Milieu therapy

Bilsen, H.P.J.G. van (1986a) Motivational Milieu Therapy, motivating heroin addicts for change , Paper presented at the 15th International Institute on the Prevention and Treatment of Drug Dependence, Noordwijkerhout. 

This sequence is very seldom allowed to occur, because we are so busy "treating" the patient, whether by chemotherapy, shock therapy, milieu therapy, group therapy, psychotherapy, family therapy... (p.85). 

Although medications are the primary treatment modality for bipolar disorder, it is important to consider the impact of medications in conjunction with other forms of treatment. For instance, milieu therapy, when inpatient care is necessary, will be most effective after initial medication response has reestablished some degree of cooperation and insight. Psychotherapy, especially cognitive, behavioral, and psycho-educational approaches, is effective with the medication-stabilized patient. Group therapy, which can include families, will often revolve around acceptance of the disease as well as of the need for long-term medication treatment, the side effects, and the implications of noncompliance. In instances of medication resistance or contraindications, ECT should be considered. 

Antipsychotics alone are as good as antipsychotics plus psychotherapy. Both are better than psychotherapy alone or milieu therapy. ECT is better than psychotherapy but not as good as antipsychotics (NB not recommended by NICE in the UK, see Chapter 4). 

When used in an economic milieu, the term benefit can mean different things to different groups, even when referring to the same drug or service. For a person who suffers from migraines the benefit of a new effective, rapid onset antimigraine therapy is that he or she may be able to alleviate the headaches more rapidly than with their current medication. Employers may benefit because their staff remain productive, and... 

In another study, psychotherapy with and without drug therapy was compared with a no formal psychotherapy control group (421,422 and 423). No valid conclusions can be drawn from this study, however, because there was no adequate control group with respect to medication. Further, the majority of the psychotherapy group received medication and the control group was treated in an entirely different milieu, with many apparently transferred to a chronic facility. 

This section will focus primarily on the development of nonviral vectors that are based on surfactants, phospholipids, and natural or synthetic polymers for their application to the delivery of macromolecules, mainly of genetic materials such as DNA or RNA. Development of safe and efficient vectors will expedite the success of human gene therapy, which has captured the attention recently of the public and the biomedical research community. Even though more and more new delivery vectors are being introduced into the scientific milieu with enhanced efficiency, it should be emphasized that safety always goes first, especially after the tragedy of J. Gelsinger in 1999. 

Here are 20 principles for providing therapy to deeply disturbed persons. Many of them are elaborated in The Heart of Being Helpful (1997b), and all of them draw on the Principles of Life that I present in Medication Madness (in press). While the focus is on providing help to emotionally disturbed and disabled patients who seek individual therapy in a private practice or clinic, the same principles apply to residential and milieu treatment as well. In a more general way, these 20 guidelines can also be applied to our experiences with other people in our workplace, families, and everyday life. 

Chronic alcohol abuse is an expression of true dependence. Thus, therapy of this addiction is dif cult and frequently without success. There is no pharmacotherapeutic silver bullet (the NMDA receptor antagonist acamprosate may be worth trying). Above all, psychotherapeutic care, a change in milieu, and supportive treatment with benzodiazepines are important. 

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