Intervention prevention program design and implementation

¶ … substance abuse treatment program for substance abuse in a middle class community located in an urban environment. The writer incorporated the local drug court prevention program into the treatment as well. There were five sources used to complete this paper.

Substance abuse is a growing problem in the United States. The incidence of substance abuse cuts across all cultural, socioeconomic and racial boundaries. It knows nothing of gender and it is not particular about the age or health status of its victims. Substance abuse is like a cancer in society, eating away at its very core from the inside out.

Substance abuse is responsible for many problems in society. Economically, substance abusers often spend more than they make, if they work at all. They destroy family relationships and are often absent as parents. In addition substance abuse can take the most ethical and hard working person and turn that person into a thief who will lie to his mother to get money for drugs or alcohol.

Substance abuse in America is at a crisis level and climbing.

Studies have shown that substance abuse programs within the correctional system have reduced recidivism rates by as much as 50% (Lemiux, 2000).

There is a dearth of research, however, that exclusively focuses on the social and family situations of substance-abusing offenders. Existing large-scale descriptive studies suggest that drug-involved offenders in the general prison population lack social support and have little contact with their families and friends (Peters et al., 1993; Singer et al., 1995) (Lemiux, 2000). "

The family systems theory sheds light on the processes by which families actually adapt to and maintain alcoholism and/or drug abuse (Lemiux, 2000). These processes are the focus of family therapy (Lemiux, 2000). Family disease models are primarily concerned with enabling, family members through their behaviors maintain or promote substance abuse (e.g., ignoring or covering up the abuse) (Lemiux, 2000). Family disease models explain why some of the court-ordered clients who were referred for evaluation do not want to include their families, lest treatment interfere with well-entrenched enabling behaviors (Lemiux, 2000)."

It was with this in mind that a model for substance abuse treatment for a middle class urban area was designed. Its mission is two fold. The first goal is to treat the substance abuser and the second goal is to treat the family so that the enabling cycle can be broken.

The Court

Often times in a middle class environment everybody works to keep the courts and officials out of the loop. There is an unspoken belief that to involve authorities, social workers and judges is to join the lower class of society which is something many middle class substance abusers fight against doing as it helps them hang onto the last shred of hope that they are indeed not addicted (Davenport, 2000). They cling to a belief that if they were addicted the courts would be involved therefore they must be okay and their loved ones or others in their lives are simply overreacting. The truth of the matter however, is that substance abusers come from all walks of life and the amount of money one makes, or the type of neighborhood one lives in has no bearing on whether or not substance abuse wreaks havoc with lives.

One of the most important elements of this treatment program is that it destroys the social boundaries that help middle class addicts believe they are still on top of things.

Courts often play active roles in the lives of families supervised by child protective services (CPS). Judges adjudicate dependency, mandate services, determine placements of children, and order continued supervision or termination of parental rights or services (Davenport, 2000)."

One recent study examined effects of court orders with regard to substance abuse treatment and found that when there are courts involved with families court intervention had a mixed outcome but in some areas it was a positive result.

In recent years, researchers have suggested that substance abuse may be a significant factor in all types of domestic violence, including child maltreatment (Wolfner & Gelles, 1993) (Davenport, 2000). The most recent report from the National Clearinghouse on Child Abuse and Neglect indicated that illicit drug abuse probably contributed significantly to increased rates of suspected maltreatment and documented injuries (Sedlak & Broadhurst, 1996) (Davenport, 2000). Furthermore, increasing rates of reported physical and sexual abuse, as well as increased numbers of children entering child welfare systems for neglect, have been correlated to widespread substance abuse problems, especially in inner cities (Davenport, 2000). Although most child welfare professionals recognize the relationship between substance abuse and child welfare referrals, actual prevalence rates of child abusers who misuse substances tend to be elusive because not all investigated families are carefully screened for substance use and abuse patterns. The issue is complicated by the understandable inclination of most substance-abusing families to conceal alcohol and drug problems (Davenport, 2000). "

There is little doubt about the negative impact that substance abuse has on the abuser and the family members of the abuser, therefore this treatment program was designed using methods and ideas from several successful programs as well as a drug court intervention model.

The Treatment Program

This program will use both a 12 step program and a cognitive behavior model as part of the treatment as studies indicate that they are both effective treatments.

Cognitive-behavioral treatment assumes that substance abuse is a learned behavior, whose onset and perpetuation is influenced by distorted beliefs about the effects of the abused substance and by reliance on substance use as a (maladaptive) coping behavior (Moos, 1998). Primary cognitive proximal outcomes of C-B treatment are an enhanced sense of self-efficacy to remain abstinent in high-risk situations, decreased positive anticipated consequences of drinking or using drugs (positive substance use expectancies) (Moos, 1998), and increased expectancies regarding the benefits of quitting or reducing drinking behavior or drug use and reduced expectancies regarding the costs of such outcomes (positive outcome expectancies) (Moos, 1998). In addition. most C-B programs attempt to impart cognitive and behavioral coping skills that clients can use to avoid drinking, drinking excessively or using drugs in situations that previously had been associated with heavy drinking or drug use. Many C-B programs also teach patients general methods for coping with stressful situations (Moos, 1998)."

The population of this substance abuse treatment and prevention program will center on a court order. One of the things that research has shown is that if a participant has a court order mandating that they enter and continue treatment they are more inclined to stick with the program.

Population

The population of the treatment program will be comprised of males and females that have a demonstrated addiction to alcohol or drugs. They will have demonstrated this addiction through the loss of a job or family as well as encountering legal issues due to their drug or alcohol use in the past three months.

The participants will agree to turn themselves over to the local drug court program and will agree to abide by its rules and mandates as well as the treatment program provided at the center.

Drug Court

Drug court for the purpose of this treatment program will meet weekly in the judge's chambers. The General Sessions judge oversees the drug court program and has instilled the following rules pertaining to drug court participants.

Each participant will submit to a weekly random drug test. The failure to take the test will result in a failed test record and the participant will be sanctioned with jail time on his or her days off from work.

The number of days that the judge will set for a failed test will be dependent on other factors such as the participant's participation in the rest of the programs offered, days missed in those program and other elements that indicate the participant's commitment to the program.

In addition to the weekly testing the participant will be required to undergo a psychological evaluation screening for depression and other mental illness issues and if diagnosed will attend weekly therapy sessions with a court appointed therapist to deal with that issue only. All substance abuse therapy sessions will be handled through the treatment program.

A recent study concluded that participants of substance abuse programs do better if they are provided group therapy opportunities in which they are taught better communication skills for all areas of life.

The study performed assessments of coping skills before entering treatment, while in treatment and following their treatment and discovered that the coping skills the participants received while in substance abuse treatment classes helped them communicate more effectively which helped them reduce their craving to numb themselves with substances.

The center will consist of a building that will house in-patient participants as well as provide space for the outpatient services that will be provided.

When a participant contacts the center and requests an assessment he or she will be asked to come into the center and go through a four hour assessment and evaluation by a certified drug and alcohol counselor.

During the assessment the participant will be asked to disclose how often and how many incidences of substance abuse he or she has participated in during the last week. He or she will also be asked to disclose what substances have been used in that time frame.

In addition the participant will participate in an interview in which he or she will provide a life history and a description of when they first began using and why and how much they currently spend on drugs or alcohol.

One element of the assessment will be specifically to ascertain what type of support system the participant has at home and at work if he or she holds a job.

When the assessment is completed the counselor will make a recommendation for treatment depending on the assessment outcome.

The recommendation will be for inpatient, intensive outpatient or low outpatient services depending on the need of the client.

The counselor will file a report with the court system advising the court of what recommendations were made so that the court can oversee the compliance by the client of treatment.

In patient

The inpatient program will consist of an inpatient program with a duration of 28 days. The first week will be referred to as a "Black out" week during which time the participant can have no contact with family or friends.

This black out period is to help the client adjust to the new surroundings, adapt to the program regime, get started in the various groups and therapies and reduce the chance of contacting an enabler that might interfere with the treatment plan.