Discuss about the Drug Addiction for Public Health Issue.
The key public health issue is the increasing prevalence of drug addiction in the world. In this essay alcohol addiction is the prime focus. In Australia, alcohol is the most widely used drug. Alcohol abuse destroys the life of an individual as it leads to depression, liver damage, cancer and compromised immune system. It also has overwhelming consequences for the family and society. Most people addicted to alcohol admit that it is a disease which can never be cured (Wilkinson & SanchezCraig, 2016). A considerable research has been conducted on interventions for alcohol use disorders and has been found successful in complete recovery of alcoholics. The primary goal of alcohol treatment is to stop the drinking habit in the patient and help in refraining from alcohol abuse in future. There are diverse paths to the goals as alcohol use disorder is multifactorial. It involves social, biological, and psychological factors (Flores, 2013). The essay discusses the methods of treatment of alcohol addiction within medical establishments. The paper discuses the most effective methods and what might improve the success rates of alcohol rehabilitation.
The conventional medical treatment for alcohol dependence involves “detoxification, rehabilitation and maintenance of sobriety”. Detoxification is essential immediately after the discontinuation of alcohol use (Wilkinson & SanchezCraig, 2016). This is a critical step as there are several side effects associated with withdrawal such as hallucination, seizure, and some cases death. It is followed by rehabilitation treatment to prevent future alcohol use in the patients. The rehabilitation can be both inpatient and outpatient and includes the use of intensive counselling and therapy as detoxification does not prevent cravings. It usually lasts 30-90 days for detoxification and sometimes even longer. Patients in rehab are provided with a pleasant atmosphere to solely focus on recovery. Various therapies are used by the counsellor to attain a goal of helping the patients to find positive ways to deal with stress and anxiety associated with alcohol abuse that begins after the process of detoxification. After completing the inpatient rehabilitation treatment, the patients are exposed to outpatient rehab treatment which includes engagement in self support groups and programs like Alcoholics Anonymous for maintenance of sobriety. However, the in-patient alcohol rehabilitation is more advantageous than the outpatient rehabilitation as in the former one receives “round-the-clock” care where as in the later the patient can continue with professional and social life while receiving treatment for addiction (Küfner & Feuerlein, 2012). These treatment methods are described in subsequent paragraphs.
It may be surprising but there are ranges of medications available in market that have the potential to treat alcohol dependence and maintain abstinence. These medication works by reversing the changes in brain initiated by alcohol consumption. According to meta-analysis of Maisel et al., (2013) acamprosate and naltrexone is highly efficacious in helping the alcoholic to remain abstain alcohol abuse. These medications were evaluated for its efficacy in decreasing heavy drinking and craving based on 64 randomised, placebo-control trials. It was found from the study that the success rate of these medications was high if the detoxification occurred prior to treatment or in case of longer period of abstinence before the commencement of treatment. Similar study by Mann et al. (2013) found Nalmefene to have clinical benefits on patients. It is effective in reducing alcohol consumption as it is an opioid system modulator. The success rate of this medication is high which made it a potential “new pharmacological treatment paradigm”. Upon testing the medicine on 289 patients it was found that Nalmefene increases liver enzymes. It has been successful in decreasing alcohol dependence by addressing the unmet medical needs of the patients. Another medicine is Disulfrum which is effective in blocking the alcohol metabolism in body causing flushing of skin and nausea consequently driving people to avoid drinking. Naltrexone, Acamprosate, Disulfiram, topiramate and gabapentin are the medications that have been approved by U.S “Food and Drug Administration” are non-addictive. The last two are also effective in preventing seizures caused by withdrawal and reduces craving (Müller et al., 2014). Scientists are intensely working to increase this list of medication to provide the patients with multiple options.
There are various types of behavioural treatments that incorporate motivational support, empathy, and focus on changing attitude and behaviour. These treatments mainly avoid heavy confrontation. Four of the main behavioural treatments will be discussed in the essay which is highly documented in the literature. Firstly, Cognitive Behavioural Therapy is the most effective treatment approach for alcoholism. This is the one-on-one therapy where the counsellor focuses on identifying the factors called “cues” that caused alcohol addiction. It identifies the situation that led to management of stress by heavy drinking which is the risk for relapse. A rich literature is available citing the effectiveness of this therapy in decreasing alcohol dependency. This method is successful because a therapist works on thought process of the client behind heavy drinking. The therapist then tends to change the thinking pattern and helps the alcoholics to develop skills necessary to handle the consequences of problem drinking (Kendall & Hollon, 2013). Secondly, Motivational Enhancement therapy is the treatment approach that focuses on changing the Client’s drinking behaviour. This is the short term treatment where counselor helps patients to recognise their personal strength. The key mechanism is to strengthen motivation in client and build self confidence by educating them about the health risks of alcohol addiction such that the patient sticks to the treatment plan. It has been recognised to be effective treatment method by the “National Institute on Alcohol Abuse and Alcoholism” (NIAAA) because it is cost efficient, based on self motivation, person-centred approach and improving relationship benefits (Verster et al., 2012).
Thirdly, Marital and Family counselling is the treatment approach that involves the patient’s family members. This method is effective in improving the family relationships of the client. The basis of this treatment approach is strengthening the family support as they share close connection with the client and trigger motivation for change. They are involved in developing problem solving skills and assigning accountability. This therapy has been reported with high rate of success as it not only benefits the client but also the family in deterring the use of alcohol through future generations (Mistral, 2016). Fourthly, Brief interventions are counselling sessions that either takes place individually or in group within stipulated time. In this treatment approach, the therapist informs the patients about their drinking patterns and the potential risks involved and receives personalised feedback. Based on the feedback, the treatment goals and approaches are set. Advantages of group therapy is a sense of community or universality felt by the client by having several members to share their dreams, fears and experiences with (Sobell, 2013).
According to Berne, (2016) psychotherapy is the other most effective and successful therapy in reducing alcohol dependency. The aim of this therapy is to address the root cause of the problem and resolve them in the most comprehensive manner. People seeking treatment respond to challenges by learning coping skills. Therapist aims to increase self observation, self-awareness, and encourage the client to change their behaviour and thinking pattern. This therapy usually consists of 1 hour sessions where client and the therapist engage in intense talking to reveal the causes of addiction and factors inhibiting abstinence.
Flores (2013) highlighted about other treatment method for alcohol addiction which is “Alcoholics Anonymous” or AA founded in 1938. In this method, small or big local group of alcoholics are formed who attend public meetings free of cost and share their problems in abstaining from alcohol abuse or recovery from addiction. The members of the group help each other in overcoming challenges in recovering from addiction. The basis of this treatment approach is a “12 step recovery program”. The first step involves an alcoholic to admit the helplessness in addiction and powerlessness over alcohol. The second step involves making the client believe that there is a greater power that will help alcoholic gain control over alcohol. This step includes religious influence in the process of healing. Various tactics are used to help the individual stay sober during recovery such as rewards for the length of time a person stays sober. The final steps of the program involves motivating the client, spiritual awakening, practicing the lessons of AA and pass on the lessons to other alcoholics.
Treatment for alcohol addiction can only be initiated when the individual accepts the problem of drinking, aware of its consequences and agrees to abstain from drinking. For any treatment method to be successful it is required for the client to understand that alcoholism is curable disease. However, not all the treatment methods have equal efficacy. Not all the patients respond equally to all the treatments. There is no evidence that one treatment is better than the other for all patients. However, according to literature review Alcoholics Anonymous is recognised as high profile treatment program in the world that has worked for several patients and they have been zealous in their support for organisation but not for all patients.
References
Berne, E. (2016). Transactional analysis in psychotherapy: A systematic individual and social psychiatry. Ravenio Books.
Flores, P. J. (2013). Group psychotherapy with addicted populations: An integration of twelve-step and psychodynamic theory. Routledge, 164-214
Kendall, P. C., & Hollon, S. D. (Eds.). (2013). Cognitive-behavioral interventions: Theory, research, and procedures (Vol. 21). Academic Press, 319-352
Küfner, H., & Feuerlein, W. (2012). In-Patient Treatment for Alcoholism: a multi-centre evaluation study. Springer Science & Business Media.
Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., & Finney, J. W. (2013). Meta?analysis of naltrexone and acamprosate for treating alcohol use disorders: When are these medications most helpful? Addiction, 108(2), 275-293. doi:10.1111/j.1360-0443.2012.04054.x
Mann, K., Bladström, A., Torup, L., Gual, A., & van den Brink, W. (2013). Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene. Biological psychiatry, 73(8), 706-713.
Mistral, W. (Ed.). (2016). Integrated Approaches to Drug and Alcohol Problems: Action on Addiction. Routledge, 109-120.
Müller, C. A., Geisel, O., Banas, R., & Heinz, A. (2014). Current pharmacological treatment approaches for alcohol dependence. Expert opinion on pharmacotherapy, 15(4), 471-481.
Sobell, M. (2013). Behavioral treatment of alcohol problems: Individualized therapy and controlled drinking (Vol. 563). Springer Science & Business Media.
Verster, J. C., Brady, K., Conrod, P., & Galanter, M. (2012). Drug abuse and addiction in medical illness: Causes, consequences and treatment (1. Aufl.;1;2012; ed.). New York, NY: Springer-Verlag. doi:10.1007/978-1-4614-3375-0
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