Best Practices in Addiction Treatment

How an Understanding of Trauma Informs the Development of the Interventions

Most soldiers suffer from Post Traumatic Stress Disorder (PTSD) due to the exposure to traumatic incidences during the course of dispensing their mandate. Studies have established a great connection between PTSD and addiction. This assertion holds because most soldiers struggling with addiction also exhibit signs of PTSD. According to recent statistics from the Department of Veteran Affairs, about 2 out of 10 retired soldiers suffering from PTSD also struggle with alcoholism, hence an indicator that substance abuse among the veterans is closely linked to trauma (Volkow, 2011). In addition, the statistics indicate that 1 out of 3 veterans seeking treatment for substance abuse also suffer from PSTD.

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Nurses and other medical staff engaged in the provision of medical treatment for veterans are well versed with the stressful situations that veterans go through (Potenza, 2008). Research indicates that treatment is more effective when both PTSD and drug addiction interventions are run concurrently than dealing with each problem at a time. Guided by research findings by different scholars, nurses in the Department of Veterans have thus adopted treatment methods that facilitate dealing with both problems simultaneously in a bid to ensure that the desired results are achieved (Seal et al., 2012).

In the veterans’ department, care is afforded in stages after the recognition that the two problems cannot be eradicated in the short term. Therefore, long-term intervention measures are needed due to the trauma, which is evident amongst the veterans. However, in some cases, the emphasis is laid on the causes of addiction as opposed to the problem of addiction itself. In such cases, nurses concentrate on treatment based on the common PTSD symptoms.

The Neurobiological Processes and Behavior Consequences of Addiction

The “neurobiology of addiction involves more than the neurochemistry of reward” (Seal et al., 2012, p. 946). The frontal cortex of the mind and the primary white matter linkages “between the frontal cortex and circuits of reward, motivation, and memory are fundamental in the materializations of deformed impulse control, altered judgment, and the dysfunctional pursuit of rewards, which appears as a desire by the affected individual to look normal” (Seal et al. 2012, p. 946).

The frontal lobes are imperative in hindering impulsivity and helping human beings to delay indulgence aptly. In cases where individuals suffering from addiction exhibit problems “in controlling their gratification, there is a neurological locus of these problems in the frontal cortex” (Potenza, 2008, p. 3185). Research indicates that the frontal lobe morphology, connectivity, and functioning continue to grow in one’s lifetime and thus exposure to drug and substance abuse harms or deters growth, which causes adverse effects on the behavior of the affected individual. Early “exposure to drugs and other substances may have severe consequences on the development of the frontal lobe morphology, connectivity, and functioning, and thus it increases the risk of addiction” (Potenza, 2008, p. 3185).

Addiction causes great impairment in the functioning of the brain since it attacks some sections of the brain slowly, thus causing problems in perception, wisdom, impulse control, compulsivity, and judgment. Persons struggling with addiction are often reluctant to calls for change in behavior. In addition, alcohol and drug abusers exhibit a perceptible lack of pleasure of the enormity of cumulative dilemmas and complications

The Bio-Psycho-Social-Spiritual Impact of Addiction on Individuals, Families, and Society

Psychosocial development is a continuous development process that occurs in one’s lifetime (Glasner-Edwards & Rawson, 2010). However, the development may be altered by certain factors, which include stress, addiction, and exposure to traumatic incidences among others. However, addiction is the most notable cause of retarded psychosocial development. Most people suffering from addiction are prone to the problem of addiction.

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Persons with addiction problems tend to avoid intimate relations and they often prefer living alone (Miller, Sorensen, Selzer & Brigham, 2006). This aspect could be used to explain the reason why most veterans are divorced and they have tendencies of engaging in harmful activities such as unprotected sex. Addiction leads to low self-esteem among the drug users, and in most cases, they tend to live in isolated places to avoid mixing with other members of society. Since the addiction problem among veterans is connected to stress and trauma, the effects on their mental health cannot be overlooked.

The Cultural Factors that Affect Assessment and Interventions of Addiction

Despite the established guidelines for healthcare provision requirements for nurses and other medical staff, the issue of culture and religion must be considered while meeting the health care needs for patients in a clinical setting (Potenza, 2008). Cultural beliefs vary from one individual to another and certain forms of treatment may not be accorded to some patients due to socio-cultural inhibitions. Therefore, nurses must be careful when recommending certain types of treatment to addiction patients. Apparently, what may seem fit to the healthcare provider may be prohibited culturally to the patient.

One of the cultural barriers to treatment of addiction is the belief by certain communities on non-disclosure of personal information to medical staff. This barrier is most notable amongst American immigrants who believe in non-disclosure of information concerning their personal lives. Given that addiction treatment involves counseling; such individuals will be reluctant in disclosing their addiction status to healthcare providers, thus delaying health care provision or preventing it all together (Petrakis, Rosenheck & Desai, 2011).

Stigma is another cultural factor that greatly affects treatment of addiction and it is common in the Asian communities living in America (Miller et al., 2006). People suffering from addiction are prone to stigmatization from other members of the community, which leads to their reluctance in seeking medical attention from healthcare professionals. Moreover, some communities believe in other forms of medication and they rarely rely on the modern medication for treatment (Seal et al., 2012). Therefore, it becomes hard for nurses to administer treatment to such groups.

The Most Current Evidenced Based Practice for Addiction Treatment

Opioid Addiction

Methadone is one of the most recognized drugs for the treatment of problems related to opioid addiction as it produces the desired results when combined with behavioral therapy (Volkow, 2011). Opioids are meant to relieve pain, but currently, they are commonly used amongst persons suffering from PTSD. The administration of methadone blocks the impacts of illicit opioids coupled with reducing cravings for the drug among its users. It is highly effective when combined with behavioral therapy such as group counseling. Naltrexone is another effective drug in the treatment of opioid-related addictions. Just like methadone, naltrexone has been in use for a long time in the US (Glasner-Edwards & Rawson, 2010). Naltrexone reverses the effects of opioids and the treatment is based on the principle that the absence of the desired feeling within an addict will compel him/her to quit the abuse.

Alcohol Addiction

Opioid abuse has been identified as one of the leading causes for craving alcohol among its users (Potenza, 2008). Given that Naltrexone reverses the effects of opioids, it is an effective medication for the treatment of alcoholism prompted by opioid addiction.

Acamprosate

Acamprosate is another important treatment method that has been approved by the Centre for Disease and Control (CDC) for the treatment of alcoholism (Fontana & Rosenheck, 2008). The drug reduces the symptoms associated with the sudden withdrawal from alcoholism. Other medications that have been tested and recommended for treatment of alcoholism include Disulfiram and Topiramate (Volkow, 2011). Disulfiram is used to induce undesirable reactions such as nausea, vomiting, and palpitations upon intake of alcohol by the abuser. The above treatments produce good results when integrated with behavioral therapy. Behavioral therapy imparts skills to the patient that enables him/her to fight addiction effectively with the help of medication.

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Cognitive-Behavioral Therapy (CBT)

CBT is combined with other medications in order to produce the desired results in the treatment of addiction to alcohol, cocaine, and other substances (Petrakis et al., 2011). CBT involves imparting coping skills to the victims of addiction, which include skills to identify the positive and negative consequences of substance abuse coupled with self-monitoring skills meant to empower client to identify cravings in early stages and developing the requisite skills to avert it (Potenza, 2008). Research indicates that the skills acquired by the recipients remain viable even after quitting the behavior.

Motivational Incentives Method

This method of treatment involves the use of incentives to cause behavior change among drug addicts exhibiting undesirable behaviors due to addiction (Volkow, 2011). The method has worked effectively in reducing addiction to marijuana, alcohol, tobacco, and opioids among other popular drugs. Studies conducted to determine the effectiveness of the treatment reveal that the method is successful in motivating drug abusers to accept medication coupled with promoting abstinence.

Community Reinforcement Approach Plus Vouchers

This approach involves a 24-week intervention plan and it targets persons suffering from cocaine and alcohol addictions (Glasner-Edwards & Rawson, 2010). The therapy is integrated with material gifts in the form of vouchers to cause behavior change amongst the patients. The treatment aims at achieving abstinence through incentives aimed at maintaining the abstinence state amongst the patients.

The Legal and Ethical Issues Inherent in the Model of Practice in the Field of Addiction

In providing treatment to veterans involved in alcoholism and drug abuse, nurses and other medical staff are locked in ethical dilemmas. Some of the issues that are inherent in the field of addiction include

Justice

The medical code of ethics requires all patients be afforded equal treatment irrespective of age, gender, or status (Fontana & Rosenheck, 2008). In affording care for the veterans, personal prejudices ought to be shelved in a bid to achieve effective and fair treatment to all in accordance with the principle of justice. Given that drug addiction interventions involve persons with impaired judgment, the principle may present controversies in individual cases depending on the attention required by the client. Nurses taking care of the veterans need to understand the principle of counter-transference, which denotes the conscious reactions to the client’s demands. Drug addicts may be stubborn, thus prompting nurses to respond negatively to their demands.

Beneficence

This principle requires healthcare providers to act in a manner that maximizes the benefits accruing to the patient and minimize the chances of harm (Volkow, 2011). In taking care of alcoholic individuals, care must be taken concerning their culture and social norms since they may not be congruent with what the nurses see as good (Seal et al., 2012). In other words, some actions may be executed in good faith, but they may contradict the client’s religious and cultural beliefs.

Boundaries

The issue of boundaries is another source of controversy in treatment against alcoholism and substance abuse (Potenza, 2008). The principle of boundaries requires that healthcare providers to cease from engaging in boundary violations such as engaging in an intimate relation with the client, acquiring personal gains, or other gestures that may be misinterpreted (Miller et al., 2006). However, some scholars have tried to draw a line between beneficial and harmful boundaries by claiming that relations meant for the benefit of the client are justified, since they produce the desired results.

Confidentiality

The principle of confidentiality requires the privacy of the clients’ information to be maintained at all cost (Glasner-Edwards & Rawson, 2010). However in some cases, this principle is compromised due to the use IT system to store data as such records are accessible to other staff members. Court orders requiring the disclosure of confidential information regarding the client may also undermine the principle of confidentiality (Fontana & Rosenheck, 2008). However, through consultation with their supervisors, nurses may provide only the relevant data required in a particular case.

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Informed Consent

This aspect is another controversial principle that requires healthcare providers to disclose all material facts regarding the treatment to be afforded to patients before obtaining their consent (Petrakis et al., 2011). However, this requirement is undermined by the fact that persons suffering from addiction are not in a position to make viable judgments. However, nurses must disclose all the facts regarding the treatment and notify the clients of their rights before obtaining written consent.

References

Fontana, A., & Rosenheck, R. (2008). Treatment-seeking veterans of Iraq and Afghanistan: Comparison with veterans of previous wars. The Journal of Nervous and Mental Diseases, 196(7), 513-521. Web.

Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy, 97(2), 93-104. Web.

Miller, R., Sorensen, L., Selzer, A., & Brigham, G. (2006). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of Substance Abuse Treatment, 31(1), 25-39. Web.

Miller, R., Zweben, J., & Johnson, R. (2005). Evidence-based treatment: Why, what, where, when, and how. Journal of Substance Abuse Treatment, 29(4), 267-276. Web.

Petrakis, L., Rosenheck, R., & Desai, R. (2011). Substance use comorbidity among veterans with posttraumatic stress disorder and other psychiatric illness. The American Journal on Addictions, 20(3), 185-189. Web.

Potenza, M. (2008). The neurobiology of pathological gambling and drug addiction: an overview and new findings. Philosophical Transactions, 363(1507), 3181-89. Web.

Seal, H., Shi, Y., Cohen, G., Cohen, E., Maguen, S., Krebs, E., & Neylan, T. (2012). Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. JAMA, 307(9), 940-947. Web.

Volkow, N. (2011). Principles of Drug Addiction Treatment: A Research-Based Guide. Darby, PA: DIANE Publishing. Web.

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