Psychoeducation of Methadone, Research Paper Example

Addiction to opiate such as heroin among other drugs has been a cause of grave concern to the communities in American History especially during the time period 1865 to 2000. Amicable solution has in most time has been difficult, tentative as well as controversial. Since the inception of methadone maintenance treatment, several million people have derived significant benefits in as far recovery opiate addiction is concerned. Consequently, their lives and health have been drastically improved. Family and social lives have been favorably redeemed while others have returned to their places of work as well as schools. Therefore, the victims have been changed to become productive members of community[1].

However, psycho education of methadone is still a basic necessity because the merits as well the effectiveness of methadone maintenance treatment in addition to the treatment for addiction have not received the needed acceptance and universal understanding.

 Psycho-Education is an issue of great significance in Methadone clinics amongst the community. The use as well as the abuse of opiate has gained proliferation among people with the great contributor of the problem being lack of access to appropriate knowledge regarding this important issue. Consequently, there is a dire need for educating the people with regard to this issue. The use of methadone maintenance as an approach of treatment has gained a lot of recognition over the past 150 years with majority of people being subjected to a wide array of facets in as far as substance abuse is concerned. According to the perception of the entire society, the blame is squarely laid on the user[2]. The history of the Americans from 1865 to 2000 has been characterized by false misconception regarding the issue of illegal substances, the disclosure of which has been blamed on the different entities instead of focusing on the potency associated with the actual substances.

Based on the fact that the victim together with their parents hardly accepts the reality of substance abuse addiction, psycho-Education plays a significant role towards de-stigmatization associated with psychological disturbances of drug abuse. Available statistics reveal that over 980, 000 Americans are heroin and opiate addicts[3]. This has been identified as a potential predisposing factor to infections of sexually transmitted ailments, hepatitis B and C, HIV, liver disease, additional physical as well as mental problems of health and to the extreme, premature death.

Methadone maintenance is a program of treatment that was initiated in 1960’s to address the issues of addicted individuals through administration of Methadone on a daily basis. In its inception, it was tailored to serve multi-component purposes of a treatment program with its major emphasis on vocational training as well as a process of resocialization.

Majority of the victims have a basic 60-120 mg dose requirement in a day to meet the optimum range of their therapeutical effects with respect to methadone[4]. Relative to the victims on significantly lower doses, the victims requiring higher doses exhibit a longer stay in treatment, they use less amounts of heroin along with other drugs and also have lower cases of infection with HIV. However, there are other victims in need of higher doses for the treatment to be effective.

In the history of the Americans dating back from 1900 when the country was in a prohibition movement, the people of this country laid all the blames on mishaps which were linked to the use of alcohol on Irish immigrants along with the conspiracies that were associated with Roman Catholic Church. The use of opium in this era was used by the Chinese and the effects were seen as the means of seducing women in the acts of prostitution. On the other hand, Marijuana had not been illegalized until 1937 and therefore the Latin American Culture derived great pressure as they used the drug. Based on the evident historical viewpoint as hinted in this paper, along side the associated accusations; there is an indication of the issue as stemming from history with regard to the American culture. And consequently, the blame that is associated with the discursive changes was left on diverse entities that can be held accountable for the current society as it appears.

Discursive changes associated with the use of drugs were placed on drugs instead of being placed on the user based on specific beliefs as well as aspects of the society and therefore the issue surrounding drug abuse was hardly taken on a serious note. In 1972 however, President Nixon made a significant milestone in this respect through “National Council for Drug Abuse and Prevention” which he founded then[5]. This was a significant turning point in the perception of substance abuse among the citizen who attributed a higher profile of seriousness to the menace.

With a particular focus on opiates, it is important to account for the reason behind victims abusing the drug. Available statistics indicate that most of the users of the drug derive a feeling of relaxation after using the drug. With injection of opiates to the user, a feeling of immediate “rush” is usually experienced. The user also experiences additional effects that are unpleasant such as nausea, restlessness as well as vomiting. The victim may also experience oscillatory feelings between alertness and drowsiness. If the doses are significantly large, the pupils of the victim becomes smaller in size, the skin turns in to a bluish color and becomes moist and cold and it is difficult to awaken the victim. The victim also experiences breathing problems and death can easily take place.

The question of the driving force to the use of of the drug and consequently its addition is very important considering the side effects that are associated with the use of the drug. One of the most important factor is associated with euphoria while the issue of withdrawal and withdrawal avoidance also plays a significant contribution. According to the National Council for Drug Abuse Prevention perceives addicts of opiate to be pleasure-seeking hedonists. The ethical reason behind attempts of discouraging opiate use among the victims is allied to the fact that excessive consumption of drugs causes destruction to the human character. The drugs of the category of heroin, crack as well as cocaine are powerfully reinforcing to most of the users. The users prejudice some pleasure and oblivion which consequently results to a devotion towards seeking pleasure in their lives[6]. According to the viewpoint of others, the introduction of the council by President Nixon led to the perception of opiate addiction as the role played by enemy deviant. Both of the mentioned viewpoints hold significant gravity and they are varied in today’s society. The traditional viewpoint of psychologist along with psychiatrists with respect to opiate addiction is based on emotional as well as mental problems[7].

The consideration of psychological ideals in combination with the physical attributes of addiction results to the knowledge of Methadone Maintenance Therapy, commonly abbreviated as MMT. This concept is coupled with the recently emerging methadone clinics in the society. According to the studies that have been conducted, the effectiveness of methadone has indicated a dose-response interaction. Higher doses have been proven to result to drastic use of heroin and the patients can be able to stay for long in treatment and the criminal activities are drastically reduced. Some evidence from research indicates the need for determination of the doses based on the needs of the individual. However, it is widely evident that application of higher doses has become ore effective with majority of patients responding well with a daily dose intake of 60-120 mg. consequently, fixed doses have commonly been administered in majority of the clinics uniformly to all patients. The common practice has been a continued use of drugs such as heroin, cocaine, alcohol and marijuana for most of the MMT patients after their treatment and admission. The reason behind this trend is attributed to the long history of addition, the reasons behind the use of the drugs, complexity of the situation of the patient and the reason behind their use of the drug and also the biological basis behind their drug addiction. Majority of the patients lack the potential for full control over addiction in most times. The realistic expectations behind treatment are based on realization that recovery is a daily routine associated with intermittent relapses.

Abuse of opiate has turned in to an epidemic issue ad therefore the Methadone Clinics have a very significant role to play in developing productiveness in a community whose members are exposed to addiction demons. Therefore, evidence-based approach should take the center stage in Methadone clinics in their assessment of the victims of opiate with the use of multimodal approach, through integration of pharmalogic as well as psychological strategies with the intentions of deterring the aberrant drug-linked behaviors.

It has become imperative to acknowledge and also recognize a very important element of recognition of anomalous drug-related behaviors which has drastically proliferated in the community; this is an important facet of concern to the clinicians whose specialty is therapy in this field. This is also a fact that is commonly known to the society as a result of its prominence in media stories that are transmitted every day. Methadone Clinics have operated in deeper disciplines in our society which has bred a misconstrued perception of the issue and therefore education is needed with this respect.

In the past 35 years, Methadone Maintenance Therapy has been consistent with social, legal as well as vital health benefits since its inception in its capacity of an experimental project. The program adopted the strategies of multimodal therapy, continuation of reassessment, as well as compliance monitoring in addition to cognitive-behavioral therapy.

Giving the details of beliefs associated with Psychologists alongside the existing predisposing factors which are the basis of addiction, it is imperative to have a clear focus on the link between the opiate addiction and prejudicial Psychiatric factors which have been evident in as far as opiate addiction is concerned. In this respect, issues of preadolescent sexual abuse, bipolar disorder together with depression will take the center stage. These are also coupled with notable social factors such as road accidents, cigarette smoking, problematic cultures, lack of family support and the history of the family with respect to prescription drug abuse.

A number of predisposing factors have been attributed to drug abuse and they are considered as “yellow lights”. The fact of an entire patient population with pain takes in to account of just a portion of the population entangled in the aberrant behaviors with even a smaller proportion being addicted in the true sense. Interestingly enough, the prime global medical information sources source gives addiction definition as a compulsive drug use resulting to harm or dysfunction alongside continued use even with the occurrence of harm as well as dysfunction. It therefore becomes imperative to try and fathom the disparities as well as the distinction between addiction, abuse or misuse, physical dependence and tolerance in order to have a clear picture of the depth that treatment is able to pervade.

The notable characteristics that are associated with addiction are behaviors typical of impaired control with respect to the use of the drug, craving for the drug, and continued use of the even with the associated harm and compulsive use of the drug. Addiction can therefore be summarized in terms of three C’s. They are Compulsive use of the drug, absence of Control, and repetition even after onset of adverse Consequences[8].

Another important aspect of appreciation is the altered homeostasis nature associated with Physical Dependence with consideration of a number of levels of activity and drug effect. If the victim discontinues the intake of the drug at this juncture, then symptoms associated with homeostasis disruption are consequently evident. Abuse as well as misuse of drug is associated with a badly chosen medication through consumption of a higher dose as compared to the one that has been prescribed.

During psycho education of methadone, it is important to understand the implication of abuse as well as misuse which have the implication of medication use in a manner that is inappropriate. It includes the consumption of the dose in higher quantities as compared to the rightful prescription. Understanding of the implication of tolerance is also important which on the other hand is used in reference to declining pharmacological effects that is developed as a result of repetitive exposure to the drugs over a long time period in such a manner that the victim will only produce similar effects with significantly higher doses[9]. Physical dependence along with tolerance are issues that unavoidable in a situation that specific medication have been administered for prolonged period of time and on regular basis. Substance dependence is consequently classified as a syndrome based on all factors behind its development[10].

In the course of psycho education of methadone, it is important to consider a comprehensive understanding of related terminologies so that the clinicians have a clear insight of the actual treatment that is underway. Withdrawal is yet another term that requires clarification as an issue of pertinent importance in psycho education of methadone. The implication of withdrawal is a psychological as well as a physical syndrome that arises from an abrupt cessation of drug use. Notable mild category symptoms of withdrawal include insomnia, feeling of dizziness, irritability, anorexia, anxiety and also agitation. The symptoms associated with withdrawal have diverse manifestations within different patients based on specific characteristics of the individual, notably age and the health status. The onset of withdrawal is estimated to be effective after 12 to 24 hours and the trends proceeds to the peak during the next 1 to 3 days[11]. As a result of the disparity of factors that determine the rate of withdrawal in different in individuals, the withdrawal symptoms have a significant impact on the mental state as well as the health of the victim.

Psycho education of methadone in the course of Methadone Maintenance Therapy calls for application of cognitive therapy ion addition to a counseling due to a variety of psychological; issues that surround the mild symptoms which are associated with withdrawal. The psychological issues develop complexity depending on the extent of withdrawal.

The abuse of opiate in form of analgesic medications, i.e. the painkillers has been a contentious problem affecting American communities and it is allied to addiction, overdose of drugs and even death. The pervasiveness of abuse of prescription opiate has exceeded the extent of abuse of illicit drugs. This has therefore escalated the visits of cases related to opiate analgesics in emergency departments in most hospitals coupled with a significant upsurge of deaths which are attributed to overdose of the drugs. Methadone may be life threatening and also cause danger incase it is used in an inappropriate manner. Long standing concerns have been evident on issues of diversion of use of methadone for illegitimate purposes[12].

The establishment of Methadone Maintained Therapy was meant to serve the purpose of preventive therapy to overcome the pain that is associated with withdrawal. The discovery of methadone was an avenue of opiate dependency treatment. This consequently results to an improvement in psychological as well as physical well being with respect to adverse effects that are associated with heroin which has been intravenously administered, in addition to alternative forms of abused opiates subsequent to a clinical pharmacology study that forms the basis of establishment of conventional methadone clinics. In the schedule of Methadone Maintained Therapy, Recovery-Oriented psychotherapy is sometimes incorporated. Victims of able means may opt for the choice of private practice therapists[13]. The impact of psychotherapy is enhancement of recovery quality but for the victims who are in need of consolidating as well as establishing total abstinence, then they are referred to addiction specialist who offer collaborative efforts.

A motivational enhancement activity for the patient who is seeking psychotherapy has proved with greater percentage positive change without the patient recognizing the problem of their drug use. At this level the therapist observes where patient is on the graph towards changing from drug addiction[14]. First, the patient is unaware of the existence of problem; second, the patient starts recognizing the advantages and disadvantages of finding a solution to the prevalent problem; third, the patient prepares by making small changes in behavior; forth, the patient takes action where he spends more time in making personal changes and finally maintains the change through ongoing prevention, avoiding tempting situations and other means available at the patient’s disposal.

The other method of therapy that is mostly used together is abstinence oriented therapy whereby the therapist encourages the belief that abstinence is the basic to other methods making the drug use the main concern. These methods works to help the patient to have a clear understand about abstinence as the priority towards recovery. The therapist at this level is very careful in maintaining the patient committed in the treatment while engaging to abstinence. The main challenge to this form of treatment is the distress of what brought them to the psychotherapy and also the connection of that prevailing stress t alcohol and use of drug. For one to establish abstinence, careful interventions seem to be highly organized and monitored on the development of behavior change that comes out after the process.

Cognitive-behavior from comprehensive research done indicates to be also effective. In this method, the therapists put more emphasis on the way the patient can become stable and remain abstinent. It focuses deeply on the issues related to bottlenecks to abstinence since it is very difficult to formulate an effective behavior change strategies ignoring the patency as to where the problem emanates.

At this stage of patient recovery the therapist usually examines lifestyles dynamics that are useful in this process for the patient to maintain a stable healthy sobriety. It resembles psychotherapy in many was along this period of a patient’s recovery stage. At the beginning the conceptual groundwork should be laid early enough as other issues including emerging unwanted behavior can be solved more effectively and efficiently when the real time comes.

Methadone Clinic were founded to rehabilitate people who suffer from alcohol and drug addictions regains a healing process and finally lead a reasonable stable health. Even though this paper focuses more on the psychological perspective, opium addiction has many facets and we need to look for helping answers to many questions concerning addictions[15]. The true and only way to get such solutions embarks on the means of education and treatment.

Bibliography

Brands, Bruna & David Marsh. Methadone maintenance treatment: a Canadian perspective. CMAJ 157(4): 399-401, 1997.

David Keys, Myth-making and opiate abuse: A nearly symbolic interactionist theory of addiction in the fieldwork of Alfred Lindsmith and its opposition. Contemporary Justice Review, 11, 177-186, 2008.

Erdelyan, Mark. Methadone Maintenance Treatment: A Community Planning Guide. Toronto, CAMH, 2000.

Fischer, Benedikt. Prescriptions, power and politics: the turbulent history of methadone maintenance in Canada. Journal of Public Health Policy 21(2): 187-210, 2000.

Jennifer Havens,Ph.D,M.P.H., Carrie B.Oser, Ph.D, M.S., Carl G. Luekefeld, D.S.W., J. Matthew Webster, Ph.D., Steven S. Martin, M.Sc., M.A.,Daniel J/ P’Connell,Ph.D, M.A., Hilary L. Surratt, Ph.D., M.A., and James A. Inciardi, Ph.D.. Differences in Prevalence of Prescription Opiate Misuse Among Rural and Urban Probationers. The American Journal of Drug and Alcohol Abuse, 33, 309-317, 2007.

Kenneth L. Kirsh, PhD, Scott M. Fishman, M.D., (2011). Multimodal Approaches to Optimize Outcomes of Chronic Opiod Therapy in the Management of Chronic Pain. Wiley Periodicals, S1, S1-S11.

Mark Latowsky, M.D.(2006) Methadone Death, Dosage and Torsade de Pointes:Risk-Benefit Policy Implications. Journal of Psuchoactive Drugs, 38 (4), 513-519.

Ries Richard, Fiellin David, Miller Shannon, Saitz Richard, Principles of Addiction Medicine 4^th Ed. (Philadelphia:LippincottWilliams&Wilkins,1146,2009.

Wilford Bonnie, Earley Paul, SalsitzEdwin, ASAM’S. Review Course in Addiction Medicine(Maryland:American Society of Addiction Medicine Inc.)175. 2010.

[1] Brands, Bruna & David Marsh. Methadone maintenance treatment: a Canadian perspective. CMAJ 157(4): 399-401, 1997.

[2] Ries Richard, Fiellin David, Miller Shannon, Saitz Richard, Principles of Addiction Medicine 4th Ed (Philadelphia:LippincottWilliams&Wilkins, 1146, 2009.

[3] Wilford Bonnie, Earley Paul, SalsitzEdwin, ASAM’S. Review Course in Addiction Medicine(Maryland:American Society of Addiction Medicine Inc.)175. 2010.

[4] Wilford Bonnie, Earley Paul, SalsitzEdwin, ASAM’S. Review Course in Addiction Medicine(Maryland:American Society of Addiction Medicine Inc.)175. 2010.

[5] David Keys, Myth-making and opiate abuse: A nearly symbolic interactionist theory of addiction in the fieldwork of Alfred Lindsmith and its opposition. Contemporary Justice Review, 11, 177-186, 2008.

[6] Erdelyan, Mark. Methadone Maintenance Treatment: A Community Planning Guide. Toronto, CAMH, 2000.

[7] Wilford Bonnie, Earley Paul, SalsitzEdwin, ASAM’S. Review Course in Addiction Medicine(Maryland:American Society of Addiction Medicine Inc.)175. 2010.

[8] Fischer, Benedikt. Prescriptions, power and politics: the turbulent history of methadone maintenance in Canada. Journal of Public Health Policy 21(2): 187-210, 2000.

[9] Mark Latowsky, M.D. Methadone Death, Dosage and Torsade de Pointes:Risk-Benefit Policy Implications. Journal of Psuchoactive Drugs, 38 (4), 513-519, 2006.

[10] Kenneth L. Kirsh, PhD, Scott M. Fishman, M.D., Multimodal Approaches to Optimize Outcomes of Chronic Opiod Therapy in the Management of Chronic Pain. Wiley Periodicals, S1, S1-S11. 2011.

[11] Jennifer Havens,Ph.D,M.P.H., Carrie B.Oser, Ph.D, M.S., Carl G. Luekefeld, D.S.W., J. Matthew Webster, Ph.D., Steven S. Martin, M.Sc., M.A.,Daniel J/ P’Connell,Ph.D, M.A., Hilary L. Surratt, Ph.D., M.A., and James A. Inciardi, Ph.D.. Differences in Prevalence of Prescription Opiate Misuse Among Rural and Urban Probationers. The American Journal of Drug and Alcohol Abuse, 33, 309-317, 2007.

[12] Wilford Bonnie, Earley Paul, SalsitzEdwin, ASAM’S. Review Course in Addiction Medicine(Maryland:American Society of Addiction Medicine Inc.)175. 2010.

[13] Erdelyan, Mark. Methadone Maintenance Treatment: A Community Planning Guide. Toronto, CAMH, 2000.

[14] Mark Latowsky, M.D. Methadone Death, Dosage and Torsade de Pointes:Risk-Benefit Policy Implications. Journal of Psuchoactive Drugs, 38 (4), 513-519, 2006.

[15] Mark Latowsky, M.D. Methadone Death, Dosage and Torsade de Pointes:Risk-Benefit Policy Implications. Journal of Psuchoactive Drugs, 38 (4), 513-519, 2006.