Drug rehabilitation
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.
Drug rehabilitation
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Treatment includes medication for depression or other disorders, counseling by experts and sharing of experience with other addicts.[1]
Psychological dependency[edit]
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the person new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs but to examine and change habits related to their addictions. Many programs emphasize that recovery is an ongoing process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.")
Whether moderation is achievable by those with a history of misuse remains a controversial point.[2]
The brain's chemical structure is impacted by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process.[3]
Recovery[edit]
The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery.[35] The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal well-being[36] while other studies have considered "near abstinence" as a definition.[37] The wide range of meanings has complicated the process of choosing rehabilitation programs.
The Recovery Model originates in the psychiatric survivor movement in the US, which argues that receiving a certain diagnoses can be stigmatizing and disempowering.[38] While other treatment programs are focused on remission or a cure for substance abuse, the Recovery Model takes a humanistic approach to help people navigate addiction. Some characteristics of the Recovery Model are social inclusion, empowerment to overcome substance use, focusing on strengths of the client instead of their deficits and providing help living more fulfilling lives in the presence of symptoms of addiction. Another key component of the Recovery Model is the collaborative relationship between client and provider in developing the client's path to abstinence. Under the Recovery Model a program is personally designed to meet an individual clients needs, and does not include a standard set of steps one must go through.[39]
The Recovery Model uses integral theory:[40] a four-part approach focusing on the individual, the collective society, along with individual and external factors. The four quadrants corresponding with each in Integral Theory are Consciousness, Behavior, Culture and Systems.[41] Quadrant One deals with the neurological aspect of addiction. Quadrant Two focuses on building self-esteem and a feeling of connectedness, sometimes through spirituality. Quadrant three works on mending the "eroded relationships" caused by active addiction. Quadrant Four often involves facing the harsh consequences of drug use such as unemployment, legal discrepancies, or eviction.[42] The use of integral theory aims to break the dichotomy of "using" or "not using" and focuses instead on emotional, spiritual, and intellectual growth, along with physical wellness.
Criminal justice[edit]
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings.[43] There are a great number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U.S. Constitution, mandating separation of church and state.[44][45]
In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act.
Criticism[edit]
Despite ongoing efforts to combat addiction, there has been evidence of clinics billing patients for treatments that may not guarantee their recovery.[1] This is a major problem as there are numerous claims of fraud in drug rehabilitation centers, where these centers are billing insurance companies for under-delivering much-needed medical treatment while exhausting patients' insurance benefits. In California, there are movements and laws regarding this matter, particularly the California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses.
Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance use treatment.[84] With long wait lists in limited state-funded rehabilitation centers, controversial private centers rapidly emerged.[84] One popular model, known as the Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies.[84] Under the guise of helping patients with opioid addiction, these centers would offer addicts free rent or up to $500 per month to stay in their "sober homes", then charge insurance companies as high as $5,000 to $10,000 per test for simple urine tests.[84] Little attention is paid to patients in terms of addiction intervention as these patients have often been known to continue drug use during their stay in these centers.[84] Since 2015, these centers have been under federal and state criminal investigation.[84] As of 2017 in California, there are only 16 investigators in the CA Department of Health Care Services investigating over 2,000 licensed rehab centers.[85]
By country[edit]
China[edit]
As of 2013 China has compulsory drug rehabilitation centers. It was reported in 2018 1.3 million drug addicts were treated in China's compulsory detox centers.[90][91]
Compulsory drug rehabilitation has a long history in China: The Mao Zedong government is credited with eradicating both consumption and production of opium during the 1950s using unrestrained repression and social reform.[92] Ten million addicts were forced into compulsory treatment, dealers were executed, and opium-producing regions were planted with new crops. Remaining opium production shifted south of the Chinese border into the Golden Triangle region.[92]
Indonesia[edit]
In 2015 the National Narcotics Board (Indonesia) was pushing for compulsory drug treatment for people with drug dependence.[93][94]
Iran[edit]
According to statistics best case scenario less than a 25% of addicts go back to being healthy.[95] There are two types of rehab one is Revolutionary Guard Corp or FARAJA run article 16 quarantine which is part of operations cleaning the cities from addicts and homeless just as well, the others article 15 and article 17 run by others including State Welfare Organization of Iran and also those run by Ministry of health and medical education.[96][97] There are also places called Trust houses since July 2023 run by IRGC.[98][99][100]
Italy[edit]
In 1963, Pierino Gelmini founded Comunità Incontro, a drug rehabilitation center in Amelia, Italy.[101]