Acute Detoxification Treatment
Blog: News & Views from the Field
Acute Detoxification Treatment
Beginning in the 1990’s, availability and abundance of powerful opioid painkillers led to a new population struggling with opioid addiction throughout New England. While regulatory efforts to reduce the supply of painkillers entering the illicit market were often successful, heroin quickly became a substitute for prescription opioids as its price saw dramatic decreases over the last decade. Heroin is a highly addictive drug that continues to contribute to the staggering number of drug overdoses in New England.
By now we’ve all heard about naloxone, or Narcan as its commonly called in the news, but what is it really? And should you have some on hand if you or a loved one is suffering with opioid addiction? Narcan is a very effective medication used to reverse the effects of a potentially fatal opioid overdose. Historically Narcan was most often administered intravenously or subcutaneously, but as its popularity has grown amongst first responders and other emergency medical personnel, it is now found in auto-injectors (like an epi-pen for allergic reactions) and nasal applicators. The advent of nasal Narcan in particular, allows lay people to use it, making it an invaluable tool for those of us who have loved ones struggling with opioid addiction or are struggling with the disease ourselves.
Narcan is a drug and therefore it’s regulated by the FDA in the United States. While it is not a controlled substance, it is a prescription medication which a doctor can prescribe for you (like that epi-pen we mentioned earlier). But many states have responded to the nations growing opioid crisis by issuing what is in essence a standing prescription for the drug, so anyone can go into a pharmacy and purchase it directly from the pharmacist without a prescription written in your name. Laws differ from state to state and are changing quickly, but the LawAtlas keeps a very good collection of current laws where you can check the status of laws in your state.
As the presidential campaigns are starting and the candidates are formulating their battle strategies, criminal justice reform is the one place with surprising agreement. We see leaders and supporters of both parties joining forces to advance criminal justice reform and support treatment efforts throughout the system.
A number of historical developments have set the stage for the shift from being primarily “tough on crime” to effective treatment, but the critical role of substance abuse treatment in the history of rehabilitation in American Corrections is often overlooked. It is important to challenge this omission of the important role played by substance abuse treatment; primarily therapeutic communities (TCs) that have become the vanguard of effective rehabilitation in most U.S. prison systems. By focusing on treatment of substance abusers, a classification that includes most offenders and is highly correlated with recidivism, it became possible to introduce effective rehabilitation programming into prisons and to begin challenging the old adage that “nothing works in correctional rehabilitation”.
This blog is part of a series which examines the role of entrepreneurship in substance abuse treatment and rehabilitation. A key component of future success is engaging the “Digital Divide” that represents a significant vocational barrier for recovering individuals.
The Digital Divide represents the separation between individuals who know how to use a computer and appreciate the value of computer skills, and those who do not. It highlights who has access to information technology in various geographical regions, communities, and societies. Beyond looking at the connected and unconnected, the Digital Divide exemplifies major economic and social inequalities in the world today. Without access and the ability to use a computer, an individual is greatly restricted in their ability to be competitive in today’s world. This is especially true for criminal justice clients and individuals in recovery whose successful employment prospects are limited.
Over the years, the therapeutic community (TC) has evolved and gained acceptance as an effective substance abuse treatment model in prisons and community-based settings. As the TC continues to mature, some of its limitations for future success have become increasingly apparent. For one, many recovering individuals lack knowledge and ewhile knowledgeable about recovery and interpersonal relations skills, are much are less knowledgeable about technology. With the deepening Digital Divide separating the more educated and moneyed class from blue collar and less educated groups (that many recovery individuals come from) the vocational challenges intensify as many low tech technical jobs disappear.
"This correspondence is forwarded from a Massachusetts Correctional Institution" was stamped on the back of the envelope containing a letter from a client whom I've worked with across multiple treatment episodes over the last eight years. My first reaction was relief that she was alive, because I recently heard that she had relapsed.
As I read her letter, I learned of her most recent relapse and the ensuing emotional, physical and legal hurricane that followed. During a two week lapse she lost her car, her apartment, her freedom, and twice, her life. One overdose was reversed by a friend's nasal naloxone (Narcan). The next overdose was reversed at the emergency room and left her with several broken ribs.
An expected standard in the behavioral health industry is for treatment to be culturally responsive. That is, cultural competence should be demonstrated by the organization, as well as, by the clinical staff delivering services. But what exactly does it mean to be culturally competent?
To answer this question we must first recognize what culture is and how it impacts all of us. Each person, client and clinician, comes to the therapeutic environment with their own history and experiences which provide a framework for how each views the world.
When mindfulness practice, a non-judgmental, observational approach, is incorporated into addiction treatment, a client can utilize the power of conscious thought and action to replace identification with addictive impulses and behaviors. Or more simply, the practice of mindfulness can help our clients experience a deep connection with the present moment. This is in contrast to the characteristic patterns of addictive thinking, which often includes rumination about the past and future, obsessive cravings, and distracted attention. Scans conducted on individuals who practiced only 10 hours overall of mindfulness already demonstrate differences in the neurochemistry of their brain.
Reentry and reintegration of criminal justice clients are the primary goals of all criminal justice rehabilitative efforts. There are few who would disagree that jobs are a major key to successful recovery. There is a need for a fresh approach to employment through entrepreneurial trainings and opportunities for prison inmates and participants in community substance abuse treatment programs. The focus of this blog is on increasing employment opportunities for substance abusers as a means of aiding recovery, reducing recidivism and facilitating a prosocial lifestyle. The need to improve employment opportunities is evident from the substance abuse and criminal justice literature. Research has demonstrated the effectiveness of substance abuse treatment in reducing drug use and recidivism, while employment – an important aspect of a prosocial lifestyle -- has lagged behind. Thus, new models for providing vocational training must be developed. In light of this need, the proposed alliance support the utilization of social entrepreneurship as a means of making vocational training a more significant treatment tool, one that is thoroughly integrated into the recovery process.
Neurological science has demonstrated that the practice of mindfulness improves learning as well as quality of life, enhances the ability to cope with problems when they arise, and interestingly enough, makes learning new concepts actually meaningful, as opposed to simply learning a new concept because you are being told to do so. In learning the practice of mindfulness, clinicians have a unique opportunity to make learning new ways of thinking a meaningfulness experience.