• Leading Edge Psychotherapy: The psychotherapy team

    Posted on July 24, 2013
    A psychotherapy team involves multiple therapists who meet successively with the same client for individual therapy. Therapy teams have begun to emerge, in varying degrees, in a few state-of-the-art addiction treatment facilities. Their emergence may have occurred somewhat serendipitously but as Pasteur remarked “chance favors the prepared mind.” To my mind the experience with the team format highlights the illusion of believing that a client exists as such and that the client’s problems or difficulties exist as such. By “as such” I am referring to the idea that the client and his or her difficulties can be apprehended or discovered as they “really” are, objectively, in pretty much the same way that a physician (with the help of lab tests, etc.) can detect/diagnosis an established me...
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  • Addiction and Youth

    Posted on July 24, 2013
    Addiction, Recovery and Society How society should view addiction Ending recoveryism Let’s stop insisting addiction is a disease Will insurance cover addiction treatment if addiction is not a disease? AA’s dominance in the US is harmful Court-ordered 12-step attendance is illegal CRAFT: An alternative to addiction "intervention" Substance abuse evaluations in child custody cases Addiction and youth Teach teens drinking before it kills them Why do college students drink so much? Why does anyone? From adolescent substance experimentation to addiction Helping your troubled teen without making things worse Alcohol advertising targets youth Addiction impaired professionals On June 30, 2008, the state of California stopped its medical diversion program.  ...
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  • Herbal remedies and acupuncture for addiction recovery

    Posted on July 24, 2013
    Traditional Chinese medicine revolves around herbal remedies and acupuncture. Might these ancient therapies be successfully used in modern addiction treatment? Chinese and American researchers studied the existing evidence and concluded that, although more testing is need, some traditional remedies can compliment modern medicine for promoting addiction recovery (Lu et. al., 2009). The research team examined texts and computerized literature concerning treatment and neurobiology of herbal medicines as well as acupuncture for drug abuse and dependence. They found that acupuncture showed evidence for clinical efficacy in opiate withdrawal, but it showed poor efficacy for alcohol and nicotine withdrawal and relapse prevention. No large studies support the efficacy of acupuncture for coca...
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  • Residential addiction treatment: Possibly helpful, probably not essential

    Posted on July 24, 2013
    Residential addiction treatment: Possibly helpful, probably not essential A. Tom Horvath, Ph.D., ABPP The reason almost all health insurance companies have stopped paying for residential addiction treatment is that the effectiveness ofresidential treatment and outpatient treatment has been compared many times, with no advantage being found for residential treatment.  The July, 1986, issue of the American Psychologist contains the definitive article (by Miller & Hester) on this subject.  Their article “reviews findings from 26 controlled studies, which have consistently shown no overall advantage for residential over nonresidential settings.”   You might question whether a 1986 article would still be relevant this many years later.  However, more recent evidence has not led to ...
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  • Levels of care in addiction treatment

    Posted on July 24, 2013
    Levels of care in addiction treatment A. Tom Horvath, Ph.D., ABPP There are many places you might receive assistance for overcoming addiction.  These places are generally referred to as “levels of care.”  By understanding the levels available you can choose the level most suitable for you.  We start with the least complicated and expensive level and work up.  We leave out detoxification (withdrawal), which occurs across several levels depending on how severe it is.  A comprehensive list of US addiction treatment facilities, across all levels of care, is provided by the federal government: http://findtreatment.samhsa.gov/ Natural recovery.  There is no professional or organized care involved at this level.  Natural recovery is the process of using your natural environment to he...
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  • Drug treatment and drug rehab for individuals with disabilities

    Posted on July 24, 2013
    Research shows that substance abuse is a significant problem for individuals with physical, mental, or psychological disabilities. In fact, as a whole, individuals with disabilities use alcohol and other drugs as much or more than the general population, and they are at greater risk for problems associated with substance abuse (Moore, 1991). However, little research has examined substance abuse, drug treatment and drug rehab for individuals with disabilities. When treating a primary disability, healthcare practitioners may fail to recognize secondary substance abuse. Substance abuse disorders often reduce the already-scant resources of a disabled individual. For example, many disabled people have limited social resources and low socioeconomic status; these problems are often exacerba...
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  • Melancholia and stimulant drug recovery

    Posted on July 23, 2013
    Major depressive disorder (MDD), or clinical depression, is characterized by low mood, low self-esteem, and loss of interest or pleasure. The DSM-IV recognizes five subtypes of MDD. Could different subtypes of MDD affect drug recovery for different substances? If so, a drug rehab would need to consider these subtypes when treatment plans are formulated. To begin, let’s review the subtypes of MDD. The five subtypes are as follows: Seasonal affective disorder (SAD) typically occurs during the autumn or winter months and resolves in the spring. The diagnosis of SAD can be made if at least two depressive episodes have occurred in colder months with none at other times, over a time frame of at least two years. Postpartum depression refers to an intense depression experienced by wome...
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  • How personality disorders might affect drug rehab and addiction recovery

    Posted on July 23, 2013
    Cluster B personality disorders (e.g., borderline personality disorder) and substance use disorders (SUD) are both marked by impulsivity and poor behavioral control. Previous studies (e.g., Taylor, 2005) have found evidence that symptoms of cluster B personality disorder and SUD are significantly and positively correlated. Because of accumulating evidence which suggests that personality disorders are prevalent in opioid dependent populations, along with evidence linking cluster B personality disorder characteristics and SUD severity, Murray et. al. hypothesized that opioid dependent patients with cluster B personality characteristics would have elevated methadone dose prescriptions (2008). Such a finding would have immediate implications for the doses of methadone, and possibly other me...
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  • Modafinil with CBT may improve drug rehab for gay men with HIV

    Posted on July 23, 2013
    Methamphetamine use has been linked to increased risk of human immunodeficiency virus (HIV) among gay men. Methamphetamine is a highly addictive stimulant that may lower inhibitions, increase sexual arousal, and lead to risky sexual behavior such as unprotected sex. Further, methamphetamine may be injected, and needle-sharing is also a risk factor for HIV.  These two epidemics have spread concurrently among gay men. There is a need for specialized approaches for addiction treatment and drug rehab for gay men with HIV, if such approaches could be developed. Researchers from the New York State Psychiatric Institute and Columbia University evaluated the efficacy of modafinil plus cognitive behavioral therapy as a treatment for methamphetamine dependence among gay men with HIV (McElhiney...
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  • Drug rehab may soon include pharmacogenetics

    Posted on July 23, 2013
    Pharmacogenetics looks at genetic variation to predict individual differences in response to medications. Individuals may metabolize the same medication in different ways, and their genotype may indicate some of these differences in drug metabolism. Proponents of pharmacogenetics hope that this relatively new field of study will lead to increased efficacy and safety for a wide array of drugs, including those used for addiction treatment. The addiction medicine aspects of drug rehab may be substantially improved if pharmacogenetics lives up to its promise. Haile, Kosten, and Kosten researched how genetic variation might affect responses to cocaine, amphetamine, and methamphetamine and how genetic differences might guide pharmacotherapy. They performed a cross-referenced literature sea...
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