(10), 691-722. Retrieved from www.sciencedirect.com/science/journal/00115029/54/10
Barnett, N., Tidey, J., Murphy, J., Swift, R., & Colby, S. (2011). Contingency management for alcohol use reduction: A pilot study using a transdermal alcohol sensor. Drug And Alcohol Dependence, 118(2-3), 391-399. doi:10.1016/j.drugalcdep.2011.04.023
Dutra, L., Stathopoulou, G., Basden, S., Leyro, T., Powers, M., & Otto, M. (2008). A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders. American Journal Of Psychiatric, 165(2), 179–187. Retrieved from www.ajp.psychiatryonline.org/data/Journals/AJP/3849/08aj0179.PDF
Drug Use in Pakistan 2013.(2013). Results of the Survey on Drug Use in Pakistan.Retrieved from www.unodc.org/documents/pakistan/Survey_Report_Final_2013.pdf
Huebner, R., & Kantor, L. (2011).Advances in Alcoholism Treatment. Alcohol Research & Health, 33 (4), 295-299. Retrieved fromhttp://pubs.niaaa.nih.gov/publications/arh334/295-299.pdf
Mental Health and Drug and Alcohol Office. (2008). NSW Health Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines. Sydney: NSW Department of Health
Liddle, H. A. (2013). Multidimensional Family Therapy for Adolescent Substance Abuse: A Developmental Approach. Interventions for Addiction, 3.Retrieved from http://dx.doi.org/10.1016/B978-0-12-398338-1.00010-5
Nowinski, J. (2003).Facilitating 12-Step Recovery from Substance Abuse and Addiction.Treating Substance Abuse. New York: Guilford Press
Prochaska, J., Norcross, J., &Diclemente, C. (2013). Applying the stages of change.Psychotherapy in Australia, 19(2). Retrieved fromwww.psychotherapy.com.au
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