Addiction Treatment

The Roots of Alcoholics Anonymous

In October 1909, Dr. Alexander Lambert announced to a New York Times reporter that he had found a cure for alcoholism and drug addiction—a cure that would work in less than five days—consisting of belladonna (deadly nightshade) and the fluid extracts of xanthoxylum (prickly ash) and hyoscyamus (henbane). Howard Markel, M.D., writes for the New York Times today that Dr. Lambert was hardly a quack seeking a headline: he was widely known as Theodore Roosevelt’s personal physician, a professor of medicine at Cornell Medical College, and an expert on alcoholism.

Full Story

Batterers and Substance Abuse

Batterers who have substance problems have many special treatment needs when seeking substance recovery. These individuals have two serious issues that must be resolved simultaneously in order to be successful in recovery from either domestic violence or substance use. Relapse in either substance use or battering can lead to relapse in the other problem. The relationship between substance use and intimate partner battering is intricate and complex. Domestic violence incidents, for example, are considered to involve higher risk for victim injury if substances are involved. Additionally, there are many ways that batterers use substances to perpetuate or attempt to control their abusive behaviors.

One of the major substance-related difficulties in partner violence is that batterers have impaired decision-making when intoxicated. Control of violent behavior for batterers is largely a matter of making conscious choices for safety based upon empathy for others. Intoxication can sabotage the batterers’ ability to make such recovery-based decisions and to use cognitive coping skills designed for safety.

Intoxication also leads to poor impulse control that can override recovery efforts and safety plans meant to control coercion and abuse of partners. Poor impulse control allows emotions to surface with fewer mental checks and balances than are present when not intoxicated. High emotionality is a classical trigger to violence relapse for many batterers who use substances. High emotionality is also a common trigger for relapse to substance use.

Batterers who use substances also tend to have a more distorted perception of others when intoxicated. This can lead them to believe that their victims have hidden agendas, are provocative, disrespectful or any number of other things that trigger the impulse to control and abuse partners. Misinterpreting cues and situations because they are intoxicated can sabotage the batterers’ usual efforts to control violence. Substance use in these cases greatly increases the risk of partners becoming targeted and consequently harmed through the misperception of the batterer. Batterers who make conscious recovery efforts to stop violence are sabotaged by their continued use of substances.

Similarly, it is well known that batterers with substance use disorders do not always become nonviolent with sobriety. It is, however, something of a stretch of the imagination to say that batterers who continue violence while abstaining from substances are “sober”. Sobriety, especially in the self-help recovery community, is based upon the use of spiritual principles in one’s behavior and relationships. For this reason, a violent lifestyle is philosophically at odds with the concept of having sobriety from substances.

There are significant ways that domestic violence and substance use are distinct from each other, but they do share many characteristics. For example, denial is a core problem in each. For both the batterer and a substance user denial impedes recovery. Responsibility for behaviors is blamed on situations and others and, at times, there is not even an awareness of being responsible for problems. The tendency to avoid responsibility and blame others increases the dangerousness of batterers and the chances of relapse to substance use.

There are other effects of battering and substance use that are similar in both problems such as difficulty functioning in daily life, at work and in responsible and protective parenting. Legal problems are also typical. Depression, poor self-esteem and poor self-image are common characteristics of the two as well.

Treatment issues for batterers who use substances include the need to examine the relationship between battering and substance use. Some of these are:

• How much violence occurs when intoxicated and how does intoxication change the frequency of violence or the severity of violence?

• At what point during substance use does violence occur?

• Which is triggered first, substance use or violence?

• What substances are used in episodes of violence?

• Are substances used after episodes of violence?

• What does the batterer expect from substance use?

• Are substances used along with the victim?

• Is the victim’s use of substances used as excuse violence?

• What are the batterer’s expectations when the victim is using substances?

• Is the victim ever coerced to use substances with manipulation, intimidation or other tactics?

• Are substances used as “an excuse” for violence?

• Are substances used in premeditation preparing for violence?

Questions such as these help clarify the cycle of substance use and battering that are specific to the individual. Such an inventory allows recovery efforts to focus upon the specific coping skills and strategies needed at each step in the dual abuse cycle. In this way, relapse prevention for both issues can be thoroughly addressed. These intertwined and closely related issues create many challenges in achieving recovery and maintaining a good relapse prevention program.

Additionally, the close and complex relationship between substance use and domestic violence requires that good treatment for either screen for both problems or be prepared to handle many of the issues that surface for both. For example, both groups in treatment frequently reveal that they have experienced childhood abuse and/or neglect, have witnessed parental violence and were children of parents with substance problems. These types of trauma can present long-range and significant problems that impede recovery efforts in both substance use and battering. While some of this work is long-term and will require specific counseling apart from the primary issues of substance use and violence, it is important that they are identified, a plan is formulated and initial coping skills are learned in order to be successful in the first phases of substance recovery and nonviolence.

Treatment for substance use disorders occurs in phases and is typically time-limited. Treatment is necessarily specific in each stage as it identifies the goals for successful recovery such as detoxification, education and engagement with recovery supports. Longer term substance treatment focuses upon maintenance of sobriety and relapse prevention. Similarly, treatment for intimate partner violence is also typically time-limited and very goal specific. It is common for batterers to participate in educational groups that focus upon information about the cycle of violence, the impact of violence, coping strategies to stop battering and to prevent relapse. While substance use and domestic violence are commonly concurrent issues, treatment programs do not typically treat them simultaneously as, for example, some programs treat concurrent disorders of mental illness and substance problems. For these reasons addicted batterers may need to be referred to multiple services or multiple programs in order to successfully resolve a variety of issues that prevent us sustained recovery from substance use and battering.

Treatment providers for each problem should be able to screen and make appropriate referrals for additional services that are needed to thoroughly treat substance problems, domestic violence, parenting, trauma, mental health symptoms, self-esteem and anger and impulse control problems. Often, the legal system is involved in getting individuals to substance treatment and also to treatment for domestic violence. Court involvement helps to ensure that treatment needs are identified and appropriate services secured and coordinated. Treatment compliance is usually also monitored by the courts for such clients. Clients with substance use and domestic violence who wish to be compliant with court orders and/or to enter recovery successfully may need help in navigating multiple services and access to multiple programs. Court monitoring programs can provide the structure needed to assist them.

Increasing Neurogenesis Could Prevent Drug Addiction and Relapse

pResearchers at UT Southwestern Medical Center hope they have begun paving a new pathway in the fight against drug dependence. Their hypothesismdash;that increasing the normally occurring process of making nerve cells might prevent addictionmdash;is based on a rodent study demonstrating that blocking new growth of specific brain nerve cells increases vulnerability for cocaine addiction and relapse./p Full Story

Studies Examine Effectiveness of Mindfulness Mediation on Addictions

With the growing instances of alcoholism and addictions throughout the nation, scientists continue to try to develop methods of treatment that are safe and effective. The Badger Herald recently reported on an alternative method studied by the University of Wisconsin.

Full Story

New Jersey Bill Would Allow Judges to Favor Treatment over Jail Time

New Jersey’s drug-free school-zone law, passed in 1987 to protect schoolchildren, could be amended to give judges more discretion in sentencing offenders under a bill that is now being considered.

Full Story

Treatment Center Helps Addicted Women Become Better Parents

At the Women’s Treatment Center, a residential rehab facility in Chicago, women are taught to overcome their addiction and become better mothers to their children.

Full Story

Patient Values Must be Considered When Recommending Treatment

When selecting the best healthcare choice, customers should be able to select an option most closely aligned with their values. The same is true when seeking treatment for alcohol and drug addiction as the patient is more likely to respond successfully to care consistent with their views on life.

Full Story