Substance abuse self-treatment

Caroll, Robert T xld. Substance Abuse Treatment. The Skeptic s Dictionary. Available online. URL http //skepdic.com/sat.html. Updated on November 11, 2003. This contrarian approach to substance abuse treatment acknowledges the good intentions of pioneers such as Charles Dederich of Synanon but argues that a number of programs violate human rights. The author questions the role and self-interest of professional interventionists who try to get substance abusers into treatment. He also argues that there is an inherent contradiction between the disease model of substance abuse and the moral approach of 12-step organizations such as Alcoholics Anonymous. 

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

Substance Use Disorder. Patients abusing alcohol or other substances may be prone to erratic behavior reminiscent of the Cluster B personality disorders. If these behaviors occur exclusively in a context of intoxication or during periods of heavy substance use, then the diagnosis of a Cluster B personality disorder is not warranted. Instead, treatment should be focused on the substance use disorder. This is not to say, however, that substance use disorders and Cluster B personality disorders cannot occur together. In fact, the difficulty that these patients have in self-soothing leaves them especially vulnerable to substance abuse. 

Many substance abusers turn to drugs as a form of self-medication for conditions such as depression. Thus, long-term treatment with antidepressants may prove useful to recovering substance abusers. It is important to note that phenothiazines, a type of antipsychotic medication, can be fatal when used with hallucinogens including DMT. This is especially true if the phenothiazines are mixed with strychnine or belladonna alkaloids. 

Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Habcrie, B., ct al. (2004). Self-help organizations for alcohol and drug problems Toward evidence-based practice and policy. Journal of Substance Abuse Treatment, 26, 151-158. 

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