Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
usually conducted. Alcohol withdrawal abates after 2 to 5 days. Careful medical intervention is required for individuals who have a history of seizures or delirium tremens, especially when combined with elevated blood pressure, rapid pulse rate, and agitation (Doweiko, 2015; Straussner, 2014). It is important for clinicians to understand that clients should not be advised to stop using alcohol “cold turkey” without consulting a medical professional. Opiate withdrawal is typically not as life-threatening as withdrawal from severe addiction to other substances such as alcohol, benzodiazepines (e.g., Xanax), or barbiturates. Although opioid withdrawal can be very uncom- fortable, it is not usually deadly and has been compared to a bad case of the flu and lasts about a week (Straussner, 2014). Opioid withdrawal symptoms can include depressed mood, nausea, rhinorrhea (excessive mucous fluid in nasal cavity), sweating, fever, sleeplessness, gastrointestinal problems, cramp- ing, restlessness, vomiting, muscle pain, and other unpleasant symptoms. Medical detoxification facilities will commonly use decreasing doses of opiate-based medications such as metha- done, buprenorphine (Subutex), buprenorphine combined with naloxone (Suboxone), or clonidine to ease this discomfort. Many patients will try to detoxify by themselves, away from medical care, “going cold turkey” in a range of ways. Careful monitoring during detoxification is typically done on inpatient units to ensure continuous monitoring, with the availability of immediate intervention in the case of lethal withdrawal reactions. Inpatient detoxification increases the likelihood that the client will participate in a comprehensive assessment and gives greater consideration to further treatment (Straussner, 2014). Outpatient detoxification is employed in the absence of concern over life-threatening withdrawal symp- toms. Clients will often prefer outpatient detoxification, as it is less expensive and less intrusive or disruptive. Abstinence from alcohol or drugs is seldom achieved by detoxification alone, however, whether it is provided in an acute care set- ting or on an outpatient basis. Therefore, if relapse is to be prevented, additional treatment strategies are usually required (Straussner, 2014). REHABILITATION TREATMENT PROGRAMS Rehabilitation treatment programs are often a next step after successful detoxification. Because detoxification is not associ- ated with long-term decreases in substance use, rehabilitation treatment programs can be helpful. These rehabilitation treatment programs can aid individuals in adjusting to life without substance use. Often, individuals with substance use disorders spend a significant amount of time obtaining, using, and recovering from substance use. Therefore, in addition to providing clients with coping skills, inpatient rehabilitation treatment programs can give them something to fill their time while they are adjusting to not using substances. Furthermore, inpatient rehabilitation treatment programs can help individu- als deal with any underlying symptoms that the substances were masking in the short term, such as anxiety or depression (Straussner, 2014).
Both short- and long-term inpatient rehabilitation programs are available, as well as outpatient rehabilitation programs and therapeutic communities—all of which are invaluable to the person’s recovery (Straussner, 2014). These structured treatment settings vary based on the needs of the individual. These settings can allow individuals to maintain abstinence while learning coping strategies and help them develop new hobbies or lifestyles that encourage them to discontinue their drug or alcohol use. Intensive outpatient programs are also a viable treatment option for many individuals who meet cri- teria for SUDs. These programs allow individuals to receive intensive treatment while also engaging in daily life activities so that the coping skills have a chance to generalize to their daily lives while they are still in a supportive treatment envi- ronment. (This option is discussed in the next section.) Day treatment programs and part-time residential facilities, includ- ing substance-free housing, allow individuals with a paucity of social or vocational resources (e.g., young adults) to receive social and vocational support while receiving treatment. In addition to the traditional inpatient, and the more com- mon intensive outpatient, programs, there are a growing number of evidence-based treatment (EBT) approaches that have been shown to be effective in a number of research stud- ies. (For a list of EBT approaches, see the National Registry of Evidence-Based Programs and Practices in the Resources section of this course). RESIDENTIAL AND INTENSIVE OUTPATIENT TREATMENT Although their numbers have declined dramatically and their length of stay has been reduced to about 7 days, residential treatment facilities, usually known as rehab centers , remain an important part of the continuum of care for clients with SUDs (American Society of Addiction Medicine, n.d.). Today, insurance restrictions have limited the usage of rehabilitation facilities mainly to those who can afford to pay for their own treatment, as well as individuals who are more severely affected and medically compromised and whose care is more likely to be supported by public funds. Most rehabilitation centers follow a structured schedule that includes meditation, lectures, peer support (including 12-step programs), individual psychotherapy, group psychotherapy, recreational activities, and occupational therapy. Because this structured schedule does not generalize to daily life, many individuals relapse after leaving these facilities. For this and other reasons, some people choose intensive outpatient pro- grams either instead of rehabilitation centers or immediately after attending the rehabilitation center. Intensive outpatient treatment typically consists of a half day of treatment every day for at least two weeks, and the programming is typically similar to that in rehabilitation centers. Recently, however, the use of intensive outpatient programs has declined in favor of traditional outpatient treatment coupled with 12-step program (e.g., Alcoholics Anonymous [AA]) involvement. The expense
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