Introduction
Hydrocodone addiction has continued to be a persistent and ever growing crisis in United States. Minimal attention has been given to hydrococone abuse compared to other illegal drugs such as marijuana, heroin and cocaine. According to The Federal Enforcement Administration, hydrocodone is the highest abused prescription drug in US.
It is estimated that its usage has increased more than four times over the last decade. In addition, a five fold increase in the number of emergency visits has been reported in major hospitals (Hydrocodone, 2003, para. 2). This research paper describes hydrocodone addiction and gives suggestions on interventional approach which best fit in alleviating the problem.
Role of addictive and other compulsive behaviors
Hydrocodone refers to a narcotic substance capable of eliciting a calm euphoric state resembling that of morphine or heroin. Although the drug is imperative in reducing the level of pain in humans, its chronic usage has resulted into dependency similar to addiction to hard drugs.
The classification of pure hydrocodone is under schedule II substance. This means that its use is often restricted. However, majority of the prescriptions are usually laced with other non narcotic ingredients to come up with useful medicinal products such as Vortab which are classified under schedule III. This makes it to be widely used and distributed due minimal restrictions (Hydrocodone, 2003, para. 2).
Addictive and compulsive behaviors are common occurrences witnessed among addicts all over the world. Addiction refers to development of a certain set of behaviors in an individual’s life which become a habit and overly pervasive in a person’s life. The behaviors developed affect an individual’s life with regard to time management and execution of important tasks. Majority of the addicts experience strong behaviors which determine their lifestyle (Inaba & Cohen, 2007, p. 32).
According to Holtzman (2000), the behaviors result from a strong desire to control inner feelings in ones personal life. Compulsive behaviors are not only repetitive but also purposeful. This leads to assertion that they are mainly undertaken in a ritualistic manner. Considering the wide range of activities to be undertaken by individuals suffering from compulsive behaviors, they experience difficulty in establishing a strong relationship with other people due to their obsession with other things.
Despite living in denial of the existing predisposition, these individuals are aware of the repercussions of not obtaining treatment for their medical condition. There is a strong link between addiction, psychological, social and physical aspects of an individual. Addictions and compulsive behaviors present a serious challenge to households and the entire country with regard to economic loss.
To gain a better understanding on hydrocodone abuse and the implications of compulsive behaviors resulting from addiction in an individual, a closer evaluation of historical and contemporary cases with particular interest on prevention and treatment of hydrocodone addiction is necessary.
The ancient civilization ushered in the usage of opium and alcohol as part of cultural practices. Over the years massive developments have occurred resulting into emergence of a wider distribution channel of the drugs particularly heroine and opium.
Despite their illegalization, majority of people still continue to make millions of dollars through its trade. Advancements in technology and infrastructure coupled with an increased desire to self treat have culminated into an upward trend in abuse of the over- the-counter prescriptions.
According to Inaba & Cohen (2007, p. 1-3), availability of hydrocodone as a primary ingredient in several painkillers makes its consumption to be frequent leading into addiction in the long term. Its wide usage has prompted authorities to consider a number of measures aimed at controlling its rampant abuse.
Interventional programs aimed at investigating suitable prevention and treatments have taken centre stage with the increment in the number of cases regarding dependency of hydrocodone. Similar to other opioids, control is usually simple especially with cooperation of the addict.
Advising the patient to take the drug coupled with any other medication containing some analgesic sparing properties is encouraged. Potentiators such as hydroxyzine and nefopam are believed to offer the safest combination which not only guarantees lowering of dependency but also offers the best alternative in drug control.
Addiction brings a satisfying feeling which promotes abuse of hydrocodone. This serves as the easiest escape route for several people particularly when faced with stressful and difficult situations. Since addiction is considered to be a gruesome disease, the only way to break from it is by seeking help from professionally trained counselors.
The counselor guides the individual through the rehabilitation program. It is only through the help of a trained counselor that an can addict start making rational decisions while starting to enjoy a healthy living. The professionals give advice regarding management of withdrawal symptoms that are associated with numerous relapse (Inaba & Cohen, 2007, p. 32).
Incorporating a detoxification program must be encouraged for individuals willing to manage their addiction. Considering the developed dependency, the addicts are provided with a place where they can manage their withdrawal symptoms.
Firm commitment and efficient application of a detoxification program offers the right combination for long lasting treatment to living a sober life. Experiences during rehabilitation and the reflections an addict undergoes are pivotal in creating a positive change in the mind and live of addicts (Holtzman, 2010, para. 13).
Diagnosis of opioid dependency is paramount in preventing persistence of physical and mental health damage. Although, it is very difficult to differentiate hydrocodone withdrawal symptoms due to similarities with other mental conditions, identification of dependency particularly before an individual being engaged in a meaningful task is a clear indication.
Most importantly, preoccupation with usage and involvement in certain chores are paramount in distinguishing the case. Continued and compulsive utilization of the drugs even after learning of its adverse consequences is another indicator that is vital in diagnosing the condition. Relapse of the drug effects should be considered as a clear indicator of chronicity with regard to hydrocodone.
In order to attain a successful diagnosis, combination of several techniques is encouraged. In view of this, taking into consideration the risk factors that a person is exposed to helps in developing a clear picture of the diagnosis (Huppert & Roth, 2003, p. 64).
Engaging the client and family members in interviews also provides the physician with an opportunity to come up with an effective diagnosis while at the same time deciphering the level of progression. In addition, utilizing collateral information from other health record plays a major role in corroborating and influencing decision making considering the fact that dependency is a gradual process which is manifested over a considerable duration.
In addition, establishing the usage of the drugs in relation to their consequence will aid in understanding the body organs or systems which could have been affected by intoxication. Establishing both physical and psychological diagnosis is also important in developing linkages between the two diagnostic criteria. DSM-IV diagnostic criterion is the most utilized in United States due to its holistic nature and broadness which ensures effective establishment of addiction disorders.
Analysis of social factors affecting addiction
Hydrocodone addition is a common phenomenon amongst various societies around the world. The addict is excessively protected from discrimination by the rest of the society particular with regard to the right to access medications. In addition, buying drugs in over- the-counter should not be pegged on valid prescriptions but on demand by the customers.
On the other hand, authorities in various parts of the world should protect the consumers from overexploitation by pharmaceutical companies. This can be attained by ensuring affordability of their drugs by incorporating small packets in their packaging process.
Prevalence of hydrocodone addiction cuts across ethnic and cultural diversity with regard to population dynamics. In the United States, the Hispanics and African Americans are slightly high affected by this problem compared to the whites in other countries. The most important aspect is the degree of to which long term rehabilitative is embraced.
Majority of the addicts did not perceive the value of enrolling in rehabilitative centre due to lack of information regarding the potential risks posed by the intoxication of vital organs. The discrepancy may have resulted from differences exhibited in their health seeking behavior. For example, African Americans lag behind with regard to acquiring health insurance and belief in culture (Powell, 1991, p. 32).
Management of interventions targeting hydrocodone addiction must consider certain ethical considerations that are aimed at protecting patient’s rights and upholding their dignity. Counselors encounter dilemma particularly while offering linkages and continuity between evidence based research and practice.
Demand for specific and much necessary credentials in a certain profession before offering service to patients is also an ethical dilemma which continually affects counselors and other health care providers. In addition, issues regarding communication and to a large extent confidentiality must be observed at all times taking into account the associated stigma from the society. In addition, care providers must also uphold regulations which require them to seek informed consent especially during unusual circumstances (Holtzman, 2000, p. 210).
Trends in diagnosis and treatment
Diagnosis of addictive and compulsive behaviors is usually achieved through DSM-IV framework carried out by a psychiatrist. The method is effective and holistic since it takes into account patient presentation and assessment of doctors in reference to the guidelines (Blanco et al, 2000, p. 948).
However, its application is limited especially in areas where there are few qualified medical personnel. In addition, its reliance on manifestations of obsessions and compulsions may lead into a wrong diagnosis since the symptoms are concordant with other mental disorders.
Medication is not effective compared to behavioral therapy. This arises from the fact that it does not instill the much needed commitment so as to sustain long term compliance (Allan, 2009, p. 23). Use of benzodiazepines has been proved to be ineffective with several strains of antidepressant depicting slowness in achieving the desired impact. In summation, combination of two or more methods of treatment is encouraged in boosting effectiveness of intervention.
Interventional approach
Several approaches have been utilized in management of addicts with varying success based on individuals or groups. Individualized drug counseling is a direct approach aimed at reducing or positively influencing an addict’s behavior. With regard to this, the approach conjoins other confounding factors in related to intervention. Considering their contribution towards choice of prescription drugs over seeking full medication, it is paramount to integrate the method.
In addition, the method addresses issues related to content and the overall structure of the recovery program used on the patient. Despite the fact that the approach greatly emphasis on the need for short term behavioral goals, it plays a major role in helping the patient to develop useful coping strategies. In addition, it strengthens tools which are useful in instilling and maintaining abstinence especially among drug addicts (Mercer & Woody, 1999, p. 43).
In this approach, addiction counselor encourages embracement of a 12 step approach which sets a platform for making referrals to essential supplies (Mercer & Woody, 1999, P. 43). The much needed psychiatric employment coupled with supplemental medical and other services are among the supplies which enhance efficacy of this program. Concerned individuals are required to avail themselves at least two times in each week in order to attend the counseling sessions while communicating their progress to the counselor.
The efficacy of this interventional approach has been tested and positive empirical findings reported. For example, a comparative analysis of opiates addict who were taking methadone regimen with another group receiving the same dosage of methadone coupled with counseling revealed significant differences (Stein, 1995, p. 87).
Slight improvement in health was observed in the group receiving methadone only while enhanced and significant improvement was reported in the other group that utilized a combination. Consideration of confounding factors such as employment and workplace environment was responsible for making substantial improvement in relation to the overall outcome of the treatment (Galanter & Pattison, 1984, p. 65).
To reinforce the effectiveness of the intervention, application of specific regimen of medication depending on the sensitivity of each individual combined with counseling would enhance recovery at a faster rate while minimizing side effects in the body. This would serve in boosting adherence to the recovery program thus translating into life time commitment in order to maintain the change and abstinence attained.
Limitations to the counselor
Care providers are faced with a challenge when attending patients due to the holistic environment in which they operate from. As an addiction counselor, the client remains at the centre of the recovery program thereby necessitating consideration of their values in the overall rehabilitation process.
The counselor may face limitations particularly if the cultural background, preferences and personal beliefs of the patient differ from the values held by the counselor and the hospital. If the values of the patient are divergent from those of the counselors, a referral is facilitated to a facility where the values are similar.
This mainly occurs if a suitable professional who uphold the same values is not found within the ranks of the establishment. In addition, the counselor is required to seek advice from the immediate supervisor particularly when cases of ethical dilemmas are noted.
Consultations are imperative since they provide the counselor with authority to conduct the procedure or another solution to the predicament faced. In tandem with consultations, the counselor and the patient must discuss pertinent issues in order to attain consent of the patient before implementing the intervention program. Failure to engage in constructive dialogue with the patients as a result of constraints or barriers is a common occurrence in the counseling session.
Addiction may culminate into development of mental disorders. This may curtail the patient’s communication prowess. Considering the fact that counseling is dependent on exchange of information for it to be effective, the counselor may be required to consult the supervisor or one of the family members who is recommended by the patient (Mercer & Woody, 1999, p. 54).
Professional issues in addiction
Despite the fact that medical field is reminiscent of ethical challenges, the counselors in charge of addiction encounter specific and unique ethical challenges that area characteristic of their profession. The addiction counselors are faced with a dilemma on the boundaries of practice in the profession in relation to making pertinent treatment decisions.
The decisions taken must be in line with the federal statues. In addition, the hospital policies must be consistent with the laws of the land. Respecting confidentiality of patient management is also essential. The counselor has the mandate to protect the contents of the privileged communication between the patients with him/her (Powell, 1993).
Addiction treatment is mainly dependent on emotional detachment and faith for effective recovery to occur. Despite the lack of advanced research on management of the addiction, specific interest has occurred with regard to chemical addictions thus ushering in the linkages between empirical findings and practice.
While addiction has continually been perceived as a behavioral and sociological problem, empirical findings have revealed that chemical addiction as a form of brain disease results from destabilization of biochemistry and anatomy of specific neurons in the brain. Alteration of brain functioning interferes with normal operation of the body mechanisms such as homeostasis and communication (Gutstein & Akil, 2001, p. 23).
In addition, genetic factors are believed to enhance inception of dependence while also influencing people to have varying vulnerability to disorders. Despite advancements in research, minimal integration of empirical finding has occurred in modern day treatment programs.
Conclusion
Hydrocodone addiction has continued to be persistent and increasing crisis the United States. However, the problem receives minimal attention compared to other illegal drugs such as marijuana, heroin and cocaine. Addictive and compulsive behaviors have continually affected the design and prevention programs due to their complexity and dynamic nature.
The values and preferences of the patient must be at the centre stage when implementing the recovery program. Observance of confidentiality and ethics is imperative in the overall success of the recovery program.
Utilization of a combination of treatment methods offers a better alternative especially when dealing compulsive behaviors. Individualized drug counseling offers the best interventional approach especially when the medications being used are tested for sensitivity in the individuals to minimize side effects.
Ethical dilemmas and communication barrier are the main limitations encountered by addiction counselors when executing their duties. For treatment to be effective, it is imperative to integrate empirical findings into the clinical practice in order to enhance the efficiency of the interventional approaches. Concerted efforts are needed by al stakeholders in order to win the fight against hydroconode addiction.
Reference list
Alan, F., Schatzberg, M., Nemeroff, C. & Ballon, J. (2009). The American Psychiatric Publishing Textbook of Psychopharmacology (Schatzberg, (4 Ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
Blanco, C., Olfson, M., Stein, D., Simpson, H., Gameroff, M. & Narrow, W. (2006). Treatment of obsessive-compulsive disorder by U.S. psychiatrists. Journal of Clinical Psychiatry 67 (6), 946–51.
Galanter, M., & Pattison, E.M. (1984). Advances in the Psychosocial Treatment of Alcoholism. Washington, DC: American Psychiatric Press.
Gutstein, H. & Akil, H. (2001). Opioid analgesics. In: Hardman, J. & Limbird, L. ed. In Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th Ed. New York, NY: McGraw-Hill.
Holtzman, E. (2000). Addictive Behaviors, Compulsions and Habits: A Spectrum of Need Intensity. Web.
Huppert, K. & Roth, J. (2003) Treating Obsessive-Compulsive Disorder with Exposure and Response Prevention. The Behavior Analyst Today, 4 (1), 66 – 70.
Hydrocodone. (2003). The Facts about Hydrocodone Addiction. Web.
Inaba, D. S., & Cohen, W. E. (2007). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (6th ed). Medford, OR: CNS Publications Inc.
Mercer, D. & Woody, G. (1999). Therapy Manuals for Drug Addiction Series: Individual Drug Counseling. Web.
Powell, D. J. (1991). Supervision: Profile of a clinical supervisor. Alcoholism Treatment Quarterly, 8(1), 69-86.
Powell, D. J. (1993). Clinical supervision in alcohol and drug abuse counseling. New York: Lexington Books.
Stein, C.S. (1995). The control of pain in peripheral tissue by opioids. New England Journal of Medicine, 332, 1685–1690.