Drug and alcohol abuse can lead to health concerns, trouble with interpersonal relationships, and a loss of production in the workplace.
Addiction is a chronic brain disease that creates chemical changes in the brain and the natural reward and motivation centers. Someone suffering from a substance abuse dependency may spend most of their time seeking drugs or alcohol, as well as using and recovering from the effects of the substance abused.
Substance abuse is perpetuated regardless of any negative health, emotional or social consequences. Often, a substance addict may be in denial that a problem exists, and there may be no internal motivation to seek help voluntarily. Many times, an outside source or pressure is needed to facilitate the initiation of a treatment program, and this outside pressure may come in the form of a legal mandate.
Regardless of the reason for entering a treatment program, research shows that rehab has positive potential for success. The National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research Department formulated a study of a group of men that showed that after five years, both those who entered into treatment voluntarily and those who were mandated to attend treatment had similar success rates. Success was measured based on abstinence levels, re-arrest and employment rates. At the end of the five-year follow-up, both groups of men were less likely to relapse, had high sustained abstinence rates, low instances of re-arrest and improved employment rates. While the group who were required to attend treatment may not have initially possessed the internal motivation to change and remain drug- or alcohol-free, treatment likely provided them with this desire.
When Mandatory Treatment Is Required
Drugs and alcohol alter mental states and heighten the probability of engaging in risky or dangerous behaviors. Substance abuse may also increase the risks for engaging in criminal behavior. Many crimes are drug-related offenses, such as possession, trafficking, or using, while others crimes are committed in an attempt to obtain more drugs. For example, someone may steal property or money in order to buy drugs. Still other crimes are committed while under the influence of drugs.
The Bureau of Justice Statistics (BJS) published a 2004 survey done by the U.S Department of Justice (DOJ) showing that as many as 32 percent of state inmates and 26 percent of federal prisoners reported being under the influence of drugs while committing the offence they were currently incarcerated for. The DOJ survey also found that one in four violent offenders in state prisons were under the influence of drugs when they committed their crimes.
When criminal offenses are drug- or alcohol-related, substance abuse treatment is often court-mandated. For example, if you are charged with driving under the influence (DUI), public drunkenness, or underage drinking, you may be required to participate in an alcohol treatment program. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that one of the primary reasons people enter into alcohol treatment programs is due to a court-mandate, with as many as 36 percent of those entering treatment in 2002 doing so under direction from the criminal justice system. Drug or alcohol treatment may be a condition of parole or probation after serving time for a crime. A special court even exists for those charged with drug- or alcohol-related offenses.
Most states and 47 percent of the counties in the United States are currently being served by drug courts, as reported by the Office of National Drug Control Policy. Drug courts serve to divert nonviolent drug offenders into a drug treatment program instead of taking further or traditional legal action. The National Institute on Drug Abuse (NIDA) estimates that substance abuse and addiction cost society $524 billion a year in incarceration, crime, health care, loss of productivity and drug enforcement. Drug courts seek to lower these costs to taxpayers as well as offer a more productive option than incarceration.
Drug court mandates a year-long supervised drug or alcohol treatment program in an attempt to attain long-term recovery. The National Association of Drug Court Professionals (NADCP) reports that as many as 75 percent of those graduating from adult criminal drug court will not be rearrested for committing further crimes within their lifetimes.
Drug court participants are closely monitored to ensure they stay in treatment and participate in the program while remaining drug- or alcohol free. Drug court requires the following in order to avoid further legal troubles:
- Participation in intensive treatment programs required to achieve and maintain sobriety for the full year term
- Regular random drug tests must produce negative results
- Court, personal, societal and family obligations as mandated by the drug court judge are upheld
- Regular court appearances in front of the drug court judge in order to review and evaluate progress
Drug court participants are sanctioned for not completing any aspects of these obligations and rewarded for doing well in the treatment program. In order to be eligible for drug court in lieu of traditional legal proceedings, you cannot be a violent offender. Drug court eligibility further varies between individual state and county courts. Most accept drug- and alcohol-related crimes, including crimes committed in an attempt to obtain drugs. If a victim is involved in the crime, most drug courts will require the victim’s consent as well as payment of restitution. Most drug courts are for adult offenders and function within the adult justice system, although family and juvenile drug courts exist as well.
Perhaps one of the potential shortcomings of mandatory treatment and the drug court model is the lack of consistency. Each drug court or state will have different requirements and program parameters. There are 2,500 drug courts operating independently in the United States, according to the Office of National Drug Control Policy. When a strong partnership exists among law enforcement and the drug court team, it creates higher success rates. The creation of a national law enforcement task force and the training opportunities provided by the National Drug Court Institute (NCDI) seek to ensure certain standards and increase efficacy of the drug court model and treatment programs.Research seems to debunk the thought that a substance abuser must voluntarily seek treatment in order for it to be successful. If proper treatment is received for the necessary length of time, mandatory treatment may be just as successful as treatment that is sought independently. Legal pressure may actually make court-ordered treatment more effective, as the threat of legal action or incarceration may serve as a motivator to remain abstinent and make the necessary lifestyle changes to sustain recovery. Successful completion of a treatment program greatly increases the odds of remaining free from substance abuse for the long-term, as Maryland’s Alcohol and Drug Abuse Administration (ADAA) found a reduction in substance abuse of one-third to two-thirds after treatment.
Treatment Methods
Whether mandated or voluntary, treatment for a substance use disorder seeks to first stabilize the individual and then works to provide the necessary tools for reintegrating a healthier and more whole individual successfully into society. Evidence-based treatment models combine scientific knowledge, clinical expertise and each individual’s personal preferences in order to successfully treat substance abuse disorders. Behavioral therapies teach life skills and mechanisms to avoid or cope with stressors and potential triggers when returning to everyday life. Self-esteem is bolstered while negative self-images are explored and positively modified.
Substance abuse and depression, anxiety, mood disorders, and other mental health disorders commonly co-occur. This means that someone suffering from a substance use disorder may also be diagnosed as suffering from a mental health disorder at the same time or vice versa. For example, the U.S. Department of Justice and the Bureau of Justice Statistics found that 74 percent of state prisoners with a mental health concern also suffered from substance abuse or dependency. When two disorders co-occur in the same person simultaneously, comprehensive dual diagnosis treatment can be most helpful. Dual diagnosis treatment models employ teams of medical professionals who work together to monitor and successfully treat multiple disorders at the same time. This type of integrated treatment provides the highest rates of long-term recovery and the reduction of potential relapse.
Many times the use of medications is necessary during recovery. These may be mood stabilizers, antidepressants or medications to aid the detox process. Some addictive substances have withdrawal symptoms that may need to be medically managed to ensure safety and comfort. Medical detox should be provided in a safe and secure environment supervised by medical professionals. After achieving physical stabilization, the emotional aspects of substance abuse, dependency, and/or addiction can be identified and managed. Group, individual and family counseling and therapy sessions aid in building up a network of support that is necessary to facilitate long-term recovery. Healthy lifestyle changes are also implemented during treatment. Self-help, 12-Step, and other support groups provide a secure and supportive environment, helping to prevent relapse and encourage long-term recovery.
At FRN, our treatment centers are full-service facilities with highly trained and compassionate professionals on hand, providing a wide range of services to promote the successful treatment of substance abuse and mental health disorders. Call us today to learn more.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton