ड्रग्स एडिक्शन -ईलाज क्या है ?

                                  

ड्रग्स एडिक्शन का ईलाज एडिक्टस  की  ड्रग्स को लेने के लिए बैचेनी - ड्रग्स को ढूंढ़ने और प्रयोग करने से रोकने के लिये एक साहयता है। 

ईलाज की विभिन्न सैटिंग हो सकती है ,विभिन्न तरीके हो सकते है  व विभिन्न समय अवधि हो सकती है।

एक छोटी अवधि का एक बार में लिया गया  ईलाज काफी नहीं होता है। अधिकतर ईलाज एक लंबी चलने वाली प्रकिर्या है जिसमे अनेक भाग होते है और लगातार देखभाल आवश्यक है। 

ईलाज विभिन्न प्रकार का हो सकता है जिसमे बिहैवियर थेरैपी - कॉउंसलिंग -मैडीकशन अथवा इन सब का सयुंक्त रूप से प्रयोग हो सकता है। 

विशेष प्रकार का ईलाज अथवा विभिन्न ईलाजो का सयुंक्त ईलाज एडिक्ट की आवश्यकता व उसके द्वारा प्रयोग की जाने वाली ड्रग्स पर निर्भर करता है। 

सर्वोत्तम ईलाज विभिन्न थेरैपी का सयुंक्त  प्रयोग व अन्य सर्विस का जोड़ होता है जो एडिक्ट की आवश्यकताओ को पूरा कर सके। 

एडिक्ट की आवश्यकताओ मे उसकी उम्र -कल्चर -जैंडर -दूसरी ड्रग्स का भी उपयोग -तनाव -जॉब व फिजिकल इतिहास सम्मिलित होता है। 

ईलाज संबधी दवाईया जैसे मैथाडोंन -बिनोर्फिन व नालट्रेक्सोन अफीम के एडिक्ट के  ईलाज के लिये उपलब्ध है। 

साईकोएक्टिव दवाईया जैसे एंटी डिप्रेसेन्ट - एंटी एनाक्सटी - मूड स्टेबलाईजर व एंटी साईकोटिक भी ईलाज  के सफलतापूर्वक पूरा होने मे मददगार है जब एडिक्ट मेंटल -डिसऑर्डर से गुजर रहा हो। जैसे तनाव -चिड़चिड़ापन या सिजोफ्रेनिया। 

बिहैवियर थेरैपी एडिक्ट को ईलाज मे भाग लेने के लिये प्रोत्साहित  करती है। ड्रग्स से दूर रहने के व रिलैप्स होने से बचने के तरीके बताती है व यदि एडिक्ट रिलैप्स हो जाता है तो उसे उस स्थिति को संभालना सिखाया जाता है।

बिहैवियर थेरैपी व  दवाईयो का  सयुंक्त प्रयोग अधिक असरकारक होता है क्योकि यह एडिक्शन के विभिन्न पहलू पर कार्य करता है। 

असरकारक ईलाज के सिद्धांत।

1. एडिक्शन एक गंभीर बीमारी है जो दिमाग के फंक्शन और व्यवहार पर प्रभाव  डालती है लेकिन ईलाज योग्य है। 
2. एक ही ईलाज सबके लिये उचित नही हो सकता। 
3. ईलाज हमेशा उपलब्ध होना चाहिए। 
4. सही ईलाज ऐडिक्ट की विभिन्न आवश्यकता पर भी केन्द्रित होना चाहिये ना की केवल ड्रग्स पर। 
5. एक निश्चित समय तक ईलाज मे रहना आवश्यक है। 
6. काउंसलिंग -अकेले या सामूहिक थेरैपी व अन्य बिहेवियरल थेरैपी सबसे ज्यादा उपयोग की जाने वाली विधि है। 
7. दवाईया ईलाज का एक महत्वपूर्ण तत्व है विशेषतया जब काउंसलिंग व बिहेवियरल थेरैपी के साथ सयुंक्त किया जाये। 
8. एक एडिक्ट के ईलाज व सर्विस योजना का लगातार मुल्यांकन करना चाहिये व परिवर्तन करना चाहिये ताकि वह उसकी बदलती आवश्यकताओ को पूरा कर सके। 
9. बहुत से ड्रग्स एडिक्ट अन्य मानसिक डिसऑर्डर से पीड़ित होते है। 
10. मैडिकल डीटॉक्सीफिकेशन केवल ईलाज का पहला हिस्सा है। 
11. ईलाज के समय मरीज के ड्रग्स लेने के संबध मे ध्यान रखना चाहिये क्योकि ईलाज के दौरान रिलैप्स के अवसर बने रहते है। 

PRINCIPLES OF DRUG DEPENDENCE TREATMENT. part 3

PRINCIPLE 3: EVIDENCE-INFORMED DRUG DEPENDENCE TREATMENT.

Description and Justification -

Evidence-based good practice and accumulated scientific knowledge on the nature of drug dependence should guide interventions and investments in drug dependence treatment. The high quality of standards required for approval of pharmacological or psychosocial interventions in all the other medical disciplines should be applied to the field of drug dependence.

Components -

•  There is a range of evidence-based pharmacological and psychosocial interventions relevant to different stages in the addiction career and treatment process. No single treatment is appropriate for all patients and differentiated and targeted treatment interventions to respond best to the specific needs of each clinical condition. For example, moderate cases may be handled in primary care settings (e.g. general practitioners with relevant training), while more severely affected patients, especially those with co-morbidities, may require multidisciplinary interventions, including psychiatric evaluation and care.

• Sufficient duration. In treating complex chronic diseases and preventing relapse, long-lasting treatment programmes have been found the most effective strategy and may be necessary for the more severe forms of drug dependence. It is therefore key for treatment services to develop approaches to facilitate long term patient retention in treatment.

•  The integration of psychosocial and pharmacological treatment methods can improve the outcome and should be proposed to the patients as part of a comprehensive approach. A holistic treatment orientation, treating the whole person, rather than the addiction only, has been shown to have better results in terms of relapse prevention.

•  Multidisciplinary teams including medical doctors, psychiatrists, psychologists, social workers, counsellors, and nurses can respond best to the needs of patients, also due to the multi-factorial nature of drug dependence. Treatment and care for physical conditions (liver disease, infections, pain, etc) and concomitant psychiatric disorders utilizing both medications and psychosocial interventions may significantly improve the treatment outcomes.

•  Brief interventions. Individuals with experimental and occasional substance use can benefit from screening and brief interventions, which are an effective and economical prevention option, also at the early stages of substance use disorders.

•  Outreach and low-threshold interventions can reach patients not motivated to engage in structured forms of treatment. These interventions offer a comprehensive package of measures to prevent the health and social consequences of drug dependence and have demonstrated effectiveness in preventing the transmission of HIV/AIDS and other blood-borne infections.

•  Basic services offering the essential support to stop or reduce drug use need to be distributed and widely available thorough the territory, including detoxification, psychosocially assisted opioid agonist pharmacotherapy of opioid dependence, counselling, rehabilitation strategies and social support.

•  Medically supervised withdrawal is required for patients who are heavy dependent users of certain substances (such as opioids, sedative/hypnotic substances, and alcohol) and are likely to experience withdrawal complications. Detoxification is a preparatory step to start long lasting drug-free oriented programs.

Maintenance medications with proven efficacy and effectiveness in preventing relapse and stabilizing drug dependent patients are available only for opioid dependence. These medications belong to two main groups: long-acting opioid agonists and antagonists. Opioid agonist pharmacotherapy is one of the most effective treatment options for opioid dependence when methadone or buprenorphine are administered at a individualized dosage for a period of several months to years. Alternatively, a defined group of opioid dependent patients who are detoxified and highly motivated can be prescribed an antagonist medication (naltrexone) as part of continuing relapse prevention treatment.

•  Psychological and social interventions have demonstrated to be effective in rehabilitation and relapse prevention, both in out-patient and residential settings. Psychotherapies such as cognitive behavioural therapy, motivational interviewing and contingency management, have shown promising results. Social support interventions like employment programmes, vocational training and legal advice and support have been demonstrated to be effective in facilitating social inclusion.

•  Self-help support groups complement formal treatment options and can support standardized psychosocial interventions.

•  Socio-cultural relevance. Evidence-based treatment methodologies and strategies need to be adapted to the diverse regional, national and local circumstances, taking into account both cultural and economic factors.

•  Knowledge transfer and ongoing clinical research implemented in different settings and regions is key to permanently improve the treatment programs available to patients.

•  Training of treatment professionals from early on in their careers, including within university curricula and continuing education is essential to disseminate evidence-based methodologies.

Actions to promote this principle -

Ensure that:-

1. available resources are invested in evidence-based interventions

2. a comprehensive treatment system offers a wide range of evidence-based and integrated pharmacological and psychosocial interventions, aimed at treating the whole person. The range includes interventions of diverse intensity, from outreach, low-threshold and brief interventions to long-term, structured treatment
3. the duration of treatment interventions is determined by individual needs, and there are no pre-set limits to the duration of treatment
4. whenever possible, services are staffed by multidisciplinary teams adequately trained in the delivery of evidence-based interventions
5. basic services including detoxification, psychosocially assisted opioid agonist maintenance pharmacotherapy for opioid dependence, counselling, and social support are available thorough the territory
6. more complex cases, including patients with concomitant severe somatic and psychiatric disorders receive adequate care, possibly through referral to specialized services
7. psychosocial interventions have demonstrated to be effective in rehabilitation and relapse prevention, both in out-patient and residential settings, in particular cognitive behavioural therapy, motivational interviewing and contingency management, employment and vocational training, counselling and legal advice.
8. interventions are adapted for relevance to the socio-cultural environment in which they are applied, constantly updated in accordance to research developments and diversified research is conducted in all regions of the world.

PRINCIPLES OF DRUG DEPENDENCE TREATMENT. part 2

PRINCIPLE 2: SCREENING, ASSESSMENT, DIAGNOSIS AND TREATMENT PLANNING

Description and Justification

Patients affected by drug use disorders often have multiple treatment needs across a range of personal, social and economic areas that cannot be addressed when taking into consideration only their addictive symptoms in a standardized way. As for any other health care problems, diagnostic and comprehensive assessment processes are the basis for a personalized and effective approach to treatment planning and engaging the client into treatment.

Components

•  Screening is a useful assessment procedure to identify individuals with hazardous or harmful drug use, or drug dependence, as well as associated risk behaviors (viral transmission via needle sharing and/or unprotected sexual activity, potentially violent behavior, suicide risk). There are standardized tools to assess drug use and its severity in an individual that help to consider the degree of help required. These tools can be applied in different environments (primary health care system, school health and counseling services, and employee assistance programmes at workplaces).

•  Assessment and diagnosis are core requirements for treatment initiation. Diagnostic criteria commonly used in the mental health field are the references to reach a diagnosis of a drug use disorder. Diagnosis of comorbid psychiatric disorders is ideally made and followed-up by a psychiatrist, while with adequate training, other health care professionals can successfully identify and manage drug use disorders and associated psychiatric co-morbidity.

•  A comprehensive assessment takes into account the stage and severity of the disease, somatic and mental health status, individual temperament and personality traits, vocational and employment status, family and social integration, and legal situation. It further considers environmental and developmental factors, including childhood and adolescent history, family history and relationships, social and cultural circumstances, and previous treatment attendance. An adequate assessment process creates the environment for the development of a therapeutic alliance to engage the patient into treatment.

• The treatment plan, developed with the patient, establishes goals based on the patient’s identified needs and sets interventions to meet those goals. A care or treatment plan is a written description of the treatment to be provided and its anticipated course. Care plans set the specific needs of the individual patient and how they are going to be met by the service. The plan is then monitored and revised periodically as required to respond to the patient’s changing situation. While current research results do not support matching patient profiles to specific treatment approaches, there is evidence that matching responses and interventions to client needs following a serious diagnostic process and extensive assessment improves the treatment outcomes.

Actions to promote this principle

Ensure that:

1. primary health care staff, as well as employee assistance programmes and health/counseling staff in social services, at schools and in the criminal justice system are aware of the benefits of screening, early identification of drug use and brief interventions and are trained to administer such screening tools and associated interventions packages.

2. patient risk behaviors associated with drug use disorders are assessed at all relevant venues (primary health care, outreach services, emergency services, social services, etc) and responses planned in consequence.

3. accurate diagnosis of drug dependence and other co-morbid conditions is established before initiating drug dependence treatment, in particular, pharmacological treatment.

4. clinical protocols specify requirements for comprehensive patient assessment and the treatment plan development, patient progress monitoring and revision of written care plans, and the relevant staff is trained to fulfill these tasks.

5. documentation and standardization of all treatment steps are required from all staff involved in the treatment plan in order to ensure quality treatment for all patients

PRINCIPLES OF DRUG DEPENDENCE TREATMENT.

This paper outlines nine key principles for the development of services for the treatment of drug use disorders. It is recognized that in some circumstances resources will be rather limited and priorities in resource allocation need to be set. It is important that in such situations, a response to drug use disorders is developed as “building blocks” on which more diverse and sophisticated interventions can be developed and incorporated in the treatment system as further resources become available. Depending on human and financial resources available and the quality level of the existing health system in each country, the actions suggested by the present document may be progressively and gradually implemented, taking into account the outlined components for each principle as a general framework.

PRINCIPLE 1: AVAILABILITY AND ACCESSIBILITY OF DRUG DEPENDENCE TREATMENT.

Description and Justification

Drug dependence and it's associated social and health problems can be treated effectively in the majority of cases if people have access to a continuum of available and affordable treatment and rehabilitation services in a timely manner. To this end, all barriers limiting accessibility to treatment services need to be minimized for people to have access to the treatment that best fits their needs.

Components

Many factors contribute to treatment accessibility:

1. Geographical accessibility, distribution, and linkages.

• Health care system and public health networks, in cooperation with social services and the broader community, can provide essential prevention and treatment services and support for people with drug use disorders in their communities. Social services and other institutions (e.g. schools, civil society organizations, and self-help groups) can serve as points of the first contact for potential patients and help them access treatment.
• In a comprehensive treatment system a large scale, distributed network of treatment facilities that can respond to various needs of individuals seeking treatment permits an adequate response in each community.
• The basic prevention and treatment services for drug use disorders need to be within the reach of people with different levels of income.
• Within a continuum of care, people with drug dependence should have access to treatment services through multiple entry points.
• Outreach services, as part of a continuum of care, are needed to reach the ‘hidden’ populations most affected by drug use, often non-motivated to treatment or relapsing after a treatment program. Outreach services are particularly important to attract problematic drug users early and to establish contact with the population of people with severe disorders who may not seek treatment because of stigma and marginalization.

2.Timeliness and flexibility of opening hours. Same-day admission or short waiting time for structured services, as well as a provision of immediate intermediate services, including patient information. A wide range of opening hours will facilitate access to services for individuals with employment or family responsibilities.

3.Legal framework. Requirements to register drug addicts in official records, if associated with the risk of sanctions, may discourage patients from attending treatment programmes, thus reducing accessibility.

4.Availability of low threshold services. Flexibility in the organization of treatment services will improve access by a larger range of individuals in need. This includes the availability of services with a low threshold for patient admission and the removal of unnecessarily selective criteria.

5.Affordability. Payment for treatment and rehabilitation services may constitute a significant barrier for patients in many cases without sources of income. Insurance coverage or inclusion of drug dependence care in the public health care system is therefore key to promote access for those most in need.

6.Cultural relevance and user-friendliness. Current knowledge indicates that a treatment climate that is culturally sensitive, preferably multi-professional, team orientated, and that encourages patient participation and involvement in treatment facilitates patient access and retention in treatment, and ultimately improved treatment outcomes.

7.Responsiveness to multiple needs and diversification of settings. The availability of specialized services and residential settings to care for the more complex cases, e.g., patients with drug dependence and associated somatic or psychiatric disorders is essential to increase accessibility.

8. Criminal justice system responses play a significant role in improving access for individuals affected by drug dependence to treatment services: law enforcement officials, courts and prisons may closely collaborate with the health system to encourage drug-dependent individuals to enter treatment.

9.Gender-sensitiveness of services. Services tailored to gender-specific treatment needs can improve accessibility by responding to differential stigmatization, child care needs, and issues in pregnancy.

Actions to promote this principle

Ensure that:
1. the system of services permeates both urban and rural areas and builds upon the primary health care system. Key components include proactive outreach, low-threshold, early identification and brief intervention in primary health and social care services, basic drug dependence treatment services, and referral to treatment services from the criminal justice system.
2. legal frameworks guarantee protection from potential sanctions for those seeking treatment.
3. there are a functional referral and counter-referral mechanisms between different services in the system as well as to and from other agencies, facilitating a continuum of care.
4. the number of people on waiting lists and waiting times are minimized, and that intermediate responses are available.
5. staff attitudes are welcoming and non-judgmental.
6. services take into account and respect cultural norms.
7. patients’ perspectives are taken into account in service design and development.
8. eventual service costs to patients are affordable and waved if necessary.
9. services for women in primary health care and facilities for children of parents with drug dependence are built in close relationship with drug dependence treatment programs.