Introduction
Following the cravings of natural curiosity, man has always been eager to gain new experiences and sensations, drawing them from any possible source. The culture of taking drugs as an exciting and at the same time relaxing pastime roots in the oriental countries and has gradually spread its deathly embrace all over the world. People may try drugs with a view to joining a fancy social group or escape from routine reality, or out of despair, or simply for fun. However it may be, more often than wanted, drugs do not remain a single instance in one’s life, since envisaging drugs as an easy way of achieving the desired state one develops a severe addiction to them and suffers grave consequences which in the worst case can be lethal. So threatening is the drug situation nowadays that it has become a worldwide social issue that attracts the attention of specialists and requires immediate and effective action. Addiction to drugs is viewed as a complex disease, the roots of which go deep both in the physiology and psychology of human beings. Starting as a voluntary act, drug-taking promptly develops an intensive uncontrollable craving for new ‘fixes’ even if the addict recognizes the negative consequences it entails. Since drug addiction is characterized by devastating effects on a wide range of human life aspects, its treatment requires a complex approach involving both the physiological and the psychological sides. In modern practice, the three major ways of treating drug addicts are cognitive–behavioral therapy, pharmacological therapy, and motivational enhancement therapy.
Cognitive-behavioral therapy
When prompt action is required in drug addiction treatment, the option to choose is cognitive-behavioral therapy (CBT). Taking into account the conditions at clinics where resource capabilities may be restricted, the briefness of the CBT approach allows of achieving a relatively long-term result in resolving immediate problems within a short time period and at rather a low cost. Basing on the importance of the learning process in the development of drug addiction practice, CBT makes use of the learning process, firstly, in helping the patients to recognize the conditions which stimulate them to take drugs; secondly, in teaching the patients to avoid such potentially drug-taking situations; and thirdly, in introducing the strategies of coping efficiently with the patients’ state and problems caused by drug abstinence. In order to achieve the best results, the program of CBT comprises two essential stages. The first stage, functional analysis, is designed as information exchange between the doctor and the patient, during which they establish the patient’s ideas and feelings before, during and after taking drugs, as well as the possibly risky situations involving drug use. Basing on the results of the previous analysis, the second stage, skills training, is an individualized program of actions that stimulates the patient to stop the behavior that led to drug abuse and acquire the habits of a healthier lifestyle. As CBT aims at the patient’s adjustment to normal daily life, it is set on an outpatient basis; and for the best efficiency of CBT, the preferable format of the sessions is individual and the course of treatment standardly takes twelve weeks. (“A Cognitive-Behavioral Approach: Treating Cocaine Addiction”)
As it appears from the general review, the theoretic basis of CBT is developed on the notions of learned behavior, functional analysis, and skill training. Drug addicts may acquire their behavior in three ways: firstly, by modeling the behavior of the others, repeating their actions; secondly, by operant conditioning, i.e. performing a certain mode of behavior in order to achieve the pleasant consequences it entails; and thirdly, by classical conditioning, i.e. by linking the drug-taking behavior to certain stimuli that fade with the time, leaving the patient with drug addiction as such. In order to disclose the behavioral models underlying one’s addiction, CBT performs functional analysis focusing on: firstly, the deficiencies and obstacles in the patient’s life that led him/her to drug addiction; secondly, the skills and strength that may help the patient overcome the addiction; and thirdly, the determinants of drug use, i.e. the conditions accompanying the devastating habit. In the process of analysis, the domains to be explored include social, environmental, emotional, cognitive and physical aspects of the addict’s life. Upon completion of the analysis, CBT employs the psychological tactics of “unlearning” the destructive skills that led the patient to drug-taking behavior and learning the skills that would bring him/her back to a healthy life; at this stage it is vital, firstly, to match the material presented by the therapist to the needs of the exact patient, secondly, to set an appropriate background for practicing and consolidating the acquired skills, and thirdly, to express praise and encouragement for successful completion of the tasks. (“A Cognitive-Behavioral Approach: Treating Cocaine Addiction”)
One of the distinctive features of CBT is its didactic approach to the structure of the course. Each of the sixty-minute sessions is organized according to the 20/20/20 Rule. The first third of the session is dedicated to listening to the patient’s concerns and experiences with drug craving and exercises in order to assess the development undergone since the previous session. The therapist spends the second twenty minutes for a detailed introduction of another skill and relating it to the present situation and concern of the patient. During the last third of the session, the patient and the therapist discuss the former’s understanding of the new topic and design the practical application of the new skill in the patient’s routing of the following week. In order to achieve immediate results, the therapists tend to introduce the most critical skills of behavior at the beginning, shifting the more general information closer to the end of the treatment course. (“A Cognitive-Behavioral Approach: Treating Cocaine Addiction”)
Pharmacological therapy
One of the methods often combined with CBT is the one that employs medication. Making wide use of such preparations as methadone, buprenorphine, and naltrexone, pharmacological therapy is regarded efficient at different stages of drug addiction treatment, suppressing the symptoms of drug withdrawal, on the one hand, and assisting in the restoration of normal brain functioning, on the other hand. The application of the aforementioned preparations occurs in two stages: at first, the detoxification of the patient’s body occurs, whereupon the maintenance process pursues. The detoxification process is standardly designed in accordance with one of the following protocols: long-term (180 days), short-term (up to 30 days), rapid (3 to 10 days), and ultrarapid (1 to 2 days). In common practice, preference is given to the long-term and short-term protocols, but the negative outcome of such treatment shows rather frequently in relapses in the detoxified body. However, the other, more rapid types of protocols do not guarantee a better result, despite the enthusiasm of certain therapists, as the ultimate condition of pharmacological therapy success is its combination with methods of psychological treatment of drug addicts. (Katz, Katz, and Mandel 136–137)
One of the oldest opioids traditionally used in maintenance therapy is methadone. Due to the capacity for long action of this synthetic opioid agonist, one dose of methadone is sufficient to satisfy the patient’s craving for drugs, which would otherwise require multiple shots of heroin throughout the day (Katz, Katz, and Mandel 137). Methadone allows of preventing the effects of opioid withdrawal in patients, blocking the effects of illegal drug abuse, and decreasing the overall craving for opioids (National Institute on Drug Abuse 37). Being an especially powerful opioid, methadone is only available at specialized institutions, e.g. methadone maintenance clinics, and according to estimations is applied to not more than twenty percent of the US heroin addicts (Katz, Katz, and Mandel 138).
The especial attractiveness of buprenorphine as a pharmacological means of treating drug addiction consists in its relative safety: buprenorphine carries a comparatively low risk of overdose. This quality allowed for introducing buprenorphine as a medication for opioid addiction at establishments other than specialized institutions, which made this kind of pharmacological treatment available for a wider range of patients in general medical settings. For patients who due to certain life circumstances cannot afford a course of treatment in a specialized establishment, buprenorphine treatment appeared a perfect option, since it can be conducted on an ‘office’ basis, by a large number of accredited specialists including primary care physicians, internists, pediatricians, and psychiatrists. (National Institute on Drug Abuse 38–39)
Originally developed as a preventive measure against relapse in drug addicts, naltrexone is an opioid antagonist that does not furnish the euphoric effects normally produced by drugs on the addicts. Due to this quality of naltrexone, it is advised that patients should be detoxified prior to naltrexone treatment traditionally conducted in outpatient medical settings. However, certain precautions such as careful medical monitoring should be followed during the application of naltrexone since it is frequently noncompliant with patients. Naltrexone therapy is mostly advised by specialists to individuals possessing a level of internal and external motivation high enough to endure the opioid withdrawal period during which naltrexone does not compensate for the generally sought effects of traditional drugs. (National Institute on Drug Abuse 40–41)
Motivational enhancement therapy
Another approach to drug abuse treatment based on the achievements of motivational psychology and behavioral studies is motivational enhancement therapy (MET). Devised to produce rapid effects, MET, as opposed to CBT, does not aim to educate and train the patient, but rather envisages the treatment course as a way of mobilizing the patient’s own resources by providing consistent motivating impulses. While for achieving the desired result the method of CBT requires a whole course of treatment, the attraction of MET consists in the fact that this kind of therapy can be efficiently applied even in cases when the communication with the patient is limited to a very small amount of sessions. (Miller 1)
Assuming the point that improvement is the patient’s own responsibility and capability, the MET approach strives to evoke the patient’s inner motivation by applying five motivational principles. Firstly, it is important for the therapist to employ his/her reflective listening skills in order to express empathy with the patient and show respect for the latter’s freedom of choice and self-direction. Secondly, the patient should develop a sense of discrepancy between his/her drug-involved state and the healthy existence he/she could lead. Thirdly, in no case should direct argumentation or persuasion be used by the therapist, since it is up to the patient to develop an understanding of his/her situation. Fourthly, in case of the patient’s resistance to the course of treatment, the therapist should in no case impose ‘the right way’ on the patient; he/she should rather assume a “roll-on” attitude and let the patient explore an own way to a solution. And finally, the patient’s self-esteem should be supported by recognizing his/her self-efficacy as the key factor in changing the drug addict’s behavior. (Miller 4–6)
In order to implement the aforementioned principles, a number of practical strategies are used, with a separate set of strategies applicable to each of the three phases of the treatment. During the first stage, when the motivation for change is built, the therapists listen to the patient eliciting from his speech the self-motivational statements that would play a key role in the future treatment; he/she presents personal feedback to the patient’s considerations, handles any possible resistance, and provides summarizing of the obtained information for the patient’s further comprehension. The second stage is dedicated to strengthening the patient’s commitment to change, and at that time it is of especial importance to recognize readiness for change in the patient; to discuss a plan of change taking into account the patient’s free choice; to provide information and advice for a more successful behavior; to change the planning worksheet in accordance with the circumstances. The last stage of the treatment deal with developing the follow-through strategies which involve reviewing the patient’s progress, renewing his/her motivation and commitment, and outlining the course of further treatment. (Miller 7–38)
Upon reviewing and comparing the three most widespread ways of treating drug addiction, it becomes apparent that each of them should be applied in combination with another cognitive: simultaneous practice of pharmacological therapy with behavioral therapy or motivational enhancement therapy allows achieving better results since in such cases both the physiological and the psychological issues of drug addiction are dealt with.
Works Cited
“A Cognitive-Behavioral Approach: Treating Cocaine Addiction.” drugabuse.gov. National Institute on Drug Abuse. 2009. Web.
Miller, William R. “Motivational Enhancement Therapy with Drug Abusers.” Motivational Interviewing Page.1995. Web.
Katz, Nikita B., Olga A. Katz, and Steven Mandel. “The Pharmacologic Treatment of Alcohol and Drug Addiction.” Drug Courts in Theory and Practice. Ed. James L. Nolan. Hawthorne, NY: Walter de Gruyter, Inc., 2002. 127–140. Print.
National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. 2nd ed. Author, 2009. Print.