Assessing Substance Abuse Treatment Effectiveness

Assessing Substance Abuse Treatment Effectiveness

Abstract

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Drug dependence refers to the chronic, relapsing disorder that requires specialized treatment to deal with it. The treatment plans for substance abuse aim at cutting down the cycle of dependence through various processes. The treatment programs assessed in this paper include long-term residential treatment programs, walk-in-clinics, short term residential programs, out-patient programs, individual counseling and group counseling. The type of treatment plan adopted depend on the factors such as drugs under question, history of drug use, previous plan adopted, social requirements, criminal records, economic capability and characterizes. The treatment plans were found to follow a unique model of process that included; interactions with patient, program, and provider, there therapeutic relationship with the therapist, levels of engagement, proximal results and the ultimate outcomes. An effective substance treatment plan is considered in terms of the level of reduction in drug use, and ability to prevent a relapse, frequency in use, and reduction in amount of drugs used. It was observed that residential program treatment plans were more effective to reduce the substance use. In terms of cost –effectiveness, the outpatient drug-free treatment plan was found to be more effective.

Introduction

Drug dependence is considered as a chronic, relapsing disorder that needs specialized treatment to delay with it. The main focus of the treatment plans is to break the cycle of dependence which proves to be quite difficult as the process causes physical, psychological, emotional, economic, and social pain. Drug abuse treatment entails the process of breaking the person’s reliance of the illegal drugs such as heroin, cocaine and even from the licit drugs such as alcohol. This requires a complex and variable network of services structured to meet the many needs of the individual. The treatment programs are offered in hospitals, long-term residential treatment programs, walk-in-clinics, counseling centers, therapist’s offices and church centers. The selection of the setting and the type of treatment plan adopted is based on issues such as the type of drug or substance, history of drug use, last drug treatment plan adopted, social needs, criminal records, economic level, and individual characteristics. Some of the substance abuse treatment programs that will be evaluated for effectiveness include; long term residential treatment. 

Model of the substance treatment process

The model helps capture the major domains that make up the treatment process. The model shows the interactions of the patient, program, and provider determinants offered to the patients, the therapeutic relationship with the therapist, level of patients engagement in the process, the proximal outcomes that helps achieve the ultimate outcomes. The patient characteristics may not be direct components of the process but contribute immensely to the treatment, its selection and planning, level of engagement and the treatment outcomes. The characteristics of the patient also affect the relationship between the treatment and outcomes. 

The program-level characteristics is the another crucial domain that is related to the organization and structure, policies, approach of the treatment, and readiness for change. The organizational structure related to the issues such as ownership, physical design, and size of the group, total patients characteristics, Staff available and the prescribed period for the program. The policies in a treatment program deals with the set procedures to deal with different procedures. The orientation adopted for the treatment involves to the modalities applied for the program. The environmental features of a program refer to the social climate of a program (Finney, 2007).

The other domain on the provider characteristics involved in the treatment program. This feature is concerned with the within-program variation in the provider features. Issues considered here include the competence, quality, and continuity of individual caregivers.

Therapeutic alliance is considering an important aspect of the treatment program. It affects and also influenced by the treatment program provided. It is essential in moderating the treatment offered on the patient’s involvement in treatment. The therapeutic relation is largely affected by the patient’s and therapist characteristics. The treatment provided entails the interventions offered to the patient. Most programs apply varied approaches for different patients. The proximal outcomes represent eh cognitions, attitudes, personality variables, or behaviors being investigated and targeted to be affected by the treatment offered.  These outcomes may be assessed at any level of the treatment program. The ultimate outcomes are the end points that the treatment plan ought to affect. (Finney, 2007)

Types of Substance Abuse Treatment Program

Long-term Residential Treatment

This treatment program offers twenty four hours days care in non-hospital settings. One of the best treatment models involves the therapeutic community that requires planned periods of stays extending between six and twelve months in the facility. This program seeks to achieve socialization of the individual and takes advantage of the programs whole community including the residents, staff, and the social life to act as active components of the treatment. This program helps deals with addiction. Here, addiction is considered in the perspective of a person’s social and psychological shortcomings, thereby mandating the treatment to concentrate on creating personal accountability, responsibility and productive social lives (NIDA, 2012). Treatment adopted in this program is highly structured and at times involves confrontation. Activities are designed to help the patients analyze their damaging beliefs, self-concepts, and destructive behavioral patterns. The goals are to help individuals come up with and adopt new, harmonious, destructive interaction behaviors with others.

Short term residential treatment 

This form of treatment program offers intensive treatment in a relatively short period. The treatment is based on a modified 12-step approach. The programs were originally set to deal with alcohol issues but have been since then adopted to deal with other types of substance use disorders. The treatment requires a 3-6 week hospital-based inpatient treatment phase (NIDA, 2012). This is then followed by an extended outpatient therapy and engagement in self-help group. The aftercare programs are relevant to help decrease the risk of relapse after finishing the residential setting.

Outpatient treatment programs

This involves widespread services that differ in type and intensity. The treatment is less costly as compared to the residential or inpatient treatment. The programs are suitable for people in jobs or placed under extensive social programs. Some of these programs are low-intensity only dealing with drug education. Other outpatients’ models are intensive thereby offering excellent services (Mcrty, et al. 2014). Many outpatient programs involve group counseling as a major component. Some programs are molded to treat even other medical or metal issues that the patients have on top of their substance use (NIDA, 2012). 

Individualized drug counseling

This form of treatment program put its focus on putting an end to behavior of depending on a particular drug. It is also expanded to deals with areas of impaired functioning that includes the employment status, engagement in criminal activity, and family and social interaction. It mainly focuses in achieving short-term behavioral goals. This is achieved by helping the patient develop coping strategies and measure to help them abstain from the drug use and avoid incidences of relapse. The most adopted counseling method involves 12-step participation accomplished once or twice a week. Referrals are made for any other identified medical, psychiatric, employment and services that may be deemed important (NIDA, 2012).

Group counseling 

This is a form of therapy that capitalizes on social strengthening provided through peer discussion to help promote drug-free lifestyles. The combination of the individualized drug counseling with individualized drug counseling structures within the principles of cognitive-behavioral therapy or contingency management is essential in the attainment of positive outcomes (NIDA, 2012).

Description of an effective drug abuse treatment

Developing an effective substance abuse treatment requires integration with criminal justice, social, and medical services for the best outcomes. The issue of drug and substance abuse is intertwined with the other social, medical, and legal consequences. An effective substance treatment program should help achieve the following outcomes. The main outcome aims to reduce use of the primary drug; the effectiveness measures here include; abstinence, decreased time to relapse, reduction in frequency of drug use, and reduction in amount of drug used. An effective treatment program is also assessed according to its ability to improve the functioning of drugs users in their places of employment. This considers number of days worked, or enrollment in a training program. An effective treatment program is also capable to improve the education status with regard to school attendance, improved grades, and overall performance. Medical conditions considered include less hospitalization, and less doctors’ visits. Interpersonal relationships with family, friends and employers needs to be improved legal status is considered in terms of improvements in legal status such as probation, parole, and incarceration, reduced arrests, fewer convictions, as  well as less involvement in criminal acts  (Mignon, 2015) An effective mental health status aims to achieve improved moods, reduced psychotic states, personality traits as well as reduced need for admission into mental health facility. Most assessment  on substance treatment effectiveness are mainly based on the achieving reduced crime, reduced drug use, less involvement in domestic violence, decline in the engagement in risky behavior, improvement in employment period as well as positive change in the accrued social values and networks.

Effectiveness of the Substance Abuse Treatment Program

The effectiveness of these programs was assessed in a study through the use of logistic regression analyses. Some observational study using the SROS allowed clients to self-select programs or get referred to the treatment program. When analyzed, it was found out that the residential program clients were found to have lower rate of abstinence as compared to the outpatient drug-free treatment. It was also deduced that patients with less psychiatric comorbidity and less glued to substance use were more likely to reduce their substance use after being engaged in an inpatient settings as compared to the outpatient drug-free program. It has also been noted a significant difference in the reduction of drug use in when patients are admitted to the residential program unlike when they applied detox methods. Clients taken for the residential program are more likely to experience decrease in their substance usage levels. In terms of cost effectiveness, the outpatient drug-free treatment program is the most effective. Generally the less intensive treatment programs were found to be more effective in terms of cost effectiveness as compared to the intensive programs. The effectiveness of the programs is largely connected to the characteristics of the clients as well as that of the therapists (Mojtabai & Zivin, 2013).

Conclusion

Substance abuse treatment programs aims to help patients reduce their dependence on the drug’s use and improve their quality of life. The treatment programs are all structured into some domains including; the patient characteristic, the therapist’s characteristic, programs features, orientation of the program, therapeutic relationship, proximal outcomes, and final results. Some of the types on treatment programs were found to be; long-term residential treatment, short-term residential treatment, outpatient, treatment progress, individualized drug counseling, and the group counseling. The measures of effective normally used for assessing the treatment programs include the reduced drug use, less involvement in domestic violence, decline in the engagement in risky behavior, improvement in employment period as well as positive change in the accrued social values and networks. In considering the types of treatment methods available, it was noted that residential treatment programs was more effective in enhancing reduced drug use and relapse. However based on cost-effectiveness, the outpatient treatment program was found to be more effective.

References

Finney, J. (2007). Assessing Treatment and Treatment Processes. National Institute on Alcohol Abuse and Alcoholism.

Mcrty, D., Braude, L., Lyman, R. D., Daniels, A., Ghose, S., & Rittmon, M. (2014). Substance Abuse Intensive Outpatient Programs. Psychiatruc Service, 718-726.

Mignon, S. (2015). Substance Abuse Treatment: Options, Challenges, and Effectivess. New York: Springer Publishing Company.

Mojtabai, R., & Graff Zivin, J. (2013). Effectiveness and Cost-effectiveness of Four Modalities for Substabces Disorders. Health Services Research, 233-259.

Morral, A., McCaffrey, D., Ridgeway, G., Mukherji, A., & Beighley, C. (2006). The Relative Effectiveness of 10 Adolescent Substance Abuse Treatment Programs In the United Stated. Pittsburgh: Rand Coperation .

Mounra, A., Ferras, L., & Negreiros, J. (2015). The Effectiveness of Substance Abuse Treatment: Deelopement of a Brief Questionnaire. Archives of Clinical Psychiatry.

NIDA (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved February 15, 2017, from gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition“>https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition

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