Ask the Expert
Treatment 101: Recovery Today
View the Webcast "Treatment 101"
Ask the Expert:
Wilson M. Compton, M.D., M.P.E.
, Director, Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse (NIDA)
I viewed the Web Cast this morning and one of the doctors (Dr. Willenbring) mentioned that one big treatment need was in Juvenile Detention Facilities. He stated that they were not/not able to assess substance abusers to get them the resources needed or treatment. Was he referring to short term detention or long term incarceration facilities? What are the next steps to improve this?Answer: There is a need for additional treatment resources at all levels for juveniles in the criminal justice system. This not only includes increasing treatment capacity for incarcerated youths, but also prevention efforts for those who are at risk for substance abuse and improved follow-up of youths who have completed treatment. A good resource for more information on treatment in the criminal justice system is NIDA's "Principles of Drug Abuse Treatment for Criminal Justice Populations." It includes specific information on the unique treatment needs of juveniles in the criminal justice system (p. 27), and can be viewed and downloaded at: http://www.nida.nih.gov/PODAT_CJ/index.html.
- What can be done to treat someone with a severe cocaine addiction and who also experiences bi-polar disorder? Is there a treatment program that specializes in this condition and if so are there any who have Spanish-speaking staff?
Answer: Persons with cocaine addiction and bi-polar disorder are successfully treated every day. There are many programs across the U.S. that specialize in dual-disorders. You should consult with your local physician or psychiatrist to see what resources are in your area. For additional background reading on treating addiction and co-occurring mental conditions, visit NIDA's newly released research report, "Comorbidity: Addiction and Other Mental Illnesses" (pp.7-9), which can be viewed and downloaded at: http://www.nida.nih.gov/researchreports/comorbidity/index.html.
- What types of medications would you recommend for an individual in recovery who is at moderate to high risk of relapse? Specifically, if a person has a co-occurring disease, what type of psychiatric medications (anti-psychotics, anti-depressants, anti-anxiety, and mood stabilizers)?
Answer: There are several medications for preventing relapse currently available in the U.S. for tobacco, alcohol and opioid addictions. Medications can be a key part of improving treatment outcomes for all of these substances. However, which particular medication to recommend depends on a number of factors and should be undertaken under the supervision of a qualified healthcare professional. One thing to keep in mind is that medication is almost always meant to be combined with therapy and/or self-help, and rarely used as the only method for preventing relapse. In addition, the use of medications to treat psychiatric disorders other than the addiction depends largely on the individual, the type of disorder they are suffering from, and how well they would tolerate the different medication options. As I recommended above, NIDA's "Comorbidity: Addiction and Other Mental Illnesses," is a good resource for additional information in this area: http://www.nida.nih.gov/researchreports/comorbidity/index.html.
- I've done some research and have found that there is a link between emotional intelligence and substance abuse. However, I cannot find research that looks at increased emotional intelligence improving relapse rates. Do you know of any research in this area?
Answer: This is an interesting question. To date there has been little research examining emotional intelligence and drug abuse published in peer-reviewed journals. There has been some work examining emotional intelligence and substance use initiation:
- Riley H, and Schutte NS (2003) Low Emotional Intelligence as a Predictor for Substance-Use Problems, Journal of Drug Education, 33(4);391-398
- Trinidad DR, and Johnson CA (2002) The Association Between Emotional Intelligence and Early Adolescent Tobacco and Alcohol Use, Personality and Individual Differences, 32(1);95-105
- I am a primary care doctor. If I identify an adolescent who has an early problem, but I am unable to treat them, where do I send them? How accessible is treatment for specialized populations, such as for adolescents, women, and minority populations? What else can I do to help my patient?
Answer: The availability of treatment resources varies greatly by region. Urban areas tend to have a greater diversity of specialized resources compared to rural areas. The last thing you want to do is give up on your patient. As a primary care physician you carry a great deal of influence with your patients. I suggest that you continue to support your patient's efforts to quit using drugs. You may also wish to refer him/her to a local self-help group ? preferably one with younger attendees. I'd also recommend that you familiarize yourself with NIDA's new online screening tool. It was designed to help primary care doctors screen adult patients for substance abuse, and thus it is not appropriate for use with adolescents. This resource guides primary care doctors through a brief series of questions and, based on the patient's responses, generates a substance involvement score that suggests the level of intervention needed for adults. The online screening tool is part of NIDA's new physician's outreach campaign, NIDAMED. The NIDAMED toolkit also includes an online resource guide with detailed instructions on how to implement the screening tool, discuss screening results, offer a brief intervention and make necessary referrals. All of the NIDAMED tools can be viewed online at: http://www.nida.nih.gov/nidamed/screening.
- Dr. Willenbring refers to 'no wrong door to recovery' being focused on treatment mechanisms for recovery. Where does recovery support fit within the treatment model? Additionally, how does self-help and mutual support fit with this model?
Answer: Key to any successful treatment system is the idea that no matter where someone enters care, they will be able to access the services which will best meet their needs. Thus, persons entering care through the mental health system or the general health system or the criminal justice system, should have access to the same types and range of needed services as those who enter care through the substance abuse treatment system directly.Self-help and mutual support are key components of disease management and intervention for many persons, and use of these services is associated with improved recovery outcomes for many. Key is to use the treatment process itself to promote use of these important components of long-term recovery.