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%
(Mumble and Kornberg, 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 (Mumble
and Kornberg, 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 (Wilkinson and
Mistral, 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.
Specifically, the study intends to answer the following queries:
-
What could be the most recommended chemical
dependent rehabilitation program for offenders?
-
What are the risks to be taken note of in
undergoing such rehabilitation program?
-
What are the barriers to be considered in
allowing a criminal offender in undergoing the treatment program?
-
Are there other alternative treatment programs
available that could present the same effects and treatment for offenders?
-
What are strengths, weaknesses, opportunities,
and threats that can be attributed to undergoing such programs?
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
(Clemens, 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 (Clemens, 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 Alvarez-Niemeyer, Nun-Gutierrez and Rodriguez-Credo (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
Castro-Sari nana 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 Medina-Mora
et. al 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, Sanchez-Huascar et. al. 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
Sanchez-Huascar et. al 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 Alvarez-Niemeyer,
Nun-Gutierrez, and Rodriguez-Credo, 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 (Droves, 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 (Bridge and Robinson, 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 (Bridge and Robinson, 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 (Droves, 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 (Droves, 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
(Muslins, 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 $200 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 $246 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 Walberg 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).
…
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 involves 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 Macmenamin and Ralph, 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 (Remedy 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
(Saunders 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 (Remedy et. al.,
1998; Saunders et al, 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 (Kelley and Pothered, 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.
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. Do you recognize the fact that you are a chemical
dependent individual?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
2. Do you recognize that your situation affects your
behavior entirely?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
3. Do you believe that your chemical dependency has given
you any advantages?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
4. I perceive drugs or excessive use alcohol a tool for the
disruption of my future.
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
5. 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
6. Are you satisfied with the extent of treatment provided
to you?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
7. 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
8. Has your attention been completely diverted from the use
of alcohol/drugs?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
9. Has your condition improved from the time you entered
the institution?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree
10. 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
11. Are the activities facilitated in this institution
successful in treating your addiction?
1 Strongly 2 Agree 3
Uncertain 4 Disagree 5 Strongly
Agree
Disagree