Drug rehabilitation

(Redirected from Rehabilitation centers) Processes of treatment for drug dependency

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Medical intervention

Drug rehabilitation
ICD-9-CM	94.64
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The 2010 ISCD study "Drug Harms in the UK: a multi-criteria decision analysis" found that alcohol scored highest overall and in **Economic cost**, **Injury**, **Family adversities**, **Environmental damage**, and **Community harm**.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and medical consequences that can be caused.

Treatment includes medication for comorbidities, counseling by experts, and sharing of experience with other recovering individuals.

Psychological dependency

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach patients new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use addictive substances. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs but to examine and change habits related to their addictions. Many programs emphasize that recovery is an ongoing process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.")

Whether moderation is achievable by those with a history of misuse remains a controversial point.

The brain's chemical structure is altered by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process.

Types

Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups, extended care centers, recovery or sober houses, addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs.

In an American survey by three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring treatment responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics Alcoholics Anonymous identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction).

Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. Whatever the methodology, patient motivation is an important factor in treatment success.

For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like methadone and buprenorphine can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs.

Types of behavioral therapy include:

Cognitive-behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse.
Multidimensional family therapy, which is designed to support the recovery of the patient by improving family functioning.
Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment.
Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance.
EEG Biofeedback augmented treatment improves abstinence rates of 12-step, faith-based, and medically assisted addiction for cocaine, methamphetamine, alcohol use disorder, and opioid addictions.

Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use. Research has shown that most patients need at least three months of treatment and longer durations are associated with better outcomes. Prescription drug addiction does not discriminate. It affects people from all walks of life and can be a devastatingly destructive force.

Medications

Certain opioid medications such as methadone and more buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use, and the risks associated with it, such as disease, arrest, incarceration, and death, in line with the philosophy of harm reduction. Both drugs may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids. All available studies collected in the 2005 Australian National Evaluation of Pharmacotherapies for Opioid Dependence suggest that maintenance treatment is preferable, with very high rates (79–100%) of relapse within three months of detoxification from levo-α-acetylmethadol (LAAM), buprenorphine, and methadone.

According to the National Institute on Drug Abuse (NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and Hepatitis C by stopping or reducing injection drug use and drug-related high risk sexual behavior. Naltrexone is a long-acting opioid antagonist with few side effects. It is usually prescribed in outpatient medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk in the first three months by about 36%. However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates average 12% at 90 days for naltrexone, average 57% at 90 days for buprenorphine, average 61% at 90 days for methadone).

Ibogaine is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome. The drug is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered tend to have little oversight and range from motel rooms to one moderately-sized rehabilitation center.

A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction. These medications include bupropion and nortriptyline. Bupropion inhibits the re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant which has been used to aid in smoking cessation it has not been FDA approved for this indication.

Acamprosate, disulfiram and topiramate (a novel anticonvulsant sulphonated sugar) are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them to maintain abstinence for several weeks, even months. Disulfiram produces a very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. It is more effective for patients with high motivation and some addicts use it only for high-risk situations. Patients who wish to continue drinking or may be likely to relapse should not take disulfiram as it can result in the disulfiram-alcohol reaction mentioned previously, which is very serious and can even be fatal.

Nitrous oxide, also sometimes known as laughing gas, is a legally available gas used for anesthesia during certain dental and surgical procedures, in food preparation, and for the fueling of rocket and racing engines. People who use substances also sometimes use gas as an inhalant. Like all other inhalants, it is popular because it provides consciousness-altering effects while allowing users to avoid some of the legal issues surrounding illicit substances. Misuse of nitrous oxide can produce significant short-term and long-term damage to human health, including a form of oxygen starvation called hypoxia, brain damage and a serious vitamin B12 deficiency that can lead to nerve damage.

Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions.

Residential treatment

In-patient residential treatment for people with an alcohol use disorder is usually quite expensive without insurance. Most American programs follow a 28–30 day program length. The length is based solely upon providers' experience. During the 1940s, clients stayed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. 70% to 80% of American residential alcohol treatment programs provide 12-step support services. These include, but are not limited to AA, Narcotics Anonymous, Cocaine Anonymous and Al-Anon. One recent study suggests the importance of family participation in residential treatment patient retention, finding "increased program completion rate for those with a family member or significant other involved in a seven-day family program".

Brain implants

Patients with severe opioid addiction are being given brain implants to help reduce their cravings, in the first trial of its kind in the US. Treatment starts with a series of brain scans. Surgery follows with doctors making a small hole in the skull to insert a tiny 1mm electrode in the specific area of the brain that regulates impulses such as addiction and self-control. This treatment is for those who have failed every other treatment, whether that is medicine, behavioral therapy, and/or social interventions. It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies.

Recovery

The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal well-being while other studies have considered "near abstinence" as a definition.

The Recovery Model originates in the psychiatric survivor movement in the US, which argues that receiving a certain diagnoses can be stigmatizing and disempowering. Some characteristics of the Recovery Model are social inclusion, empowerment to overcome substance use, focusing on strengths of the client instead of their deficits and providing help living more fulfilling lives in the presence of symptoms of addiction. Another key component of the Recovery Model is the collaborative relationship between client and provider in developing the client's path to abstinence. Under the Recovery Model a program is personally designed to meet an individual clients needs, and does not include a standard set of steps one must go through.

The Recovery Model uses integral theory: a four-part approach focusing on the individual, the collective society, along with individual and external factors. The four quadrants corresponding with each in Integral Theory are Consciousness, Behavior, Culture and Systems. Quadrant One deals with the neurological aspect of addiction. Quadrant Two focuses on building self-esteem and a feeling of connectedness, sometimes through spirituality. Quadrant three works on mending the "eroded relationships" caused by active addiction. Quadrant Four often involves facing the harsh consequences of drug use such as unemployment, legal discrepancies, or eviction. The use of integral theory aims to break the dichotomy of "using" or "not using" and focuses instead on emotional, spiritual, and intellectual growth, along with physical wellness.

Criminal justice

Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There are a great number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U.S. Constitution, mandating separation of church and state.

In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act.

Counseling

Traditional addiction treatment is based primarily on counseling.

Counselors help individuals with identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it's more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. Counselors are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It's very common to see them also work with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her. Counseling is also related to "Intervention"; a process in which the addict's family and loved ones request help from a professional to get an individual into drug treatment.

This process begins with a professionals' first goal: breaking down denial of the person with the addiction. Denial implies a lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, instead of continuing the destructive behavior. Once this has been achieved, the counselor coordinates with the addict's family to support them in getting the individual to drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family.

One approach with limited applicability is the sober coach. In this approach, the client is serviced by the provider(s) in his or her home and workplace—for any efficacy, around-the-clock—who functions much like a nanny to guide or control the patient's behavior.

Twelve-step programs

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displays addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network that can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939. These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological and legal grounds. Opponents also contend that it lacks valid scientific evidence for claims of efficacy. However, there is survey-based research that suggests there is a correlation between attendance and alcohol sobriety. Different results have been reached for other drugs, with the twelve steps being less beneficial for addicts to illicit substances, and least beneficial to those addicted to the physiologically and psychologically addicting opioids, for which maintenance therapies are the gold standard of care.

SMART Recovery

SMART Recovery was founded by Joe Gerstein in 1994 by basing REBT as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. It does not subscribe to disease theory and powerlessness. The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of the SMART Recovery programs are:

Building and Maintaining Motivation,
Coping with Urges,
Managing Thoughts, Feelings, and Behaviors,
Living a Balanced Life.

This is considered to be similar to other self-help groups who work within mutual aid concepts.

Client-centered approaches

In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items, in the therapeutic relationship, could help an individual overcome any troublesome issue, including but not limited to alcohol use disorder. To this end, a 1957 study compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in the outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques. The authors note two-factor theory involves stark disapproval of the clients' "irrational behavior" (p. 350); this notably negative outlook could explain the results.

A variation of Rogers' approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs, such as Arizona's Department of Health Services.

Psychoanalysis

Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also explained substance use. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesized specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural, and political factors, encapsulation, traumatophobia, and masturbation as a form of self-soothing. Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings to regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.

Relapse prevention

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt's (1985) Relapse Prevention approach. Marlatt describes four psycho-social processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancy, attributions of causality, and decision-making processes. Self-efficacy refers to one's ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancy refers to an individual's expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual's pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in the consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual can employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse.

Cognitive therapy

An additional cognitively-based model of substance use recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as "I am undesirable," activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs ("I can handle getting high just this one more time") are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist's job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunction. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

Emotion regulation and mindfulness

A growing literature is demonstrating the importance of emotion regulation in the treatment of substance use. Considering that nicotine and other psychoactive substances such as cocaine activate similar psycho-pharmacological pathways, an emotion regulation approach may be applicable to a wide array of substance use. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. Acceptance and commitment therapy (ACT), is showing evidence that it is effective in treating substance use, including the treatment of polysubstance use disorder and tobacco smoking. Mindfulness programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts, appear to prevent impulsive/compulsive responses. Research also indicates that mindfulness programs can reduce the consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates.

Dual diagnosis

People who are diagnosed with a mental health disorder and a simultaneous substance use disorder are known as having a dual diagnosis. For example, someone with bipolar disorder who also has an alcohol use disorder would have dual diagnosis. On such occasions, two treatment plans are needed with the mental health disorder requiring treatment first. According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder.

Behavioral models

Main article: Community Reinforcement Approach and Family Training

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exist for both working with the person using the substance (community reinforcement approach) and their family (community reinforcement approach and family training). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on the use of problem-solving techniques as a means of helping the addict to overcome his/her addiction.

The way researchers think about how addictions are formed shapes the models we have. Four main Behavioral Models of addiction exist: the Moral Model, Disease Model, Socio-Cultural Model and Psycho-dynamic Model. The Moral Model of addiction theorizes that addiction is a moral weakness and that it is the sole fault of the person for becoming addicted. Supporters of the Moral Model view drug use as a choice, even for those who are addicted, and addicts as people of bad character. Disease Model of addiction frames substance abuse as 'a chronic relapsing disease that changes the structure and function of the brain'. Research conducted on the neurobiological factors of addiction has proven to have mixed results, and the only treatment idea it offers is abstinence. The Socio-Cultural Model tries to provide an explanation of how certain populations are more susceptible to substance abuse than others. It focuses on how discrimination, poor quality of life, lack of opportunity and other problems common in marginalized communities can make them vulnerable to addiction. The Psycho-Dynamic Model looks at trauma and mental illness as a precursor to addiction. Many rehabilitation centers treat "co-occurring" disorders, which refer to substance abuse disorder paired with a mental health diagnosis.

Barriers to treatment in the US

Barriers to accessing drug treatment may worsen negative health outcomes and further exacerbate health inequalities in the United States. Stigmatization of drug use, the War on Drugs and criminalization, and the social determinants of health should all be considered when discussing access to drug treatment and potential barriers.

Broad categories of barriers to drug treatment are: absences of problem, negative social support, fear of treatment, privacy concerns, time conflict, poor treatment availability, and admission difficulty. Other barriers to treatment include high costs, lack of tailored programs to address specific needs, and prerequisites that require participants to be house, abstinent from all substances, and/or employed. (See low-threshold treatment and housing first for more context on the latter point.)

Loss of Child/Dependent Access

In certain states, providers due to mandatory reporting methods and guidelines inform Child Protective Services of substance abusing parents for Schedule 1 substances including cannabis/marijuana. If a mother tests positive for using the substance during pregnancy in South Carolina she may be required to forfeit her child.

Further, barriers to treatment can vary depending on the geographical location, gender, race, socioeconomic status, and status of past or current criminal justice system involvement of the person seeking treatment.

Criticism

Despite ongoing efforts to combat addiction, there has been evidence of clinics billing patients for treatments that may not guarantee their recovery. This is a major problem as there are numerous claims of fraud in drug rehabilitation centers, where these centers are billing insurance companies for under-delivering much-needed medical treatment while exhausting patients' insurance benefits. In California, there are movements and laws regarding this matter, particularly the California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses.

Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance use treatment. With long wait lists in limited state-funded rehabilitation centers, controversial private centers rapidly emerged. One popular model, known as the Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies. Under the guise of helping patients with opioid addiction, these centers would offer addicts free rent or up to $500 per month to stay in their "sober homes", then charge insurance companies as high as $5,000 to $10,000 per test for simple urine tests. Little attention is paid to patients in terms of addiction intervention as these patients have often been known to continue drug use during their stay in these centers. Since 2015, these centers have been under federal and state criminal investigation. As of 2017 in California, there are only 16 investigators in the CA Department of Health Care Services investigating over 2,000 licensed rehab centers.

By country

Afghanistan

In Afghanistan since the Taliban took power in 2021, they have forced drug addicts into compulsory drug rehab.

China

As of 2013 China has compulsory drug rehabilitation centers. It was reported in 2018 1.3 million drug addicts were treated in China's compulsory detox centers.

Compulsory drug rehabilitation has a long history in China: The Mao Zedong government is credited with eradicating both consumption and production of opium during the 1950s using unrestrained repression and social reform. Ten million addicts were forced into compulsory treatment, dealers were executed, and opium-producing regions were planted with new crops. Remaining opium production shifted south of the Chinese border into the Golden Triangle region.

Indonesia

In 2015 the National Narcotics Board (Indonesia) was pushing for compulsory drug treatment for people with drug dependence.

Iran

According to statistics best case scenario less than a 25% of addicts go back to being healthy. There are two types of rehab one is Revolutionary Guard Corp or FARAJA run article 16 quarantine which is part of operations cleaning the cities from addicts and homeless just as well, the others article 15 and article 17 run by others including State Welfare Organization of Iran and also those run by Ministry of health and medical education. There are also places called Trust houses since July 2023 run by IRGC.

Italy

In 1963, Pierino Gelmini founded Comunità Incontro, a drug rehabilitation center in Amelia, Italy.

References

^ "Investigation Uncovers Fraud by California Rehab Clinics - Partnership for Drug-Free Kids - Where Families Find Answers". Partnership for Drug-Free Kids - Where Families Find Answers. Archived from the original on 4 May 2017. Retrieved 24 October 2017.
Marlatt GA, Donovan DM (2005). Relapse Prevention. New York City: The Guilford Press. pp. 81. ISBN 1-59385-176-6.
^ "Principles of Effective Treatment". National Institute on Drug Abuse Abuse. Archived from the original on 15 February 2021. Retrieved 15 November 2017.
Schaler JA (1997). "Addiction Beliefs of Treatment Michael Vick Providers: Factors Explaining Variance". Addiction Research & Theory. 4 (4): 367–384. doi:10.3109/16066359709002970. hdl:1903/25227. ISSN 1476-7392.
"How effective is drug addiction treatment?". drugabuse.gov. Archived from the original on 27 February 2021. Retrieved 25 February 2021.
"NIDA InfoFacts: Treatments Approaches for Drug Addiction] National Institute on Drug Abuse (NIDA)". Archived from the original on 5 August 2012. Retrieved 17 August 2010.
Curry, S.; Wagner, E. H.; Grothaus, L. C. (June 1990). "Intrinsic and extrinsic motivation for smoking cessation". Journal of Consulting and Clinical Psychology. 58 (3): 310–316. doi:10.1037/0022-006x.58.3.310. ISSN 0022-006X. PMID 2195084. Archived from the original on 2 February 2023. Retrieved 2 February 2023.
Principles of Drug Addiction Treatment Archived 1 September 2010 at the Wayback Machine National Institute on Drug Abuse (NIDA)>
"Motivational Interviewing". SAMHSA. Archived from the original on 13 December 2012.
Stitzer ML, Petry NM, Peirce J (June 2010). "Motivational incentives research in the National Drug Abuse Treatment Clinical Trials Network". Journal of Substance Abuse Treatment. 38 (Suppl 1): S61-9. doi:10.1016/j.jsat.2009.12.010. PMC 2866424. PMID 20307797.
Scott WC, Kaiser D, Othmer S, Sideroff SI (7 July 2009). "Effects of an EEG biofeedback protocol on a mixed substance abusing population". The American Journal of Drug and Alcohol Abuse. 31 (3): 455–69. doi:10.1081/ADA-200056807. PMID 16161729. S2CID 6931394.
Dehghani-Arani F, Rostami R, Nadali H (June 2013). "Neurofeedback training for opiate addiction: improvement of mental health and craving". Applied Psychophysiology and Biofeedback. 38 (2): 133–41. doi:10.1007/s10484-013-9218-5. PMC 3650238. PMID 23605225.
Arani FD, Rostami R, Nostratabadi M (July 2010). "Effectiveness of neurofeedback training as a treatment for opioid-dependent patients". Clinical EEG and Neuroscience. 41 (3): 170–7. doi:10.1177/155005941004100313. PMID 20722354. S2CID 35834162.
Dalkner N, Unterrainer HF, Wood G, Skliris D, Holasek SJ, Gruzelier JH, Neuper C (26 September 2017). "Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder". Frontiers in Psychology. 8: 1688. doi:10.3389/fpsyg.2017.01688. PMC 5622970. PMID 29018397.
Lackner N, Unterrainer HF, Skliris D, Wood G, Wallner-Liebmann SJ, Neuper C, Gruzelier JH (July 2016). "The Effectiveness of Visual Short-Time Neurofeedback on Brain Activity and Clinical Characteristics in Alcohol Use Disorders: Practical Issues and Results". Clinical EEG and Neuroscience. 47 (3): 188–95. doi:10.1177/1550059415605686. PMID 26415612. S2CID 34971632.
Horrell T, El-Baz A, Baruth J, Tasman A, Sokhadze G, Stewart C, Sokhadze E (July 2010). "Neurofeedback Effects on Evoked and Induced EEG Gamma Band Reactivity to Drug-related Cues in Cocaine Addiction". Journal of Neurotherapy. 14 (3): 195–216. doi:10.1080/10874208.2010.501498. PMC 2957125. PMID 20976131.
Unterrainer HF, Lewis AJ, Gruzelier JH (2013). "EEG-Neurofeedback in psychodynamic treatment of substance dependence". Frontiers in Psychology. 4: 692. doi:10.3389/fpsyg.2013.00692. PMC 3787602. PMID 24098295.
Rostami R, Dehghani-Arani F (September 2015). "Neurofeedback Training as a New Method in Treatment of Crystal Methamphetamine Dependent Patients: A Preliminary Study". Applied Psychophysiology and Biofeedback. 40 (3): 151–61. doi:10.1007/s10484-015-9281-1. PMID 25894106. S2CID 42223626.
"Quantitative Electroencephalography-Guided Versus Scott/Peniston Neurofeedback With Substance Use Disorder Outpatients" (PDF). www.aapb.org/files/publications/biofeedback/2007/biof_winter_pilot_study.pdf. Archived (PDF) from the original on 5 May 2019. Retrieved 1 June 2019.
Keith JR, Rapgay L, Theodore D, Schwartz JM, Ross JL (March 2015). "An assessment of an automated EEG biofeedback system for attention deficits in a substance use disorders residential treatment setting". Psychology of Addictive Behaviors. 29 (1): 17–25. doi:10.1037/adb0000016. PMC 5495545. PMID 25180558.
"Drug Addiction Style". Los Angeles(CA), USA. 22 March 2021. Archived from the original on 16 April 2021. Retrieved 22 March 2021.
^ Mattick RP; Digiusto E; Doran CM; O'Brien S; Shanahan M; Kimber J; Henderson N; Breen C; Shearer J; Gates J; Shakeshaft A; NEPOD Trial Investigators (2004). National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD): Report of Results and Recommendations (PDF). National Drug and Alcohol Research Centre, Sydney. Commonwealth of Australia. ISBN 978-0-642-82459-2. Monograph Series No. 52. Archived from the original (PDF) on 9 March 2011.
"National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) Report of Results and Recommendations". Archived from the original on 6 March 2016.
Alper KR, Lotsof HS, Kaplan CD (January 2008). "The ibogaine medical subculture". Journal of Ethnopharmacology. 115 (1): 9–24. doi:10.1016/j.jep.2007.08.034. PMID 18029124. Archived from the original on 6 February 2008.
^ Klein JW (July 2016). "Pharmacotherapy for Substance Use Disorders". The Medical Clinics of North America. 100 (4): 891–910. doi:10.1016/j.mcna.2016.03.011. PMID 27235620.
^ "CLINICIAN SUPPORT MATERIALS". pubs.niaaa.nih.gov. Archived from the original on 31 January 2017. Retrieved 15 November 2017.
Pharmacotherapies Archived 12 September 2010 at the Wayback Machine National Institute on Drug Abuse (NIDA). Retrieved on 2010-08-17
Daynes G, Gillman MA (May 1994). "Psychotropic analgesic nitrous oxide prevents craving after withdrawal for alcohol, cannabis and tobacco". The International Journal of Neuroscience. 76 (1–2): 13–6. doi:10.3109/00207459408985987. PMID 7960461.
Gillman MA (1994). "Analgesic nitrous oxide for addictive withdrawal". S Afr Med J. 84 (8 Pt 1): 516. PMID 7825096.
"South African Brain Institute (SABRI) - profile". S A B R I. Archived from the original on 29 March 2023. Retrieved 7 March 2023.
"How Much Does Alcohol Rehab Usually Cost?". WebMD. Archived from the original on 2 February 2023. Retrieved 2 February 2023.
^ Glaser G (April 2015). "The Bad Science of Alcoholics Anonymous". The Atlantic. Archived from the original on 19 December 2021. Retrieved 29 February 2016.
McPherson C, Boyne H, Willis R (2017). "The Role of Family in Residential Treatment Patient Retention ". International Journal of Mental Health and Addiction. 15 (4): 933–941. doi:10.1007/s11469-016-9712-0. hdl:10613/5152. ISSN 1557-1874. S2CID 35574165.
"Brain implants used to fight drug addiction in US". BBC News. 8 November 2019. Archived from the original on 9 November 2019. Retrieved 11 November 2019.
Webb L (July 2012). "The recovery model and complex health needs: what health psychology can learn from mental health and substance misuse service provision". Journal of Health Psychology. 17 (5): 731–741. doi:10.1177/1359105311425276. PMID 22021273. S2CID 12725414.
"What is recovery? A working definition from the Betty Ford Institute" (PDF). Archived from the original (PDF) on 9 August 2017. Retrieved 15 November 2017.
White WL (March 2012). "Recovery/Remission from Substance Use Disorders" (PDF). Archived from the original (PDF) on 21 August 2017. Retrieved 1 November 2017.
Adame AL, Knudson RM (1 April 2008). "Recovery and the Good Life: How Psychiatric Survivors Are Revisioning the Healing Process". Journal of Humanistic Psychology. 48 (2): 142–164. doi:10.1177/0022167807305544. ISSN 0022-1678. S2CID 145567401.
Webb L (1 July 2012). "The recovery model and complex health needs: What health psychology can learn from mental health and substance misuse service provision". Journal of Health Psychology. 17 (5): 731–741. doi:10.1177/1359105311425276. ISSN 1359-1053. PMID 22021273. S2CID 12725414.
Duffy, James D. (2020). "A Primer on Integral Theory and Its Application to Mental Health Care". Global Advances in Health and Medicine. 9. doi:10.1177/2164956120952733. PMC 8981233. PMID 35392430. S2CID 224948883.
Amodia D (January 2006). "An Integral Approach to Substance Abuse". ResearchGate.
Du Plessis G (6 July 2010). "The Integrated Recovery Model for Addiction Treatment and Recovery". Rochester, NY. SSRN 2998241. Archived from the original on 4 July 2023. Retrieved 21 November 2021. {{cite journal}}: Cite journal requires |journal= (help)
"Alcoholics Anonymous AA Meeting Directory". Archived from the original on 16 August 2018. Retrieved 25 November 2018.
Egelko B (8 September 2007). "Appeals court says requirement to attend AA unconstitutional". San Francisco Chronicle. Archived from the original on 4 October 2009. Retrieved 8 October 2007.
"United States Court of Appeals for the Ninth Circuit" (PDF). Archived from the original (PDF) on 24 October 2021. Retrieved 29 January 2008.
Counselors Archived 10 September 2010 at the Wayback Machine United States Department of Labor. Retrieved on 2010-08-17
"Drug treatment". keyhealthcare. 28 July 2021. Retrieved 27 June 2022.
Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. 2001. ISBN 978-1-893007-16-1. OCLC 32014950.
Bandura, A. (1999). "A sociocognitive analysis of substance abuse: An agentic perspective". Psychological Science. 10 (3): 214–17. doi:10.1111/1467-9280.00138. S2CID 14083384.
Wood, Ron (7 December 2006). The suit challenges court-ordered 12-step programs: Constitutionality of forced participation in the program is questioned. The Morning News. Retrieved 2008-5-22.
Ferri M, Amato L, Davoli M (July 2006). "Alcoholics Anonymous and other 12-step programmes for alcohol dependence". The Cochrane Database of Systematic Reviews (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID 16856072. Archived from the original on 29 September 2018. Retrieved 18 June 2018.
Moos RH, Moos BS (June 2006). "Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals". Journal of Clinical Psychology. 62 (6): 735–50. doi:10.1002/jclp.20259. PMC 2220012. PMID 16538654.
Moos RH, Finney JW, Ouimette PC, Suchinsky RT (March 1999). "A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes". Alcoholism: Clinical and Experimental Research. 23 (3): 529–36. doi:10.1111/j.1530-0277.1999.tb04149.x. PMID 10195829.
"Introduction to SMART Recovery". SMART Recovery. Archived from the original on 1 January 2019. Retrieved 31 December 2018.
William Cloud; Robert Granfield (2001). Recovery from Addiction: A Practical Guide to Treatment, Self-Help, and Quitting on Your Own. NYU Press. p. 67. ISBN 978-0-8147-7276-8. Archived from the original on 4 July 2023. Retrieved 8 June 2018.
Rick Csiernik (2016). Substance Use and Abuse, 2nd Edition: Everything Matters. Canadian Scholars' Press. p. 269. ISBN 978-1-55130-892-0. Archived from the original on 4 July 2023. Retrieved 8 June 2018.
Jeffrey D. Roth; William L. White; John F. Kelly (2016). Broadening the Base of Addiction Mutual Support Groups: Bringing Theory and Science to Contemporary Trends. Routledge. ISBN 978-1-134-92780-7. Archived from the original on 4 July 2023. Retrieved 8 June 2018.
Ends EJ, Page CW (June 1957). "A study of three types of group psychotherapy with hospitalized male inebriates". Quarterly Journal of Studies on Alcohol. 18 (2): 263–77. doi:10.15288/qjsa.1957.18.263. PMID 13441877.
Cartwright AK (December 1981). "Are different therapeutic perspectives important in the treatment of alcoholism?". British Journal of Addiction. 76 (4): 347–61. doi:10.1111/j.1360-0443.1981.tb03232.x. PMID 6947809.
Division of Behavioral Health Services, ADHS/DBHS Best Practice Advisory Committee. "Client Directed, Outcome-Informed Practice (CDOI)". Archived from the original on 19 May 2007. Retrieved 6 January 2012.
Hopper E (December 1995). "A psychoanalytical theory of 'drug addiction': unconscious fantasies of homosexuality, compulsions and masturbation within the context of traumatogenic processes". The International Journal of Psycho-Analysis. 76 (Pt 6): 1121–42. PMID 8789164.
Marlatt GA (1985). "Cognitive factors in the relapse process". In Gordon JR, Marlatt GA (eds.). Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press. ISBN 978-0-89862-009-2.
Glavin C (6 February 2014). "Cognitive Models of Addiction Recovery | K12 Academics". www.k12academics.com. Archived from the original on 30 July 2020. Retrieved 1 October 2018.
Beck AT, Wright FD, Newman CF, Liese BS (16 January 2001). "Ch 11: Focus on Beliefs". Cognitive Therapy of Substance Abuse. Guilford Press. pp. 169–86. ISBN 978-1-57230-659-2.
Mendelson JH, Sholar MB, Goletiani N, Siegel AJ, Mello NK (September 2005). "Effects of low- and high-nicotine cigarette smoking on mood states and the HPA axis in men". Neuropsychopharmacology. 30 (9): 1751–63. doi:10.1038/sj.npp.1300753. PMC 1383570. PMID 15870834.
^ Carmody TP, Vieten C, Astin JA (December 2007). "Negative affect, emotional acceptance, and smoking cessation". Journal of Psychoactive Drugs. 39 (4): 499–508. doi:10.1080/02791072.2007.10399889. PMID 18303707. S2CID 44838398.
Ruiz FJ (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy. 10 (1): 125–62. Archived from the original on 23 February 2012. Retrieved 6 June 2013.
Hayes S. "State of the ACT Evidence". ContextualPsychology.org. Archived from the original on 22 January 2013. Retrieved 6 June 2013.
^ Black DS (April 2014). "Mindfulness-based interventions: an antidote to suffering in the context of substance use, misuse, and addiction". Substance Use & Misuse. 49 (5): 487–91. doi:10.3109/10826084.2014.860749. PMID 24611846. S2CID 34770367.
Chiesa A, Serretti A (April 2014). "Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence". Substance Use & Misuse. 49 (5): 492–512. doi:10.3109/10826084.2013.770027. PMID 23461667. S2CID 34990668.
Garland EL, Froeliger B, Howard MO (January 2014). "Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface". Frontiers in Psychiatry. 4 (173): 173. doi:10.3389/fpsyt.2013.00173. PMC 3887509. PMID 24454293.
Khantzian EJ (1 January 2003). "Understanding Addictive Vulnerability: An Evolving Psychodynamic Perspective". Neuropsychoanalysis. 5 (1): 5–21. doi:10.1080/15294145.2003.10773403. ISSN 1529-4145. S2CID 143711390.
Pickard H (July 2020). "What We're Not Talking about When We Talk about Addiction". The Hastings Center Report. 50 (4): 37–46. doi:10.1002/hast.1172. PMID 33448417. S2CID 225605587.
Heather N, Best D, Kawalek A, Field M, Lewis M, Rotgers F, Wiers RW, Heim D (4 July 2018). "Challenging the brain disease model of addiction: European launch of the addiction theory network". Addiction Research & Theory. 26 (4): 249–255. doi:10.1080/16066359.2017.1399659. ISSN 1606-6359. S2CID 149231198.
Volkow ND, Koob GF, McLellan AT (January 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". The New England Journal of Medicine. 374 (4): 363–371. doi:10.1056/NEJMra1511480. PMC 6135257. PMID 26816013.
Smith M (2020). "Sociocultural Model". A Comprehensive Guide to Addiction Theory and Counseling Techniques. Routledge. pp. 114–125. doi:10.4324/9780429286933-6. ISBN 978-0-429-28693-3. S2CID 243153343. Archived from the original on 21 November 2021. Retrieved 21 November 2021.
Rapp RC, Xu J, Carr CA, Lane DT, Wang J, Carlson R (April 2006). "Treatment barriers identified by substance abusers assessed at a centralized intake unit". Journal of Substance Abuse Treatment. 30 (3): 227–35. doi:10.1016/j.jsat.2006.01.002. PMC 1986793. PMID 16616167.
Guerrero E, Andrews CM (December 2011). "Cultural competence in outpatient substance abuse treatment: measurement and relationship to wait time and retention". Drug and Alcohol Dependence. 119 (1–2): e13-22. doi:10.1016/j.drugalcdep.2011.05.020. PMC 3189424. PMID 21680111.
https://www.dailynews.com/2016/12/13/can-marijuana-break-up-a-family-parents-face-custody-issues-over-legal-cannabis-use/amp/
https://truthout.org/articles/south-carolina-is-ripping-infants-away-from-their-mothers-over-pot-use/
Pullen E, Oser C (June 2014). "Barriers to substance abuse treatment in rural and urban communities: counselor perspectives". Substance Use & Misuse. 49 (7): 891–901. doi:10.3109/10826084.2014.891615. PMC 3995852. PMID 24611820.
Taylor OD (6 May 2010). "Barriers to Treatment for Women With Substance Use Disorders". Journal of Human Behavior in the Social Environment. 20 (3): 393–409. doi:10.1080/10911351003673310. ISSN 1091-1359. S2CID 72642532.
Owens MD, Chen JA, Simpson TL, Timko C, Williams EC (August 2018). "Barriers to addiction treatment among formerly incarcerated adults with substance use disorders". Addiction Science & Clinical Practice. 13 (1): 19. doi:10.1186/s13722-018-0120-6. PMC 6102909. PMID 30126452.
^ "Fatal overdoses, fraud plague Florida's booming drug treatment industry". NBC News. Archived from the original on 1 November 2017. Retrieved 1 November 2017.
Sforza T, Saavedra T, Schwebke S, Basheda L, Schauer M, Gritchen J, Wheeler I (21 May 2017). "How some Southern California drug rehab centers exploit addiction". Orange County Register. Archived from the original on 27 October 2017. Retrieved 1 November 2017.
"Under Taliban, Kabul's drug addicts forced into withdrawal". 18 October 2021. Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"Now in power, Taliban set sights on Afghan drug underworld". 7 October 2021. Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"Photos: Drugs addiction – a big challenge for Taliban government". Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"In Pictures: Afghan drug underworld in the Taliban's crosshairs". Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"A jail by another name: China labor camps now drug detox centers". Reuters. 2 December 2013. Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"1.3 million drug addicts treated in China's compulsory detox centers | english.scio.gov.cn". english.scio.gov.cn. Archived from the original on 22 January 2022. Retrieved 2 March 2022.
^ Alfred W. McCoy. "Opium History, 1858 to 1940". Archived from the original on 4 April 2007. Retrieved 4 May 2007.
"BNN: Pecandu Narkoba Wajib Jalani Rehabilitasi". 23 May 2015. Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"Forced rehabilitation of drug users in Indonesia not a solution". 2 July 2015. Archived from the original on 2 March 2022. Retrieved 2 March 2022.
"Archived copy". Archived from the original on 27 June 2023. Retrieved 4 July 2023.{{cite web}}: CS1 maint: archived copy as title (link)
"Archived copy". Archived from the original on 4 July 2023. Retrieved 4 July 2023.{{cite web}}: CS1 maint: archived copy as title (link)
"نگهداری از معتادان متجاهر در مراکز قرنطینه سپاه". fa. 7 February 1399. Archived from the original on 4 July 2023. Retrieved 4 July 2023.
"سپاه قم ۳۴ خانه اعتماد برای مقابله با آسیب‌های اعتیاد تشکیل ..." Economic News Agency | خبرگزاری اقتصادی ایران. 25 June 2023. Archived from the original on 4 July 2023. Retrieved 4 July 2023.
"Archived copy". Archived from the original on 4 July 2023. Retrieved 4 July 2023.{{cite web}}: CS1 maint: archived copy as title (link)
"سپاه معتادان متجاهر مبتلا به کرونا را "جمع‌آوری" می‌کند". ایندیپندنت فارسی (in Persian). 4 August 2020. Retrieved 4 July 2023.
Guerrera, Antonello (13 August 2014). "E' morto don Gelmini, il prete anti-droga amico di Berlusconi" (in Italian). la Repubblica. Archived from the original on 16 August 2014. Retrieved 26 September 2014.

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