Basics of Effective Treatment in Drug Addiction

By Iram Sharif

Basics of Effective Treatment in Drug Addiction

First of all, it is necessary to understand that drug/alcohol (substances) addiction is a chronic, pervasive, relapsing disease as it prey the individual’s brain abusing substances. Continuous and excessive usage of these substances alter the original brain structure and functions thus, compensatory mechanisms take their control to the original functions. That’s why a person with Addiction faces difficulty in giving up of drugs/alcohol despite of having complete treatment and follow up phases, cannot control his/her craving (demand to take drugs) and gets repeatedly entrapped by relapsing phases (till to their deaths). Thus altered brain mechanisms not only take part in the development of uncontrolled habit of abusing substances but also compel individuals with drug/alcohol addiction to must take substances to meet their craving needs.

Process of treatment

When individual becomes addicted, no one area of life remains safe due to addiction. That’s why addiction is said to be a bio-psycho-social-spiritual disease. So, an effective treatment demands multiple strategies as per affected area of life. Must remember that no single therapy is appropriate to treat a person. A person needs eclectic (combination of strategies) approach to treat or manage his/her substance. Detoxification (first line of treatment) alone is hardly adequate to support addicted individuals to achieve long-term abstinence. Pharmacological treatment provides an alternative but same stimulation or pleasure as happens due to taking drugs. Person gradually slows down his/her substance taking quantity. Psychological therapies are applied to manage individuals’ life problems, related to all possible domains. Behavior therapies are important in shaping their maladaptive behaviors and habits. These therapies work on motivation, replacement, shaping, and resistance breaking elements through the use of incentives or reinforcements. Physical therapies facilitate their functional motor skills. Occupational therapies enhance their occupational and motor facilitations. Speech and language therapies improve their communicative, socio-cognitive, and swallowing issues. To get most effective outcome, family therapy or counseling is a crucial component of treatment. Family patterns, communication styles, and living styles need to be change.  Thus each type of selection of treatment strategy depends upon their individual needs. Treatment selection also depends upon individual’s age, gender, ethnicity, and culture. The treatment that start from detoxification and goes through different therapeutic strategic implications ends up with continuous follow ups to shape a goal directed and meaningful life for patients.

Recovery

Earlier & immediate treatment with appropriate timing and duration (variable according to type and chronicity of addiction) enhances the chances of recovery. Most of rehabilitation centers keep patients for 6 months (long duration) or 1 month (short duration). As recovery from addiction is not possible in most of cases. No complete cure to till date is possible. At medical end recovery lays at chances. It all depends upon patient’s end. The more the patient is motivated to give up it, the more the recovery is possible. Recovery from substance addiction is a long term, complicated and difficult process. Person with drug addiction has many relapses in his/her life and undergoes multiple episodes of treatment. When patients faced more hurdles with no better solutions, their chances to use substances increase. If they have developed better cope up abilities and know how to deal with life difficult circumstances, definitely they can defeat their drug/alcohol addiction habit. So, there is a need to design an effective, motivational, goal achieving, solution oriented and meaningful programs or strategies that engage patients to adopt healthy and positive life styles. Such program must has all crucial components (all life related aspects, goals and living standards, support groups etc.) related to patient’s needs. Person with substance addiction must be monitored continuously for their whole lives.

Therapist/counselor’s skills

v  Must have background information (substance definition, nature, types, modes, harmful effects etc.) knowledge about medical and psychological illnesses, terms and conditions

v  Must know about co-morbid disorders/illnesses (e.g., HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases; any other mental illness/disorder such as depression, aggression, memory loss, etc.) that can co-occur with alcohol/drug addiction.

v  Must be experienced and skilled to deal with such patients

v  Must be certified in substance addiction treatment from a recognized and valid institute

v  Must have knowledge about pharmacology (Basics, types, working, side effects etc.)

v  Must be an effective treatment planner to cover all needed areas of life

v  Must know the Referrals and services available for such persons

Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results.

Basic Treatment Services

Inpatient & outpatient services

1.      Detoxification services

2.      Medications

3.      Symptomatic treatments

4.      Psychological treatments

5.      Psycho-social interventions

6.      Religious/spiritual interventions

7.      Relapse prevention services

8.      Support/self-help group

Open access services

1.      Psycho-education services (patients, families, communities)

2.      Parental training

3.      Community based interventions

4.      Prevention of adverse consequences services (infectious diseases, AIDS/HIV, hepatitis B and C, each substance use harmful effects, mental diseases, overdose risk exposures, injecting equipment knowledge etc.)

5.      Basic survival services, health, welfare and legal services

From NGOs and Govt. services

1.      Awareness day celebrations

2.      Drug prevention walks

3.      Training/awareness workshops

4.      Awareness campaigns

Note: Community based treatment programs, awareness campaigns, training programs are important. NGOs, Govt. and psychological/social associations (societies, forums, foundations, institutions etc.) with collaboration can develop and introduce such programs in more effective way. If campaigns will run at village, town, cities, provincial and national levels by using man power and electronic/print media power then chance will be increased to have a drug free environment. With continuation of data collection, analysis and reporting, an accurate figure of evaluation can be obtained. 

Dysarthria

By Iram Sharif

Dysarthria

(Role of speech language therapist, occupational therapist & clinical psychologist) 

Dysarthria is an umbrella term used for motor speech disorders caused by muscle (muscles of phonation, respiration, articulation and reflex activities) weakness. The muscle weakness make it harder for a person to talk. This muscle weakness range from mild to severe and thus specify the severity of problem. Its signs and symptoms are varied as having slurred or mumbled (salad like speech that is very difficult to understand by the listener) speech, person talks either very fast or very slow, robotic or choppy, very soft speech, harsh or breathy voice. Person can speak with too much resonance (oral sounds are emitted from nose), assimilative resonance (vowels are sound out from nose adjacent to nasal consonants), with low or no resonance. As volume, regulation, and control of expiratory air is necessary to correct the phonation (voice production). So good breath control is needed to attain normal healthy voice. Because poor breathe control will cause motor speech problems, poor quality of voice and incorrect realization of phonemes. Good phonation (voice production) also depends upon the healthy pitch and inflection (modulation of intonation) levels. Person with dysarthria not be able to move lips, jaws, tongue, throat or vocal cord muscles precisely. When muscles like lips, jaws, tongue, and throat do not move precisely, they cause articulatory difficulties (production of sounds). And these articulatory difficulties reduce the comprehensibility of speech of these persons for the listeners. This condition is referred to as unintelligible speech. Unintelligibility Also disturbs the rate, rhythm, stress and intonation patterns. So intelligibility is the basic index for judging the speech comprehension, integration and coordination of motor speech process.

Dysarthria is caused due to brain damage and it is categorized by muscular severity, location and type of lesion in the brain. Common classification includes flaccid (lack of normal muscle tone), spastic (greater than normal muscle tone), ataxic (imprecise/inaccurate or slow muscle movements), mixed, hyper (quick, unstained, involuntary movements) and hypo (slow or limited movements) kinetic dysarthria. Childhood (when brain is underdeveloped either born with dysarthria or after birth due to brain damage) and adulthood (when brain has fully developed) dysarthria.    

Google.com

 Management

Its treatment/management needs a team approach.

1.       General health physician

2.       Specialized doctors

3.        Neurologists

4.       Ear, nose, throat (ENT) Specialists

5.       Neuropsychiatrists

6.       Neuropsychologists

7.        Clinical psychologists

8.       Speech and language therapists/pathologists (work on speech, language, communication, socio-cognitions &  swallowing conditions)

9.       Physical therapists (to enhance person’s physical capacity)

10.   Occupational therapists (to enhance person’s functional capacity)

11.   Case/Social workers or nurses

12.   Specially trained attendants

And any other health professional according to the need of patient.

Here I shall discuss briefly the roles of some health professionals to develop awareness in common people

Speech language therapists/pathologists (SLT/SLP)

They play their role in screening, assessment, diagnosis and treatment in dysarthria. They work on facial muscles by using messages/exercises (face, lips, jaws, tongue, cheeks etc.), compensatory mechanisms, speech generating devices, provide communication aids, therapies, and many more procedures depends upon the nature of disorder. They also can counsel the patients about their disorder, also provide education aimed at preventing further complications related to dysarthria. If patient has swallowing problem with the motor disorders then they also provide aid in relieving the problem by utilizing messages, exercises, alternative feeding methods, postural and food modifications. They work in team approach with other professionals. They help the patients to maximize their potential.

Occupational therapists (OT)

They promote functionality and facilitate movements to patients with motor disorders. They provide functional training of motor skills (bed mobility and transfers, balance and mobility, reducing fall risk, and improving hand function), process skills (organization and task adaptation), and psychosocial adaptation. To maximize function, OT performs task modifications (use of adapted utensils, built-up handles, adaptive clothing), environmental modifications (rearranging furniture, organizing ramps and walk-in shower, grab bars) and prescription of assistive devices (raised toilet seats, walking aids, splints and braces).

Clinical psychologist

They psycho-educate the patients about the nature, symptoms, prognosis, causes and management of disorders. Clinical psychologists play a bridging role in between neurologists and psychiatrists. They are a critical member of rehabilitation team approach to help the patients in gaining their maximum potential. Neurogenic, structural and especially functional/psychogenic/psychological movement disorders (gait disorders, tremor, dystonia, etc.) are source of disability or distress usually managed through behavior therapy, functional cognitive behavior therapies, hypnosis and effective counselling techniques. These therapies are provided by clinical psychologists. They also help in ongoing assessment to get qualification of treatment as proven good or bad. They can make referrals and suggestion of assistive devices and aids. Like OTs clinical psychologists facilitate daily/adaptive (communication, cognition, dressing, toileting, fine & gross motor skills, independent living, safety management living skills, eating, drinking, reading, writing, memory, organization, task management, psychosocial and many other self-management skills).  Daily scheduling, transitions between activities all are managed by clinical psychologists.

Case workers

They work like social workers or any related discipline like social work. They work as professionals in team approach and are a part of assessment and management of disorders. Caseworker duties consist of evaluating client necessities, attending to concerns, educate and motivate the clients to change, make referrals to community agencies and also play a central role in coordination of care providers. They provide coordinate care and services to the patients. They work on clients’ problem-solving skills. The caseworker develops a case plan by identifying (client' needs, resiliency, motivation and strengths/weaknesses etc.) the action steps required to bring the desired changes in the clients.  Timelines based on goal accomplishments are not only discussed but also written into the plan.

References

Makoutonina, M., & Rao, A. (2018). Role of the occupational therapist. Retrieved from

https://www.movementdisorders.org

Mary, Dr. (2018). The Role of Caseworkers. Work - Chron.com, Retrieved from

http://work.chron.com/role-caseworkers-23053.html.