Treatment for Chemical Dependency
Levels of Dependency
More than thirty years ago, the World Health Organization (WHO) recommended the term "drug dependence" to describe the use of drugs on a periodic or continual basis. There are several aspects of drug dependence, including:
- Physical dependence
- Psychological dependence
Tolerance refers to the need to use more and more of a drug to achieve the same effects.
Physical dependence occurs when the body needs the drug to be able to function.
Psychological dependence means the user relies on the drug for a sense of well-being and is convinced that he or she needs the drug in order to function.
Withdrawal occurs when someone who is physically or psychologically dependent on a drug stops using the drug. It often includes both physical and psychological symptoms.
Alcoholism and Alcohol Abuse
Alcoholism is the state of being physically dependent on the drug alcohol. Its symptoms include increased tolerance over time, accompanied by alcohol withdrawal syndrome (sickness, convulsions, delirium tremens) if usage stops. A strong desire to continue drinking heavily is almost always present.
Alcohol abuse, or problem drinking, refers to difficulties in daily living due to drinking too much. These difficulties may include problems in relationships, academic problems, problems on the job, or legal problems such as Driving While Intoxicated (DWI). Physical dependence on alcohol may or may not be present.
There are 12-15 million alcoholics in the United States and approximately 24-36 million problem drinkers. People of all social and economic classes abuse alcohol or are alcoholics.
Drinking patterns normally fall into three categories:
- Social drinker
- Problem drinker
Social drinkers typically drink slowly and know when to stop drinking. They do not drink to get drunk. Social, or responsible, drinkers also:
- Eat before or while drinking
- Never drive after drinking
- Respect nondrinkers
- Know and obey laws related to drinking
For some people, social drinking may progress to problem drinking. Problem drinkers regularly drink to get drunk and often try to solve problems by drinking. They also frequently:
- Experience changes in personality and mood
- Drink when they should not, e.g., before driving or going to class or work
- Cause problems to others by haring self, friends, family, strangers
About one-third of problem drinkers progress to alcoholism. The overall progression from social drinker to alcoholic may take several years; although for reasons not yet understood, young people appear to move through the stages more rapidly. Alcoholics generally spend a lot of time thinking about drinking and planning when and where to get the next drink. They also:
- Keep bottles hidden for quick pick-me-ups
- Start drinking without conscious planning and lose awareness of the amount consumed
- Deny drinking and often drink alone
- Need to drink before facing a stressful situation
- May have "blackouts"-cannot remember what they did while drinking although they may have appeared normal to others at that time
- Go from having hangovers to more dangerous withdrawal symptoms, such as delirium tremens (DTs), which can be fatal.
- Have or cause major problems within the family, with school and friends and with the police
Problem drinkers and alcoholics often employ two major defense mechanisms-minimization and rationalization-to deny the extent of their abnormal behavior.
Examples of minimization include:
- I only drink on weekends; you only have a problem if you drink every day.
- I never miss class no matter how much I drank.
- Now if I drank like Doug, then I would have a real drinking problem.
Examples of rationalization include:
- My grandfather drinks like a fish and he's never been sick in his life.
- I'm not hurting anyone else, so back off.
- Everyone in my family uses alcohol this way.
Alcoholism and the Family
At least seven million American teens have alcoholic parents. Alcoholism runs in families, and children of alcoholics are four times more likely than other children to become alcoholic. Young people in such families may have a variety of worries and concerns. For example, they may feel guilty, mistakenly believing that they are the main cause of a parent's drinking.
Older teenagers may worry constantly about the situation at home. In particular, they are afraid the alcoholic parent will become sick or injured and therefore, be unable to care for the younger members of the family. Older adolescents often worry that because of the unpredictable emotional states of the alcoholic parent, the regular daily schedule, which is very important for younger siblings, does not exist in the household. Faced with these challenges, it is not surprising for older teens to have difficulty concentrating on schoolwork and maintaining friendship.
At the same time, some older children of alcoholics may act like responsible "parents" within the family in an effort to hold things together. They may cope with the alcoholism by becoming controlled, successful "overachievers" throughout the school years, and at the same time be emotionally isolated from peers and teachers. Whether their parents are receiving treatment for alcoholism, adolescents can benefit greatly from educational programs for children of alcoholics such as Al-Anon and Alateen.
Professional help, the earlier the better, is also important in preventing more serious problems for the young person, including alcoholism. One of the most widely reported benefits teenagers say they gained from counseling was the relief that came from truly knowing that they were not responsible for the drinking problems of their parents.
Many people used to believe that drug users had to hit "rock bottom" (lose everything) before they could be convinced to seek help. Most drug users, however, can be persuaded to enter some form of treatment before this stage through a process called an "intervention."
An intervention involves setting up a meeting with the drug user that includes individuals with whom she or he has a strong connection. In an intervention at the workplace, for example, the initial meeting would be with the drug user's supervisor, personnel from human resources involved in the company's employee assistance program, and possibly, co-workers. During the meeting, specific concerns about work-related performance would be discussed and supported with irrefutable documentation [meetings missed, sick days, alcohol on breath, missed deadlines, excuses, etc.]. Often, family members are brought in to confront the user with additional documentation of irresponsible actions. The more key people who are involved, and the more documentation presented, the less likely it is that the user can make excuses, rationalize or lie about her or his actions.
By focusing on the behaviors of the users [with supporting times, places and dates], as opposed to their personality, drug users can often be convinced that a problem does exist. Even if the user minimizes the problem and only seeks treatment to placate the others, this is still a positive step and may signal the beginning of recovery.
Treatment is a process that prevents, alters or interrupts the progression of the dependency. It may involve "intervention" or "rehabilitation." A variety of treatments are available for chemical dependency. Some of them may be used alone or in cooperation with others. Treatment choices include:
- Medical treatment
- Inpatient and outpatient programs
- Therapeutic communities
- Twelve-step programs
- Employee assistance programs (EAPs)
- Student assistance programs
- Pharmacological approaches
Medical treatment is overseen by medical personnel. It includes detoxification, which involves weaning the patient off the drug while minimizing withdrawal symptoms and controlling possible seizures. Complete physical exams at the beginning of this process allow physicians to attend to physical ailments such as liver and kidney problems.
Inpatient and outpatient programs are offered by licensed medical and psychological professionals, who provide a combination of individual, group and family therapy. Attention is also paid to managing relapse or a recurrence of the drug-taking behavior.
Therapeutic communities involve a live-in residential arrangement, whereby support is provided by paraprofessionals who are former addicts. Sometimes known as halfway houses, these settings may be necessary when the danger of relapse is particularly high. Like many inpatient and outpatient programs, therapeutic communities are often affiliated with community mental health centers.
Twelve-step programs such as Alcoholics Anonymous (AA) use a voluntary support group format to help recovering addicts. Members meet regularly to assist others to remain drug free. AA and similar programs, including Narcotics Anonymous and Cocaine Anonymous, are often employed as an adjunct to professional treatment programs. Because alcohol abuse affects so many more lives than other drugs, support groups for spouses and teenagers of alcoholics (Al-Anon and Alateen) have also been founded to help these persons cope with the alcohol abuser.
Employee assistance programs are offered by many employers. Employers have a strong interest in intervening in drug use. Drug-dependent employees are less productive and more likely to injure themselves and others. Their need for coverage may drive up health care costs. The threat of losing one's job (as well as one's status, ability to support one's family, etc.) is a powerful motivator for many people to re-examine their behavior and get help.
Student assistance programs may be available in your community. If your school has this program, invite the teacher or counselor in charge of the program to talk about it to the class. These programs seek to identify and work with students who are considered at exceptionally high risk for involvement with drugs.
Pharmacological approaches are now available to support all the listed treatment formats. Various psychoactive drugs may be prescribed to facilitate the counseling process, relieve depression and prevent relapse. Antidepressants (Prozac, Zoloft, Celexa) and mood stabilizers (Lithium, Depakote, Neurotin) are most commonly used. Developed more 50 years ago, Antabuse (disulfram) interacts with alcohol to produce headaches, nausea and vomiting whenever the alcoholic drinks. In 1995, however, a new drug, called "Naltrexone," was approved by the FDA. Naltrexone reduces the craving for alcohol as well as the pleasurable sensations usually experienced when drinking.