The problem of Addiction to Alcohol and Drugs is a growing social concern. This is especially so with an increasing number of our adolescents and young adults, experimenting not only with alcohol and nicotine, but also marijuana (ganja), narcotics, prescription medication and various forms of inhalants. In response to this, we are witnessing a growth in the number of facilities for the treatment of Alcoholism and Drug Addiction. For instance, the De-Addiction Network coordinated by NIMHANS, Bangalore, currently has a membership of over 15 such facilities, most of which are spread in and around Bangalore.
We acknowledge the fact that some differences may exist among the various treatment centres with regards to philosophy and approaches to treatment modalities and intervention. However, there are also concerns about some treatment interventions that include various forms of emotional and physical abuse and violence currently in practice. While such interventions have little or no therapeutic value in themselves, they also fail to comply with contemporary standards of mental health care.
The basic goals of treatment and rehabilitation of persons suffering from alcoholism and drug addiction is shared by all treatment facilities. However, as health professionals committed to this common cause, we need to call to question practices such as violence that compromise the respect and dignity of individuals under our care.
Thus for the sake of greater professionalism and therapeutic effectiveness among the growing number of service providers, there is a need to work towards some common guidelines that elicit ‘Standards of Minimum Care and Ethical Practices’, in the treatment of Alcoholism and Drug Addiction.
Minimum documentation and case records on both medical care and therapy should be maintained on all patients. This enhances the effectiveness of the ongoing treatment plan and serves to keep a therapeutic continuity in case of a relapse. These may include but not limited to the following:
The organizational structure should facilitate an environment that promotes treatment and recovery in a holistic manner. Primacy should be given to both the therapeutic and the medical care of patients by ensuring full time medical personnel and a healthy counsellor-to-patient ratio of 1:8 on the staff. This results in greater individual attention and care during treatment.
An Emergency Protocol should be developed to effectively deal with any emergencies, such as medical complications during withdrawals, accidents, suicide and other medical emergencies. Observation and medical supervision by medical personnel should be ensured for the patients during the phase of withdrawal
Patients should have access to regular medical check-ups and treatment when indicated. Periodic psychological and mental status evaluation should be facilitated, and when dual diagnosis is indicated, access to psychiatric evaluation and treatment should be ensured. Supervised administration of medication should be ensured for patients in withdrawals and those with dual diagnosis.
Developing a well-balanced dietary schedule could monitor nutritional care. Patients should be provided with an aggressive education and awareness campaign on the subject of HIV/AIDS and other sexually transmitted diseases. This is a critical issue considering the fact that the relationship between alcoholism / drug addiction and HIV / AIDS is very high in our country. Consequently, alcoholics and drug addicts comprise a high-risk group for the above diseases.
During treatment the following should be ensured:
Treatment & Rehabilitation
Daily activities should be structured so as to facilitate treatment and rehabilitation.
Activities could include but not limited to the following:
The treatment staff should ideally represent an inter-disciplinary team of mental health professionals in the treatment of alcoholism and drug addiction. This could comprise both regular and consultative roles, such as the following:
Personal care and grooming of every patient should be ensured especially of those with dual diagnosis and those in the initial withdrawal period. This includes monitoring their personal hygiene such as regular bath, clean clothes, lice infestation, haircuts, etc.
De-Addiction literature describes Alcoholism and Drug Addiction as a family disease. Hence, any treatment intervention of a chemically dependent individual would remain incomplete without the family’s active participation in their own treatment and recovery as co-dependents.
Education and counselling for the family members should be provided, considering the characteristic co-dependent family dynamics that often accompanies alcoholism and drug addiction. Some of these areas of growth include denial, detachment, obsession, repression, dependency, anger, guilt, lack of trust, poor communication, low self-worth, and weak ego boundaries.
Regular family education and family therapy sessions at the treatment facility will ensure greater awareness and effective participation of the family in the patient’s long term recovery. Regular participation of the family in local self-help groups such as the Al-Anon, Alateen, and the Nar-Anon, will ensure a healthy support system for the families in dealing with their co-dependency issues and in their own self-development.
The completion of treatment and the subsequent rehabilitation back to normal life is a very critical period in the life of a person recovering from alcoholism and drug addiction. Care and preparation at the time of discharge could help address many ongoing issues and assist in the prevention of a possible relapse.
This could include the following:
In the eventuality of a relapse back to active addiction, the patient should be provided with a relapse treatment of a shorter duration. The focus will then be on the dynamics and process of the recent relapse and ways of preventing one in the future.