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Treatment Protocol 

The following steps are followed after admission of an inmate is cleared:

Varied Forms of Addiction

Physical dependency on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behavior is suddenly discontinued. 

While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other categories of substances share this property and are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. 

So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the primary attribute of an addictive substance is usually its ability to induce pleasure and its facility in becoming routinely used. 

A notable exception to this is nicotine. Users report that a cigarette can be pleasurable, but there is a medical consensus that the user is likely fulfilling his/her physical addiction and, therefore, is achieving pleasurable feelings relative to his/her previous state of physical withdrawal. 

Further, the physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of most users' addictions. Although 35 million smokers make an attempt to quit every year, fewer than 7% achieve even one year of abstinence (from the NIDA research report on nicotine addiction). 

Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. 

Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them. The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. 

Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. 

The vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of time, one will most likely become physically dependent. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. 

That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine. Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article.

Physical dependency

In brief, the treatment begins with a one-week detoxification process in which residents receive medication to help them withstand withdrawal symptoms, which begin to show up a few hours after the effects of drugs or alcohol wears off. Withdrawal can be extremely uncomfortable without professional help.

Another factor to be aware of during the withdrawal is drug craving. Drug craving is the result of the drug's imprinting in the memory, a pleasant association of euphoria with the drug. The subconscious memory then motivates the individual to seek this drug because of the false imprint. The brain, in effect, has been trained that using the drug is the fastest way to feel good. Due to the extreme physiological or physical pain some experience during the withdrawal, they can relapse before they complete the withdrawal process. 

This is an important reason why withdrawal should take place at an inpatient drug rehabilitation center. There the individual will be removed from the immediate access to drugs or alcohol. Withdrawal done at an inpatient drug rehab also provides the safety of medical supervision by trained professionals who are better able to monitor the process.  

Withdrawal has many variables. Everything from the type of drug, quantity of regular use, to the length of time the drug was abused, factors into how intense or mild an individuals drug withdrawal experience will be. As mentioned, the type of drug used plays an important part.

The withdrawal symptoms of various drugs and alcohol are listed in detail here.  

Psychological dependency

Another factor to be considered is psychological dependency, a dependency of the mind which leads to psychological withdrawal symptoms (such as cravings, irritability, insomnia, depression, anorexia etc). 

Addiction can in theory be derived from any rewarding behavior, and is believed to be strongly associated with the dopaminergic system of the brain's reward system (as in the case of cocaine and amphetamines). 

Some claim that it is a habitual means to avoid undesired activity, but typically it is only so to a clinical level in individuals who have emotional, social, or psychological dysfunctions, replacing normal positive stimuli not otherwise attained (see Rat Park). It is considered possible to be both psychologically and physically dependent at the same time. Some doctors make little distinction between the two types of addiction, since the result, substance abuse, is the same. 

However, the cause and characteristics of each of the two types of addiction is quite different, as is the type of treatment preferred. Psychological dependence does not have to be limited only to substances; even activities and behavioral patterns can be considered addictions, if they are harmful, e.g. gambling, Internet use, usage of computers, sex / pornography, eating, self-harm or work.

Treatment Modality Matrix

Behavioral Pattern

Intervention

Goals

Low self-esteem, anxiety, verbal hostility

Relationship therapy, client centered approach

Increase self esteem, reduce hostility and anxiety

Defective personal constructs, ignorance of interpersonal means

Cognitive restructuring including directive and group therapies

Insight

Focal anxiety such as fear of crowds

Desensitization

Change response to same cue

Undesirable behaviors, lacking appropriate behaviors

Aversive conditioning, operant conditioning, counter conditioning

Eliminate or replace behavior

Lack of information

Provide information

Have client act on information

Difficult social circumstances

Organizational intervention, environmental manipulation, family counseling

Remove cause of social difficulty

Poor social performance, rigid interpersonal behavior

Sensitivity training, communication training, group therapy

Increase interpersonal repertoire, desensitization to group functioning

Grossly bizarre behavior

Medical referral

Protect from society, prepare for further treatment

*Adapted from: Essentials of Clinical Dependency Counseling, Aspen Publishers

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