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  1. BitterSweet
    19884.jpg You’ve hit bottom and want help for your drug addiction. Where do you turn?

    The answer lies in a patchwork of residential drug-rehabilitation centres and non-residential self-help programs, counselling, and treatment services.

    Some programs are strictly psychological interventions, while others involve the use of medication. Programs can be motivational or confrontational, one-on-one or as part of a group.

    What works?

    “There is no agreement. You’ll get a variety of dogmatic opinions. But basically you’re condemned to have a variety of opinions as to what’s best,” said Bruce Alexander, a professor emeritus of psychology at Simon Fraser University.

    Drug-treatment strategies have come under scrutiny in the wake of the death of 31-year-old Canadian actor Cory Monteith, star of the hit TV series Glee, from a heroin and alcohol overdose.

    Monteith had reportedly checked himself into a drug-rehab facility — it is not known where — in April. His death in a Vancouver hotel last weekend prompted headlines like “When Rehab Doesn’t Work” and “How the Drug Treatment System Failed Cory Monteith.”

    Similar questions followed the alcohol-related death two years ago of singer/song writer Amy Winehouse, whose single “Rehab” included the lyric, “They tried to make me go to rehab, but I said, ‘no, no, no.’”

    Figuring out the best course of treatment depends on your profile, experts say. Are you an occasional user or an everyday user? For two years or two decades?

    Those who are more severely addicted, for instance, might be better suited going to an in-patient treatment facility.

    Whether attending an in-patient or out-patient program, approaches vary widely in terms of the counselling clients receive.

    One approach, called motivational enhancement therapy, gets the client to reflect on the consequences of their drug use on their health, their relationships, and priorities in life, said Julian Somers, a clinical psychologist and professor at SFU.

    Sometimes, delivering the hard facts can be quite impactful, such as telling a client that consuming a certain amount of a drug, at their weight, could be lethal, he said.

    Other strategies might focus on addressing the possible roots of someone’s drug use, such as a childhood trauma, and helping them develop other coping skills. (Monteith’s troubles reportedly began following his parents’ divorce when he was young).

    Another approach might be to get the client to focus on scenarios that lead to drug use, and finding ways to avoid those scenarios. If drugs were used in the past as a way to unwind or to celebrate an occasion, for instance, are there alternative activities?

    Some programs require complete abstinence from day one of treatment, while others identify ways of reducing harm without necessarily requiring abstinence. This latter approach recognizes that some people are unprepared to stop their drug use and puts more emphasis on minimizing the risks of death, disease or injury.

    Tim Stockwell, a professor of psychology at the University of Victoria, said one of the pitfalls of abstinence-centred programs is after a period of abstinence, tolerance levels drop, so if a client relapses and uses the same dosage they had used before treatment, they could overdose.

    Drug-based therapies are not fully developed but some have shown promise. Methadone, for instance, has been used to treat heroin addicts. Because it is an opiate substitute, it helps to prevent the onset of withdrawal symptoms, while also blocking the euphoric effects of heroin, according to a Health Canada study examining substance abuse treatment.

    In an article in Scientific American following Amy Winehouse’s death, Bankhole Johnson, a professor of neuroscience at the University of Virginia School of Medicine, said while there wasn’t a good drug yet for cocaine addiction, there were drugs to help treat alcohol and opiate addictions.

    “I don’t believe that traditional rehab using self-help methods is effective. In fact, the data suggest that they’re not much better than spontaneous rates of recovery,” he was quoted as saying.

    “The medicines that work are better than the psychological treatment alone.”

    One growing area is pet or animal-assisted therapy, pairing drug-addicted individuals with dogs, cats, even horses, as a way to help them relieve stress and anger and feel compassion.

    A high-tech experimental treatment developed out of Duke University uses video software to expose drug-addicted individuals to a virtual world that might simulate a crack den, for example, and then aims to help them control their cravings.

    Following an intensive phase of treatment, experts agree follow-up care is critical to success. That means ensuring that individuals have support from professionals, family and friends who can help them stay on track.

    “It’s not a one-quick fix,” said Colleen Dell, professor of sociology and public health, and research chair in substance abuse at the University of Saskatchewan.

    Somers said while a lot of treatment programs have been set up to help drug-addicted individuals with severe or complex needs, such as those with mental disorders, who are pregnant or who have HIV/AIDS, there still remains a lack of programs for the majority of people with addictions.

    That said, he acknowledged that Canada has been a “pioneer” in certain areas, including providing services to homeless people with addictions and in its treatment of criminal offenders who are drug-dependent.

    A report a few years ago by the National Treatment Strategy Working Group in Ottawa identified the harmful use of alcohol and drugs as a $40-billion-a-year problem in Canada and called for greater integration between health and social service providers to help those with substance abuse problems.

    “The vast majority of Canadians affected by substance abuse problems do not use specialized addiction services. However, they do access other sectors of the health-care system — as well as other systems such as social services, housing and education,” the report said.

    “Research findings suggest that providing appropriate services and supports across a range of systems not only reduces substance use problems but also improves a wide range of outcomes related to health, social functioning and criminal justice.”

    ***

    Questions to ask when considering substance-abuse treatment:

    *Does the provider conduct an assessment to develop an individualized treatment plan?

    *Does the provider vary the treatment plan according to the severity of the client’s problem?

    *Does the provider insist on abstinence or will they accept clients who wish to reduce their use?

    *Does the provider offer a range of services to address all relevant needs?

    *Does the treatment plan change according to the client’s changing needs?

    *Does the provider offer after-care and post-treatment support?

    Author: Douglas Quan, PostMedia News
    Date: July 19, 2013
    Source: Canadian Centre on Substance Abuse
    http://www.vancouversun.com/health/Where+turn+when+rock+bottom/8683743/story.html

Comments

  1. Crystal_Queen
    Re: Canada's Patchwork of Drug Treatment: Where Do You Turn When You've Hit Rock Bott

    I actually disagree... there are NO options in Canada..
    they put you on a waiting list...6 months later they pair you up with a doctor.
    If you don't agree with his/her treatment options...your back on a list.
    and its your fault for being "difficult" . It would be nice to "shop around" for a dr. like in the US as
    terrible as that sounds lol..we should be able to "pick" our drs based on their records...not them
    picking us based on how easy we are to treat. lol
  2. varuka
    Re: Canada's Patchwork of Drug Treatment: Where Do You Turn When You've Hit Rock Bott

    crystal queen
    that sounds terrible!!!
    my pet rock just started a subutex program last week, she called to schedule an appointment and two days later she was sitting in the dr's offics. Now, it was $800. for one visit and she has to return in two weeks, it'll be 200. for that visit, and then 200. a month per month per visit forever after. and my god dont get me started on the price of the meds!!! but, i guess we Americans get sp pissed off about the price of our healthcare that we forget how lucky we are to be able to pick up the phone and go. IF IF IF IF IF you have that $$$$$$$. it makes the world go 'round.
  3. BitterSweet
    Re: Canada's Patchwork of Drug Treatment: Where Do You Turn When You've Hit Rock Bott

    My experience with the Canadian health care system (both for physical and mental illnesses) has been fairly well; it is hit and miss with doctors. I found a good centre that is sort of an establishment of all around mental health care - they have psychiatrists for every mental illness under the sun, and you can choose which psychiatrist you wish to work with, of course some are more expensive than others, and without insurance at this place, it can be costly ($100/hour to see my psychiatrist) and the one hour meetings are basically just a repeat of all the meetings before.

    But there are also general therapists who are good to work with, so you can have all your mental health needs in one cooperative centre. However, this is not specific to addiction. Addiction services, in my experience, have been crap. As for government funded initiatives like providing people with safe needles or funding methadone programs, I've never had to personally experience them but I am sure for those who need such help are appreciative to a certain extent (particularly for needle users). I've seen what government funded detox centres look like, and I wish I had known before I went in that it really was a place for people coming off the streets. Other than that, it is near impossible to find a medical detox centre, except for some of the major hospitals, but there is a waiting list. And once you get in, I don't think it's very good.

    I tried one inpatient rehab centre in 2010, apparently one of the better ones, at the tune of $6,000 for 28 days - what a joke! If that is higher end, well, I don't want to see lower end. I've tried free addiction counseling services, which was actually one of the better addiction treatment resources I found in the community. The one hour a week with an addiction specialist was much more valuable in treating my addiction then the weekly therapy sessions with my hired therapist at the centre I go to. But eventually my counseling sessions were so repetitive that there was nothing new to talk about at weekly sessions; I was not practicing any of the things I was supposed to be, and thus everything was like a broken record.

    There are other types of things; hotlines if you need someone to talk to (that are free) and you can reach someone immediately, particularly encouraged if you are feeling suicidal. And of course there are lots of 12 step program meetings everywhere. I figure that addiction can really be just a symptom of greater issues, especially if mental illness existed prior to the addiction (true in my case), so using resources to treat the reason I feel I need to use helps me the most. All in all, the resources are there and I don't expect them to be perfect, but they are very scattered, and one bad experience can put a person totally off trying new things. I have had a lot of bad psychiatrists and doctors but also a few good ones. I take the ones I don't like with a grain of salt, and I immediately try to get a new one. But once you find a suitable psychiatrist and general practitioner (of course the process of being referred to specialists can take a while, and you need to be referred to a psychiatrist by your general practitioner).

    I've always great insurance coverage under my mom, and I see how much my meds cost without insurance; there is no way a person could afford the costs of basic medications like SSRIs. From what I know of the American health care system, I think it sounds horrible. I like Canada's health care system; if something is wrong you can walk into a hospital and see a doctor. From what it sounds like in America, such a random hospital visit would actually cost money.

    I heard the health care system in France is excellent; I don't know about the European countries, Australia, China, etc. though. Could be interesting to see how these countries handle their health care.
  4. bobes
    Re: Canada's Patchwork of Drug Treatment: Where Do You Turn When You've Hit Rock Bott

    As a former therapist at CAMH, I drew the conclusion that there are very few options for Canadians (and their families...and far fewer effective ones. )

    In Toronto, withdrawal management services (detoxes) consist of waiting lists for dusty concrete rooms with rows of rusty beds and thin blankets. Support consists of food shelter, time to detox and encouragement to attend aa/na/?a Supervision is provided by dreary peacekepers.

    Treatment options for Canadians include waiting lists for a variety of loosely associated 28 day "experiences" which consist primarily of pseudo cultist indoctrinations to aa/na/?a . Participants usually emerge well fed, rested and invested with a sense of pride for enduring the process. Lack of follow-up or meaningful aftercare result in dismal medium term success. Glowing 90% success rates emblazoned across glossy brochure covers are a result of the disappearance of the those who relapse or self evaluated testimonials not supported by drug testing.

    Access to the low to medium end retreats can be immediate if accompanied by $8-30K cash enrollment fees. Those relying on their health insurance wait weeks or months. Those without health insurance are all waiting many, many months for a few "community beds" set aside.

    Some clients consider it a resort/holiday experience if they are low income.

    CAMH which has a large share of funding differs in that they support the aa/na/?a doctrine but focus on a harm reduction modality.

    I also worked amongst a relatively smaller subset of private sole or small group independent practitoners using either treatment modalility . I suspect they could fare better due to the greater focus on the individuals specific needs.

    Often the victims who suffer most are families who watch their loved ones fail and fail again without much real support, hope or encouragement.

    But in closing I must stress that, in my opinion, and before I sound like Im condemning our system......
    the single greatest obstacle to helping Canadians solve their addiction problems is simply the lack of a cure to the disease. And the final insult is the stigma of moral failure as a result of relapse. No similar stigma is associated with the real tragedy of cancer victims....buts thats another whole vent

    bobes
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