Most Effective Rehabilitation Method of Chemically Dependent Offender Populations
Outline: (flow of discussion) –Plan – refer to abstract
Title page
Table of contents
Introduction
Background
Objectives
Statement of problem
Significance of study
Scope and limitations
Review of related literature
Methodology
Results and findings
Analysis, discussion and interpretation
Conclusion, summary and recommendation
References
Chapter 1
Introduction
Several problems are being faced by many societies nowadays, given by the fact that the society is continually changing. The changes the society encounter leads to the modification of the lifestyle of many individuals, most especially the younger generation, who become easily influenced and swayed by a number of factors that surround them. Changes in the society are evident in terms of economy, politics, education, industry, and in technology, which depends upon the use and the need of a particular society. Such changes can be perceived as advantages in terms of its use in globalization and internationalization, such that particular nations become associated with a number of countries worldwide to expand their businesses through different strategies and approaches. Such changes also enhance and develop the skills of many individuals to learn the universal language and become globally competitive in different aspects of learning and knowledge. The sciences also become much more developed and improved, thus, improving the lives of many through its various practical, advanced, and revolutionizing applications. In this regard, changes in the mentioned fields can be seen to bring success and prestige to individuals and societies. However, these changes not only bring about success, prestige, and development to the members of society, but disadvantages and problems as well. Unlike the previously mentioned advantages brought about by the changes in the society, problems and challenges effect chaos and discord among individuals and families. Along with the success and development of societies are the problems its face, including the upsurge cases of drug and alcohol addiction, crimes, graft and corruption, unsafe working and living conditions, poverty, unemployment, illnesses, and deaths. From this, it can be seen that along with the development of societies are its drawbacks that may become part of its consequences.
In relation to all these challenges in the society is one of the gravest problems, which is chemical dependency. The issue of chemical dependency is associated to certain concepts, including habit, disorder, disease, abuse, substance, effects, and criminality. Because it is associated with such concepts, it is generally thought of connoting negative impressions and impacts. Generally, the concept of chemical dependency is associated with terms such as alcoholism, drug addiction, and substance use and abuse. Nevertheless, this concept is defined as a disease, disorder or illness that is characterized by addiction to a mood-altering chemical, including drugs and alcohol, thus, transcending age, gender, race, religion, or economic status (“Chemical Dependence or Dependency”, 2004). It can become a progressive, chronic, and fatal disease if untreated, that is why treatments and preventions are given importance and emphasis, especially with the younger generation. In addition, the concept of chemical dependency is commonly associated with criminality and mental disorders, which are considered the effects of becoming chemically dependent individuals. In this sense, such individuals are termed as Chemically Dependent Criminal Offenders or COCO, who commit grave violations against other individuals, the community, and the State due to the strong influence of alcohol or drugs. Nowadays, given the changes that take place in the society, most criminal offenders are comprised by adolescents or the younger generation, who become as such due to the influence of drugs or alcohol. According to the Juvenile Rehabilitation Association or JAR, 82% juvenile offenders use chemical substances. The most common major problems among the youth today include substance abuse and drug related crimes. In this regard, several governments come up with ways on reducing criminality and juvenile delinquency through different rehabilitation programs and treatments that would improve the situation of the chemical dependent adolescents in order to improve the society as a whole. However, despite the number of chemical dependence rehabilitation programs, not all are considered to be effective, as many criminal offenders presently convicted were influenced by drugs or alcohol during their crime. As reported, 1 in 4 violent offenders in prison committed their crime offenses under the influence of drugs, with a percentage of 72% (Mumble and Kornberg, 2007). In addition, more than half of the prisoners in the United States indicated symptoms consistent with drug dependence or abuse, having a percentage of 53%, and such dependence was associated with a range of symptoms, including behavioral, cognitive, and physiological problems (2007). These data indicate that despite the efforts of governments to help the society alleviate the impacts of drug and alcohol dependence, crimes attributed to chemical dependence continue to increase. With this problem at hand, this research study aims to examine the most effective rehabilitation method or technique for the chemical dependent offender population.
This research study will be divided into five chapters in order to provide ease and consistency on the discussion of the topic. The first part will be discussing the problem uncovered by the researcher and provide ample background on the topic. The chapter will constitute an introduction to the whole research study, the statement of the problem in order to present the basis of the study, a discussion on the scope of its study, as well as its effects to individuals and its significance to the society as a whole.
The second chapter will be discussing the relevance of the research study in the existing literature. It shall provide studies on the different drug and alcohol rehabilitation methods currently used, their process, duration and development, and the elements that foresee substance exploit problems. In addition, the study shall also provide an ample assessment of offenders with chemical dependency problems, the evaluation processes and tools presently in use for testing, the chemical dependency treatment effects of the offenders, the constructive dependency treatment results, and its impacts to the individuals being treated and to the society. After the presentation of the existing related literature, the researcher shall provide a synthesis of the whole chapter in relation to the study.
The third part of the research study shall be discussing the methods and procedures used in the study. The chapter shall comprise of the presentation of the utilized techniques for data collection and research methodology. Similarly, it will also contain a discussion on the used techniques in data analysis as well as the tools used to acquire the said data. The fourth chapter will be an analysis of the collected and tabulated data. Computations and correlations will be made in order to uncover relationships and to address the statement of the problem noted in the first chapter. The last chapter shall comprise of three sections, namely, the summary of the findings, the conclusion of the study, and the recommendations. With these three portions, this chapter will be able to highlight the implication of the findings in relation to the data obtained.
Background of the Study
Given the problem at hand, House Bill 3900 (sec 26 – 28) indicates the enhancement, implementation and examination of the Chemical Dependency Disposition Alternative or CODA, which gives courts with a verdict alternative for chemically dependent youth. Drug treatment is the primary responsibility of the CODA, thus, becoming responsible for providing immediate solutions to the factors that contribute to the problems that the youth in the society are facing today. According to a particular study, adolescents are the recurrent patients in abuse treatment programs of the government (Brown, 1990). Although they have less duration of substance abuse, their bigger participation with alcohol and marijuana can probably make them become poly-drug addicts and have illegal records. Because of this, the call for the guidance of their family and various academic institutions becomes crucial. In addition to this is the Juvenile Justice Act, which was created for juveniles who are chemically dependent to ensure that they would benefit from treatment. Under this Act and the mentioned House Bill, the court may order an examination to determine if the juvenile is chemically dependent and amenable to treatment, and may also order a second examination if so requested by the state (“House Bill Report SUB 1337”, 2001). Moreover, with persistent action, the government also came up with other laws, such as the ‘Social Host’ Laws in the United States, which would allow police to enter private homes to break up underage drinking parties and impose fines on adults who allow gatherings to take place (“Social Host Laws Proliferate in U.S.”, 2007). In this regard, this law becomes a preventive measure that would restrict juvenile drinking, which can be causes for committing crimes and damage to the community. With the help of these laws and regulations, the importance of preventing chemical dependence and crimes can be promoted.
Despite such restrictions and regulations, increase in the incidences and cases of crimes related to chemical dependency can still be observed in the society. In the event of chemical dependency of juveniles and adults, it would be very helpful to determine and consider the possible and necessary treatments that they can undergo to provide them with a safe and decent life and well-being, which reinforces their right as an individual in the society. With this, several types of chemical dependency treatment programs are recognized, which can help chemical dependents, most especially chemical dependent offenders to start anew. There are five types of chemical dependency treatment programs, and most of theses originated from adult treatment programs. The first program is through Therapeutic Communities, wherein a patient lives in a drug-free residence. Its main principle is to treat drug abuse as social and not medical in nature. The duration of this treatment is from three to 15 months, depending on the cooperation and recovery of the patient. Its completion rate is only 10 to 18% of the total patient population (Hengelo, 1996). The second type of chemical dependency treatment program is the Residential Settings, wherein the patient is placed in a boarding school that usually has an inpatient non-hospital based treatment program. Through the program that caters residential settings, the substance abuser is made to believe that he or she can still be a prolific member of the society, given the natural residential features of the boarding school. The duration of this program is usually 7 to 90 days, depending on the program principles. The third type of chemical dependency treatment program is the Outpatient Treatment, which is a less limiting type of treatment program among the rest. It lets the patient live with their families and communities, thus, giving them the immediate opportunity to exercise newly attained skills or behavioral transformation learned from the program. The fourth type is the Community Monitoring, wherein the patient may be presently using a substance, along with monitoring. Monitoring can be done through routine analyses and counseling with a probation officer or a social worker. In this program, the patients are considered to undergo a house arrest, to be imposed on curfew, or be electronically monitored by their district officers. The last type of chemical dependency treatment program is the Self-Help and other community based groups, which involve the contribution and assistance of community groups in the treatment of substance abusers. This program is often considered as an effective aftercare because it gives positive role models and emotional supports from the elder members of the program. Identification of such treatment or rehabilitation programs enables recognition of advantages in determining the best rehabilitation program.
Primarily, knowing the best chemical dependency rehabilitation program would enable increase knowledge in the treatment of substance abusers. Many researchers would be able to engage in further research and observation that would entail the advancement and the development of the recognized most effective rehabilitation program. Thus, in this case, the recognized most effective rehabilitation program would be further developed and enhanced to help many chemical dependents with their treatment.
Second, recognizing the best chemical dependency rehabilitation program would improve the services and facilities of rehabilitation centers, which would help further address the needs and the problems of substance users and abusers. It has been reported that most clients valued visiting rehabilitation center facilities beforehand, for these facilities play a very important role in helping the chemical dependent with his or her recovery, such that they influence life-changing experiences and understanding of the nature of chemical dependency of clients (Wilkinson and Mistral, 2006). There are approximately 37.9% of the chemical dependents that have been able to obtain treatment in the United States (“More than 10 percent of U.S. adults abuse drugs”, 2007), and with no available data on how many were treated from rehabilitation centers. In this sense, improving the facilities and services of rehabilitation centers may provide an increase in the number or percentages of treated chemical dependents.
Third advantage that can be recognized is the fact that recognizing the best rehabilitation program available would support the community and the local and the national government with its endeavors of promoting peace and order in the country, which would encourage safety, development, and progression. In this regard, having a safe and peaceful society can promote development and improvement in the country, such that many individuals and establishments would gain the trust of other businesses and in turn, promote its economic prosperity. With fewer crimes due to the influence of drugs and alcohol, more business establishments and firms would have the chance to function effectively in the society, through having increased transactions and negotiations from foreign investors, who would bring success, profit and advancement to a number of companies.
Fourth and last recognized advantage of recognizing the most effective chemical dependent rehabilitation program is providing additional knowledge with the families of chemical dependents that would give them the confidence and the hope that their loved one will be able to be treated from its condition. If this research study would become successful in so doing, the determined most effective rehabilitation program can be recommended to the government and other health-related institutions and organizations to further provide assistance to chemical dependent offenders. With these reasons, determination of the most effective chemical dependent rehabilitation program would be able to help many individuals in terms of treatment and acceptance in the society.
Objectives of the Study
This research study will be done to help increase knowledge and information regarding the rehabilitation methods for chemically dependent offenders and the effectiveness of a number of rehabilitation methods for their treatment. Hence, this research study will be conducted to determine which of the rehabilitation methods for chemically dependent offender populations is the most effective. The specific research objectives for this study can be summarized as follows:
1) To find out causes of addiction and chemical dependency in the target population;
2) To determine the effects of chemical dependency to individuals and to the society;
3) To determine the different drug and alcohol rehabilitation methods currently used, including its process, duration and development;
4) To identify the elements that foresee substance exploit problems or the problems that lead to chemical dependency;
5) To provide an ample assessment of offenders with chemical dependency problems;
6) To evaluate processes and tools presently used for testing;
7) To determine alternative treatment methods available for chemical dependents;
8) To determine the chemical dependent treatment effects of the offenders;
9) To identify the constructive dependency treatment results in offenders;
10) To recognize the impacts of such actions to the society; and
11) To give recommendations to the readers, to the government, and to the society
Statement of the Problem
The increase in the number of chemically dependent criminal offenders in the society of the United States leads to the recognition of a number of chemical dependent rehabilitation programs. Due to the perceived significant and essential role played by chemical dependency rehabilitation programs in the treatment of drug and alcohol dependents, it is important to recognize the different rehabilitation and treatment methods that would help in the recovery of substance dependents and in the alleviation of the number of criminal cases related to substance use in the U.S. society. This study intends to examine the most effective rehabilitation program for chemical dependent offender population in the United States. Specifically, the study intends to answer the following queries:
Significance of the Study
This research study will be a significant in knowing the perceived best and most effective chemical dependent treatment programs for offender population, which could be suggested to the government and to the families of the substance dependent. It will be significant in the development of more scientific and research-based approaches in addressing the different problems regarding the relationship of substance abuse and the increase in criminal cases in the U.S. society. In addition, this research study can also be significant in providing wider knowledge and alternatives for the government and the families of the substance abusers regarding other available treatment and therapies for the chemical dependent offenders. Moreover, this study can be significant in the endeavor for the improvement and development of the services and facilities of different rehabilitation or treatment programs that would further cater to the needs of the chemical dependent offender population in the society of the United States.
Scope and Limitations
The research study intends to examine the most effective rehabilitation or treatment program for the chemical dependent population. For this study, primary research will be conducted using anonymous questionnaires that will be sent to the general population in California of legal age. The questionnaires will be used to collect quantitative data. Qualitative data would be gathered using secondary research based on related literatures.
In relation to the previous discussion, limitations and other key assumptions were also considered, and are as follows:
- Are the results of the research study valid?
- Was the data relevant to the research questions?
- Were the data collection methods appropriate for the research objectives?
- Was the data collection comprehensive enough?
- Were the data appropriately analyzed, with the findings adequately supported?
Obstacles of the Research Study
Despite the aim and the perceived significance of this research study, a number of obstacles or problems could be encountered. Essentially, there are a small number of sensible and pragmatic barriers in this research study or dissertation. The main practical apprehension is the expensiveness of purchasing journals online. This is a practical concern because monetary costs are one of the main important factors that will keep this study going. Another practical obstacle is the availability of resources regarding the rehabilitation programs for chemical dependent offenders. There are limited studies that are related to the focus of this study. Limited local references can affect the development of this research study. On the other hand, in terms of empirical obstacles, there might not be sufficient statistics to show what program is the most effective in treating offenders with substance abuse. In simple terms, there could be difficulty in obtaining relevant and sufficient statistics from financial service institutions. This is where secondary research will come to play. The surveys and interviews to be conducted with families and social institutions are intended to make bridges that will lead to the acquisition of important references. Overall, resources and cooperation are the two major obstacles in the study. In addition, another difficulty that can be recognized is in the process of the model to be used in the research study, which is the input-process-output-model. Difficulty would rely on the different issues that the study might be able to face. In this regard, the information required should be arranged conveniently for a more effective and efficient analysis. The effective execution of the process will be the main importance and concern of the research study because it will determine the quality of the output.
Ethical Considerations and Standards
The position of the researcher in the research study is crucial because he or she will be the one to conduct the whole process of the research study. This particular research study has a political influence in nature because many laws and regulations under the judicial and community sectors govern rehabilitation programs of chemical dependent offenders. The role of the researcher is to attain the necessary information needed in the study as much as possible, and to create connections with important people who will be helpful in assisting the progress of the study. In relation to the role of the researcher is his or her responsibility to deem ethical considerations that will be applied in accomplishing the research study. Given the sensitive situation being experienced by the families of chemical dependent offenders and the social institutions handling their cases, most of the target respondents would be hesitant to share their views because of certain factors they are afraid of or uncomfortable with. As an ethical stance, confidentiality of the identity and participation of the respondents will be ensured throughout the research. Furthermore, important but confidential information that respondents do not want to talk about or give away would also be respected, especially in the process of an interview. As part of the ethical consideration of this research study, complete information, such as the goal and aim of the study would be provided to the respondents thus, respecting their right to be informed. Racial discrimination would not be observed in this study, for all races would be considered sources of relevant data. With regards to the accomplishment of the paper, strict compliance with citing references is to observed in order to avoid plagiarism of literatures to be used.
Chapter 2
Review of Related Literature
This part of the paper will review the related literatures conducted on the area of study. By doing this, the research may be guided consequently by primarily discovering where the research is coming from, what and how much have been studied regarding the topic, and what it is yet to discuss. Aside from providing the background of the study, this chapter will provide its readers the necessary backbone and support for the research study to stand credible and reliable. In addition, by appraisal or evaluation of past researches related to the study, a historical perspective may be given. The researcher will be able to gain new insights on how much venture has been explored before, which will enable reflection, comparison, learning, and producing a stronger and more efficient study. This chapter will also present the research study a rich source of data, both new and old, which will augment and enrich the study. This part of the research study will also accentuate how it will contribute to the field of study it has chosen and further improve it.
Causes of Addiction and Chemical Dependency
According to the United States census in 2000, adolescents make up the largest generation in American history (Clemens, 2004). However, with such dominance, substance use among them becomes prevalent. In 2002, more than 11% of youth, having an age range of 12-17 years were current drug users, with drugs including marijuana, cocaine, heroin, hallucinogens, inhalants, tranquilizers, and stimulants, while 28.5% were alcoholics (Clemens, 2004). With such prevalence, it can be perceived that several causes might be attributed to such large occurrence in adolescents. In this regard, it would be helpful to determine the several causes of substance use and abuse to further understand the concept of chemical dependence.
Primarily, Chenier (2001) summarized the causes or factors that may trigger drug or alcohol addiction among juveniles or adolescents, and in so doing, it would be helpful to adopt a medical, psychological, sociological, economic, legal, criminological, pharmacological, and philosophical approach. The author stressed that chemical dependence may be attributed to a genetic component, to an addictive personality type, to critical environmental circumstances, and to a physiological connection. In this sense, as previously stated, no one is excluded from the list of individuals who may be able to become chemical dependents. However, Chenier (2001) pointed out that the male gender, the unemployed, the aboriginal peoples, and the street youth are the ones having a higher chance of becoming dependent on such substances.
In support of this, several other authors have attempted to explain the causes of chemical dependence among the youth. As cited in the work of Alvarez-Niemeyer, Nun-Gutierrez and Rodriguez-Credo (2006), authors like Petridis, Flay and Miller in 1995 proposed a conceptual model that includes three kinds of influences, namely, cultural and attitudinal, social and interpersonal, and individual baggage. Another study cited is the study done by Castro-Sari nana in 2001, which identified a total of 50 factors that relate to teenage chemical abuse. These factors were classified into three groups by using an epidemiological model. The model includes a predisposing environment, the drug itself, and the individual. The third study cited was done by Medina-Mora et. al in 1995 who suggested that easy access to drugs and other substances, drug users among family or peers, peer approval, a perception of low risk, and an unpleasant mood state are also linked to cause chemical dependency in the younger generation. From this aspect, it can be seen that personal and social factors contribute to the tendency of individuals to become chemical dependents.
In addition, Sanchez-Huascar et. al. 2002 pointed out that domestic violence and sexual abuse could also be considered as causes of chemical dependence. Along with that, Bryant et. al 2000 considered school-related factors such as academic failure, absenteeism, peer drug use, and psychological distress can be linked to teenage chemical dependence. This particular study cited placed an emphasis on a related study done by Sanchez-Huascar et. al in 2002, stressing that teenagers who engage in misconduct and had low school performance scores had higher chemical dependence and tendency compared to teenagers who are highly motivated and focused with their studies. In support of such claims, a number more authors have considered the influence of family factors such as faulty and triangulated communication, inter-parental conflicts, affection-deprived family environment, ineffective problem-solving patterns, low familial satisfaction levels, type of religious practice, family disintegration, and low levels of parental monitoring are also attributed as causes of chemical dependence (as cited in Alvarez-Niemeyer, Nun-Gutierrez, and Rodriguez-Credo, 2006). As such, it can be seen that in the social point of view, the school and the family of the younger generation, or the immediate sub-society of the younger generation, determine their tendency to become chemically dependent.
In summary, the perceived causes of chemical dependence in the younger generation may be grouped into three. First cause involves the genetic or the hereditary influence one has from being a chemical dependent, which determines his or her ability to become more susceptible of developing a tendency to become a substance user. A particular study supports this claim, with the emphasis on the influence of the brain chemical dopamine that mediates intercellular communication, and with which substance use may be determined by variants of genes that regulate it (Droves, 2002). Second cause involves the individual per se, and his or her preferences, control, choice, physiology, attitude, and mood towards the use of drugs or alcohol. One possible cause of addiction or chemical dependence involves the loss of control in one’s self, which could determine their ‘gusto’ over alcohol or drugs. Likewise, their preference over the use and abuse of substances also depends on how they handle taking them. Last cause involves the social network or the community from where the individual functions, and includes the influences given by one’s family, peers, school, and culture. In this regard, it can be perceived that this involves one’s exposure to drugs and alcohol, thus, determining his or her extent in becoming chemical dependent. However, it does not follow that the more exposure to such substances leads to chemical dependency. In this sense, the preferences and the choice of an individual in terms of using drugs and alcohol become the decisive factor. From this, it can be understood that the range of problems and causes determine the extent of chemical dependency one will be able to experience and go through.
Effects of Chemical Dependency
It is a given fact that chemical dependency has several known negative effects that may create havoc within the individual or the chemical dependent and within his or her community and the larger society. Determining such effects leads to knowing the mechanism of chemical dependency and addiction, which would later be crucial in understanding the larger picture. As previously defined, chemical dependency is a progressive and chronic disease that is due to addiction or craving of a particular chemical or drug. Fairly similar is the concept of addiction, which is defined as a disease or complex phenomenon with important psychological and social causes and consequences, and involves a biological process, involving a repeated exposure to a drug over time (Starr, 2002). With these similar definitions, it can be perceived that the two concepts are both considered a disease that affects the biological and physiological functions of an individual. However, aside from seeing addiction and chemical dependence as a disease, the society also perceive them as more than mere drug use, but as a behavior exhibiting a compulsive pattern of drug-seeking and drug-taking that takes place at the expense of most of their other activities (Bridge and Robinson, 2003). This definition helps many understand that the concept of chemical dependence affects the individual and social behavior of a person, thus, it is perceived rooted at one’s biological and physiological processes. As such, the mechanism of addiction or chemical dependence can be stressed out, thus, helping individuals understand the concept and the situation of chemical dependent offenders.
The mechanism of addiction or chemical dependence relates to the biological and physiological function of the human body, and determines one’s pleasure responses towards a chemical or substance. Usually, chemical dependents take drugs or alcohol to attain ‘highs’ and escape social, mental and physical stresses. However, they also take drugs and alcohol to avoid withdrawal ‘lows’. This process can be explained using the Opponent Process Theory, which explains that a pleasant dose of drug or chemical activates a dose-dependent a-process in the brain reward circuit system that in turn, triggers the activation of a negative or opponent b-process. This b-process helps restore homeostasis in the brain and brings it back to its normal state. The summation of the actions of the two processes creates the final subjectively experienced state by the person, resulting to the A-state or the pleasant state, caused by the a-process, and the B-state or the negative state that is caused by the b-process (Bridge and Robinson, 2003). During repeated drug use, the dopamine system is being induced, which is a brain neurotransmitter that mediates the communication among brain cells in certain brain regions, and play a role in the pleasant or rewarding effects of substances, such as drugs and alcohol (Droves, 2002), thus, creating changes in the function of the brain. The neurological, chemical, and physical structure changes in the function of the brain results from the repeated exposure of an individual to addictive substances, thus, creating the chemical conditions that produce changes in the behavior of the person, in terms dependence, tolerance, sensitization, and craving (Starr, 2002). From these explanations, it can be understood that the changes in the behavior and responses of chemical dependents depend on the changes brought about by their continued and prolonged exposure to various chemicals or substances. The changes in their physiological and behavioral response determine their actions towards themselves, their family, and their society.
Several effects are recognized in relation to chemical dependency or substance addiction. Primarily, the sensitization of individuals is affected with the increase of drug or alcohol use. Sensitization refers to the increase in a drug effect with repeated drug administration, depending on the biological system of the person that mediates different drug effects and adapt in different ways to repeated drug exposure. Sensitization can be seen in two ways, either affecting the individual’s psychomotor activities or one’s motivation. Psychomotor changes in the individual may include increase or decrease in arousal, attention and motor behavior, producing heightened movement, exploration, and approach. In terms of behavioral or motivational sensitization, changes are exhibited in the physical structure of neurons, changing the patterns of synaptic connectivity within brain regions thus, alter the information processing of the brain (Bridge and Robinson, 2003). In simple terms, a known effect of chemical dependence is the changes in terms of the physical and behavioral aspects of the person that may affect his or her actions toward his or her family and community.
The second known effect is the development of tolerance to both the pleasurable and aversive effects of substance use, which supports the development or maintenance of an addiction. The development of tolerance of substances in substance users requires the individual to consume increasing drug amounts to achieve the desired pleasurable or rewarding effects (Droves, 2002). With the development of such tolerance, the rate of substance use greatly increases, thus, enabling the individual to become more drug or alcohol dependent. In this regard, a substance user is able to attain pleasure or reward from the use of the substance through continued use in high doses. With this, the substance dependent would be more reliant on the substances, thus, making him or her lose control of his or her behavior.
The third effect of chemical dependence is the prevalence of a variety of physical, mental, and behavioral disorders, such as AIDS, HIV, tuberculosis, hepatitis, and other reproductive related diseases in both genders. The unsafe use of intravenous drugs is both directly and indirectly responsible for more than one-third of all AIDS deaths in the United States, including the increasing transmission of tuberculosis and hepatitis B and C. With this, addiction or chemical dependence and HIV infection is one of the major public health challenges in the country. In addition, chemical dependence, particularly alcoholism causes liver disease and other neurological and pathological diseases that are fatal (Starr, 2002). Becoming an alcohol or drug addict leads to the tendency of using other substances or drugs, such as nicotine that is present in tobaccos and cigarettes. In this regard, the use of many and various substances presents the tendency of acquiring a number of different diseases, thus, shortening the life expectancy rate of chemical dependents. Another point to consider is the damage produced by alcohol and other substances to fetal and neonatal development, being contributory to the causes of birth defects and neonatal morbidity. In this regard, the issue of the increasing number of female chemical dependents must be addressed, as having physical diseases attributed to alcohol and drug use significantly similar to males (Blame, 1990). Documented prenatal substance exposure presented effects on fetal and child development, thus, affecting 20% of newborn children in America and causes one in every ten cases of mental retardation (Starr, 2002). In addition, the increase in alcohol intake, particularly in women makes them sexually aggressive and promiscuous (Blame, 1990), thus, increasing the incidences of rape, early pregnancy, single parenthood, and abortion in the society. In this regard, the issue of chemical dependence cannot only be regarded as a medical or behavioral issue, but as a moral issue as well.
Fourth known effect of substance abuse and dependence brings impaired judgment, depression, hopelessness and desperation on the part of the addict, leading him or her to suffer from mental disorders that would lead the person to commit suicide or inflict injuries (Muslins, 1999). These incidents lead to the substantial increase of use of the healthcare system, and particularly of expensive emergency rooms and trauma care services in hospitals and healthcare centers, as 60% of all emergency room visits are related to drug and alcohol problems. In addition, substance use causes close to half of all fatalities in motor vehicular accidents, with more than 100,000 American citizens dying (Starr, 2002). With this, it can be perceived that the influence of the use of either alcohol or drugs impairs the ability of individuals to control not only their mental behavior but their physical and motor skills as well.
Another evident effect of substance or chemical dependence is the break up and deterioration of family ties, which causes child abuse and family violence. A study cited in Starr in 2002 reports that 78% of female victims who survived domestic violence attacks reported that their attacker had been using drugs or alcohol. Moreover, substance use also leads an individual to commit rape and sexual assault, thus, committing violations and crimes against other individuals and the society. It leads to the abuse and neglect of children, and in some instances, fathers even sexually abuse their children due to the influence of drugs or alcohol, leading to a rough estimate of ten million children affected because of such causes. Substance use and abuse also leads to high rates of divorce and broken families, causing at least three-fourths of cases where children are removed from their families and placed in foster care (Starr, 2002). With this, it can be understood that due to chemical dependence, most children are deprived of their rights to live peacefully and rightfully, thus, affecting not only their lifestyle, but their perception and view of life as well. This event influences them to either disregard or give importance to the value of having a family and of becoming influenced by substance use.
Muslins (1999) reports that due to chemical dependence, important social, occupational, or recreational activities are being abandoned, and this increases the costs of U.S. employers annually. A study cited in the work of Starr in 2002 estimated that addiction costs U.S. businesses a total of 0 billion yearly, due to lost workdays, premature deaths of workers including on-the-job accidents, and half treatment costs such as fetal alcohol syndrome and AIDS. This leads to the increase in costs of the U.S. society, due to the loss of productivity, increase in direct financial burdens on government programs, and even social deterioration. A study done analyzes economic data stating that alcohol and drug abuse cost the U.S. society a total of 6 billion (Starr, 2002). In this regard, it can be perceived that chemical dependence not only affect the individual user but the whole society as well. It provides the individual with diseases and mental disorders, which cause him or her to commit crimes and other violations towards other individuals and towards the society. Furthermore, due to chemical dependence, children and families are not able to obtain their rights in the society that would allow them to live peacefully and rightfully in their communities.
Chemical Dependence Rehabilitation Methods Currently Used
As previously discussed, there are five types of chemical dependency treatment programs or methods used today, namely, Therapeutic Communities, Residential Settings, Outpatient Treatment, Community Monitoring, and Self-Help. These five treatment programs are general treatment or rehabilitation programs helping many substance or chemical dependents to overcome their condition, thus, enabling them to function effectively and normally in the society. Historically, formalized testing in the field of addiction began in the late 1970s with the National Board of Medical Examiners, which developed examination modules for medical students. Following this is the California Society for the Treatment of Alcoholism and Other Drug Dependencies, which established an examination for demonstrating expertise in addiction in 1983. In 1986, the American Society of Addiction Medicine began the development of a related national chemical dependence examination, which led to the development of other procedures that developed and improved training standards in relation to substance abuse academic medical training. These training standards provided a model for the development and improvement of substance abuse training programs, assisted fellowship applicants in the evaluation of their training needs, and helped in the establishment of certifiable specialty training for the field (Burns et. al., 1991). With the development and improvement of such standards and fields, the problems and the causes of chemical dependence were identified and given importance in terms of treatment and recovery. As such, specific models and treatment programs are being used today.
Specifically, the AA model is one of the most popular chemical dependence treatment programs being used today, including a twelve-step program for any self-defeating or compulsive behavior, such as Cocaine Anonymous, Debtors Anonymous, Dual Disorders Anonymous, Ethics Anonymous, Gamblers Anonymous, Nicotine Anonymous, Overeaters Anonymous, Sex and Love Addicts Anonymous, Survivors of Incest Anonymous, and Workaholics Anonymous. The AA model characterizes or perceives addiction as a progressive, chronic, and deadly disease that leaves the substance dependent or addict “powerless” and experiencing a “loss of control” in the ability to desist a drug of choice. It requires a commitment to total abstinence, the embrace of spirituality, and life-long participation in AA or other twelve-step programs, because it sees an addiction as something that is treatable but never entirely curable. Another treatment program is termed as SOS, which stands for Secular Organizations for Sobriety that was founded by James Christopher in 1986. The program is a non-religious, abstinence-based self-empowerment program that uses the principles of cognitive therapy and visceral synchronization. In views addiction as having three components, namely, a physiological need, a learned habit, and a denial of the need and the habit. The third known treatment method in the United States is the RR or Rational Recovery program that employs an addictive voice recognition technique or the AVERT, which is based on the experiences of former addicts. It views chemical dependence as personal matters that have nothing to do with acquiring, maintaining, or ending an addiction, but develops a thinking skill that aids addicts to recognize and resist the internal “voice” that pressures them to use chemicals for their pleasure. Fourth treatment program is the SMART or Self Management and Recovery Training, which assists its members in maintaining abstinence from various substances, through a continuum of recovery that focuses on the quality of life. It achieves its goals through scientific practice and knowledge, abstinence from addictive chemicals, nurturance of emotional independence and self-reliance, and assistance in giving dependence on support groups (Leman ski, 2000). These and other treatment or rehabilitation programs are being used by the families of chemical dependents in the United States to ensure treatment and recovery of their chemical dependent relatives.
Alternative Rehabilitation or Treatment Methods
Most of the chemical dependency rehabilitation and treatment organizations use the AA model or approach in administering treatment of substance dependents. As a matter of fact, more than 93% of U.S. treatment centers are still locked into the AA approach (Leman ski, 2000). However, despite the success of the use of such an approach, which lasted for more than 60 years, many criticisms have been made regarding the approach that made many researchers to come up with the use of alternative methods for chemical dependency treatments. The major criticism for the AA model and other twelve-step programs is that the treatment is not scientifically-based, but instead is based on religion, spirituality and talk-therapy (Leman ski, 2000). Nowadays, more and more medical practitioners are open to using alternative methods that can be regarded as cost-effective and less conventional.
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However, despite the large number of treatment programs available for chemical dependency recovery, its selection can be confusing to a family in the middle of a crisis. For this reason, the National Council on Alcoholism and Other Drug Dependencies and various community programs can provide a summary of local treatment resources. Moreover, these programs can suggest levels of care based on interviews with family members and the addicted family member, which in this case is the chemical dependent offender. Nevertheless, a more accurate recommendation would only be made after the patient has been assessed by healthcare professionals. A number of treatment programs provide free assessments and give out recommendations regarding the required level of treatment (Landry, 1994).
Assessment Used for Chemical Dependent Offenders
The treatment of chemical dependents involves first the evaluation and assessment, treatment planning, medical and psychiatric management, psychosocial rehabilitation, and continuing care (Landry, 1994). It is important to assess and evaluate first the condition of the chemical dependent to be able to administer an effective treatment program suitable for his or her condition. A number of evaluation and assessment phases must be undergone by the chemical dependent to ensure that all stages of his or her condition would be properly examined. Primarily, screenings would be done to help determine whether the individual has a substance disorder and whether further evaluation is recommended. After this evaluation, the diagnostic evaluation is done, which documents the presence of a substance use disorder and describes that disorder, thus, providing health professionals with useful and relevant information regarding the problem of the offender. An intake evaluation is also done to trace the medical history of the patient, and becomes the basis for the decision in admitting the patient or to make a referral to other treatment programs (Landry, 1994).
Specifically, in treatment settings, patients are provided with medical assessments to determine their current medical problem. Medical assessments include detection of addiction-related problems, such as withdrawal, AIDS, hepatitis, or other diseases. The patient undergoes a physical examination, a thorough drug history, x-ray, electrocardiogram, urinalysis, blood tests, and other drug screening tests. Another form of assessment done is the nursing assessment, which takes place during detoxification in inpatient settings. Daily nursing assessment involves the patient’s response to drug cessation, to medication, interactions with other patients and staff, and early response to treatment. Third assessment done is the psychiatric assessment, which is used to confirm the presence and severity of substance use disorders. This type of assessment is a question-and-answer type of assessment, with self-report tests, structured interviews, and personality tests (Landry, 1994).
The next assessment done is the nutritional assessment, which is necessary because during active addiction, nutritional needs are unmet. For this reason, the nutritional needs of the chemical dependent is being evaluated to determine other diseases that may have been caused by his or her condition, thus, requiring additional treatment and care. Nutritionist and other healthcare professionals use structured interviews and laboratory tests to determine the presence and severity of nutritional problems. The fifth assessment to be utilized is the family assessment, where family therapy specialists interview the patient and other family members of the chemical dependent to obtain a clearer understanding of the addict’s family dynamics, effects of addiction on the family, and the effect of family structure on the individual’s addiction. This type of assessment provides information on the expected level of support and understanding of the family of the addict for the treatment and recovery. The next type of assessment done is the social and emotional assessment, which recognizes the fact that different social and emotional problems may have contributed to the drug or alcohol use of the individual. These problems or issues must be identified for a more effective prevention and recovery. In this regard, the social and emotional strengths and weaknesses of the chemical dependent, which would be helpful in administering treatment that would involve the enhancement of poor skills and the encouragement of the use of such skills for personal growth. Another type of assessment that must be done is the recreation, stress, and leisure assessment that involves participation in various activities and exercises that promote pleasure, and this includes sports, hobbies and games. This form of assessment recognizes the fact that during the course of addiction or chemical dependence, the addicts seize to participate in recreational and leisure activities, thus, with this form of assessment, the chemical dependent would be able to enjoy his or her life through interactive and social activities. The next type or form of assessment is the legal assessment, which helps the chemical dependent to address problems such as court appearances that would contribute to the severity of stress and anxiety, thus, reducing the effectiveness of treatment. The last type of assessment to be done is the vocational assessment, which would help the chemical dependent obtain and maintain their jobs or employment. Through this assessment, the chemical dependent is monitored to help them return to their jobs, thus, making them realize their importance to the society and to their community. This form of assessment examines and evaluates the individual skills, interests, job history and addiction-related occupational problems of the chemical dependent, thus, determining the areas that need to be addressed during the treatment and recovery period (Landry, 1994).
Aside from the use of such assessment methods is the frequently used form of assessment, which is with the help of counselors or through counseling orientations. These counseling orientations are usually facilitated by psychiatrists, who use a clinical model in determining problems related to chemical or substance dependence. This form of assessment can be used effectively because it is scientifically and research-based, thus, facilitating a scientific approach concerning the treatment of chemical dependents. Counseling orientations use a clinical model that helps the patient and the clinician to understand or treat a clinical problem (as cited in Johnson et. al., 1994), where in this case addiction or chemical dependency is treated as a clinical problem. This specific type of clinical assessment uses an instrument to measure substance abuse through the Powerless-Empowerment Scale, which is a substance abuse counseling assessment method that involve the degree of responsibility of clients should assume for their recovery and how much power they have to overcome their addictions (Johnson et. al., 1994). With such assessment methods, chemical dependent offenders are able to have an idea on the extent of their addiction and on the extent of their treatment. Furthermore, assessments are important in the effective administration of treatment of chemical dependent offenders.
To find out causes of addiction and chemical dependency in the target population;
12) To identify the elements that foresee substance exploit problems or the problems that lead to chemical dependency;
13) To determine the effects of chemical dependency to individuals and to the society;
14) To determine the different drug and alcohol rehabilitation methods currently used, including its process, duration and development;
15) To provide an ample assessment of offenders with chemical dependency problems;
16) To evaluate processes and tools presently used for testing;
17) To determine alternative rehabilitation methods available for chemical dependents;
18) To determine the chemical dependent treatment effects of the offenders;
19) To identify the constructive dependency treatment results in offenders;
To recognize the impacts of such actions to the society;
Issues
(1) Fortunately, although no cure exists, medical treatment can enable recipients to live normal, healthy, and productive lives. Treatment is cheap compared to many other common medical procedures and is highly cost-effective. (2) Now consider this: For the vast majority of victims of this disease, effective treatment is inaccessible. Most health insurance plans either do not cover it or put a variety of limits on coverage that do not apply to other diseases. Unless they can pay out of pocket, victims cannot get the treatment they need. To make matters worse, they are often told that their condition is not a real disease, or that it is their fault, or that suffering from it makes them a criminal.
The disease is drug and alcohol addiction, and the facts are real. Ubiquitous benefit caps on insurance coverage of substance abuse treatment put effective recovery out of reach for most addicts. In this Note, I assess the nature of this problem and some possible ways to address it. The general principle that I advocate is substance abuse treatment parity, which means that insurance plans should provide coverage for addiction treatment that is equivalent to that provided for analogous conditions. In some cases, failure to provide such parity should be considered illegal disability discrimination on the part of employers and insurers. Moreover, new laws should be adopted to require insurance parity explicitly.
In Part I, I review the current status of insurance coverage of addiction treatment and assess the scope of the shortfall and possible reasons behind it. In Part II, I set forth the case for insurance parity, including the nature and costs of the disease of addiction and the efficacy and cost-effectiveness of treatment, and consider some counterarguments. In Part III, I analyze the requirements of the Americans with Disabilities Act (ADA) as they pertain to insurance parity, drawing on the precedents set by recent challenges to other types of insurance discrimination. I conclude that the ADA should be interpreted to require parity in some cases, but that the potential effectiveness of this litigation strategy is limited–new reforms are necessary. In Part IV, I consider the strengths and weaknesses of current legislative proposals to accomplish insurance parity, and focus especially on the Substance Abuse Treatment Parity Act. Finally, in Part V, I offer my conclusions and recommendations for legal change and advocacy.
Treatments
Today one can join a twelve-step program for just about any self-defeating or compulsive behavior: Cocaine Anonymous, Debtors Anonymous, Dual Disorders Anonymous, Ethics Anonymous, Gamblers Anonymous, Nicotine Anonymous, Overeaters Anonymous, Sex and Love Addicts Anonymous, Survivors of Incest Anonymous, Workaholics Anonymous, just to name a few. (See my article “The Tenacity of Error in the Treatment of Addiction” in the May/June 1997 Humanist for an analysis of AA and its offspring.)
The AA model characterizes addiction as a progressive, chronic, and ultimately fatal disease that leaves the addict “powerless,” experiencing a “loss of control” in the ability to refrain from a drug of choice. The model requires a commitment to total abstinence, the embrace of spirituality, and life-long participation in AA or another twelve-step program, because addiction is defined as treatable but never entirely curable.
Despite the fact that it scarcely works and its cure is worse than its malady, the AA model became standardized within the recovery movement in the United States during the 1950s and 1960s.
Today eight such programs have achieved a significant level of success and staying power. A summary of each follows in the order of their historical development: Women for Sobriety/ Men for Sobriety P.O. Box 618 Quakertown, PA 18951 (215) 536-8026 (800) 333-16116
Women for Sobriety was founded in 1976 by Jean Kirkpatrick in Quakertown, Pennsylvania, in response to the pronounced male bias of AA. As far back as 1946, a Yale University study of AA indicated a radical difference between the recovery needs of women compared to men, yet twelve-step programs treat all members the same. WAS–and later, in 1994, Men for Sobriety–was designed to correct this obvious flaw.
Women for Sobriety and Men for Sobriety maintain a network of self-help support programs throughout the United States, Canada, Europe, New Zealand, and Australia that are sensitive to the psychological differences in the sexes. Grounded in proven principles of cognitive behavioral therapy that emphasize responsibility and individual empowerment, the programs are free and open to individuals with alcohol-related problems. More information about these programs can be found in Kirkpatrick’s books Turnabout. Help for a New Life and Goodbye Hangovers.
Health Recovery Center 3255 Hennepin Avenue S Minneapolis, MN 55408 (612) 827-7800
One unfortunate aspect of AA is its refusal to acknowledge special dietary requirements associated with many people addicted to alcohol. AA founder William Wilson began to promote biochemical repair within the organization after a special dietary regime and megavitamin therapy cured him of decades-long depression. However, when it was discovered that Wilson’s psychiatrists had also introduced him to LSD, a scandal ensued, Wilson was banned from promoting the treatment, and biochemical repair was largely dismissed as just another form of drug abuse until much later. In response to this, Dr. Joan Mathews-Larson in the mid-1970s formulated a holistic treatment approach that places a strong emphasis on diet and biochemical repair, which reports a success rate of 74 percent within the time frame of a three-and-a-half-year follow-up when used in conjunction with psychological counseling.
C. Treatment Works
One of the most intractable obstacles to insurance parity reform is the widespread but inaccurate perception that addiction treatment is ineffective. (70) In fact, studies show that treatment programs on average have an effectiveness rate of 30-60%, if effectiveness is measured in terms of the number of people who remain totally abstinent for one year or longer. (71) Individual treatment programs may achieve substantially higher abstinence rates. The Partnership for Recovery, a coalition of top treatment centers, cites success rates of 51-75%. (72) In 1989, AMR Corporation, the parent company of American Airlines, established an Employee Assistance Program (EARP) that encompassed insurance parity. In testimony to Congress, EARP manager John Saylor testified that AMR’s program had a 75-80% success rate in keeping patients sober for a year or more. (73)
Moreover, a focus on total and permanent abstinence as the sole measure of effectiveness is misplaced. Addiction is a “chronic, relapsing disorder. Total abstinence for the rest of one’s life is a relatively rare outcome from a single treatment episode.” (74) Viewed in this light, success is marked by “a significant decrease in drug use and long periods of abstinence.” (75) When this more realistic measure of success is used, success rates predictably increase; for example, the Hazel den Foundation boasts a 77% rate of keeping people “clean and sober” at the end of one year–54% having remained completely abstinent, and the remainder having had just one episode of use during that time. (76)
Indeed, although addiction treatment is not by any means universally successful, neither is treatment for many other conditions that are routinely covered by health insurance. Addiction treatment has similar success rates to those for treatment of hypertension, diabetes, and asthma. (77) Indeed, one study found that addiction treatment “ranked in the top 10 percent of medical treatments reviewed for savings in money and lives.” (78)
D. Treatment Is Cost-Effective
Substance abuse treatment has a range of economic benefits for patients, health insurers, employers, and society as a whole. These benefits mean that investments in treatment more than pay for themselves. Treatment coverage may even decrease total health care costs because the cost of treatment is outweighed by decreases in other uses of the health care system. A study of patients receiving publicly funded treatment in Washington State found that five years after treatment, medical expenses were cut in half relative to costs of those who were untreated. (79)
More likely, however, slight increases in premiums would result from parity requirements, according to several recent studies. A study by RAND Corporation economist Roland Sturm estimated that, as compared to no coverage for treatment at all, unlimited addiction treatment coverage would add .11 to premiums per plan subscriber per year. (80) This amounts to a premium increase of approximately 0.3%. (81) The same study found that a ,000 treatment cap saves members only six cents per year (versus unlimited coverage), while a 00 cap saves .39 per year. (82) Even the starkest of these differences, however, still amounts to less than fifty cents per month. Similarly, an actuarial study by Millikan and Robertson, Inc., found that full and complete insurance parity provisions, if adopted nationwide, would raise average nationwide premiums by less than 0.5%, or less than one dollar per month; more limited parity provisions would raise rates only 0.1%. (83) Another actuarial study of provisions adopted by some states found that full parity would raise premiums by only 0.2%. (84) These estimates take into account only the cost of health insurance itself and not other costs to employers and society as a whole.
Methodology
The method utilized in this research study is termed the research onion process, which will be used in order to ensure that the researcher will be able to obtain the necessary data to examine which rehabilitation program is the most effective treatment for chemically dependent offenders.
The research design used was both a qualitative and quantitative research, which use explanatory methods in describing the variables, such that the data situation and other facts collected were explained and correlated with other data. This form of research design is useful when conducting a study where data are immeasurable, such as feelings, beliefs, and thoughts (Mays and Pope, 2000). In addition, this descriptive study focuses on the conditions set and the nature that surrounds the data, and not on the correlation with other collected facts.
In order to come up with the most suitable research approaches and strategies for the study, the research onion process was utilized. The process was termed as such because the conduction of the research is like peeling the layers of an onion, in order to come to the central issue of how to collect the necessary data needed to answer the research questions and objectives. In this research process, important layers should be first peeled away, before arriving at the core of the process. With the said process, an outline on what measures to be applied are most appropriate would be made. In addition, it is not unusual for a researcher to first think of his research understanding by considering whether one should for example, administer a questionnaire or conduct interviews; this is why thoughts of this question should belong to the center of the research onion (Saunders, 2003). That is, in order to come to the central issue of how to collect the data needed to answer one’s research questions, there are important layers of the onion that needed to be peeled away. The first layer raises the question of the research philosophy to adopt. The second layer considers the subject of the research approach that flows from the research philosophy. The third layer examines the research strategy that is most applicable, while the fourth layer refers to the time horizon a researcher applies to his or her research. The fifth and final layer is the data collection methods that are to be used in the research study.
Then again, the research philosophy that is reflected in this study is positivism. With this research philosophy, a researcher prefers to work with an observable social reality in order to come up with law-like generalizations similar to those produced by the physical and natural scientists (Remedy et. al., 1998). In this tradition, the researcher becomes an objective analyst, coolly making detached interpretations about those data that have been collected in an apparently value-free manner (Saunders et al, 2003). In addition, the emphasis is on a highly structured methodology to facilitate replication (Gill and Johnson, 1997) and on quantifiable observations that lend themselves to statistical analysis (Saunders et al, 2003). The assumption is that the researcher is independent of and neither affects nor is affected by the subject of the research (Remedy et. al., 1998; Saunders et al, 2003).
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