In a 2006 report, the Substance Abuse and Mental Health Services Administration, or SAMHSA, said 47 percent of all patients in treatment for substance abuse abused multiple substances. Treatment for alcohol abuse combined with psychostimulant dependence is more complex than treatment for either disorder alone. Addressing the implications of multiple substance abuse is the first step in achieving ultimate sobriety for patients.
Withdrawal
Withdrawal constitutes the first step in treatment for alcohol and psychostimulant abuse. Getting a full medical profile -- including a psychiatric evaluation and family history -- and observation over several days is necessary to determine the proper approach for withdrawal, according to Joseph A. Troncale, M.D., of the Caron Foundation in an article written for Addiction Professional and reprinted by the Free Library. Multiple-substance abuse and "polysubstance dependence" complicate the process. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, defines "polysubstance dependence" as simultaneous abuse of three or more substances, which can include alcohol, during a 12-month period. Patients suffering from "polysubstance dependence" demonstrate no clear "drug of choice," the American Psychiatric Association reports. Most adolescents and many adults suffering from mental health disorders abuse multiple substances, even if their abuse falls short of the DSM-IV definition, according to Troncale.
Treatment Programs
Residential alcohol and psychostimulant treatment programs provide treatment for patients past the withdrawal stage. Partial hospital-based and intensive outpatient treatment programs allow patients who have a stable living situation, including a job or school program, to get support to keep them away from potential detrimental influences during treatment with minimal disruption to their living situations. Such programs provide support for patients who are not yet ready to maintain a "clean and sober" state independently, according to Helpguide.org.
Counseling and Support Groups
Outpatient drug and alcohol counseling programs are designed to accompany other treatments or as follow-up to inpatient or residential or more intensive programs, rather than as initial drug and alcohol abuse treatment, Helpguide.org says. Many self-help support groups adopt the 12-step model developed by Alcoholics Anonymous to provide additional support and minimize relapse, according to MayoClinic.com. Developing a social network that doesn't depend on alcohol or psychostimulants is an important aspect of remaining "clean and sober" over the long term, Helpguide.org claims.
Medications
A physician or drug treatment program may administer or prescribe carefully controlled doses of medications to ease symptoms of withdrawal or as part of a sustained treatment plan. Disufiram, also known as Antabuse, treats alcohol dependence by creating unpleasant symptoms in patients who attempt to drink, according to the HBO Additcions website. Methadone and buprenorphine stabilize brain chemistry without providing the "high" of heroin, the National Institute on Drug Abuse, or NIDA, says. Reduced doses of the "drug of choice" or anti-psychotic medications to address paranoid psychosis or depression are other medication-based treatments. Administering medication to patients with multiple substance-abuse histories can be problematic, Troncale claims. Also, patients who receive medically based substance abuse treatment without further support demonstrate nearly the same abuse patterns as those who get no treatment at all, according to the NIDA.
References
- SAMHSA Advisory: Nearly Half of all Patients in Treatment for Both Alcohol and Drugs
- MayoClinic.com: Drug Addiction -- Treatment and Drugs
- NIDA InfoFacts: Treatment Approaches for Drug Addiction
- Helpguide.org: Choosing a Drug Treatment Program
- "Addiction Professional"; Understanding the Dynamics of Polysubstance Dependence; Joseph A. Troncale, M.D.; January and September 2003
- American Psychiatric Association: Clarification of Concept of Polysubstance Dependence
