Substance

Substance abuse is a sickness that develops when an individual’s emotional reaction constructs a personal reality full of drug-related beliefs that support addictive behavior; therefore, the appropriate professional reaction would be to introduce the cognitive psychological model of intervention to facilitate the recognition, examination and modification of the addict’s destructive thoughts that are the foundation of his or her dependence.

Substance abuse is a complex illness that has had a profound effect upon America.  It is estimated that in the United States 46 million adults smoke, approximately 18 million people are dependent on alcohol, 20 million people are dependent on illicit drugs and the number of people addicted to both alcohol and illicit drugs is unknown.  (Business Wire, 2005, p. na)  The National Center for Health Statistics reported that in 2003 36% of high school seniors were smokers and 11% of illicit drug users were 12 -17 years of age. (DHHS, 2005, p. 515-516)

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Psychologists say that most patients report having abused some type of substance in their mid teens and they typically identify drinking a beer with friends as their first experience with potentially addictive substances.  (Henderson, 2000, p. 12)  “Gateway drugs,” such as nicotine and caffeine are usually early influences that can lead to other drugs such as alcohol and marijuana – curiosity might lead to drugs such as LSD or cocaine. (Henderson, 2000, p. 14)

There are numerous reasons why people become addicted to drugs; however some basic common factors exist.  People use substances to achieve a feeling of pleasure, the exhilaration of the high and the opportunity to share the experience with companions.  (Aaron et al., 1993, p. 22)   The progression from a casual user to and addict has no single cause for everyone.  Perhaps it’s because the high relieves anxiety, stress or boredom.  Over the course of time a dependency develops and the abuser believes that he or she can not function properly without being high.  (Aaron et al., 1993, p. 23)

It is a proven fact that when the human body is injected with any type of drug ” a certain part of the brain is electrically stimulated, an intensely pleasurable sensation occurs.” (Henderson, 2000, p. 33)  The human brain is complex and still a mystery to medical professionals; however it “is not a passive receptacle of environmental and biological influences.” (Neenan & Dryden, 2004, p. 3)  People create a reality that permits a justification to thoughts and actions, regardless of how destructive they may be.

The cognitive model of intervention is based upon the principle that humans create their own reality – a personal idealism that was developed due to the emotional response to a specific event or series of events. (Neenan & Dryden, 2004, p. 3)  In the case of substance abuse it must be assumed that without cognitive intervention the addict’s reality justifies the use of addictive substances, as well as rationalizes the fact that the threat of legal implications or health deterioration is minimal.

The cognitive approach also requires therapists to assume that if the drug user is depressed, the addict will think negatively of himself.  Addicts who are anxious will have negative beliefs about some future threat, which leads to avoidance, anxiety and panic.  (Wright, 2006, p. na)

There are three types of dysfunctional beliefs connected to the addict’s decision to use addictive substances.  Those beliefs are anticipatory, relief-oriented and facilitative or permissive.  (Wright, 2006, p. na) Anticipatory belief is the expectations behind drug use – being high makes the addict feel invincible.  Relief-oriented belief is the assumption that using drugs will alleviate whatever aspect of the addict’s life making them uncomfortable – the addict’s stress will go away if he or she uses drugs.  Facilitative or permissive beliefs justify drug use, when it is apparent that some type of negative consequence exists.  (Write, 2006, p. na)

According to the Center for Cognitive Therapy, “drug-using beliefs and desires typically are activated in specific, common, often predictable, high-risk circumstances” and these triggers can be external or internal. (Write, 2006, p. na) For example an external trigger could be something as simple as being exposed to alcohol or drugs while in the presence of a friend or family member – possibly a group of people.  Internal triggers are the result of depression or anxiety.  (Write, 2006, p. na)

At this point, the cognitive model assumes that a sequence of events takes place creating some type of internal or external trigger which leads the addict to create his personal reality that justifies his or her drug-related belief that becomes automatic thought and creates the urge use drugs. At this stage, addicts are prone to binges or other extreme behaviors associated with substance addiction. (Write, 2006, p. na)

In order for cognitive intervention to become successful, it is necessary to focus on four main components that create a vivid picture of the substance abuser.  Relevant childhood data, Dysfunctional core beliefs, Conditional assumptions, and Compensatory strategies.  (Write, 2006, p. na)  Early child hood experiences could shed some light on what contributed to the second component, dysfunctional core beliefs or the way a patient views himself, usually as someone who can not be loved or is incapable of loving.  Conditional assumptions are a set of personal rules established that allows them to avoid harm and to thrive in their environment – often these rules are for the purpose of gaining control over stressful situations.  Finally, Compensatory strategies are the behaviors and actions that help the addict deal with his or her core beliefs – example using drugs to improve efficiency or increase confidence.  (Write, 2006, p. na)  The patient and therapist work together to identify the previous information using two methods; therapist-patient interaction via psychotherapy sessions and belief questionnaires.  (Write, 2006, p. na)

The theory of cognitive intervention is to create an approach that is unique to the patient that helps weigh the pros and cons of their actions by taking an in depth look at their current state and independently make the decision to stop using drugs.  An emphasis is placed upon the patient’s state of mind during therapy – problem solving mode creates progress, as opposed to feelings of depression and anxiety.  (Leahy, 2004, p. 207)  Intervention techniques for substance abusers focus on the future – the ability to maintain a drug-free life, long term goal setting, time management and rational responses to situations that can not be predicted.  (Leahy, 2004, p. 208)

The future of substance abuse shows promise as researchers make discoveries, develop multi-systematic treatments, improve upon traditional methods, and youth are exposed to educational preventative programs. Government intolerance for illicit substance abuse will continue to shrink the drug market and. (Dupont, 2000, p. 441-442) However, as lifestyles modernize, so will the substance of choice – the fight against substance abuse will continue.  In the 2005 National Survey on Drug Use and Health: National Results, 22.2 million people were estimated to be dependent upon alcohol or illicit drugs and 3.3 million of those counted were dependent on both.  Despite the efforts to combat substance abuse, these numbers had virtually no change since 2003. (SAMHSA, 2006, p. 67-68)  The professional organizations, doctors and clinicians are actively pursuing effective treatments that focus on solutions many designed for the general population, prevention efforts, various ethnic groups and gender specific.

Behavioral Therapy continues to be a recurring theme and the effects are showing promise with alcohol abuse, smoking, as well as illicit drug abuse.  A key facet of behavior changing treatment methods is Motivational Enhancement Therapy (MET).  Intervention methods focusing on MET are drawing a considerable amount of attention from researchers. NIDA’s Clinical Trials Network continues to actively research and study new treatment interventions for substance abusers and currently have several clinical trials underway focusing on MET:  Motivational Interviews for Incarcerated Teens – 1, Effectiveness of Buspirone and Motivational Enhancement Therapy for the Treatment of Marijuana Dependence – 1 and Strategies to Help Adult ED Patients to Quit Smoking to name a few.  (NIDA (Comp.), 2006, p. na)

NIDA continues to adapt as the need for intervention programs continues to grow.  At the 2006 Blending Conference the discussion focused on the community based substance abuse programs and the lack of modernized research information.  The dissemination of fresh research information can take up to two decades and the committee felt it had an obligation to implement a solution.  (NIDA (Comp.), 2006, p. na) As a result, the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Association (SAMHSA) combined efforts and created The NIDA Blending initiative to encourage researchers to expedite the integration of new programs into the community.  (NIDA (Comp.), 2006, p. na) As a result, the Blending team has integrated state-of-the-art treatment products for substance abusers world wide.

The Blending Inactive teams have designed and completed three products to assist the substance abuse treatment and research community.  These products focus on clinician plan development information, as well as effective treatment methods for individual treatment methods.  Buprehnorphine Treatment:  Training for Multidisciplinary Addiction Professionals,  S.M.A.R.T. Treatment Planning utilizing the Addiction Severity Index, and Short-Term Opiod Withdrawal Using Buprenorphine have been distributed to clinicians.  Two products remain in development – Motivational Interviewing Assessment:  Supervisory Tools for Enhancing Proficiency (MIA:STEP) and Promoting Awareness of Motivational Incentives. (NIDA (Comp.), 2006, p. na)

In conclusion, successful substance abuse treatment is accomplished with the various disciplines of behavioral treatments.  The cognitive intervention model has proven to be successful, as this method has been integrated into treatment plans that include behavior modification, 12 Step facilitation, Motivational Intervention and pharmacological treatments for substance abuse.  Current clinical trials provide evidence that cognitive therapy is key to combating this illness, as cognitive-behavior therapy and motivational intervention are dominating research efforts combating illicit drugs such as cocaine, marijuana and methamphetamines, as well as smoking and alcohol abuse.

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