Drug & Alcohol Intervention Help - We Get Them In to Treatment : NYC Intervention Specialists

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From new research on the use of External Pharma Accountability Tools (EPAT – how I refer to them…love a good acronym!) in changing behavior. In this case, around smoking. Read it. It’s important and right:

MADISON, Wis. — University of Wisconsin tobacco researchers said that they have encouraging news for smokers trying to quit.

The Center for Tobacco Research and Intervention recently released the findings of a major study that followed smokers in Madison and Milwaukee. The study participants were given five different kinds of treatments to see which worked the best to help smokers quit.

“What we found was the highest abstinence rates — or the people who were the most able to quit — were the people who got the combination of the nicotine patch and the nicotine lozenge,” said Dr. Megan Piper. “We’re really excited because 40 percent of the people in that group were able to quit for six months.”

Piper said the study also showed the importance of counseling. She said smokers who really want to quit need support to do it.

Asked – Answered:
Published: October 6, 1981
Q. Why is toothpaste sweet and what is it sweetened with?
A. In order for toothpaste to be effective, it must be used regularly. Research has indicated that a sweet taste encourages the regular use of toothpaste.

Specific flavors have been found to appeal to certain groups of the population. A sweet combination of flavors seems to be the most appealing. Sugar, however, is not used as a sweetener in toothpaste. Most manufacturers use an artificial sweetener, usually saccharin.

Associated Press
WASHINGTON — New research shows medical spending averages $1,400 more a year for an obese person than for someone who’s normal weight.

Overall obesity-related health spending reaches $147 billion, double what it was nearly a decade ago, says the study published Monday by the journal Health Affairs.

The higher expense reflects the costs of treating diabetes, heart disease and other ailments far more common for the overweight, concluded the study by government scientists and the nonprofit research group RTI International.

RTI health economist Eric Finkelstein offers a blunt message for lawmakers trying to revamp the health-care system: “Unless you address obesity, you’re never going to address rising health-care costs.”

Obesity-related conditions now account for 9.1% of all medical spending, up from 6.5% in 1998, the study concluded.

In our work I see this truth reflected in the lives of those we help: TIME MATTERS.

30 days for “rehab” is based on numbers, and insurance and arbitrary administrative rules. It’s a number based on many things, the least of which is what is best for our loved one. The following article in the LA TIMES covers some of this ground in a fine way. Read. Rinse. Reread.

It matters.

Time.

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Wednesday, November 26, 2008
LA TIMES
The 30-day myth: Health care professionals are realizing that addiction treatment is more than a monthlong endeavor
By Shari Roan

Wednesday, November 19, 2008 11:47 AM CST
We love quick, tidy solutions. With health problems, in particular, we’re impatient. Pills to ease each and every symptom? Great. Same-day surgery? Terrific. A scheduled cesarean section? Bring it on.

But in the case of drug and alcohol dependence, it’s becoming increasingly clear that there is no such thing as get-well-quick therapy. Instead, with scientific evidence showing that the longer the treatment, the better the chance of lasting sobriety, addiction centers nationwide are lengthening their programs and firmly discouraging patients from early checkouts.

For more than a year, the Betty Ford Center in the Southern California desert has offered a 90-day residential treatment program, in addition to shorter programs, that attracts about one-third of all clients. Promises Treatment Center in Malibu now provides more than half of its clients with 45- to 90-day treatments and last year extended its young-adults program from 30 days to 90 days.

Visions, which provides adolescents with addiction treatment in Malibu, increased its program’s length from 30 days to 45. Hazelden, the legendary treatment program based in Minnesota, has added beds in nearly all of its facilities over the past two years to meet a growing demand for treatment programs of 90 days or more.

Addiction experts say that longer treatments — with the length of stay based on the client’s specific needs — will lead to fewer people cycling between 30-day hospitalizations and relapses for years on end. Forty percent to 60 percent of people relapse after drug treatment, according to the National Institute on Drug Abuse.

“Treatment is dose-related,” says Dr. Harry Haroutunian, director of the licensed professional program at the Betty Ford Center. “More is often better, depending on what you do with the time.”

Treatment programs of 28 or 30 days are still common. But this template was never based on medical evidence, says Dr. David Lewis, Vision’s medical director. Lewis, who in the 1970s helped establish the first addiction treatment program in the U.S. Air Force, says 30-day stays were scheduled for bureaucratic reasons — men and women didn’t need to be reassigned if they were away from duty for no more than 30 days. Other treatment centers followed suit, and insurers adopted the standard of 28 or 30 days of inpatient care.

Today, addiction experts recognize that it’s foolish to treat every patient the same way.

“There was a belief that 30 days was the right number,” says Dr. David Sack, chief executive of Promises and an addiction psychiatrist. “But there was absolutely no data to say 30 days was the right number. … The programs were cookie cutters. What we’re seeing now is this much broader view for how to manage addiction. There isn’t this naive optimism that people will reach 30 days and they’ll be fine.”

In fact, data suggest 30 days aren’t nearly enough.

* Research published in 1999 by Bennett Fletcher, a senior research psychologist at the National Institute on Drug Abuse, has shown that although 90 days isn’t a magic number, anything less than that tends to increase the chances of relapse. One study, of 1,605 cocaine users, looked at weekly cocaine use in the year after treatment. It found that 35 percent of people who were in treatment for 90 days or fewer reported drug use the following year compared with 17 percent of people who were in treatment for 90 days or longer. The study was published in the Archives of General Psychiatry.

* Another study, part of an NIDA-funded project called Drug Abuse Treatment Outcome Studies, followed 549 patients who had several problems in addition to their drug use and who entered a long-term residential program. Those who dropped out of treatment before 90 days had relapse rates similar to those who stayed in treatment only a day or two. After 90 days, however, relapse rates dropped steadily the longer a person stayed in treatment.

* Studies of youth also reflect the connection between longer care and a greater chance of recovery. A 2001 University of California, Los Angeles study of 1,167 adolescents receiving substance-abuse treatment found that those in treatment for 90 days or more had significantly lower relapse rates than teens in programs of 21 days.

Some of the earliest evidence emerged from high success rates in treatment of addicted health professionals, says Haroutunian: The Federation of State Physician Health Programs has long recommended 90-day treatments and continued follow-up care for doctors who abuse drugs.

Longer treatment reflects the fact that addiction is a chronic, relapsing disorder, says Lisa Onken, chief of NIDA’s behavioral and integrative treatment branch.

“The more you have a treatment that can help you become continuously abstinent, the better you do,” she says. “You have to figure out how to be abstinent. You still have cravings. You still have friends offering you drugs. You still have to figure out ways not to use. The longer you are able to do that, the more you are developing skills to help you stay abstinent.”

Additional time in treatment allows people to learn to handle stress, develop ways to cope with environmental cues that could trigger drug use and improve relationships that are needed to sustain recovery.

However, time alone isn’t a solution. Many addicts stop using for long periods of time while incarcerated but relapse after being released.

“There is no real evidence that just locking someone up, denying someone access to drugs alone, will cure an addiction,” Onken says. “It’s not just length of treatment that is important. It’s length of treatment that is working.”

The first month of treatment is now viewed as a first step, Fletcher says. It often consists largely of coping with withdrawal symptoms and establishing a relationship with a therapist.

“People are often detoxifying for 28 days,” Haroutunian says. “Their mind is not right. Their temperament is not right. They have emotional instability, poor judgment, physical complaints, sleep problems — things that keep them in a very delicate state of vulnerability to coping with life stresses. If they are out there in the world after only 28 days and get flooded with these things, they are vulnerable to relapse.”

Brain scans of recovering addicts support the idea that changes are still taking place three months or more after treatment. Chronic drug use damages the brain, such as reducing the number of dopamine receptors, chemical pathways that allow for normal brain functioning. Changes in the brain during recovery correlate to clearer thinking and more honesty on the part of the patient, Haroutunian says. It’s often only at that point that therapists discover other problems, such as physical or mental-health problems, eating disorders, gambling issues, relationship problems or a history of abuse or molestation.

“If that is not identified and treated, it can easily bring someone back to their original drug of choice,” he says.

Haroutunian notes that Alcoholics Anonymous, founded more than 70 years ago, recommends: “90 meetings in 90 days.”

“I think the founders of the 12-step program were divinely inspired in their wisdom, which science and data are now supporting,” he says.

But it’s tough to convince some addicts or their family members that three to six months of treatment offers the best chance of success. People argue that they can’t leave their jobs, school or families for that long, Promises’ Sack says. They want to put the problem behind them as quickly as possible.

“They want to believe it will be fixed up very quickly and they can go back to normal and not have to talk about it,” he says.

Instead, he compares addiction to any chronic disease, such as heart disease or diabetes, in terms of the attention and per-severance needed to remain healthy.

Longer-duration treatment doesn’t necessarily mean a hospital or residential stay, experts say. Some treatment centers and hospitals offer transition to a sober-living residence, where residents are free to go about their lives but also receive daily counseling. The Betty Ford Center has about 15 houses, with six people to a home, to continue long-term care.

The residences are designed to allow clients to return to more normal lives while offering support and advice in remaining drug-free.

“The supervision is light,” Haroutunian says. “They go into the community. But they more or less report in every day for their program.

Some people would like to commit to a longer period of treatment but can’t afford it.

Most states have laws mandating that group health insurance plans include addiction-treatment coverage, but insurance programs vary widely in the amount of inpatient care that is covered. Some plans cover 30 days of inpatient care per year, although other insurers will discontinue inpatient coverage after a week or two if a patient is physically stable. A few will pay for treatment that lasts more than 30 days.

Care is typically most expensive in the first month, Haroutunian says. At Betty Ford, the first month of inpatient treatment costs $24,000; the second and third months cost $8,000 each.

People without insurance coverage often pay out-of-pocket. The cost is overwhelming to most people, he acknowledges. “But we tell them it may save their life. Most people see the wisdom in that.”

Targets for extended treatment

Not everyone with a substance abuse disorder needs to commit to three months or more in an inpatient program, but certain groups of people do tend to require more care.

Among those are teenagers, young adults, longtime addicts, high-functioning professionals and people with psychological or mental health problems. Also, people with eating disorders and a history of abuse need to have those issues addressed during treatment — which takes additional time — or they’re likely to have more difficulty recovering, says Dr. Harry Haroutunian of the Betty Ford Center in Southern California.

The type of drug being abused can also affect treatment length, addiction experts say. Methamphetamine and heroin addictions, for example, are often more difficult to overcome.

Youths

Teenagers, young adults and people who have been addicted since their adolescence especially benefit from treatment that is 90 days or longer, says Dr. David Sack, chief executive of Promises Treatment Centers. “Young adults have special challenges,” he says. “They have failed in numerous areas of their lives, such as school. They have no occupational track record. They’re not self-supporting. They have difficulty planning. Removing drugs is not going to restore them to a normal life. A 30-day treatment is probably the tip of the iceberg for them.”

Professionals

High-functioning professionals, such as doctors, tend to require longer stays because they have often abused drugs for many years in secrecy and feel deep shame about their problem, says Haroutunian. Doctors are also required to adhere to long-term treatment in order to regain or maintain their licenses.

I read the following in RecoveryToday online, and have edited for clarity to share here.

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On any given day in the United States, one million people are in treatment for alcoholism or drug addiction. It is not getting into treatment, however, that makes the difference. Instead, it is what a person gets out of treatment. The fact that many people do not find success in treatment on their first attempt is due in part to a lack of understanding about what makes effective treatment.

1. There is no treatment formula that will work for everyone.

Occasionally, people looking for treatment will come across other individuals who are already in recovery and who insist that the only path to recovery is whatever path the recovering individual has taken. This simply is not true. The ultimate success of each individual entering treatment depends on finding the right treatment setting and methods for the individual, and everyone’s needs are different.

2. Medically supervised withdrawal is only one step in addiction treatment; alone it will do little.

Frequently, it is necessary for addicts and alcoholics to go through a medically supervised withdrawal period before they can safely enter treatment. However, some people confuse this short 3 to 7 day period with treatment, which it is not. Some people cycle in and out of these withdrawal episodes convinced that they should be able to maintain abstinence afterwards, but never finding success. Seemingly tragic, this allows some addicts to continue in their addiction while giving the appearance that they are attempting to get healthy.

3. Length of treatment counts

The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, significant improvement is reached at about 3 months. The research suggests that this may be residential, outpatient or a combination of both depending on the individual’s needs. After this initial period, additional treatment can produce further progress toward recovery.

4. Drug addiction is a multidimensional problem, and treatment needs to address all of an individual’s needs

Effective treatment must address the individual’s drug use, but also any associated medical, psychological, social, vocational, or legal problems.

5. Counseling (individual and/or group) is a critical part of effective addiction treatment.

Many alcoholics and addicts mistakenly believe that if they could just stop using for a week or two they could stop using forever. In reality, they need therapy. In therapy, addicts examine their motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Additionally, therapy helps individuals to rebuild and re-learn family and social living patterns.

6. Medications are an important part of treatment for many people. Medications such as suboxone, methadone and LAAM can all be effective in helping certain individuals stay away from illicit drugs. Some times frowned upon by some individuals in recovery the truth is that these medications allow millions of individuals to live normal, productive lives.

7. Drug testing during treatment is important.

Drugs are found everywhere, even in drug treatment. Whether treatment is offered on an outpatient, inpatient or in a jail drugs are available to individuals in treatment. This puts individuals in treatment at risk for reusing even while in treatment. It also means that every individual in treatment should be monitored for drug treatment on an ongoing basis. In this manner treatment, plans may be modified to increase the chance of ultimate success.

8. Alcoholics and addicts with mental health disorders should be treated for both at the same time.

An alcoholic or addict who also has a mental health disorder is said to have “co-occurring” disorders. In the past, the question has sometimes been should the person be treated for the mental health problem or the addiction first. People may be using drugs to deal with the mental health problem or they may have the mental health issue because of their drug use. The most effective way to deal with these two “co-occurring” disorders and deal with the addiction is to treat them at the same time.

9.Addiction Treatment works even for people who don’t choose it of their own free will.

It used to be believed that someone had to want to go into treatment before it could be effective. New research has shown that this is not the case. In fact, treatment is just as effective for individuals who are court ordered to do treatment as it is for people who figure out the need for it on their own. Families and employers can be just as effective at getting unwilling addicts into treatment. Stephen King, in his autobiography “On Writing,” tells about the intervention his wife and family performed on him. King did not want to go into treatment. He was seemingly happy doing coke and drinking mouthwash, but his wife Tabitha and his children were not happy with the situation and performed an intervention. Forced to choose between family and drugs, King made the right choice. Interventions are most successful when done correctly and with the help of a professional. For more information on interventions visit www.interventionresources.net

10. Don’t give up.

As with other chronic illnesses, relapses can occur during or after successful treatment episodes. Addicted individuals may need lengthy treatment and more than one time in treatment before they can enjoy long-term abstinence and full restoration to a drug free life. The period after treatment is just as important as being in treatment. Finding support and continuous work to stay drug free will be necessary. A slip or relapse is just an indicator that more work, and possibly more treatment, is necessary. Don’t give up.

Hi friends. Just home from the road – in Denver teaching this week and then off into the Rockies for an intervention.

I’d just landed, back in New York when an email came in last evening from Nancy Grace asking me to come on the show last night to chat about drugs and the family. A “ripped from the headlines” situation where grandma was making meth while the kids played in the room.

Here’s a bit of transcript from the show. As out there as this story may seem, consider how many times we have seen our own friends or family members put themselves or kids at risk – driving drunk, etc. So while this headline grabs the attention and collective gasp (!) consider how someone you love struggles just the same.

Don’t get me wrong – I’m not saying grandma shouldn’t end up in lock down. I’m just saying that if she’s addicted, long term treatment offers hope of the family breaking a generational cycle instead of celebrating a release from prison.

Change begins,

Brad

for the complete article:
http://www.denverpost.com/lifestyles/ci_12486264