Intervention and Treatment: Strategies for Change

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• Chapter 17
• Intervention and Treatment Strategies for Change
  

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LEVELS OF INTERVENTION IN DRUG-ABUSE PREVENTION

• Primary prevention
• Secondary prevention
• Tertiary prevention

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LEVELS OF INTERVENTION IN DRUG-ABUSE PREVENTION

• Primary prevention - minimal experience with
  drugs
• Secondary prevention - already have had some
  experience with drugs
• Tertiary prevention - objective is for these
  individuals to stay drug free and avoid relapse

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TREATMENT DRUG-ABUSE PREVENTION

• Only 10 of individuals in the US who need
  treatment for an alcohol or illicit drug problem
  actually receive treatment.
• Alcohol is most frequently treated
  substance-abuse problem (40 of treatment cases
  in licensed or certified treatment programs)

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DISPARITY BETWEEN TREATMENT NEEDED AND TREATMENT
RECEIVED IN THE U.S.
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THE BIOPSYCHOSOCIAL STRATEGY FOR TREATMENT
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FIVE SUBSTANCES ACCOUNT FOR 96 OF ALL REASONS
FOR SUBSTANCE ABUSE TREATMENT
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DRUG TREATMENT AND THE CRIMINAL JUSTICE SYSTEM

• The concepts of rehabilitation and deterrence
• Prevention through law enforcement
• Incarceration
• Prison-alternative and prison-based treatment
  programs

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DRUG TREATMENT AND THE CRIMINAL JUSTICE SYSTEM

• Incarceration (containment in jail or prison) has
  two objectives rehabilitation and deterrence.
• Rehabilitation - reduce the likelihood that the
  individual will behave in a similar way in the
  future.
• Deterrence - prevent future behavior by conveying
  the message that punishment given to others for
  similar behavior would apply to them as well.

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DRUG TREATMENT AND THE CRIMINAL JUSTICE SYSTEM

• Prison-alternative and prison-based treatment
  programs
• Half of all individuals entering a publicly
  funded drug treatment program do so because of
  legal pressure to avoid incarceration.
• drug courts - nonviolent drug offenders provided
  treatment instead of standard drug-offense
  sentence.
• less than 20 of prisoners with drug abuse
  problems in the US receive any kind of treatment
  program while incarcerated.

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FEDERAL PENALTIES FOR DRUG TRAFFICKING
Drug trafficking laws are established to control
the unauthorized manufacture, distribution by
sale or gift, and possession with intent to
distribute any controlled substance. Controlled
substances are defined by federal regulations
established in 1970 and revised in 1986 and 1988
in terms of five categories or schedules. Schedul
e I violations are the most severely punished
schedule V violations are the least severely
punished.
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FEDERAL PENALTIES FOR DRUG TRAFFICKING
Simple possession - having on ones person any
illegal or non-prescribed controlled substance in
any of the five schedules for ones personal use.
Most drug possession cases are prosecuted at
the state level In general, for every four drug
offenders presently incarcerated in the United
States, three of them are in a state prison and
one is in a federal prison.
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FEDERAL PENALTIES FOR DRUG TRAFFICKING
A controlled (scheduled) drug is one whose use
and distribution is tightly controlled because of
its abuse potential or risk. Controlled drugs
are rated in the order of their abuse risk and
placed in Schedules by the Federal Drug
Enforcement Administration (DEA). The drugs
with the highest abuse potential are placed in
Schedule I, and those with the lowest abuse
potential are in Schedule V. These schedules are
commonly shown as C-I, C-II, C-III, C-IV, and
C-V.
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FEDERAL PENALTIES FOR DRUG TRAFFICKING
Schedule I drugs with a high abuse risk and no
safe, accepted medical use in the United States.
(heroin, marijuana, LSD, PCP, and crack cocaine)
Schedule II drugs with a high abuse risk, but
also have safe and accepted medical uses in the
United States. These drugs can cause severe
psychological or physical dependence. Schedule II
drugs include certain narcotic, stimulant, and
depressant drugs such as morphine, cocaine,
oxycodone (Percodan), methylphenidate
(Ritalin), and dextroamphetamine (Dexedrine).
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FEDERAL PENALTIES FOR DRUG TRAFFICKING
Schedule III, IV, or V drugs with an abuse risk
less than Schedule II and have safe and accepted
medical uses. Schedule III, IV, or V drugs
include certain narcotic and non-narcotic drugs,
anti-anxiety drugs, tranquilizers, sedatives,
stimulants, and non-narcotic analgesics
(hydrocodone (Vicodin), diazepam (Valium),
alprazolam (Xanax), propoxyphene (Darvon), and
pentazocine (Talwin).  
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PREVENTION AND TREATMENT IN THE WORKPLACE

• Employee Assistance Programs (EAPs)
• Drug testing in the workplace
• Economic costs of AOD abuse
• Impact of drug-free workplace policies

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PREVENTION AND TREATMENT IN THE WORKPLACE

• Since 1988, all companies and businesses
  receiving any U.S. federal contracts or grants
  are required to provide a drug-free workplace.
• employee assistance programs (EAPs)
• Pre-employment drug screening is required for all
  federal employees, and periodic random drug
  testing afterward.
• infringement on individual privacy
• fact of life in corporate America
• The possibility of false-positives are
  significant problems associated with widespread
  drug screening. Even if the false-positive rate
  is low, a substantial proportion of those who
  fail the test are innocent.

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PREVENTION AND TREATMENT IN THE WORKPLACE

• Loss in productivity due to alcohol and other
  drug abuse in the workplace ranges from 60 to
  100 billion each year.
• Losses of productivity included increased
  workers compensation claims, absenteeism,
  accidents on the job, sick leave, as well as more
  numerous instances of workers arriving late or
  requesting early dismissal from work.

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REHABILITATION AND THE FIVE STAGES OF CHANGE

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

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THE SPIRAL MODEL OF THE STAGES OF CHANGE
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FAMILY DYNAMICS AND DRUG ABUSE

• Enabling behavior can be a significant obstacle
  to effective treatment
• avoiding and shielding
• attempting to control
• taking over responsibilities
• rationalizing and accepting
• cooperation and collaborating

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FAMILY DYNAMICS AND DRUG ABUSE

• Coping mechanisms of individuals within a
  dysfunctional family system can lead to the
  taking on of specific survival roles The Chief
  Enabler, Family Hero, Family Scapegoat, the Lost
  Child, and Family Mascot.
• A drug-free family is completely different from
  what it had been before

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COMPONENTS OF A COMPREHENSIVE DRUG-ABUSE
TREATMENT PROGRAM
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FINDING THE BEST TREATMENT PROGRAM

• Inpatient versus outpatient treatment
• Pharmacological versus psychotherapy or
  counseling
• Self-help groups versus individualized treatment
• Length of treatment program
• Aftercare in terms of half-way or recovery houses

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WHERE YOU CAN GO FOR HELP

• Yellow pages of the telephone book, under
  Alcoholism Information or Drug Abuse and
  Addiction Information
• National Clearinghouse for Alcohol and Drug
  Information (NCADI), accessed through its web
  site at www.health.org.

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INTERNET SOURCES FOR INFORMATION ABOUT TREATMENT
OPTIONS

• http//www.health.org for the National
  Clearinghouse for Alcohol and Drug Information
• http//findtreatment.samhsa.gov for the Substance
  Abuse and Mental Health Services Administration