Desintoxications
Basic Olicognograph: Psychologic Loops
Recommendations for successful approaches and lessons learned Involve key community stakeholders, services and systems. Apply evidence-based treatment interventions in the context of systematic project planning and development. Incorporate programme monitoring, evaluation and research activities. Undertake research on treatment methods for different population groups. Employ culturally appropriate, community-based programming strategies. Employ a range of staff, including some that reflect the population of men/women being served (ex-addict). Provide training and supervision. Address social reintegration issues. Develop collaborative relationships and agreements with other services and systems. Offer comprehensive programming that acknowledges gender differences and responds to women’s different needs. Address trauma and concurrent disorders. Provide opioid substitution treatment in the context of other components of comprehensive care. Provide comprehensive and coordinated care for pregnant and parenting women. Provide opioid substitution treatment for opioid dependent pregnant women. Multiple drugs consumption should intent a sequenece of priorities.
Family advice about desintoxication process (of one of them) may be: 1) Expect ups and downs, recovery takes years; 2) Get outside trustworthy support (but do not expect to behave exactly as you want); 3) Learn about recovery and how it can affect families; 4) Make your expectations and rules clear and confront problems honestly, but avoid giving lectures 5) Be open to meeting some of recovering addicts new friends and joining in some recovery group activities; 6) Do not try to protect the recovering person form normal problems or provide help where it is not really needed. 7) Remember you cannot make someone recover. Offer the support you can and keep yourself well.
Detoxication Limits: 1) Almost a quarter of sample drop out between assessment and 30 days in treatment.2) Predictors of early exit are: being younger; being homeless; and not being a current injector. 3) Age and injection status were both consistently associated with exit between assessment and treatment entry. 4) Those who were not in substitution treatment were significantly more likely to leave treatment at this stage. 5) There were substantial variations between agencies, which point to the importance of system factors. 6) Qualitative analysis identified several potential ways to improve services. 7) Perceived problems included: opening hours; the service setting; under-utilisation of motivational enhancement techniques; lack of clarity about expectations; lengthy, repetitive assessment procedures; constrained treatment choices; low initial dosing of opioid substitution treatment; and the routine requirement of supervised consumption of methadone.
Relapse Goals: 1) Help the patient continue to maintain abstinence; 2) Make the patient aware of the relapse process, so it can be avoided or reversed quickly; 3) Assist the addict in recognizing emotional triggers; 4) Teach the patient appropriate coping skills to handle life stresses without returning to drug use; 5) Provide the opportunity for the patient to practice newly developed coping skills; 6) Keep encouraging the behavior and attitude changes necessary to make sobriety a lifestyle.
Relapse Treatment Issues: 1) Tools for preventing relapse; 2) Identification of the relapse process; 3) Relationships in recovery; 4) Development of a drug-free lifestyle; 5) Spirituality; 6) Shame and guilt; 7) Personal inventory; 8) Character defects; 9) Identification and fulfillment of needs; 10) Management of anger; 11) Relaxation and leisure time; 12) Employment and management of money; 13) Transfer of addictive behaviors.
Desintoxications may, for some product and according importance of chronic consumption, be made ambulatory, but with an enough minimum professional cover (like nurse or enough trained technician) or interned, especially when there is a strong physical dependence (alcohol, opiates). Otherwise hospitalization will have more to do with the probability of good outcome of the mean. Not the purpose of this website to pretend you could care without life's training and no background for an ambulatory delivery; even when it is also to recognize that family care, quiet effective and peacefull attention are essential to a good withdrawal. Finally to observe that the chronic nature of addiction, just means that after a period of few weeks of withdrawal wherever it takes place, the hard work of "relapse prevention treatment" (very psychosocial, eventually pharmacologic) goes on and on.
For the patient of all the structure matrix of activities and outcomes, can be filled, by periods for the structure, progressively, by the patient according the intensity ofuse he/she has of the services of the structure. Table is made with proportions or in units, be this unit in their 3 basic forms: like time consuming, cost and quality measure (index of satisfaction, eventually something using and entropy "half-index".
Sample process vs Outcome matrix |
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proceses |
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self-efficacy expectancies |
skill acquisition |
bonding |
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outcomes |
relapse prevention |
support access |
service access |
with addicts & ex-offenders |
with counselors |
|
drug free (complete abstinance) |
% |
% |
% |
% |
% |
% |
stable employment or social integrated |
% |
% |
% |
% |
% |
% |
crime free (avoidance of criminal behavior) |
% |
% |
% |
% |
% |
% |
compliance with rules |
% |
% |
% |
% |
% |
% |
Relations with patients have guides and many complications. If referrent or therapist must have rigour, they should show also flexibility, and empathy. Not to set impossible to reach goals in the delay (while some few basic rules will be essential like in licit addictions). Services with strong rules can exist but more carefully not forced, when a convenient alternative exist, rules of the program should be adhered "freely" and progressive. Indeed a judiciary injunction just sets the rules, not in the institution of care but in the legal one (and there are deals too). If formal agreement are often difficult to non offender patient, it is to find the sort of sincerity possible to the patient, acceptable to people in charge of care and ways to make this fairly formal too, like in a contract form. For example receive the benefit of a therapeutic accomodation has to be done in a written form. Proper practical management, is is also away to enhance skills, balance between the different forms of approach, supports, rigor and flexibility, with the risk, if insisting too much on forms, to miss and confuse the patient, overcomplicating where humanity is essential. A qualitative oriented simple table report or guide for follow up you may be inspire by next one.
Individual Chart Plan of Progress |
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gains received |
other processes |
interim outcomes |
long-term out-comes |
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obtained from services (times,care, type) |
individual therapy received (quality, quantity, satisfaction, pertinence) |
skill acquisition: social, job-seeking vocational, relapse prevention |
evolved social characteristics, duration, integration |
evolved relations with peers, children, spouse/mate, relatives, employer, others |
continuation: calls, information, share, participation, collaboration |
material, supplied received |
education drug abuse, health & nutrition |
expectancies filling self-efficacity outcome compliance & difficulties of treatment |
post treatment employment, social skilled received and applied, pertinence |
employment gained, perspective, requalification, reasonable expectation |
cost savings in development perspective from drugs avoidance |
activities |
group therapy women's men's prevocacional relaspe prevention |
relationships & social support: therapist, family, peers employers spouse/mate others |
medical complica -tions & support, psychological complications |
independent living, evolved conditions: places, habitat, social environment |
employee and assistance attitude and satisfaction |
self administration supported, received, regained |
time of referrals, life counselling, health, social services legal aid, vocational |
common life skills, communities' standart values |
therapist empathy, assessment satisfaction, self-critics |
cessation of substance abuse, preferred drug other drugs |
benefits, positive modelling for others |
transportation, communications, financing |
extra programs, logistic, |
self-help & solidarity, friendylness, anter/temper control |
addiction physiology and discapacity impairment status gained |
HIV transmission behaviors physical health balance |
prevention, risks avoidded improved family and social climate |
Source: adapted nfm |
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