Most Effective Rehabilitation Method of Chemically Dependent Offender Populations
Outline: (flow of discussion) –Plan – refer to abstract
Title page
Table of contents
Introduction
Background
Objectives
Statement of problem
Significance of study
Scope and limitations
Review of related literature
Methodology
Results and findings
Analysis, discussion and interpretation
Conclusion, summary and recommendation
References
Chapter 1
Introduction
Several problems are being faced by many societies nowadays, given by the fact that the society is continually changing. The changes the society encounter leads to the modification of the lifestyle of many individuals, most especially the younger generation, who become easily influenced and swayed by a number of factors that surround them. Changes in the society are evident in terms of economy, politics, education, industry, and in technology, which depends upon the use and the need of a particular society. Such changes can be perceived as advantages in terms of its use in globalization and internationalization, such that particular nations become associated with a number of countries worldwide to expand their businesses through different strategies and approaches. Such changes also enhance and develop the skills of many individuals to learn the universal language and become globally competitive in different aspects of learning and knowledge. The sciences also become much more developed and improved, thus, improving the lives of many through its various practical, advanced, and revolutionizing applications. In this regard, changes in the mentioned fields can be seen to bring success and prestige to individuals and societies. However, these changes not only bring about success, prestige, and development to the members of society, but disadvantages and problems as well. Unlike the previously mentioned advantages brought about by the changes in the society, problems and challenges effect chaos and discord among individuals and families. Along with the success and development of societies are the problems its face, including the upsurge cases of drug and alcohol addiction, crimes, graft and corruption, unsafe working and living conditions, poverty, unemployment, illnesses, and deaths. From this, it can be seen that along with the development of societies are its drawbacks that may become part of its consequences.
In relation to all these challenges in the society is one of the gravest problems, which is chemical dependency. The issue of chemical dependency is associated to certain concepts, including habit, disorder, disease, abuse, substance, effects, and criminality. Because it is associated with such concepts, it is generally thought of connoting negative impressions and impacts. Generally, the concept of chemical dependency is associated with terms such as alcoholism, drug addiction, and substance use and abuse. Nevertheless, this concept is defined as a disease, disorder or illness that is characterized by addiction to a mood-altering chemical, including drugs and alcohol, thus, transcending age, gender, race, religion, or economic status (“Chemical Dependence or Dependency”, 2004). It can become a progressive, chronic, and fatal disease if untreated, that is why treatments and preventions are given importance and emphasis, especially with the younger generation. In addition, the concept of chemical dependency is commonly associated with criminality and mental disorders, which are considered the effects of becoming chemically dependent individuals. In this sense, such individuals are termed as Chemically Dependent Criminal Offenders or COCO, who commit grave violations against other individuals, the community, and the State due to the strong influence of alcohol or drugs. Nowadays, given the changes that take place in the society, most criminal offenders are comprised by adolescents or the younger generation, who become as such due to the influence of drugs or alcohol. According to the Juvenile Rehabilitation Association or JAR, 82% juvenile offenders use chemical substances. The most common major problems among the youth today include substance abuse and drug related crimes. In this regard, several governments come up with ways on reducing criminality and juvenile delinquency through different rehabilitation programs and treatments that would improve the situation of the chemical dependent adolescents in order to improve the society as a whole. However, despite the number of chemical dependence rehabilitation programs, not all are considered to be effective, as many criminal offenders presently convicted were influenced by drugs or alcohol during their crime. As reported, 3 in 4 violent offenders in prison committed their crime offenses under the influence of drugs, with a percentage of 72% (2007). In addition, more than half of the prisoners in the United States indicated symptoms consistent with drug dependence or abuse, having a percentage of 53%, and such dependence was associated with a range of symptoms, including behavioral, cognitive, and physiological problems (2007). These data indicate that despite the efforts of governments to help the society alleviate the impacts of drug and alcohol dependence, crimes attributed to chemical dependence continue to increase. With this problem at hand, this research study aims to examine the most effective rehabilitation method or technique for the chemical dependent offender population.
This research study will be divided into five chapters in order to provide ease and consistency on the discussion of the topic. The first part will be discussing the problem uncovered by the researcher and provide ample background on the topic. The chapter will constitute an introduction to the whole research study, the statement of the problem in order to present the basis of the study, a discussion on the scope of its study, as well as its effects to individuals and its significance to the society as a whole.
The second chapter will be discussing the relevance of the research study in the existing literature. It shall provide studies on the different drug and alcohol rehabilitation methods currently used, their process, duration and development, and the elements that foresee substance exploit problems. In addition, the study shall also provide an ample assessment of offenders with chemical dependency problems, the evaluation processes and tools presently in use for testing, the chemical dependency treatment effects of the offenders, the constructive dependency treatment results, and its impacts to the individuals being treated and to the society. After the presentation of the existing related literature, the researcher shall provide a synthesis of the whole chapter in relation to the study.
The third part of the research study shall be discussing the methods and procedures used in the study. The chapter shall comprise of the presentation of the utilized techniques for data collection and research methodology. Similarly, it will also contain a discussion on the used techniques in data analysis as well as the tools used to acquire the said data. The fourth chapter will be an analysis of the collected and tabulated data. Computations and correlations will be made in order to uncover relationships and to address the statement of the problem noted in the first chapter. The last chapter shall comprise of three sections, namely, the summary of the findings, the conclusion of the study, and the recommendations. With these three portions, this chapter will be able to highlight the implication of the findings in relation to the data obtained.
Background of the Study
Given the problem at hand, House Bill 3900 (sec 26 - 28) indicates the enhancement, implementation and examination of the Chemical Dependency Disposition Alternative or CODA, which gives courts with a verdict alternative for chemically dependent youth. Drug treatment is the primary responsibility of the CODA, thus, becoming responsible for providing immediate solutions to the factors that contribute to the problems that the youth in the society are facing today. According to a particular study, adolescents are the recurrent patients in abuse treatment programs of the government (Brown, 1990). Although they have less duration of substance abuse, their bigger participation with alcohol and marijuana can probably make them become poly-drug addicts and have illegal records. Because of this, the call for the guidance of their family and various academic institutions becomes crucial. In addition to this is the Juvenile Justice Act, which was created for juveniles who are chemically dependent to ensure that they would benefit from treatment. Under this Act and the mentioned House Bill, the court may order an examination to determine if the juvenile is chemically dependent and amenable to treatment, and may also order a second examination if so requested by the state (“House Bill Report SUB 1337”, 2001). Moreover, with persistent action, the government also came up with other laws, such as the ‘Social Host’ Laws in the United States, which would allow police to enter private homes to break up underage drinking parties and impose fines on adults who allow gatherings to take place (“Social Host Laws Proliferate in U.S.”, 2007). In this regard, this law becomes a preventive measure that would restrict juvenile drinking, which can be causes for committing crimes and damage to the community. With the help of these laws and regulations, the importance of preventing chemical dependence and crimes can be promoted.
Despite such restrictions and regulations, increase in the incidences and cases of crimes related to chemical dependency can still be observed in the society. In the event of chemical dependency of juveniles and adults, it would be very helpful to determine and consider the possible and necessary treatments that they can undergo to provide them with a safe and decent life and well-being, which reinforces their right as an individual in the society. With this, several types of chemical dependency treatment programs are recognized, which can help chemical dependents, most especially chemical dependent offenders to start anew. There are five types of chemical dependency treatment programs, and most of theses originated from adult treatment programs. The first program is through Therapeutic Communities, wherein a patient lives in a drug-free residence. Its main principle is to treat drug abuse as social and not medical in nature. The duration of this treatment is from three to 15 months, depending on the cooperation and recovery of the patient. Its completion rate is only 10 to 18% of the total patient population (Hengelo, 1996). The second type of chemical dependency treatment program is the Residential Settings, wherein the patient is placed in a boarding school that usually has an inpatient non-hospital based treatment program. Through the program that caters residential settings, the substance abuser is made to believe that he or she can still be a prolific member of the society, given the natural residential features of the boarding school. The duration of this program is usually 7 to 90 days, depending on the program principles. In relation to this is the hospital-based or the inpatient medical treatment, such as the Short-Term Residential Programs that offer relatively brief residential or inpatient medical treatment based on a modified 12-step approach. This residential or inpatient medical treatment model consists of a 3 to 6 week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in self-help groups (“Types of Treatment”, 2005). In addition, inpatient medical treatments take place either in medical and general psychiatric settings, and offer a higher level of medical supervision (“Treatment”, 2007), such as the provision of medicines and other medical-related facilities. The third type of chemical dependency treatment program is the Outpatient Treatment, which is a less limiting type of treatment program among the rest. It lets the patient live with their families and communities, thus, giving them the immediate opportunity to exercise newly attained skills or behavioral transformation learned from the program. Specifically, Outpatient Treatments are classified into two, namely, Intensive Outpatient and Regular or Normal Outpatient Treatment Programs. Intensive Outpatient Treatment broadens the continuum of care model, which attempts to match the specific needs or levels of treatment that the patient needs in particular (Roadster, 1999). On the other hand, the Regular or Normal Outpatient Treatment offers general health care services to the patient. The fourth type is the Community Monitoring, wherein the patient may be presently using a substance, along with monitoring. Monitoring can be done through routine analyses and counseling with a probation officer or a social worker. In this program, the patients are considered to undergo a house arrest, to be imposed on curfew, or be electronically monitored by their district officers. The last type of chemical dependency treatment program is the Self-Help and other community based groups, which involve the contribution and assistance of community groups in the treatment of substance abusers. This program is often considered as an effective aftercare because it gives positive role models and emotional supports from the elder members of the program. Identification of such treatment or rehabilitation programs enables recognition of advantages in determining the best rehabilitation program.
Primarily, knowing the best chemical dependency rehabilitation program would enable increase knowledge in the treatment of substance abusers. Many researchers would be able to engage in further research and observation that would entail the advancement and the development of the recognized most effective rehabilitation program. Thus, in this case, the recognized most effective rehabilitation program would be further developed and enhanced to help many chemical dependents with their treatment.
Second, recognizing the best chemical dependency rehabilitation program would improve the services and facilities of rehabilitation centers, which would help further address the needs and the problems of substance users and abusers. It has been reported that most clients valued visiting rehabilitation center facilities beforehand, for these facilities play a very important role in helping the chemical dependent with his or her recovery, such that they influence life-changing experiences and understanding of the nature of chemical dependency of clients (2006). It has been reported by the Smash's National Survey on Drug Use and Health that there were about 1.5 million youths needing alcohol treatment, and 1.4 million youths needing illicit drug use treatment (“The NCU Report: Substance Use Treatment Need among Adolescents, 2003-2004”, 2006) ), and with no available data on how many were treated from rehabilitation centers. In this sense, improving the facilities and services of rehabilitation centers may provide an increase in the number or percentages of treated chemical dependents.
Third advantage that can be recognized is the fact that recognizing the best rehabilitation program available would support the community and the local and the national government with its endeavors of promoting peace and order in the country, which would encourage safety, development, and progression. In this regard, having a safe and peaceful society can promote development and improvement in the country, such that many individuals and establishments would gain the trust of other businesses and in turn, promote its economic prosperity. With fewer crimes due to the influence of drugs and alcohol, more business establishments and firms would have the chance to function effectively in the society, through having increased transactions and negotiations from foreign investors, who would bring success, profit and advancement to a number of companies.
Fourth and last recognized advantage of recognizing the most effective chemical dependent rehabilitation program is providing additional knowledge with the families of chemical dependents that would give them the confidence and the hope that their loved one will be able to be treated from its condition. If this research study would become successful in so doing, the determined most effective rehabilitation program can be recommended to the government and other health-related institutions and organizations to further provide assistance to chemical dependent offenders. With these reasons, determination of the most effective chemical dependent rehabilitation program would be able to help many individuals in terms of treatment and acceptance in the society.
Objectives of the Study
This research study will be done to help increase knowledge and information regarding the rehabilitation methods for chemically dependent offenders and the effectiveness of a number of rehabilitation methods for their treatment. Hence, this research study will be conducted to determine which of the rehabilitation methods for chemically dependent offender populations is the most effective. The specific research objectives for this study can be summarized as follows:
1) To find out causes of addiction and chemical dependency in the target population;
2) To determine the effects of chemical dependency to individuals and to the society;
3) To determine the different drug and alcohol rehabilitation methods currently used, including its process, duration and development;
4) To identify the elements that foresee substance exploit problems or the problems that lead to chemical dependency;
5) To provide an ample assessment of offenders with chemical dependency problems;
6) To evaluate processes and tools presently used for testing;
7) To determine alternative treatment methods available for chemical dependents;
8) To determine the chemical dependent treatment effects of the offenders;
9) To identify the constructive dependency treatment results in offenders;
10) To recognize the impacts of such actions to the society; and
11) To give recommendations to the readers, to the government, and to the society
Statement of the Problem
The increase in the number of chemically dependent criminal offenders in the society of the United States leads to the recognition of a number of chemical dependent rehabilitation programs. Due to the perceived significant and essential role played by chemical dependency rehabilitation programs in the treatment of drug and alcohol dependents, it is important to recognize the different rehabilitation and treatment methods that would help in the recovery of substance dependents and in the alleviation of the number of criminal cases related to substance use in the U.S. society. This study intends to examine the most effective rehabilitation program for chemical dependent offender population in the United States, particularly in the state of South California. Specifically, the study intends to answer the following queries:
Hypothesis
The study intends to test the following hypothesis:
“The most effective chemical dependency treatment program must be adopted and implemented to treat the chemical dependent populations.”
Significance of the Study
This research study will be a significant in knowing the perceived best and most effective chemical dependent treatment programs for offender population, which could be suggested to the government and to the families of the substance dependent. It will be significant in the development of more scientific and research-based approaches in addressing the different problems regarding the relationship of substance abuse and the increase in criminal cases in the U.S. society. In addition, this research study can also be significant in providing wider knowledge and alternatives for the government and the families of the substance abusers regarding other available treatment and therapies for the chemical dependent offenders. Moreover, this study can be significant in the endeavor for the improvement and development of the services and facilities of different rehabilitation or treatment programs that would further cater to the needs of the chemical dependent offender population in the society of the United States.
Scope and Limitations
The research study intends to examine the most effective rehabilitation or treatment program for the chemical dependent population. For this study, primary research will be conducted using anonymous questionnaires that will be sent to the general population in _________ of legal age. The questionnaires will be used to collect quantitative data. Qualitative data would be gathered using secondary research based on related literatures.
In relation to the previous discussion, limitations and other key assumptions were also considered, and are as follows:
- Are the results of the research study valid?
- Was the data relevant to the research questions?
- Were the data collection methods appropriate for the research objectives?
- Was the data collection comprehensive enough?
- Were the data appropriately analyzed, with the findings adequately supported?
Obstacles of the Research Study
Despite the aim and the perceived significance of this research study, a number of obstacles or problems could be encountered. Essentially, there are a small number of sensible and pragmatic barriers in this research study or dissertation. The main practical apprehension is the expensiveness of purchasing journals online. This is a practical concern because monetary costs are one of the main important factors that will keep this study going. Another practical obstacle is the availability of resources regarding the rehabilitation programs for chemical dependent offenders. There are limited studies that are related to the focus of this study. Limited local references can affect the development of this research study. On the other hand, in terms of empirical obstacles, there might not be sufficient statistics to show what program is the most effective in treating offenders with substance abuse. In simple terms, there could be difficulty in obtaining relevant and sufficient statistics from financial service institutions. This is where secondary research will come to play. The surveys and interviews to be conducted with families and social institutions are intended to make bridges that will lead to the acquisition of important references. Overall, resources and cooperation are the two major obstacles in the study. In addition, another difficulty that can be recognized is in the process of the model to be used in the research study, which is the input-process-output-model. Difficulty would rely on the different issues that the study might be able to face. In this regard, the information required should be arranged conveniently for a more effective and efficient analysis. The effective execution of the process will be the main importance and concern of the research study because it will determine the quality of the output.
Ethical Considerations and Standards
The position of the researcher in the research study is crucial because he or she will be the one to conduct the whole process of the research study. This particular research study has a political influence in nature because many laws and regulations under the judicial and community sectors govern rehabilitation programs of chemical dependent offenders. The role of the researcher is to attain the necessary information needed in the study as much as possible, and to create connections with important people who will be helpful in assisting the progress of the study. In relation to the role of the researcher is his or her responsibility to deem ethical considerations that will be applied in accomplishing the research study. Given the sensitive situation being experienced by the families of chemical dependent offenders and the social institutions handling their cases, most of the target respondents would be hesitant to share their views because of certain factors they are afraid of or uncomfortable with. As an ethical stance, confidentiality of the identity and participation of the respondents will be ensured throughout the research. Furthermore, important but confidential information that respondents do not want to talk about or give away would also be respected, especially in the process of an interview. As part of the ethical consideration of this research study, complete information, such as the goal and aim of the study would be provided to the respondents thus, respecting their right to be informed. Racial discrimination would not be observed in this study, for all races would be considered sources of relevant data. With regards to the accomplishment of the paper, strict compliance with citing references is to observed in order to avoid plagiarism of literatures to be used.
Chapter 2
Review of Related Literature
This part of the paper will review the related literatures conducted on the area of study. By doing this, the research may be guided consequently by primarily discovering where the research is coming from, what and how much have been studied regarding the topic, and what it is yet to discuss. Aside from providing the background of the study, this chapter will provide its readers the necessary backbone and support for the research study to stand credible and reliable. In addition, by appraisal or evaluation of past researches related to the study, a historical perspective may be given. The researcher will be able to gain new insights on how much venture has been explored before, which will enable reflection, comparison, learning, and producing a stronger and more efficient study. This chapter will also present the research study a rich source of data, both new and old, which will augment and enrich the study. This part of the research study will also accentuate how it will contribute to the field of study it has chosen and further improve it.
Causes of Addiction and Chemical Dependency
According to the United States census in 2000, adolescents make up the largest generation in American history (, 2004). However, with such dominance, substance use among them becomes prevalent. In 2002, more than 11% of youth, having an age range of 12-17 years were current drug users, with drugs including marijuana, cocaine, heroin, hallucinogens, inhalants, tranquilizers, and stimulants, while 28.5% were alcoholics (2004). With such prevalence, it can be perceived that several causes might be attributed to such large occurrence in adolescents. In this regard, it would be helpful to determine the several causes of substance use and abuse to further understand the concept of chemical dependence.
Primarily, Chenier (2001) summarized the causes or factors that may trigger drug or alcohol addiction among juveniles or adolescents, and in so doing, it would be helpful to adopt a medical, psychological, sociological, economic, legal, criminological, pharmacological, and philosophical approach. The author stressed that chemical dependence may be attributed to a genetic component, to an addictive personality type, to critical environmental circumstances, and to a physiological connection. In this sense, as previously stated, no one is excluded from the list of individuals who may be able to become chemical dependents. However, Chenier (2001) pointed out that the male gender, the unemployed, the aboriginal peoples, and the street youth are the ones having a higher chance of becoming dependent on such substances.
In support of this, several other authors have attempted to explain the causes of chemical dependence among the youth. As cited in the work of (2006), authors like Petridis, Flay and Miller in 1995 proposed a conceptual model that includes three kinds of influences, namely, cultural and attitudinal, social and interpersonal, and individual baggage. Another study cited is the study done by in 2001, which identified a total of 50 factors that relate to teenage chemical abuse. These factors were classified into three groups by using an epidemiological model. The model includes a predisposing environment, the drug itself, and the individual. The third study cited was done by in 1995 who suggested that easy access to drugs and other substances, drug users among family or peers, peer approval, a perception of low risk, and an unpleasant mood state are also linked to cause chemical dependency in the younger generation. From this aspect, it can be seen that personal and social factors contribute to the tendency of individuals to become chemical dependents.
In addition, 2002 pointed out that domestic violence and sexual abuse could also be considered as causes of chemical dependence. Along with that, Bryant et. al 2000 considered school-related factors such as academic failure, absenteeism, peer drug use, and psychological distress can be linked to teenage chemical dependence. This particular study cited placed an emphasis on a related study done by in 2002, stressing that teenagers who engage in misconduct and had low school performance scores had higher chemical dependence and tendency compared to teenagers who are highly motivated and focused with their studies. In support of such claims, a number more authors have considered the influence of family factors such as faulty and triangulated communication, inter-parental conflicts, affection-deprived family environment, ineffective problem-solving patterns, low familial satisfaction levels, type of religious practice, family disintegration, and low levels of parental monitoring are also attributed as causes of chemical dependence (as cited in 2006). As such, it can be seen that in the social point of view, the school and the family of the younger generation, or the immediate sub-society of the younger generation, determine their tendency to become chemically dependent.
In summary, the perceived causes of chemical dependence in the younger generation may be grouped into three. First cause involves the genetic or the hereditary influence one has from being a chemical dependent, which determines his or her ability to become more susceptible of developing a tendency to become a substance user. A particular study supports this claim, with the emphasis on the influence of the brain chemical dopamine that mediates intercellular communication, and with which substance use may be determined by variants of genes that regulate it (2002). Second cause involves the individual per se, and his or her preferences, control, choice, physiology, attitude, and mood towards the use of drugs or alcohol. One possible cause of addiction or chemical dependence involves the loss of control in one’s self, which could determine their ‘gusto’ over alcohol or drugs. Likewise, their preference over the use and abuse of substances also depends on how they handle taking them. Last cause involves the social network or the community from where the individual functions, and includes the influences given by one’s family, peers, school, and culture. In this regard, it can be perceived that this involves one’s exposure to drugs and alcohol, thus, determining his or her extent in becoming chemical dependent. However, it does not follow that the more exposure to such substances leads to chemical dependency. In this sense, the preferences and the choice of an individual in terms of using drugs and alcohol become the decisive factor. From this, it can be understood that the range of problems and causes determine the extent of chemical dependency one will be able to experience and go through.
Effects of Chemical Dependency
It is a given fact that chemical dependency has several known negative effects that may create havoc within the individual or the chemical dependent and within his or her community and the larger society. Determining such effects leads to knowing the mechanism of chemical dependency and addiction, which would later be crucial in understanding the larger picture. As previously defined, chemical dependency is a progressive and chronic disease that is due to addiction or craving of a particular chemical or drug. Fairly similar is the concept of addiction, which is defined as a disease or complex phenomenon with important psychological and social causes and consequences, and involves a biological process, involving a repeated exposure to a drug over time (Starr, 2002). With these similar definitions, it can be perceived that the two concepts are both considered a disease that affects the biological and physiological functions of an individual. However, aside from seeing addiction and chemical dependence as a disease, the society also perceive them as more than mere drug use, but as a behavior exhibiting a compulsive pattern of drug-seeking and drug-taking that takes place at the expense of most of their other activities (2003). This definition helps many understand that the concept of chemical dependence affects the individual and social behavior of a person, thus, it is perceived rooted at one’s biological and physiological processes. As such, the mechanism of addiction or chemical dependence can be stressed out, thus, helping individuals understand the concept and the situation of chemical dependent offenders.
The mechanism of addiction or chemical dependence relates to the biological and physiological function of the human body, and determines one’s pleasure responses towards a chemical or substance. Usually, chemical dependents take drugs or alcohol to attain ‘highs’ and escape social, mental and physical stresses. However, they also take drugs and alcohol to avoid withdrawal ‘lows’. This process can be explained using the Opponent Process Theory, which explains that a pleasant dose of drug or chemical activates a dose-dependent a-process in the brain reward circuit system that in turn, triggers the activation of a negative or opponent b-process. This b-process helps restore homeostasis in the brain and brings it back to its normal state. The summation of the actions of the two processes creates the final subjectively experienced state by the person, resulting to the A-state or the pleasant state, caused by the a-process, and the B-state or the negative state that is caused by the b-process (2003). During repeated drug use, the dopamine system is being induced, which is a brain neurotransmitter that mediates the communication among brain cells in certain brain regions, and play a role in the pleasant or rewarding effects of substances, such as drugs and alcohol (2002), thus, creating changes in the function of the brain. The neurological, chemical, and physical structure changes in the function of the brain results from the repeated exposure of an individual to addictive substances, thus, creating the chemical conditions that produce changes in the behavior of the person, in terms dependence, tolerance, sensitization, and craving (Starr, 2002). From these explanations, it can be understood that the changes in the behavior and responses of chemical dependents depend on the changes brought about by their continued and prolonged exposure to various chemicals or substances. The changes in their physiological and behavioral response determine their actions towards themselves, their family, and their society.
Several effects are recognized in relation to chemical dependency or substance addiction. Primarily, the sensitization of individuals is affected with the increase of drug or alcohol use. Sensitization refers to the increase in a drug effect with repeated drug administration, depending on the biological system of the person that mediates different drug effects and adapt in different ways to repeated drug exposure. Sensitization can be seen in two ways, either affecting the individual’s psychomotor activities or one’s motivation. Psychomotor changes in the individual may include increase or decrease in arousal, attention and motor behavior, producing heightened movement, exploration, and approach. In terms of behavioral or motivational sensitization, changes are exhibited in the physical structure of neurons, changing the patterns of synaptic connectivity within brain regions thus, alter the information processing of the brain (Bridge and Robinson, 2003). In simple terms, a known effect of chemical dependence is the changes in terms of the physical and behavioral aspects of the person that may affect his or her actions toward his or her family and community.
The second known effect is the development of tolerance to both the pleasurable and aversive effects of substance use, which supports the development or maintenance of an addiction. The development of tolerance of substances in substance users requires the individual to consume increasing drug amounts to achieve the desired pleasurable or rewarding effects (2002). With the development of such tolerance, the rate of substance use greatly increases, thus, enabling the individual to become more drug or alcohol dependent. In this regard, a substance user is able to attain pleasure or reward from the use of the substance through continued use in high doses. With this, the substance dependent would be more reliant on the substances, thus, making him or her lose control of his or her behavior.
The third effect of chemical dependence is the prevalence of a variety of physical, mental, and behavioral disorders, such as AIDS, HIV, tuberculosis, hepatitis, and other reproductive related diseases in both genders. The unsafe use of intravenous drugs is both directly and indirectly responsible for more than one-third of all AIDS deaths in the United States, including the increasing transmission of tuberculosis and hepatitis B and C. With this, addiction or chemical dependence and HIV infection is one of the major public health challenges in the country. In addition, chemical dependence, particularly alcoholism causes liver disease and other neurological and pathological diseases that are fatal (Starr, 2002). Becoming an alcohol or drug addict leads to the tendency of using other substances or drugs, such as nicotine that is present in tobaccos and cigarettes. In this regard, the use of many and various substances presents the tendency of acquiring a number of different diseases, thus, shortening the life expectancy rate of chemical dependents. Another point to consider is the damage produced by alcohol and other substances to fetal and neonatal development, being contributory to the causes of birth defects and neonatal morbidity. In this regard, the issue of the increasing number of female chemical dependents must be addressed, as having physical diseases attributed to alcohol and drug use significantly similar to males (Blame, 1990). Documented prenatal substance exposure presented effects on fetal and child development, thus, affecting 20% of newborn children in America and causes one in every ten cases of mental retardation (Starr, 2002). In addition, the increase in alcohol intake, particularly in women makes them sexually aggressive and promiscuous (Blame, 1990), thus, increasing the incidences of rape, early pregnancy, single parenthood, and abortion in the society. In this regard, the issue of chemical dependence cannot only be regarded as a medical or behavioral issue, but as a moral issue as well.
Fourth known effect of substance abuse and dependence brings impaired judgment, depression, hopelessness and desperation on the part of the addict, leading him or her to suffer from mental disorders that would lead the person to commit suicide or inflict injuries (1999). These incidents lead to the substantial increase of use of the healthcare system, and particularly of expensive emergency rooms and trauma care services in hospitals and healthcare centers, as 60% of all emergency room visits are related to drug and alcohol problems. In addition, substance use causes close to half of all fatalities in motor vehicular accidents, with more than 100,000 American citizens dying (Starr, 2002). With this, it can be perceived that the influence of the use of either alcohol or drugs impairs the ability of individuals to control not only their mental behavior but their physical and motor skills as well.
Another evident effect of substance or chemical dependence is the break up and deterioration of family ties, which causes child abuse and family violence. A study cited in Starr in 2002 reports that 78% of female victims who survived domestic violence attacks reported that their attacker had been using drugs or alcohol. Moreover, substance use also leads an individual to commit rape and sexual assault, thus, committing violations and crimes against other individuals and the society. It leads to the abuse and neglect of children, and in some instances, fathers even sexually abuse their children due to the influence of drugs or alcohol, leading to a rough estimate of ten million children affected because of such causes. Substance use and abuse also leads to high rates of divorce and broken families, causing at least three-fourths of cases where children are removed from their families and placed in foster care (Starr, 2002). With this, it can be understood that due to chemical dependence, most children are deprived of their rights to live peacefully and rightfully, thus, affecting not only their lifestyle, but their perception and view of life as well. This event influences them to either disregard or give importance to the value of having a family and of becoming influenced by substance use.
Muslins (1999) reports that due to chemical dependence, important social, occupational, or recreational activities are being abandoned, and this increases the costs of U.S. employers annually. A study cited in the work of Starr in 2002 estimated that addiction costs U.S. businesses a total of 0 billion yearly, due to lost workdays, premature deaths of workers including on-the-job accidents, and half treatment costs such as fetal alcohol syndrome and AIDS. This leads to the increase in costs of the U.S. society, due to the loss of productivity, increase in direct financial burdens on government programs, and even social deterioration. A study done analyzes economic data stating that alcohol and drug abuse cost the U.S. society a total of 6 billion (Starr, 2002). In this regard, it can be perceived that chemical dependence not only affect the individual user but the whole society as well. It provides the individual with diseases and mental disorders, which cause him or her to commit crimes and other violations towards other individuals and towards the society. Furthermore, due to chemical dependence, children and families are not able to obtain their rights in the society that would allow them to live peacefully and rightfully in their communities.
Chemical Dependence Rehabilitation Methods Currently Used
As previously discussed, there are five types of chemical dependency treatment programs or methods used today, namely, Therapeutic Communities, Residential Settings, Outpatient Treatment, Community Monitoring, and Self-Help. These five treatment programs are general treatment or rehabilitation programs helping many substance or chemical dependents to overcome their condition, thus, enabling them to function effectively and normally in the society. Historically, formalized testing in the field of addiction began in the late 1970s with the National Board of Medical Examiners, which developed examination modules for medical students. Following this is the California Society for the Treatment of Alcoholism and Other Drug Dependencies, which established an examination for demonstrating expertise in addiction in 1983. In 1986, the American Society of Addiction Medicine began the development of a related national chemical dependence examination, which led to the development of other procedures that developed and improved training standards in relation to substance abuse academic medical training. These training standards provided a model for the development and improvement of substance abuse training programs, assisted fellowship applicants in the evaluation of their training needs, and helped in the establishment of certifiable specialty training for the field (Burns et. al., 1991). With the development and improvement of such standards and fields, the problems and the causes of chemical dependence were identified and given importance in terms of treatment and recovery. As such, specific models and treatment programs are being used today.
Specifically, the AA model is one of the most popular chemical dependence treatment programs being used today, including a twelve-step program for any self-defeating or compulsive behavior, such as Cocaine Anonymous, Debtors Anonymous, Dual Disorders Anonymous, Ethics Anonymous, Gamblers Anonymous, Nicotine Anonymous, Overeaters Anonymous, Sex and Love Addicts Anonymous, Survivors of Incest Anonymous, and Workaholics Anonymous. The AA model characterizes or perceives addiction as a progressive, chronic, and deadly disease that leaves the substance dependent or addict “powerless” and experiencing a “loss of control” in the ability to desist a drug of choice. It requires a commitment to total abstinence, the embrace of spirituality, and life-long participation in AA or other twelve-step programs, because it sees an addiction as something that is treatable but never entirely curable. Another treatment program is termed as SOS, which stands for Secular Organizations for Sobriety that was founded by James Christopher in 1986. The program is a non-religious, abstinence-based self-empowerment program that uses the principles of cognitive therapy and visceral synchronization. In views addiction as having three components, namely, a physiological need, a learned habit, and a denial of the need and the habit. The third known treatment method in the United States is the RR or Rational Recovery program that employs an addictive voice recognition technique or the AVERT, which is based on the experiences of former addicts. It views chemical dependence as personal matters that have nothing to do with acquiring, maintaining, or ending an addiction, but develops a thinking skill that aids addicts to recognize and resist the internal “voice” that pressures them to use chemicals for their pleasure. Fourth treatment program is the SMART or Self Management and Recovery Training, which assists its members in maintaining abstinence from various substances, through a continuum of recovery that focuses on the quality of life. It achieves its goals through scientific practice and knowledge, abstinence from addictive chemicals, nurturance of emotional independence and self-reliance, and assistance in giving dependence on support groups (Leman ski, 2000). These and other treatment or rehabilitation programs are being used by the families of chemical dependents in the United States to ensure treatment and recovery of their chemical dependent relatives.
Alternative Rehabilitation or Treatment Methods
Most of the chemical dependency rehabilitation and treatment organizations use the AA model or approach in administering treatment of substance dependents. As a matter of fact, more than 93% of U.S. treatment centers are still locked into the AA approach (Leman ski, 2000). However, despite the success of the use of such an approach, which lasted for more than 60 years, many criticisms have been made regarding the approach that made many researchers to come up with the use of alternative methods for chemical dependency treatments. The major criticism for the AA model and other twelve-step programs is that the treatment is not scientifically-based, but instead is based on religion, spirituality and talk-therapy (Leman ski, 2000). Nowadays, more and more medical practitioners are open to using alternative methods that can be regarded as cost-effective and less conventional.
One alternative method is the use of acupuncture. Acupuncture is a traditional Chinese medical technique that involves the insertion of stainless steel needles into different points in the body. These needles are inserted at particular points in the body, called acupuncture points, in order to balance the opposing forces of yin and yang. This technique unblocks the chi, or the energy that permeates all things in nature, and is believed to flow through the body along 14 main pathways termed as meridians. It is said that when yin and yang are in harmony, the chi flows freely within the body and the person is said to be healthy. However, the presence of sickness and disease obstructs the flow of the chi, thus, needing acupuncture to restore smooth flow of the chi within the body (Carroll, 2005). In addition, the idea behind acupuncture is that the presence of a disease entails the loss of balance between the yin and the yang energies, thus, disrupting the function of the whole biological system. The treatment of the disease through the activity of needles, pressure, and heat on the sensitive parts of the body may treat the patters of disharmony (“Acupuncture”, 2007). Through the extent of the use of acupuncture in both Eastern and Western countries, several ailments are said to be treated through therapy, including allergies, arthritis, kidney problems, constipation, depression and anxiety, headaches, colds, dizziness, fatigue, flu, paralysis, sexual dysfunction, stress, stroke, smoking, and high blood pressure (Carroll, 2005). In the perspective of chemical dependency, becoming substance dependent is considered the disease in this sense, thus, blocking the chi of the user. In addition, substance or chemical dependency is said to be a symptom of a system or society that is out of balance, and the lack of that balance leads to the lack of calm inner tone, which results to aggressiveness, and causing crimes in the society. The use of acupuncture as an alternative treatment of chemical dependence helps the user in stimulating his or her yin points or positive points, in order to restore inner calm tone. Acupuncture detoxification works by releasing blockages of energy or chi and correcting imbalances of energy flow, which involves homeostatic action in the autonomic nervous system, various neurotransmitters, and elements in the pituitary actions and responses in the brain (Serrano, 2007). In this sense, the use of acupuncture as a treatment alternative presents positive effects for the use of the needles in the body would eventually lead to the release of more positive energies in the body that would stimulate the smooth process of the biological functions of the body. Proper stimulation of the nerves and blood circulation in the body improves the flow of nutrients in its parts, thus, improving the distribution of minerals and nutrients in the body, essential in its vital functions. This improvement thus improves also the disposition of the substance user, and eventually, improves his or her way of thinking that would lead the individual to realize the importance of his or her life in the society.
Another alternative treatment for substance dependence is through hypnotherapy. Hypnotherapy involves psychological therapy and counseling, and is a treatment of emotional and psychological disorders, unwanted habits and undesirable feelings, using psychological techniques. Through hypnotherapy, therapeutic mental suggestions are introduced into the mind of the client in a relaxed and receptive state, in order to find meaningful alternatives to their present unsatisfactory ways of thinking, feeling or behaving (Broom, 2007). It helps clients overcome their anxiety, insomnia, stress, panic attacks, phobias and addiction, which are considered the altered state of the consciousness of the individual. During hypnotherapy, the person is in his or her relaxed state, wherein the breathing, heart rate, metabolism, and brain waves slow down, thus, becoming more receptive to suggestion and able to exert control over normal involuntary processes (Young, 2007). During this relaxed and highly receptive state, the chemical dependent can overcome his or her substance addiction through enhancing imagery techniques. A specific study points out that a reward center is present deep within the brain, where emotion-laden memories of past positive drinking or drug-taking experiences become associated with cues. Exposure to cues activates the reward center of the brain, leading to craving during abstinence. However, through hypnotherapy, experiences are changed to positive ones, thus, reducing craving, through using suggestions, reframes, metaphors, and positive imaging. A study that proves this is the study done by in 1948, who treated alcoholism by using hypnosis to enhance dream imagery (as cited in Potter, 2004). Aside from aiding in the treatment of addictions, hypnotherapy is also helpful in treating the symptoms of Post Acute Withdrawal that occurs in acute withdrawal from an addictive drug. A study done by Whitehouse et. al in 1996 reports that stress levels were lowered through hypnosis, thus, making it an alternative treatment for chemical dependency (as cited in Potter, 2004).
The third type of alternative treatment for chemical dependency is homeopathy, which involves providing an extremely small dose of substances that produces characteristics symptoms of illnesses in healthy people when given in larger doses, thus, being termed as an approach with a belief that “like cures like”. Similar to acupuncture, a key premise in homeopathy is the belief that every individual has an energy termed a vital force or self-healing response, and the disruption of such energy causes health problems (“Questions and Answers about Homeopathy”, 2007). This type of alternative strategy was discovered by a German physician, Samuel Hahnemann, who proved that same substances, in large amounts could cause disorders within the body; however, in minute doses could cure the same disorders. In the general Western medicine, strong drugs can help cure illnesses, and symptoms are caused by the illness. However, a positive outcome cannot occur with the increasing dose of medicines, and oftentimes lead to chemical dependency and masked symptoms. On the other hand, in homeopathy, the symptoms of the illness become indicative of the desire of the body to fight the illness and the type of substances required to produce a positive response by the body’s own natural healing forces of recovery (Better, 2007). Although this might be a good alternative for curing chemical dependency, it has been reported that research studies on homeopathy have been contradictory in their findings, such that some analyses concluded that there are no strong evidences that support it being effective for any clinical condition, while some positive effects were not readily explained in scientific terms (“Questions and Answers about Homeopathy”, 2007). With this, it can be understood that although homeopathy is suitable in treating chemical dependency due to its use of minute amounts of substances in the belief that it would lead to the same effects, not enough findings and studies have been able to support its effectiveness as an alternative treatment method. For this matter, it would be best if other more studies and supports should be done, before considering it an alternative treatment process for chemical dependency.
Another type of alternative treatment for chemical dependency is termed as NLP that stands for neuron-linguistic programming therapy, which is a method, set of techniques, or personal development system about human communication, perception and subjective experiences. It teaches that a specific individual can develop successful habits by intensifying helpful behaviors and reducing negative ones, and such change can be done by carefully reproducing the behaviors and beliefs of successful people, through the process of modeling. This approach or method aids individuals in terms of self-help, personal influence, and business communication. This approach is related to the treatment of substance or chemical dependency because this approach recognizes the notion that experiences are processed by the sensory systems of the brain, and the processing of that information in the brain lead one to see images and hear sounds and voices along with the creation of feelings. Processing of such information lead to the creation of representations, thus are being activated during any type of activity. The organization and arrangement of such images create impacts on the behavior of individuals. NLP techniques interrupt the maladaptive patterns in the brain, and replace them with more positive and creative thought patterns that would affect the behavior of the person. NLP techniques involve modeling, or adopting a specific behavior or belief of successful individuals, the meta-model or widening the map of the world of the person through language patterns, the Milton model, a form of hypnotherapy that uses language patterns to contact the hidden resources of one’s personality, and the representational system (“Neuron-linguistic Programming”, 2007).
Aside from these alternative methods for treatment are other treatment strategies or techniques that can also be helpful in helping the chemical dependent populations obtain recovery. These alternative treatment methods are considered outcome-based therapies, as being implemented based or according to planned results. Several methods can be named, but only a number were chosen to be considered an effective means of treating addiction. The following methods were considered as they are the ones more popular among other outcome-based methods, namely, aromatherapy, reflexology, massage therapy, art therapy, and dance/drama/music therapy.
Aromatherapy is a form of an alternative treatment, focusing on the treatment of a patient holistically, using different pleasant smelling scents from botanical oils, including lemon, rose, lavender, peppermint, and other essential oils, which affects the moods or the health of the individual as a whole. This form of therapy is based on alternative medical practices and spiritual beliefs that place a high regard on the synergy or harmony between the body and aromatic oils, thus, creating a pleasurable sensation and healing on the part of the individual. The essential oils used in aromatherapy are added to the bath, massaged directly to the skin, inhaled, or even diffused in an entire room, and this process helps an individual to have relief from pain, to care for the skin, to release and reduce tension, fatigue and stress, and to energize and rejuvenate the entire body. It is said that the aroma of the different essential oils used in aromatherapy affect the mood of an individual, reduce tension and stress, and promote relaxation, as the scent of the essential oils work on the brain and nervous system of individuals through the stimulation of the olfactory nerves in the nose (“Aromatherapy”, 2007). The use of essential oils as an alternative treatment for chemical dependency is relevant because unlike the medicines and other substances used for the conventional treatment of addicts, the oils directly affect the chemistry of the body of the individual that has no side effects. They enter and leave the body with great efficiency, leaving no toxins behind, thus, considered to be more sophisticated than most modern drugs. In addition, the use of essential oils directly affects the physiology of the body of an individual, thus, affective on the mood, as the olfactory nerves connected to the limbic system of the brain regulates sexual urges and emotional behavior (“Enhance you Life with… Aromatherapy”, 2007). This form of alternative treatment is applicable and appropriate for the treatment of chemical dependence because it also presents the same rewards and pleasurable effects in the individual, thus, helping to alleviate the addiction from harmful substances. Because essential oils are biologically and systemically-friendly, administering such substances would enable the chemical dependent to achieve a much better disposition during the treatment. Moreover, given the effects of using essential oils, the chemical dependent would be able to regulate his or her emotions, urges, and behavior, which could help the individual gather respect for him or herself and for others. Furthermore, the use of essential oils in the process of aromatherapy not only help in the treatment of the addiction per se, but also help with the treatment of its causes and symptoms, such as stress, anxiety, and other, emotional problems. Thus, this form of alternative treatment can be perceived as an appropriate form of treatment for chemical dependency. However, this type of alternative treatment is considered a complementary treatment only, which could be more effective if combined with other chemical dependency treatments.
In relation to aromatherapy is another complementary treatment, which can be done along with aromatherapy. This is commonly known as massage therapy. Massage therapy is said to be a combination of both science and art, as it provides a relaxing experience by a variety of artistic hand strokes on the body, in its aim to invigorate the mind and the body and eliminate stress scientifically (“Massage Therapy”, 2005). In this sense, massage is used for the benefits of an individual in terms of physiological, mental and mechanical aspects, and thus is termed as therapeutic or manipulative therapy (“Massage”, 2007). As a complementary form of alternative therapy, it can help in the alleviation of the addiction of patients as it aims to improve circulation in the body, to eliminate wastes and toxins, to serve as a lymphatic drainage, to ease muscular pain and to promote relaxation, to improve the immune and the digestive system, to promote a feeling of wellness, and to reduce anxiety, tension and depression (“The Aromatherapy Guide”, 2005). For this to become more effective, it would be helpful if essential oils would be used for the massage of the body. In this way, the total relaxation of both the mind and the body will be achieved in the process. In essence, it can be perceived that this form of alternative therapy can be used simultaneously with aromatherapy, and does not present any negative side effects. This is relevant and appropriate for the alternative treatment of chemical dependency because, there are no harmful chemicals or medicines used in this type of treatment, and there are no known side effects. Similarly, administering such treatment also participates in the reward and pleasure systems of the brain, as massage therapy is done with the use of essential oils and other aromatic substances. In this process, not only the olfactory senses of the individual are being stimulated, but his or her whole body as well. Specifically, the use of essential oils in massage therapy works into the skin and breathed in, thus, triggering brain responses through receptors present in the nose and pores in the skin. In turn, the brain signals the different organs in the body to produce chemicals that act on the body in various ways, such as the increase in blood flow or the slowing down of circulation, which produces a calming effect in the body (Brown, 2007). There are a number of different types of massage therapy available for use, depending on the preferences of the patients. However, because this form of alternative treatment is only considered a complementary therapy, it would be most effective if it will be done along with other chemical dependency treatments.
Another relevant alternative treatment that can be used in line with aromatherapy and massage therapy is reflexology. Reflexology, or also known as zone therapy is the application of pressure, stretch, and movement to the feet and hands to target other parts of the body, as both the feet and the hands are viewed as a mirror image of the body (Kunz and Kunz, 2003). In reflexology, each body part is represented on the hands and the feet, and pressing on these parts can have therapeutic effects that would aid in the stimulation of the flow of energy, blood, nutrients, and nerve impulses (Barrett, 2004). Reflexology involves putting pressure on the feet of the patient, where pressure signals the peripheral nervous system, enter the central nervous system, where the signals are processed in the various parts of the brain. The signal is then relayed to the internal organs to provide with needed adjustments in oxygen and other nutrients, thus, improving the function of the organ (Kunz and Kunz, 2003). In this sense, improvement of the organs and other bodily parts of an individual can be achieved through the simultaneous flow of nerve impulses from the feet and hands that would be processed in the brain. Becoming chemically dependent involves the destruction or impairment of the nerves of the individual, as the different substances used in the process largely affects various brain receptors, neurotransmitters, and parts. Specifically, alcohol acts as a depressant of the central nervous system of the brain, having effects including vitamin deficiency , and damage and overall reduction in brain size, while drugs cause various sensory and motor problems, as it damages the myelin sheath surrounding the neurons, which is responsible for the normal transmission of impulses (Choler, 2007). Thus, this damaged caused by excessive use of substances can be repaired through reflexology, which can induce the flow of nerve impulses through massage, pressure and movement in the feet. With this type of alternative treatment, the nervous system of the chemical dependents would become repaired, thus, helping them to think clearly as functional individuals in the society. Because this type of alternative treatment can help repair and strengthen the nervous system of the chemical dependent, it can enable the chemical dependents attain normal brain function, thus, enabling them to think logically and correctly. Somehow, this alternative treatment can also help them become fully recovered, thus, gain back their lives as functional and productive individuals in their communities. However, similar to previously discussed alternative treatments, reflexology is also a complementary treatment and must be done along with other treatments.
Another alternative treatment that can be used for the recovery of chemical dependents is art therapy, which explores the psyche of the chemical dependent. It is a form of an expressive therapy, which uses art materials like paints, chalk, and clay, and combines traditional psychotherapeutic theories and techniques. This type of therapy is employed both in clinical and non-clinical settings, wherein children, adolescents, and adults are the patients, and services are provided to individuals, couples, families, groups, and communities (“Art Therapy”, 2007). From this, it can be perceived that no particular client or patient can undergo such treatment, meaning all types of chemical dependents can undergo the process of treatment through art therapy. Art therapy is said to be based on the belief that the creative process involved in making art is on a basic level healing and life-enhancing, thus, helping an individual to increase insight and judgment, cope with stress and traumas, improve cognitive skills, work through addictions, build better relationships, and enjoy life’s pleasures (“Art Therapy”, 2007). Because art therapy involves and targets the mental hygiene and emotional expressions of individuals undergoing the treatment, this type of therapy enables them to undergo a creative process that would help them express their hidden feelings, emotions and ideas they suppress. Suppression of such ideas and emotions can be perceived as one of the causes of their addiction, as most of these individuals are considered “misunderstood” by their communities. Because they are not understood, the tendency for drug and alcohol use and abuse is possible, as through this they are able to gain peers who would listen to them more than their families or friends would. In addition, because art therapy utilizes drawing, painting, sculpture, photography and other forms of visual art expression (“Art Therapy”, 2007), chemical dependents would be able to express and explore their feelings, emotions, dreams, memories, and ideas, thus, enabling them to build in-depth relationships and appreciation of themselves and of others. Art therapy can develop and improve the creativity of individuals, most especially of chemical dependents, for there is a possibility that they were not able to explore this aspect of themselves prior to their addiction or dependency. With this type of therapy, they would be able to know themselves better through creative expressions, as creativity can provide a means of expression for that which has no words, or is not yet fully understood (“Types of Therapy” 2004). Art therapy can be used by chemical dependents as with this, they would be able to have a means of expressing themselves in various ways, which would give them the chance to become understood by their families and peers.
Along with art therapy are other forms of expressive arts, which include dance, drama, and music therapy. Dance or movement therapy is one of the creative arts therapies, along with drama and music therapy, which stems in the expressive nature of dance itself. It is based on the belief that dance is the most fundamental of the arts, as it involves direct expression and experience of oneself through the body, characterizes by authentic communication, and that the body, the mind, and the spirit are interconnected with one another (“Dance/Movement Therapy”, 2005). Because it believes that the action of the body is interrelated with the activity of the mind, this type of alternative therapy can be beneficial for the chemical dependents, as they would be able to exercise and develop their creativity through bodily movements and expressions. With this, the American Dance Therapy Association defined dance or movement therapy as “the psychotherapeutic use of movement as a process that furthers the emotional, cognitive, social and physical integration of the individual” (“Dance/Movement Therapy”, 2005). Dance therapy is a suitable alternative treatment for chemical dependent populations as it is suitable for all types of individuals, for individuals having any kind of illnesses, and for creatively and effectively expressing emotions, feelings, and ideas. This type of alternative treatment is suitable for chemical dependent populations for with this therapy, they will be able to enhance communication with other individuals, keep them busy and preoccupied, practice and develop creativity and express feelings and emotions, and similar with art therapy, be able to express themselves without the use of words, which can complicate their messages. Moreover, the use of dance or movement can improve their talents in the dancing, which they can further develop and consider a good option in terms of profession or hobby.
Another type of expressive art is in the form of drama, which helped develop drama therapy. Drama therapy is said to be the intentional use of drama or theater processes to be used in therapy; it is active and experiential, and can provide its participants the opportunity to tell their stories, set goals, solve problems, express their feelings and emotions, and explore interpersonal relationship skills. It involves activities including improvisation, puppetry, role-playing, mask work, pantomime, theatrical production, psychodrama, developmental psychology, theories of personality, and group processes (“Drama Therapy”, 2006). Similar to dance and art therapy, drama therapy could be utilized by the chemical dependent populations to give them the opportunity to develop and enhance their talents in drama and acting. This form of alternative treatment can assist the chemical dependent populations with coping with their problems for this would give them the opportunity to play roles that have large significance to their lives. Playing roles would develop and inculcate in them the value of life and the value of themselves, as it depicts the reality of their situation or the situation of other individuals. Problem solving and critical thinking can also be developed, as this type of therapy would involve creating situations and experiences that depict real-life situations. In this way, they would be able to learn from such situations, and use such knowledge for practical applications. Similarly, drama therapy provides the means for the chemical dependent populations to express themselves through the characters they would be portraying, with the intention to express their feelings and emotions using that particular character. Through this type of therapy, they can develop their interests and talents in acting, which can provide opportunities in this kind of field after undergoing treatment.
The last form of expressive arts is with the use of music, or through music therapy. Music therapy is said to be the use of music by a trained professional to achieve therapeutic goals, which may include developing motor skills, social and interpersonal development, cognitive development, self-awareness, and spiritual enhancement. Because this type of therapy deals with the different aspects in music, it involves activities that include songwriting, listening, rhythmic entertainment, learning musical instruments, and many others (“Music Therapy”, 2007). As such, this type of alternative treatment is similar with dance, drama and art therapy in its aims and goals, which include helping individuals to express themselves creatively through music. Because not all individuals are into creating works of art using art materials, or not into dancing, or not into acting, music therapy serves to be a good alternative or option, as music serves to be one of the most used means of self-expression and creativity. Using music as an alternative treatment and therapy for the chemical dependent populations can be deemed successful and very useful, for using music and the instruments used in creating music, a specific individual would have the chance to express their emotions and feelings. Similar with other expressive art forms, music therapy can also develop and enhance the musical skills of individuals, thus, can be an option for a career or business after treatment. Through music therapy, one will be able to communicate with him or herself, and with other people, in order to inform them of their ideas and feelings regarding life. Thus, with these different expressive art forms, the chemical dependent populations would be able to have a number of options or alternatives depending on their interests.
However, despite the large number of treatment programs available for chemical dependency recovery, its selection can be confusing to a family in the middle of a crisis. For this reason, the National Council on Alcoholism and Other Drug Dependencies and various community programs can provide a summary of local treatment resources. Moreover, these programs can suggest levels of care based on interviews with family members and the addicted family member, which in this case is the chemical dependent offender. Nevertheless, a more accurate recommendation would only be made after the patient has been assessed by healthcare professionals. A number of treatment programs provide free assessments and give out recommendations regarding the required level of treatment (Landry, 1994).
Assessment Used for Chemical Dependent Offenders
The treatment of chemical dependents involves first the evaluation and assessment, treatment planning, medical and psychiatric management, psychosocial rehabilitation, and continuing care (Landry, 1994). It is important to assess and evaluate first the condition of the chemical dependent to be able to administer an effective treatment program suitable for his or her condition. A number of evaluation and assessment phases must be undergone by the chemical dependent to ensure that all stages of his or her condition would be properly examined. Primarily, screenings would be done to help determine whether the individual has a substance disorder and whether further evaluation is recommended. After this evaluation, the diagnostic evaluation is done, which documents the presence of a substance use disorder and describes that disorder, thus, providing health professionals with useful and relevant information regarding the problem of the offender. An intake evaluation is also done to trace the medical history of the patient, and becomes the basis for the decision in admitting the patient or to make a referral to other treatment programs (Landry, 1994).
Specifically, in treatment settings, patients are provided with medical assessments to determine their current medical problem. Medical assessments include detection of addiction-related problems, such as withdrawal, AIDS, hepatitis, or other diseases. The patient undergoes a physical examination, a thorough drug history, x-ray, electrocardiogram, urinalysis, blood tests, and other drug screening tests. Another form of assessment done is the nursing assessment, which takes place during detoxification in inpatient settings. Daily nursing assessment involves the patient’s response to drug cessation, to medication, interactions with other patients and staff, and early response to treatment. Third assessment done is the psychiatric assessment, which is used to confirm the presence and severity of substance use disorders. This type of assessment is a question-and-answer type of assessment, with self-report tests, structured interviews, and personality tests (Landry, 1994).
The next assessment done is the nutritional assessment, which is necessary because during active addiction, nutritional needs are unmet. For this reason, the nutritional needs of the chemical dependent is being evaluated to determine other diseases that may have been caused by his or her condition, thus, requiring additional treatment and care. Nutritionist and other healthcare professionals use structured interviews and laboratory tests to determine the presence and severity of nutritional problems. The fifth assessment to be utilized is the family assessment, where family therapy specialists interview the patient and other family members of the chemical dependent to obtain a clearer understanding of the addict’s family dynamics, effects of addiction on the family, and the effect of family structure on the individual’s addiction. This type of assessment provides information on the expected level of support and understanding of the family of the addict for the treatment and recovery. The next type of assessment done is the social and emotional assessment, which recognizes the fact that different social and emotional problems may have contributed to the drug or alcohol use of the individual. These problems or issues must be identified for a more effective prevention and recovery. In this regard, the social and emotional strengths and weaknesses of the chemical dependent, which would be helpful in administering treatment that would involve the enhancement of poor skills and the encouragement of the use of such skills for personal growth. Another type of assessment that must be done is the recreation, stress, and leisure assessment that involve participation in various activities and exercises that promote pleasure, and this includes sports, hobbies and games. This form of assessment recognizes the fact that during the course of addiction or chemical dependence, the addicts seize to participate in recreational and leisure activities, thus, with this form of assessment, the chemical dependent would be able to enjoy his or her life through interactive and social activities. The next type or form of assessment is the legal assessment, which helps the chemical dependent to address problems such as court appearances that would contribute to the severity of stress and anxiety, thus, reducing the effectiveness of treatment. The last type of assessment to be done is the vocational assessment, which would help the chemical dependent obtain and maintain their jobs or employment. Through this assessment, the chemical dependent is monitored to help them return to their jobs, thus, making them realize their importance to the society and to their community. This form of assessment examines and evaluates the individual skills, interests, job history and addiction-related occupational problems of the chemical dependent, thus, determining the areas that need to be addressed during the treatment and recovery period (Landry, 1994).
Aside from the use of such assessment methods is the frequently used form of assessment, which is with the help of counselors or through counseling orientations. These counseling orientations are usually facilitated by psychiatrists, who use a clinical model in determining problems related to chemical or substance dependence. This form of assessment can be used effectively because it is scientifically and research-based, thus, facilitating a scientific approach concerning the treatment of chemical dependents. Counseling orientations use a clinical model that helps the patient and the clinician to understand or treat a clinical problem (as cited in Johnson et. al., 1994), where in this case addiction or chemical dependency is treated as a clinical problem. This specific type of clinical assessment uses an instrument to measure substance abuse through the Powerless-Empowerment Scale, which is a substance abuse counseling assessment method that involve the degree of responsibility of clients should assume for their recovery and how much power they have to overcome their addictions (Johnson et. al., 1994). With such assessment methods, chemical dependent offenders are able to have an idea on the extent of their addiction and on the extent of their treatment. Furthermore, assessments are important in the effective administration of treatment of chemical dependent offenders.
Testing Chemical Dependent Populations
After proper and effective assessment is done, drug testing is appropriate. This should be observed in order to assist the chemical dependent and his or her treatment on rehabilitative and punitive interventions, to reduce drug consumption by the increase in the access to treatment services, to obtain balanced punishment, justice, protection, and offender rehabilitation, and to provide needed information regarding policing and treatment policies and strategies (Matrix Research and Consultancy and NACRE, 2007). These must be taken note of in order to observe effective drug testing strategies and methods that would enable the further improvement and development of treatment methods for chemical or substance dependency.
Types of drug testing includes pre-employment drug testing and the Post-incident drug testing, which are commonly done in businesses, and the random drug testing, which is the most controversial type, as being used primarily for controlling illicit substance use in the society. This is done most especially in determining the extent of substance use of chemically dependent populations, such as in rehabilitation centers, prisons, different government agencies, and in schools.
Drug and alcohol tests are divided into two general classifications, one is through giving a sample of bodily fluids or hair and the other one is with on-site screens. The commonly used method for drug testing is through urinalysis, where a specific individual provides a sample of urine, and the amount of substance is detected either through a test card or through laboratory tests. Tests done in the laboratory may include gas chromatography or mass spectrometry and high-performance liquid chromatography or immunoassay analysis. Another way of detecting the amount of substances in the biological system of chemical dependents is through hair drug testing. This is an accurate test, as the hair can go back normally in 3 months, thus, would clearly show the use of drugs by the individual. Substances are contained in the hair shaft, and with longer strands of hair, the more the drug history of the individual can be easily detected. The third type of drug testing methods is through saliva drug screen or the oral fluid-based drug screen, where substance detection occurs after a few days. This is being used, as this type of drug test cannot be adulterated or cheated. Saliva testing can be compared to the accuracy obtained using blood samples. The last type of drug screen is in using sweat, where sweat test patches are attached to the skin of the chemical dependent for 10 to 14 days. This type of drug test is very applicable with the detection of substances for child protective services, parole departments, and other government agencies concerned with the use of drugs over long periods, and when urine samples are not applicable (“Drug Test, 2007). After gathering relevant data from the use of the different drug test methods, samples would be taken to the laboratory for additional confirmatory tests in order to determine the positivist or the negativity of the samples. This would in turn, confirm and indicate the amount of substances present in the biological systems belonging to the chemical dependent population.
With such drug test methods, the extent of chemical dependency among the target populations would be effectively and efficiently examined. The mentioned tests are not enough to confirm the presence of substances in the system of the chemical dependent. Rather, confirmatory must still be done in order to strongly indicate the presence or absence of substances.
Chemical Dependency Treatment Works
Given the above information, it would be necessary to take note if the chemical dependency treatment methods and strategies are essential and effective in the treatment and recovery of the target population. This is necessary to know the most used chemical dependency treatment used by most rehabilitation centers, and to become the basis of this research paper’s conclusion and recommendation. In addition, it would also be essential to take note of the effectiveness and efficiency of chemical dependency treatment programs to enable further investigation, study, and development that would cater to the needs of the chemical dependent populations in this study.
It has been reported that despite the number of chemical dependency treatment programs available, there are relatively few outcome studies of treatment programs for chemically dependent adolescents. A cited study in Macmenamin and Ralph (1996) indicated that relapse rates from treatment programs range from 35 to 70%, and that there is minimal information indicating the type of program used, (whether inpatient or outpatient), and whether it is effective or not. Another study indicated that adolescent chemical dependency programs that employed counselors with longer tenure, larger number of volunteers, increased delivery of mental relaxation techniques, and more practical problem solving were attributed to higher completion of treatment. However, this study did not indicate the success rate of such a program. In the comparison of different races in the American society, a specific study of American Indian and European American adolescents found out that following a four to six week inpatient treatment program, 27% of European Americans, and all American Indians continued using alcohol. On the other hand, 46% of American Indians and 41% of European Americans never used marijuana or hashish. This indicates that behavioral changes attributed to the recovery of chemical dependents from drug and alcohol use is not much written, while more literature indicating that chemical dependent populations are under treatment (as cited in Macmenamin and Ralph, 1996). With this data, it can be perceived that the success of the treatment programs were not indicated in most studies related to chemical dependency, and that most of the literatures being recovered indicate that many continue to use alcohol or drugs after being subjected to treatment. From this, it can be hypothesized that either the chemical dependency treatment program or method used in the recovery of the patient is not effective, or the chemical dependency treatment used does not suit the needs of the patient. However, despite such records, some studies indicate the effectiveness and the success rates of such chemical dependency treatment methods.
Starr (2002) reports that most studies on chemical dependency show that treatment programs on average have an effectiveness rate of 30 to 60%, if measured in terms of the number of people who remain totally abstinent for one year or longer, and where individual treatment programs may achieve higher abstinence rates. In addition, according to the Partnership for Recovery, which is a coalition of top treatment centers, success rates ranges from 51 to 75%, while the Hazel den Foundation boasts a 77% rate of keeping people clean and sober at the end of one year, having 54% being completely abstinent from substance use, and the rest having had just one episode of use during that time. Nevertheless, although addiction treatment is perceived to be not universally successful, its success rate can still be compared to the success rate of treating other diseases, including hypertension, diabetes, and asthma. Thus, as a specific study reported, addiction treatment ranked in the top 10% of medical treatments reviewed for savings in money and lives (as cited in Starr, 2002).
Another possible measure indicating the effectiveness and success of the chemical dependency treatment programs is through taking note of the lives of the treated patients after undergoing the treatment program. A study indicates that after undergoing the treatment recovery program and the discharge of the patients, significant changes in the patients’ behavior were observed. Macmenamin and Ralph (1996) reports that before admission of chemically dependent adolescents in the treatment program, 75.9% of students were enrolled in regular high school, 12% in a continuation school, 2.8% in independent study, and 6.5% were not in school. However, after the treatment program, 37% were enrolled in regular high school, 9.3% in a continuation school, 26.9% in independent study, and 9.3% were not in school, which included graduates. This study also pointed out that among their respondents, 2 out of 81 students did worse in school after discharge, while 64 out of 81 students improved. In addition, 40 out of 108 students were working before admission, while 58 out of 108 were working after discharge, resulting to an increase number of graduates and improved lives after discharge and treatment.
Moreover, the behavior of the adolescents also improved, indicated by the improvement of their relationship with their family after their discharge, having 82 out of 107 parents having improved relationships, while only 5 out of 107 parents who had worse relationships (as cited in 1996). With this data, it can be perceived that although the success rate of chemical dependency treatment programs are not always indicated in figures, it can still be regarded as an effective and efficient tool that improves the lives of the patients. However, such studies failed to indicate the most effective chemical dependency treatment programs being used and implemented in different rehabilitation and treatment centers and institutions.
Chapter 3
Methodology
This part discusses the research methods available for the study and what is applicable for it to use. Likewise, the chapter presents how the research study was implemented and how it came up with relevant findings. Moreover, this chapter also presents the various procedures and strategies in identifying the sources for the needed information to know the relative preferences of the chosen respondents in terms of the treatment of chemically dependent populations. It specifies the research design that was followed, the process of data gathering, and the data analysis method that would be used.
Research Method
Three kinds of research methods can be used in doing research studies, namely, correlation, experimental, and descriptive method. The correlation method is used with regards to ethical and practical problems with experiments. In addition, inferring causality from correlation is not actually impossible but very difficult, so this mode of study is widely acceptable, cheap and usually ethical. Nonetheless, there exist some “third variable” issues and measurement problems in the use of this type of method. In essence, this type of research method refers to studies in which the purpose is to discover relationships between variables through the use of correlation statistics.
Another type of research method is the experimental method, which is the only method that can be used to establish cause-and-effect relationships (Creswell, 1994). That is, this type of research method is the only method that can be used to explain the bases of behavior and mental processes. In this method, the subjects are split into two or more groups, where one group is called the experimental group and gets the treatment that the researcher believes will cause something to happen. This treatment is formally called the independent variable. The experimental and control groups are compared on some variable that is presumed to reflect the effects of the treatment or outcome. This is formally referred to as the dependent variable.
The third and final approach is the descriptive research method, which uses observations and surveys. In this method, it is possible that the study would be cheap and quick. It could also suggest anticipated hypotheses. Nonetheless, it would be very hard to rule out alternative explanations and especially infer causations. Thus, this study will use the descriptive approach to utilize observations in the study.
The research study started by conducting an exploratory type of research in the aim to identify the variables needed. The research study included personal interviews and self-administered questionnaires. In addition, a set of articles and other literature were used in the process of building constructs and identifying variables. After identifying constructs and variables, a questionnaire was made and distributed to respondents from different chemical dependency treatment centers and rehabilitation institutions. Particularly, the method utilized in this research study is termed the research onion process, which will be used in order to ensure that the researcher will be able to obtain the necessary data to examine which rehabilitation program is the most effective treatment for chemically dependent offenders.
Research Onion Process
In order to come up with the most suitable research approaches and strategies for the study, the research onion process was utilized. The process was termed as such because the conduction of the research is like peeling the layers of an onion, in order to come to the central issue of how to collect the necessary data needed to answer the research questions and objectives. In this research process, important layers should be first peeled away, before arriving at the core of the process. With the said process, an outline on what measures to be applied are most appropriate would be made. In addition, it is not unusual for a researcher to first think of his research understanding by considering whether one should for example, administer a questionnaire or conduct interviews; this is why thoughts of this question should belong to the center of the research onion (Saunders, 2003). That is, in order to come to the central issue of how to collect the data needed to answer one’s research questions, there are important layers of the onion that needed to be peeled away.
The first layer raises the question of the research philosophy to adopt, particularly of positivism. With this research philosophy, a researcher prefers to work with an observable social reality in order to come up with law-like generalizations similar to those produced by the physical and natural scientists ( et. al., 1998). In this tradition, the researcher becomes an objective analyst, coolly making detached interpretations about those data that have been collected in an apparently value-free manner (et al, 2003). In addition, the emphasis is on a highly structured methodology to facilitate replication (Gill and Johnson, 1997) and on quantifiable observations that lend themselves to statistical analysis (Saunders et al, 2003). The assumption is that the researcher is independent of and neither affects nor is affected by the subject of the research (1998; 2003).
The second layer considers the subject of the research approach that flows from the research philosophy. Specifically, this research study adopts a deductive research approach, which moves from general ideas or theories to specific particular situations. An example of the application of this kind of research approach is knowing the number of definitions of the word ‘professional’ from a number of professional associations. The definition can be obtained by using a questionnaire, interviews, or group discussions, and through selecting a sample on the basis of age, gender, occupation, etc. The data obtained can then be collated and results presented. This research approach is relatively easy and a systematic way of testing established ideas on a range of people (Neville, 2005). In addition, this approach has five sequential stages, namely, deducing a hypothesis, expressing the hypothesis in operational terms, testing this operational hypothesis, examining the specific outcome of the inquiry to either confirm the theory or indicate the need for its modification, and modifying the theory in the light of the findings, if necessary (Robson, 1993).
The third layer examines the research strategy that is most applicable, and adopts the case study research strategy. This type of research strategy uses a particular case study or situation, which will be the basis for the collection of data, analysis of information, and report of results. Through this case study, the research would be able to understand as to why the situation happened, and the important aspects that should be given attention in the future. This research strategy also helps in generation and testing of hypotheses (“Case Study”, 2007).
The fourth layer refers to the time horizon a researcher applies to his or her research, which in this research study is referred to as the cross sectional time horizon. It has been reported that in the cross-sectional type of research, data needed in the research study are collected from the respondents at a single point in time or during a single, relatively brief timeframe. Particularly, the data are collected from multiple groups or types of people, such as from males and females, from people belonging to different socioeconomic classes, from multiple age groups, and from people with different skills and accomplishments. The advantage of using such a research approach is that the needed data can be collected from different respondents in a relatively short timeframe (“Cross-Sectional Research”, 2006). The fifth and final layer is the data collection methods that are to be used in the research study. The data collection method used in this research study would be useful in obtaining the secondary data needed, particularly the data from the target population or respondents.
Research Design
It has been previously mentioned that the second layer of the research onion process refers to the subject of the research approach, and identifies the deductive research approach as a means of obtaining the necessary data. Furthermore, the deductive approach has a number of important characteristics. Primarily, this approach is a search to explain causal relationships between variables, which consequently lead to the development of a hypothesis. Second, it involves the collection of a quantitative data and/or qualitative data, and these data are important to test a hypothesis that has been previously developed. The third characteristic of a deductive approach is that it controls to allow the testing of hypothesis. However, one must remember that with this approach, it is important that the researcher is independent of what is being observed – that is, the researcher should be objective and not subjective. In this sense, the principle of scientific strictness will be pursued, as this approach emphasizes scientific principles (Saunders et. al., 2003). Another important aspect to take note of is that the concepts are operationalisation, which will enable facts to be measured quantitatively. Finally, the deductive approach is a generalization, and to be able to do so, a sufficient numerical size of samples is needed (Saunders et. al., 2003).
However, along with the guide of the sequential stages in adopting the deductive research approach, effectively and properly obtaining data from respondents involve both a qualitative and quantitative research, using exploratory methods in describing the variables, such that the data situation and other facts collected were explained and correlated with other data. This form of research design is useful when conducting a study where data are immeasurable, such as feelings, beliefs, and thoughts (Mays and Pope, 2000). In addition, this descriptive study focuses on the conditions set and the nature that surrounds the data, and not on the correlation with other collected facts. Specifically, the qualitative method permits a flexible and iterative approach, while the quantitative research method permits specification of dependent and independent variables and allows for longitudinal measures of subsequent performance of the research subject.
During data collection, the choice and design of methods are constantly modified, based on ongoing analysis. This allows investigation of important new issues and questions as they arise, and allows the investigators to drop unproductive areas of research from the original research plan.
The value of qualitative research can best be understood by examining its characteristics. One of the primary advantages of qualitative research is that it is more open to the adjusting and refining of research ideas as an inquiry proceeds. In addition, the researcher does not attempt to manipulate the research setting, as an experimental research study, but rather seeks to understand naturally occurring phenomena in their naturally occurring states. In comparison, the quantitative method is compatible with the study because it allows the research problem to be conducted in a very specific and set terms (Cooper and Schindler, 1998). Besides, the quantitative research plainly and distinctively specifies both the independent and the dependent variables under investigation. It resolutely follows the original set of research goals, arriving at more objective conclusions, testing hypothesis, determining the issues of causality, and eliminating or reducing subjectivity of judgment (1996). In addition, this method allows for longitudinal measures of subsequent performance of research subjects (Mated, 2002). Finally, it provides achieving high levels of reliability of collected data due to, namely, controlled observations, laboratory experiments, mass surveys, or other forms of research manipulations. This study should be based on surveys and statistical treatments, such that the quantitative approach suits well with it.
Respondents of the Study
Research Instrument
The researcher designed a questionnaire for the purpose of the interview or interaction process. The primary aim of the questionnaire is to obtain data from respondents on the most effective rehabilitation methods for chemically dependent offenders. This research will use closed questions, which has pre-coded answers. Through closed questions, the researcher will be able to limit responses that are within the scope of this study. Using a multiple-choice method, the answer of the respondents would be within one of the limited expected answers of the researcher. Thus, the researcher will design a closed question type to remain focused on the statement of the problem and on the main purpose of the study. In addition, closed questions will be used in the survey because the answers are easy to analyze and are straightforward, as target respondents do not have enough time to answer open-ended questions. Because they are under medication and treatment, their attention span and even their brain function may not be suitable for open-ended questions and long interview sessions. Closed response questions save the respondent having time to think of possible replies. However, despite the use of closed questions, the interaction or interview session would be used for direct observation of the respondents.
The questionnaire consists of mainly two parts. The first part was a set of categorical questions to identify a respondent’s personal data and information, which corresponds to the demographic data the study will be needing, including the age, occupation, status, and gender. The second part of the questionnaire, which is divided into two, includes a number of questions to measure the attitudes, preferences, and factors that may affect the rehabilitation treatment of respondents. A 5-point Liker Scale was used in both the two parts of second part of the questionnaire to measure each construct. The variable used in the scale were mainly derived from the exploratory research results and from some related literature. In the Liker technique, a set of attitude statements are presented, where subjects or respondents of the study are asked to express agreement or disagreement using a five-point scale.
To find out causes of addiction and chemical dependency in the target population;
12) To identify the elements that foresee substance exploit problems or the problems that lead to chemical dependency;
13) To determine the effects of chemical dependency to individuals and to the society;
14) To determine the different drug and alcohol rehabilitation methods currently used, including its process, duration and development;
15) To provide an ample assessment of offenders with chemical dependency problems;
16) To evaluate processes and tools presently used for testing;
17) To determine alternative rehabilitation methods available for chemical dependents;
18) To determine the chemical dependent treatment effects of the offenders;
19) To identify the constructive dependency treatment results in offenders; Chapter 4 and 5
To recognize the impacts of such actions to the society; Conclusion and Recon
Issues
(1) Fortunately, although no cure exists, medical treatment can enable recipients to live normal, healthy, and productive lives. Treatment is cheap compared to many other common medical procedures and is highly cost-effective. (2) Now consider this: For the vast majority of victims of this disease, effective treatment is inaccessible. Most health insurance plans either do not cover it or put a variety of limits on coverage that do not apply to other diseases. Unless they can pay out of pocket, victims cannot get the treatment they need. To make matters worse, they are often told that their condition is not a real disease, or that it is their fault, or that suffering from it makes them a criminal.
The disease is drug and alcohol addiction, and the facts are real. Ubiquitous benefit caps on insurance coverage of substance abuse treatment put effective recovery out of reach for most addicts. In this Note, I assess the nature of this problem and some possible ways to address it. The general principle that I advocate is substance abuse treatment parity, which means that insurance plans should provide coverage for addiction treatment that is equivalent to that provided for analogous conditions. In some cases, failure to provide such parity should be considered illegal disability discrimination on the part of employers and insurers. Moreover, new laws should be adopted to require insurance parity explicitly.
In Part I, I review the current status of insurance coverage of addiction treatment and assess the scope of the shortfall and possible reasons behind it. In Part II, I set forth the case for insurance parity, including the nature and costs of the disease of addiction and the efficacy and cost-effectiveness of treatment, and consider some counterarguments. In Part III, I analyze the requirements of the Americans with Disabilities Act (ADA) as they pertain to insurance parity, drawing on the precedents set by recent challenges to other types of insurance discrimination. I conclude that the ADA should be interpreted to require parity in some cases, but that the potential effectiveness of this litigation strategy is limited--new reforms are necessary. In Part IV, I consider the strengths and weaknesses of current legislative proposals to accomplish insurance parity, and focus especially on the Substance Abuse Treatment Parity Act. Finally, in Part V, I offer my conclusions and recommendations for legal change and advocacy.
Sample Questionnaire 1
Personal Information of Respondent
Please provide necessary answers on the space provided after each item. On items with choices, please mark the corresponding answer in line with the respondent’s preference.
Name: _____________________________ Date: _________
Gender: Female ______ Male: ______
Rehabilitation Institution: ___________________________
Location: ________________________________________
Age Range:
Below 20 _____ 20 to 25 _____ 26 to 30 _____ 31 to 35 _____
36 to 40 _____ 41 to 45 _____ 46 to 50 _____ Over 50 _____
Race:
Native American _____ European American _____ African American _____ Asian _____ Others (pls. specify)___________
Religion:
Christian _____ Muslim _____ Catholic _____ Buddhism _____
Hindu _____ Protestant_____ Others _____
Marital Status:
Single _____ Married _____ Divorced/Widowed _____
Children (if any): _____
Educational Background:
High School Education _____ University Education _____
Masterly Studies _____ Doctorate Studies _____
Vocational_______
Occupation:
(A) Student (pls. specify) _____________
(B) White Collar Job – doctor, lawyer, nurse, accountant, etc
(C) Blue Collar Job – construction, domestic helper, plumber, factory worker, etc
(D) Unemployed
Substance/Chemical Used upon Arrest
(A) Alcohol
(B) Drugs (pls. specify what kind) _____________________
(C) Others (pls. specify)
Type of Chemical Dependency Treatment Currently In: __________________
Duration:
(A) Once a week
(B) Twice a week
(C) Thrice a week
(D) Daily
(E) Monthly
(F) Occasionally
(G) Full In-house Treatment
1. Regular
2. Intensive
(H) Outpatient Treatment
1. Regular
2. Intensive
Stage of Treatment
(A) Newly Enrolled
(B) Regularly attending sessions
(C) Near recovery
Sample Questionnaire 2
All items are responded to using a 5-point Liker-type scale with the following points: 1 for Strongly Agree; 2 for Agree; 3 for Uncertain; 4 for Disagree; and 5 for Strongly Disagree. Please mark the corresponding space for the points.
1. Are you unhappy with how your life has been going?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
2. Do you find yourself always having thoughts of drinking or using drugs?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
3. Do you recognize that you have a problem?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
4. Has anybody informed you that you might have a problem?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
5. Have you drank or used substances regardless of the consequences?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
6. Do you recognize the fact that you are a chemical dependent individual?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
7. Do you recognize that your situation affects your behavior entirely?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
8. Has your occupation (or schooling) or relationships been affected?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
9. Are you in jeopardy of losing your job or family because of chemical use?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
10. Do you refuse to go to places where you won’t be able to use substances or drink?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
11. Do you believe that your chemical dependency has given you any advantages?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
12. Do you perceive drugs or excessive use alcohol a tool for the disruption of your future?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
13. Have you ever spent on chemical or substance use more than you should have spent on bills or other needs?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
14. Do you hide or lie about using substances to friends or family?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
15. Do you realize the negative effects of your situation to your family and friends?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
16. Do you need to drink or use to have fun or to enhance your social life?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
17. Is it uncomfortable for you to participate in social institutions without substance use?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
18. Do you have any legal problems as a result of substance use?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
19. Do you constantly live in fear or anxiety?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
20. Do you drink or use substances to cope with feelings of pain, anger, fear, anxiety, and depression?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
21. Do you compromise your values or morals?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
22. Do you feel that you are different from others and no one understands you?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Sample Questionnaire 3
All items are responded to using a 5-point Liker-type scale with the following points: 1 for Strongly Agree; 2 for Agree; 3 for Uncertain; 4 for Disagree; and 5 for Strongly Disagree. Please mark the corresponding space for the points.
Are you satisfied with the extent of treatment provided to you?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Do you believe that the currently administered treatment is suitable to your condition?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Has your attention been completely diverted from the use of alcohol/drugs?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Has your condition improved from the time you entered the institution?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
With the extent of your knowledge, do you perceive another type of chemical dependency treatment more applicable to your condition?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Are the activities facilitated in this institution successful in treating your addiction?
1 Strongly 2 Agree 3 Uncertain 4 Disagree 5 Strongly
Agree Disagree
Credit:ivythesis.typepad.com
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