Tag Archives: Health and addiction


Buprenorphine – Addiction treatment


Buprenorphine drug may not be the best for addiction treatment and it has to be prescribed by a doctor and not across the counter

The prevalence of drug abuse in our streets is in the rise and unless something is done fast to contain the increase then the dangers are likely to be fatal. Besides rehab centers we can also use certain medications like buprenorphine which is helpful in keeping off drugs like heroin from the streets by reducing the bad withdrawal symptoms when one ceases to use drugs. This medicine closely related to heroin and often administered as treatment replacement. It is the choice drug for many even though some people choose to progressively limit their dose and eventually come off it. Normally this drug last longer in the body system and therefore its prescription is a once daily dose. To regulate its use users may be required to be taking buprenorphine in the presence of a supervisor normally the pharmacist dispensing the drug to the user. This close supervision is to ensure that only the right dose is taken and with time the user can be allowed to be taking it all by themselves after ascertaining regular dose maintenance.

Buprenorphine – Side Effects

Just in like all other medications buprenorphine drug treatment equally has side effects for instance when you start using buprenorphine you may not get it out of your system with ease irrespective of what option you went for be it inpatient or outpatient in a rehab program.

As with all medications, Buprenorphine (Suboxone) drug treatment also has some disadvantages. It is still a medication and if you prefer to break free from any kind of addiction immediately, then Buprenorphine may not be the way to go. Also, you may not be completely Buprenorphine-free by the time you leave drug treatment, even if you opt for an inpatient drug rehab program.

  • Some may consider these disadvantages while others consider them well worth the advantage of avoiding opiate withdrawal symptoms.
  • Initial studies on long-term use of Buprenorphine suggest that there are anti-depressant effects of the drug as well.
  • The dosing schedule is also relatively easy to maintain as most don’t even have to take it every day.
  • Additionally, you can’t abuse Suboxone, get high off of it or overdose on it like you can with some other opiate addiction maintenance or detox drugs, like methadone.

Much as this may offer treatment for addiction, it is in itself addictive and should not be encouraged. Its shortcomings far much out ways the advantages as illustrated in the paragraphs below.

Buprenorphine – Before using buprenorphine

Certain medications are so reactive to people and especially to those with certain health conditions. Buprenorphine is such medicine that needs to be used with extra care being taken therefore before this medication is administered, your doctor must be aware of the following to help them make a decision whether to allow or not.

  • Do you or have you ever had liver or kidney problems.
  • Do you or have you ever had prostate problems or any difficulties passing urine.
  • Do you have any breathing problems like asthma or chronic obstructive pulmonary disease (COPD)
  • Have you ever been told that you have low blood pressure
  • Do you have any problems with your thyroid or adrenal glands
  • Are you epileptic?
  • Do you have any problem with your bile duct
  • Are you pregnant or breast-feeding
  • If you have been constipated for more than a week or have an inflammatory bowel problem.
  • Do you have a condition causing muscle weakness, called myasthenia gravis?
  • Have you in the recent past had a severe head injury
  • Have you ever had an allergic reaction to any medicine
  • Are currently taking any street drugs or medicines including any medicines you are taking which are available across the counter without a prescription like herbal and complementary medicines.

Buprenorphine – Achieving the best from your treatment

  • Occasionally when using buprenorphine you may experience some discomfort during the first 3 days, this is a normal reaction and you must not attempt taking heroin on top, and again do not take more than what the doctor instructed.
  • Periodically keep regular consultations with your doctor or clinic for proper review of how you’re progressing. During these meetings you are likely to be requested to give specimen of urine from time to time for the evaluation exercise.
  • You cannot get Buprenorphine without a doctor’s prescription and you will not be able to ask for any changes to be made to your supply because your pharmacist can only dispense the prescription exactly as per the instructions of your doctor.
  • There are several different brands and strengths of buprenorphine tablets, so each time you collect a supply, check to make sure it contains what you are expecting.
  • You are more likely to succeed in staying off heroin if you have support and counseling in addition to taking buprenorphine. Local drug community teams, self-help groups and other agencies may be of help.
  • You must refrain from any street drugs or drinking too much alcohol while using buprenorphine because other street drugs such as benzodiazepines (benzos) and alcohol can affect buprenorphine and increase the chance of unwanted effects.
  • You should tell the DVLA that you are taking buprenorphine if you are a driver. You are likely to be banned from driving at first, although you may be allowed to drive again later, subject to an annual medical review. Your doctor will tell you when you can resume driving.
  • When there is need to stopping using buprenorphine discuss this with your doctor before stopping. It is important that buprenorphine should be taken regularly to reduce the risk of withdrawal symptoms occurring. When you are ready to consider becoming drug-free, your doctor will be able to help you decide on the best way to do this in order to keep withdrawal effects to minimum and manageable levels.
  • If you are planning any visit abroad, you should carry a letter with you from your doctor to explain that you have been prescribed buprenorphine. This is because buprenorphine is classed as a ‘controlled drug’ and is subject to certain restrictions.
  • If you buy any medicines, check with a pharmacist that they are suitable for you to take with buprenorphine. Many other medicines have similar side-effects to buprenorphine and taking them together will increase the risk of unwanted effects.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking buprenorphine.

Finally you have had all the attached effects and conditions while using this drug, you may wonder why use such medicine with so much conditions and believe me you are right therefore for good healthy and user friendly alternatives talk to Dr. Dalal Akoury, Founder of AWAREmed Health and Wellness Resource Center. She is a medical doctor with over two decades of addiction treatment and together with her team of experts she is offering her exclusive NER Recovery Treatment to all patients across the globe as well to other physicians and health care professionals through training, clinical apprenticeships, webinars and seminars. Your condition will be safe at this facility and you will be among many individuals and qualified professional joining this truly successful and fast addiction recovery treatment.

Buprenorphine – Addiction treatment



Moderate Drinking and the consequences attached

Moderate Drinking and the consequences attached: Drug Addiction

Moderate drinking

Moderate drinking is key to controlling addiction and a voiding life-threatening diseases resulting from alcohol addiction.

Drinking alcohol is one major cause of addiction and one which is proving difficult to quit despite knowledge of the consequences associated with it. In our desire to get rid of addiction from our societies we will be discussing moderate drinking as a step in the right direction toward achieving our objective. There is a very thin line between moderate drinking and how much should be taken within a given period of time. People who have been drinking for some time whether addicts or not will attest to the fact that they have had or witnessed some embarrassing situations in their lives while under the influence of alcohol instances like having humiliated themselves at their work stations or in a party somewhere, having hangover that ruined their plans, being met on the wrong side of the law while driving when they shouldn’t have and many other circumstances. When reality down on them the next day when the effect of their intoxication is settling they are always full of regrets and wishing to cut down on their drinking.

These are real life situations we are often faced with on a daily basis and while we are appreciating that not everyone is keen to cutting alcohol out of their lives, nor do they need to categorized alcohol users with some history of addiction or mental illness  like various diseases of the liver or pancreas, or who are pregnant or taking certain medications shouldn’t drink at all, however as for others, there is an elusive middle ground called moderation which brings us to the big question what is “moderate drinking” and how can it be accomplished? As big as the question is so is the boldness in certain decisions you may consider taking to get your drinking under control as illustrated here in.

Moderate Drinking and the consequences attached: Avoid the Pre-Party

Various studies has established that “pre-drinking” before a party or social event, is normally characterized with cheap alcohol which is taken hurriedly and in large quantities, almost doubles total alcohol consumption as well as negative outcomes such as hangovers, blackouts and unprotected sex. This practice is particularly common among adolescents and young adults who not legally allowed taking alcohol let alone buying alcohol drinks or being in such places where alcoholic beverages are sold. Nonetheless most alcohol consumers are known not to be stationery in one given join. This habit of changing drinking locations during the night out is a powerful ingredient of increased quantity of alcohol consumption and it works well in defeating the intentions of moderate drinking.

Moderate Drinking – Record keeping

The human brain and especially that of an alcohol consumer is likely to forget almost everything while drinking bringing in the need of taking notes and keeping records. This is a practice which has worked in other areas like in weight lose journal which is very helpful to people concern in sticking to their diet. Research has established that a drinking diary can help people get honest about their alcohol intake and identify problem areas. Counting drinks is very key irrespective of how you do it, whether on paper, a smartphone or with the help of a sober friend, this will help you remember the nasty truths of your drinking which you’d prefer addressing and hopefully avoid in the future.

With the records you will be able to identify your patterns and make a decision on an ideal number of drinks per day and per week and test your ability to stay within those limits. According to Dietary Guidelines for Americans they describes moderate drinking as up to one drink each day for women and two drinks each day for men and a standard drink is 12 ounces of beer, five ounces of wine or 1.5 ounces of hard liquor.

Always Have a Drink in Hand – as Long as it’s Non-Alcoholic

A number of challenging scenarios may arise when you’re socializing at a party, club or other event. Swapping alcoholic drinks for a non-alcoholic variety has two major benefits: If you’re drinking water, juice or soda, you’re likely not drinking as much booze. Also, with some type of beverage in hand, your choice to drink less (or not at all) will likely go unnoticed by friends who want a drinking companion.

Moderate Drinking – Slow Down

When out drinking whether alone or in company of friends it is worth noting that drinking too much too fast will defeat any efforts to moderate your drinking. It’s advisable to take time and only pace yourself by sipping rather than guzzling also do not participate in drinking games and purpose to be taking one drink per hour and if possible take even less than a drink in an hour and in between drinks take food and non-alcoholic drinks doing this helps you commit to moderate drinking.

Moderate Drinking and the consequences attached: Mind Your Drinking Cues.

If you track your drinking patterns long enough, you may discover certain trends. Maybe you always overdo it when a particular friend or family member is around or at a specific time of day such as when you get home from work. Or perhaps the nostalgia of a certain bar or club makes you vulnerable to bingeing, or you turn to alcohol every time you feel sad or angry. These patterns will clearly show you your triggers and with this information you may choose which people, places and things to avoid and find other activities to replace them.

Finally drinking in moderation has both risks and benefits, but drinking too much poses a clear threat to your health and well-being. Heavy drinking can cause:

  • Stroke
  • High blood pressure
  • Accidental injuries
  • Cirrhosis of the liver
  • Certain cancers among other problems

If you find yourself routinely drinking more than you planned, unable to quit or uninterested in anything but drinking, your problem may go beyond occasional overindulgence and cross into alcohol abuse or addiction. In this case, attempts at moderation will perpetuate a frustrating cycle until you seek appropriate treatment and support usually from addiction professionals like doctor Dalal Akoury who founded AWAREmed Health and Wellness Resource Center an institution where care is given professionally to all addicts in the most natural way while focusing on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE

Moderate Drinking and the consequences attached: Drug Addiction




Substance Abuse and Addiction

Substance Abuse and Addiction- Alcohol the most Abused drug

Alcohol addiction

Substance abuse and addiction are not friendly to anyone but the good news is whatever drug you are addicted to be it alcohol there is hope of recovery

In your neighborhood probably there is a bar or just any place ware legal is sold and you will confess that in those places there are individuals who will never miss visiting those joints not even for one day. These are the people I want to talk about in this article. Moderate alcohol consumption may not be that bad health wise and in fact can be soothing and relaxing. However when consumed disorderly alcohol can be poisonous and injurious to human life in many ways which includes traffic accidents, homicides, suicide and rape, alcohol abuse also has adverse effects on social and domestic life ranging from absconding employment duties, spousal and child abuse and even crime.

Those who take alcohol are likely experience changes in their bodies immediately as mood changes to complete loss of coordination, vision, balance, and speech these changes can be attributed to acute intoxication or just drunkenness. It is important for the public to know that the authorities regard a rate of 0.08% of alcohol in the bloodstream as evidence of intoxication. If the rate becomes more in the blood then this can impair brain function and eventually cause unconsciousness but an extreme overdose is serious alcohol poisoning and can be fatal.

Substance Abuse and Addiction- Understanding Alcohol Abuse

Chronic alcoholism is a potentially fatal disease characterized by continuous craving for amplified tolerance of physical dependence upon and loss of control over alcohol consumption. The physical dependence on alcohol differs with individual consumer with some chronic alcoholics get very drunk and others exercise enough control to give the appearance of coping with everyday affairs in a near-normal way. However, alcoholism can lead to a number of physical ailments, including hypoglycemia, high blood pressure, brain and heart damage, end-stage liver damage, enlarged blood vessels in the skin, pneumonia, tuberculosis, chronic gastritis, and recurrent pancreatitis.

The consequences of alcoholism may include: impotence in men, damage to the fetus in pregnant women, and an elevated risk of cancer of the larynx, esophagus, liver, breast, stomach, pancreas, and upper gastrointestinal tract. And also because alcoholics rarely have proper diets, they are at a high risk of being malnourish. Nevertheless high level consumers will have impaired liver function with one in five developing cirrhosis.

Symptoms of Alcohol Abuse

If you have to take good precaution to be free from being an alcoholic, you must know the signs and symptoms of alcohol abuse and the following are just but a few:

  • Short-term blackouts or memory loss.
  • Repeated arguments or fights with family members or friends as well as irritability, depression, or mood swings.
  • Continuing use of alcohol to relax, to cheer up, to sleep, to deal with problems, or to feel “normal.”
  • Headache, anxiety, insomnia, nausea, or other unpleasant symptoms when you stop drinking.
  • Flushed skin and broken capillaries on the face; a husky voice; trembling hands; bloody or black/tarry stools or vomiting blood; chronic diarrhea; and drinking alone, in the mornings, or in secret; these symptoms are specifically associated with alcoholism.

Keep in mind that alcohol abuse is different from alcohol dependence.

  • With abuse, a person uses alcohol in excess but may not have regular cravings, a need to use daily, or withdrawal symptoms during sudden stoppage. The person may often have heavy alcohol binge episodes separated by periods of not drinking.
  • If a person is dependent on alcohol, he or she needs to drink regularly or even daily and drink more and more to get the same effects. The person also experiences withdrawal symptoms if he or she stops drinking and wants to quit drinking alcohol but can’t.
Substance Abuse and Addiction- Treatments for Alcoholism

The ultimate objective of treatment for alcoholism is abstinence. Among alcoholics with otherwise good health, social support, and motivation, the chances of regaining is good. About 50% to 60% remain abstinent at the end of a year’s treatment and a majority of those break dry permanently. However those with poor social support, poor motivation, or psychiatric disorders have a tendency to relapse within a few years of treatment. For these people, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning.

Substance Abuse and Addiction- Conventional Medicine for Alcoholism

Treatment for alcoholism can begin only when the alcoholic accepts that the problem exists and agrees to stop drinking. They will have to understand that alcoholism is treatable and must desire to change and to diligently follow the three treatment procedures:

  1. Detoxification (detox): This may be needed immediately after stopping alcohol use and can be a medical emergency, as detox can result in withdrawal seizures, hallucinations, delirium tremens (DT), and in some cases may result in death.
  2. Rehabilitation: This involves counseling and medications to give the recovering alcoholic the skills needed for maintaining sobriety. This step in treatment can be done inpatient or outpatient. Both are equally effective.
  3. Maintenance of sobriety: This step’s success requires an alcoholic to be self-driven. The key to maintenance is support, which often includes regular Alcoholics Anonymous (AA) meetings and getting a sponsor.

Because detoxification does not stop the craving for alcohol, recovery is often difficult to maintain. For a person in an early stage of alcoholism, discontinuing alcohol use may result in some withdrawal symptoms, including anxiety and poor sleep. Withdrawal from long-term dependence may bring the uncontrollable shaking, spasms, panic, and hallucinations of DTs. If not treated professionally, people with DTs have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should be attempted under the care of an experienced doctor and may require a brief inpatient stay at a hospital or treatment center.

Treatment may involve one or more medications. Benzodiazepines are anti-anxiety drugs used to treat withdrawal symptoms such as anxiety and poor sleep and to prevent seizures and delirium. These are the most frequently used medications during the detox phase, at which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive.

There are several medicines used to help people in recovery from alcoholism maintain abstinence and sobriety. One drug, disulfiram may be used once the detox phase is complete and the person is abstinent. It interferes with alcohol metabolism so that drinking a small amount will cause nausea, vomiting, blurred vision, confusion, and breathing difficulty. This medication is most appropriate for alcoholics who are highly motivated to stop drinking or whose medication use is supervised, because the drug does not affect the motivation to drink. Our job is to help you get better and be free from any form of addiction and that is why at AWAREmed Health and Wellness Resource Center Doctor Akoury who is the founder is offering a focused Neuroendocrine Restoration (NER) treatment with the sole intension to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE when this is done you will not only have a testimony but life a productive and happy life free from addiction.

Substance Abuse and Addiction- Alcohol the most Abused drug





Children and Addiction

Children and Addiction-Alcoholics


Surely our children deserve to live in a drug addiction free environment.

The statistics of children growing up in environment where elements that triggers addiction is worrying globally and in fact in America for example it is believed that one in five adult creating a greater risk for children having emotional problems than those children brought up in a sober environment. Alcoholism for example runs in families, and children of alcoholics are four times more likely than other children to become alcoholics themselves. Compounding the psychological impact of being raised by a parent who is suffering from alcohol abuse is the fact that most children of alcoholics have experienced some form of neglect or abuse.

When a child is being raised by a parent or guardian who is suffering from alcohol abuse may have a variety of conflicting emotions that need to be addressed in order to avoid future problems. Some of the conflicting feelings may include:

  • Guilt. The child may see himself or herself as the main cause of the mother’s or father’s drinking.
  • Anxiety. The child may worry constantly about the situation at home. He or she may fear the alcoholic parent will become sick or injured, and may also fear fights and violence between the parents.
  • Embarrassment. Parents may give the child the message that there is a terrible secret at home. The ashamed child does not invite friends home and is afraid to ask anyone for help.
  • Inability to have close relationships. Because the child has been disappointed by the drinking parent many times, he or she often does not trust others.
  • Confusion. The alcoholic parent will change suddenly from being loving to angry, regardless of the child’s behavior. A regular daily schedule, which is very important for a child, does not exist because bedtimes and mealtimes are constantly changing.
  • Anger. The child feels anger at the alcoholic parent for drinking, and may be angry at the non-alcoholic parent for lack of support and protection.
  • Depression. The child feels lonely and helpless to change the situation.

Although the child tries to keep the alcoholism a secret other people around like teachers, relatives, other adults, or friends may sense that something is wrong with this child. Teachers and guardians should be aware that the following behaviors may signal a drinking or other problem at home:

  • Failure in school; truancy
  • Lack of friends; withdrawal from classmates
  • Delinquent behavior, such as stealing or violence
  • Frequent physical complaints, such as headaches or stomachaches
  • Abuse of drugs or alcohol
  • Aggression towards other children
  • Risk taking behaviors
  • Depression or suicidal thoughts or behavior

Some children of alcoholics may cope by taking the role of responsible “parents” within the family and among friends. They may become controlled, successful “overachievers” throughout school, and at the same time be emotionally isolated from other children and teachers. Their emotional problems may show only when they become adults.

It is important for relatives, teachers and caregivers to realize that whether or not the parents are receiving treatment for alcoholism, these children and adolescents can benefit from educational programs and early professional help is also important in preventing more serious problems for the child, including reducing risk for future alcoholism. Child and adolescent psychiatrists can diagnose and treat problems in children of alcoholics. They can also help the child to understand that they are not the ones responsible for the drinking problems of their parents and that the child can be helped even if the parent is in denial and refusing to seek help.

During treatment program other youngsters may be included in the group therapy this will help reduces the isolation of being a child of an alcoholic. The child and adolescent psychiatrist will often work with the entire family, particularly when the alcoholic parent has stopped drinking, to help them develop healthier ways of relating to one another.

Children and Addiction-Teens Alcohol and other Drugs

Young people particularly teenagers like to explore on things and so experimentation with alcohol and drugs during adolescence is common. Unfortunately they often don’t see the link between their actions today and the consequences for tomorrow. They also have a tendency to feel indestructible and immune to the problems that others experience.

Using alcohol and tobacco at a young age has negative health effects. It is important to note that while some teens will experiment and stop or continue to use occasionally without significant problems. Others will develop a dependency, moving on to more dangerous drugs and causing significant harm to themselves and possibly others. It is difficult to know which teens will experiment and stop and which will develop serious problems. Those teenagers who are likely to bear the greater risk are those:

  • with a family history of substance use disorders
  • who are depressed
  • who have low self-esteem, and
  • who feel like they don’t fit in or are out of the mainstream

There is no limit on the kinds of drugs teenagers’ abuse it is all round to them a variety of drugs, both legal and illegal. The use of illegal drugs is increasing, especially among young teens. The average age of first marijuana use is 14, and alcohol use can start before age 12. The use of marijuana and alcohol in high school has become common.

Drug use is associated with a variety of negative consequences, including increased risk of serious drug use later in life, school failure, and poor judgment which may put teens at risk for accidents, violence, unplanned and unsafe sex, and suicide. Parents can prevent their children from using drugs by talking to them about drugs, open communication, role modeling, responsible behavior, and recognizing if problems are developing.

Children and Addiction-Warning signs of teenage alcohol and drug use

Physical: Fatigue, repeated health complaints, red and glazed eyes, and a lasting cough.

Emotional: personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgment, depression, and a general lack of interest.

Family: starting arguments, breaking rules, or withdrawing from the family.

School: decreased interest, negative attitude and drop in grades, many absences, truancy, and discipline problems.

Social problems: new friends who are less interested in standard home and school activities, problems with the law, and changes to less conventional styles in dress and music.

Some of the warning signs we have discussed so far can be signs of other problems as well which parents may use to recognize signs of trouble and possible use of alcohol and other drugs with their teenager. If you have concerns you may want to consult your physician to rule out physical causes of the warning signs. However when this persist seeking an expert opinion would be necessary. Doctor Dalal Akoury is fellowship trained and certified in anti-aging functional and regenerative medicine, as well as having more than two decades of accumulated experience in emergency medicine, pediatrics, and a master’s degree in public health. She has also served fellowships in pediatric hematology/oncology and has performed research in leukemia and the effects of smoking. Problems affecting your children will be safe in the care of such experts like doctor Akoury.

Children and Addiction-Alcoholics



Treatment Models for mental health and addiction

Treatment Models for mental health and addiction-Current Models discussed


when both treatment for addiction and mental health problems are administered well you will surely get your life back.

Every day mental health and alcohol and other drugs (AOD) abuse treatment fields have become increasingly aware of the existence of patients with dual disorders, attempts are being made to adapt treatment to the special needs of these patients. The attempts have reflected philosophical differences about the nature of dual disorders, as well as differing opinions regarding the best way to treat them. These attempts also reflect the limitations of available resources, as well as differences in treatment responses for different types and severities of dual disorders. Three approaches have been taken to treatment.

Treatment Models for mental health and addiction-Sequential Treatment

The first and historically most common model of dual disorder treatment is sequential treatment. In this model of treatment, the patient is treated by one system (addiction or mental health) and then by the other. Indeed, some clinicians believe that addiction treatment must always be initiated first, and that the individual must be in a stage of abstinent recovery from addiction before treatment for the psychiatric disorder can begin. On the other hand, other clinicians believe that treatment for the psychiatric disorder should begin prior to the initiation of abstinence and addiction treatment. Still other clinicians believe that symptom severity at the time of entry to treatment should dictate whether the individual is treated in a mental health setting or an addiction treatment setting or that the disorder that emerged first should be treated first.

The term sequential treatment describes the serial or non-simultaneous participation in both mental health and addiction treatment settings. For example, a person with dual disorders may receive treatment at a community mental health center program during occasional periods of depression and attend a local AOD treatment program following infrequent alcoholic binges. Systems that have developed serial treatment approaches generally incorporate one of the above orientations toward the treatment of patients with dual disorders.

Treatment Models for mental health and addiction-Parallel Treatment

A related approach involves parallel treatment: the simultaneous involvement of the patient in both mental health and addiction treatment settings. For example, an individual may participate in AOD education and drug refusal classes at an addiction treatment program, participate in a 12-step group such as AA, and attend group therapy and medication education classes at a mental health center. Both parallel and sequential treatments involve the utilization of existing treatment programs and settings. Thus, mental health treatment is provided by mental health clinicians, and addiction treatment is provided by addiction treatment clinicians. Coordination between settings is quite variable.

Treatment Models for mental health and addiction-Integrated Treatment

A third model, called integrated treatment, is an approach that combines elements of both mental health and addiction treatment into a unified and comprehensive treatment program for patients with dual disorders. Ideally, integrated treatment involves clinicians cross-trained in both mental health and addiction, as well as a unified case management approach, making it possible to monitor and treat patients through various psychiatric and AOD crises.

There are advantages and disadvantages in sequential, parallel, and integrated treatment approaches. Differences in dual disorder combinations, symptom severity, and degree of impairment greatly affect the appropriateness of a treatment model for a specific individual. For example, sequential and parallel treatment may be most appropriate for patients who have a very severe problem with one disorder, but a mild problem with the other. However, patients with dual disorders who obtain treatment from two separate systems frequently receive conflicting therapeutic messages; in addition, financial coverage and even confidentiality laws vary between the two systems.

Treatment Models for mental health and addiction-Treatment Models

  • Sequential: The patient participates in one system, then the other.
  • Parallel: The patient participates in two systems simultaneously.
  • Integrated: The patient participates in a single unified and comprehensive treatment program for dual disorders.

In contrast, integrated treatment places the burden of treatment continuity on a case manager who is expert in both psychiatric and AOD use disorders. Further, integrated treatment involves simultaneous treatment of both disorders in a setting designed to accommodate both problems.

Treatment Models for mental health and addiction-Critical Treatment Issues for Dual Disorders

Mental health and addiction treatment programs that are being designed to accommodate patients with dual disorders should be modified to address the specific needs of these patients. Although there are different dual disorder treatment models, all such programs must address several key issues that are critical for successful treatment. These issues include:

  • Treatment engagement
  • Treatment continuity and comprehensiveness
  • Treatment phases
  • Continual reassessment and re-diagnosis

Treatment Engagement

In general, treatment engagement refers to the process of initiating and sustaining the patient’s participation in the ongoing treatment process. Engagement can involve such enticements as providing help with the procurement of social services, such as food, shelter, and medical services. Engagement can also involve removing barriers to treatment and making treatment more accessible and acceptable, for example, by providing day and evening treatment services. Engagement can be enhanced by providing adjunctive services that may appear to be indirectly related to the disorders, such as child care services, job skills counseling, and recreational activities. It may also be coercive, such as through involuntary commitment or a designated payee.

Engagement begins with efforts that are designed to enlist people into treatment, but it is a long-term process with the goals of keeping patients in treatment and helping them manage ongoing problems and crises. Essential to the engagement process is:

  • A personalized relationship with the individual
  • Over an extended period of time
  • A focus on the stated needs of the individual

For patients with dual disorders, engagement in the treatment process is essential, although the techniques used will depend upon the nature, severity, and disability caused by an individual’s dual disorders. An employed person with panic disorder and episodic alcohol abuse will require a different type of engagement than a homeless person with schizophrenia and poly-substance dependence. With respect to severe conditions such as psychosis and violent behaviors, therapeutic coercive engagement techniques may include involuntary detoxification, involuntary psychiatric treatment, or court-mandated acute treatment.

Treatment Continuity

To treat patients with dual disorders, it is critical to develop continuity between treatment programs and treatment components, as well as treatment continuity over time. In practice, many patients participate in treatment at different sites. Even in integrated treatment programs, many patients require different treatment services during different phases of treatment. For this reason, treatment should include an integrated dual disorder case management program, which can be located within a mental health setting, an addiction treatment setting, or a collaborative program.

Treatment Comprehensiveness

An overall system for treating dual disorders includes mental health and addiction treatment programs, as well as collaborative integrated programs. Programs should be designed to:

  • Engage clients
  • Accommodate various levels of severity and disability
  • Accommodate various levels of motivation and compliance
  • Accommodate patients in different phases of treatment.

There should be access to abstinence-mandated programs and abstinence-oriented programs, as well as to drug maintenance programs. Different levels of care, ranging from more to less intense treatment, should be available.

Phases of Treatment

In general, the medical term acute describes phenomena that begin quickly and require rapid response. Acute problems are contrasted with chronic problems. Most commonly, acute stabilization of patients with dual disorders refers to the management of physical, psychiatric, or drug toxicity crises. These include injury, illness, AOD-induced toxic or withdrawal states, and behavior which are suicidal, violent, impulsive, or psychotic.

The acute stabilization of AOD use disorders typically begins with detoxification, such as inpatient detoxification for patients with significant withdrawal or outpatient detoxification for mild to moderate withdrawal, as well as nonmedical withdrawal, such as occurs in social-model detoxification programs. Also, initiation of methadone maintenance can provide outpatient acute stabilization for patients addicted to opioids.

Acute stabilization of psychiatric symptoms more frequently occurs within a mental health or emergency medical setting, but involves a range of treatment intensity. Patients with severe symptoms, especially psychotic, violent, or impulsive behaviors, usually require acute psychiatric inpatient treatment and psychiatric medications, while patients with less severe symptoms can be treated in outpatient or day treatment settings. It is important that dual disorder programs that provide stabilization to patients with acute needs should have the capability to:

  • Identify medical, psychiatric, and AOD use disorders
  • Treat a range of illness severity
  • Provide drug detoxification, psychiatric medications, and other bio-psychosocial levels of treatment
  • Provide a range of intensities of service.

These programs should be capable of promoting the patient’s engagement with the treatment system. They should be able to aggressively provide linkages to other programs that will provide ongoing treatment and engagement.

Sub-acute Stabilization

The medical term sub-acute describes the status of a medical disorder at points between the acute condition and either resolution or chronic state. The sub-acute phase of a medical problem occurs as the acute course of the problem begins to diminish, or when symptoms emerge or reemerge but are not yet severe enough to be described as acute.

As AOD-induced toxic or withdrawal symptoms resolve, constant reassessment and re-diagnosis is required. During this phase, a psycho-educational and behavioral approach should be used to educate patients about their disorders and symptomatology. During this phase, treatment providers should provide assessment and planning for dealing with long-term issues such as housing, long-term treatment, and financial stability.

Treatment Models for mental health and addiction-Current Models discussed