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.

The evaluation of treatment services for drug addiction

Human Well-being Psychological Association

The evaluation of treatment services for drug addiction

www.Google.com

By Iram Sharif

Why the use of drug and alcohol addiction is increasing day by day?

Why large no of users are entering in rehabilitation centers & never get relief?

Why preventive measures are not working at all?

Why service providers (rehab centers, hospitals, outpatient, on-line, private NGO’s and government level institutes) are failing in providing relevant and beneficial services?

The following article will helpful in the identification of drawbacks of our services and polices and also in improving this system for better quality management of drug addiction.

First of all, there is need to know the disparities in service delivery and receiving. As in Pakistan, drug addiction has become a national level issue. No doubt paper work has been done to an extent but not in an effective and systematic way. To deal with this issue only paper work is not enough but there is also a need to establish the operative procedures, principles, polices, and guidelines at national level. To implement proper law in such a way that no person can dare to use or sell the drugs openly & freely.

To prevent addiction at all, need to review the systematic procedure from government level to local community level so as to fill the gaps in the system. As the policy makers, program planners, managers and key decision makers have not been developed any effective policy, treatment modality and provider setting services in this regard to date so, all polices, principles and guidelines need to be developed as well as implementation in an effective way. Effective means “beneficial and positive health related reforms” that should give positive outcome. How can we know about positive and negative outcome of any treatment planning, implementation, service delivery setting or policy guidelines? Obviously through the conduction of researches. But there are marked lapses among all of the above mentioned areas that need an effective planning to make and implement drug addiction program.

 At national level (Govt. role & responsibilities) there is need for;

1.   The development of law and order
2.    The development of rational policies
3.  Establishment of principles, rules and guidelines
4.  Expert program  planners, managers and key decision makers
5. Effective and well organized social care systems
6. Availability of scarcity of resources
7. Scientific studies (well controlled) for policy/program evaluation
8.   Schematic and arranged service provision
9.  cost effective analysis systems
10.  Health reforms
11.  Expert health provider
12.  Well-equipped treatment settings
13.   Systematic monitoring and evaluation systems

Secondly (health provider role and responsibilities) to familiar with;

1.        The difference between treatment and management
2.             The difference between rehabilitation and habilitation
3.              The difference between inpatient and outpatient door
4.             Treatment setting
5.             Treatment modalities
6.             Areas to investigate and to cure/manage
7.            Stages of treatment

Third thing that is a very critical component in making good or worse a treatment program is the role of

1.          Expertise in development of policy, principles, guidelines and programs
2.         Expertise (health providers) in handling the patients  

They must be certified, professional, and experiential who never work for their own benefits and not to prefer individual opinion.

Forth evaluation area is patient related

•          Who is patient/client?
•           Life areas (personal, social, physical, psychological, religious/spiritual)
•           Process of undergoing a treatment
•           Health providers?

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•           Service setting?
•            Duration of treatment/management?
•              Treatment modalities?
•           During and after treatment what plans will            go through?

These are very important things to get a positive outcome in any prevention program.

Your feedback will be important for me and others to make more reforms in this area. So please write your feedbacks.

Note.

A workshop on “patient-clinician variables of drug addiction” final part of “Drug Addiction Community Awareness Program” is going to be conduct in the month of August. This workshop is offered for those candidates who have attended the first workshop held at 29-4-2018.  Please contact at the following number to confirm your presence and also to get a form.

Objectives of “patient-clinician variables of drug addiction” workshop

This will discuss only process of treatment and strategies to handle the patients during and after treatment.

Dysphagia and role of speech therapists

Dysphagia and role of speech therapists

www.google.com

By Iram Sharif

         Dysphagia, or difficulty swallowing, is a condition that can be caused as a result of surgery, due to neurological conditions (e.g., Parkinson’s disease or stroke), digestive disorders including acid reflux or head injuries and can also be a part of normal aging. Children with developmental disabilities like autism also often have dysphagia. People with dysphagia are at risk for choking, dehydration, malnutrition and pneumonia, which can be triggered when food or drink enter the lungs. Signs of dysphagia may include drooling and poor oral management, food or liquid remaining in the oral cavity after the swallow, inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity, food and/or liquids leaking from the nasal cavity, complaints of food "sticking”, globus sensation or complaints of a "fullness" in the neck, complaints of pain when swallowing, wet or gurgly sounding voice during or after eating or drinking, coughing during or right after eating or drinking, difficulty coordinating breathing and swallowing, recurring aspiration pneumonia/respiratory infection and/or fever, extra effort or time needed to chew or swallow, changes in eating habits—specifically, avoidance of certain foods/drinks & weight loss or dehydration from not being able to eat enough. Treatment of dysphagia depends on its cause. It involves multidisciplinary team approach.

Role of speech-language therapist

        They can advise for food management for patients with swallowing issues and in doing so they work as life survival person. Having stroke often paralyzes one side of the throat, a swallowing specialist like a speech-language pathologist first ​might use an imaging test to identify what exactly is going wrong, and then coach the patient on ways to tilt his or her head while eating in order to better prevent food from getting into the airway.​ Mouth and throat exercises can also help patients boost their swallowing abilities that can be administered by speech-language therapists/pathologists. They can administer many types of exercises, maneuvers, compensatory mechanisms and postural techniques to enhance the normal swallowing in patients of paralysis, strokes, dementia and many others.

Role of speech-language therapist

Role of speech-language therapist

(In Pakistan less awareness is found in public about speech therapist’s role)

By Iram Sharif

Speech and language therapist is a professional person who deals with speech-language, socio-cognitive, communicative, eating/drinking or swallowing issues.

 They work to improve respiration (fluency disorders; stuttering, cluttering etc.) phonation (voice issues), resonance (Nasality issues) and articulation (articulation errors; substitution, omission, distortion & addition issues) areas.

They work in hospital settings to deal with neurological conditions (Aphasia, Dysphagia, Dysarthria, dementia, strokes, paralysis, etc.) by working on patients’ live survival, managing their oral and pharyngeal phases, advise and refer for surgical procedures in cases of clefts (lips & palates), paralysis and cancers etc. They advise for augmentative and prosthetic devices, work on communication and counseling services, and advice for food management for patients with swallowing issues. They can administer many types of exercises, maneuvers, compensatory mechanisms and postural techniques to enhance the normal swallowing in patients of paralysis, strokes, dementia and many others.  Exercises and compensatory mechanisms are also used to strengthen the muscles. They assess and manage areas of speech and language disorders as a result of any anatomical loss.

They work with normal population/general education setting to identify their hidden/unidentified disabilities or problems which may manifest in the form of any speech and language problem and results in students ‘educational failures or drop outs from normal educational settings and can refer them to their respective professional. They identify any voice, pitch, rate, tone, volume issues. Identify and refer to audiologists for appropriate fitting of amplifications to the students with slight or mild hearing losses and also work with students for bridging their gaps in speech and language concepts.

They can work in special education settings to work with the following disorders (articulation, hearing impairments, intellectual disabilities, cerebral palsy, speech and language delays/disorders and more).