Community Treatment of Drug Misuse: More than Methadone by Nicholas Seivewright

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By Nicholas Seivewright

Lately, methadone has been the therapy of selection for heroin dependency. This process has had substantial good fortune, yet hence different remedies were missed. This booklet attracts at the author's direct scientific event and uses overseas examine findings to supply a finished and designated advisor to carrier provision and remedy for drug misuse, together with methadone and replacement opiate substitutes, detoxing equipment, naltrexone and relapse prevention, and attainable ways with non-opiate clients. insurance areas emphasis on social elements in drug misuse and dependency, and the resultant therapy concerns and sensible problems. Illustrative case experiences are featured during the textual content. Combining a hugely functional technique with a powerful study base, this ebook might be a necessary source for psychiatrists and different execs curious about the administration of drug misuse.

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If it is virtually guaranteed that they can have their methadone back should they prove unable to cope with the detoxification, that can have a major demotivating effect, while if that safety net is not there, users who might be able to detoxify will be deterred. Of course, this difficulty also applies to community detoxifications from methadone, but in the case of costly inpatient treatment the implications of aborting a detoxification to re-establish methadone are magnified. The particular problems of inpatient care and long-term residential rehabilitation for drug misusers are best addressed by those with a substantial commitment to such treatment, including services with specialist inpatient units for this group (Strang et al.

In our clinics we generally aim to eliminate benzodiazepine misuse, but in those who wish to avoid a high methadone dosage and are capable of stabilizing, or who fail to respond to psychological treatment of associated anxiety problems, prescribing of benzodiazepines is sometimes accommodated. Unfortunately there are some individuals who will still use benzodiazepines even on high-dose methadone, and these difficult clinical situations are discussed further in the section on prescribing benzodiazepines in Chapter 2.

In general, once again, the 34 A medical treatment for social reasons? most positive evidence is in favour of a systematic and comprehensive approach. McLellan et al. (1993) randomly assigned 92 methadone patients to three groups which differed in levels of psychosocial services, with the actual methadone treatment remaining the same. Some 69% of subjects who received virtually only the methadone prescription continued to use other opiates or cocaine, with lower levels in groups who received additional counselling (41%), or counselling plus on-site medical and psychiatric services, workshops on employment skills and family therapy (19%).

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