Social Interventions for Addiction Disorders

Social Interventions for Addiction Disorders

Sojan Antony

Introduction

Human beings like to have pleasure. They tried various ways to experience that exciting mood altering substances. That enquiry led to the discovery of various addictive substances. Behavioral and learning theories analysis show pleasurable activities would be repeated. Modern human brain related science adds that changes in the brain structure and chemistry do not allow few among users to stop, though they face harmful effect. Socialization process by family, peer, school, religion and work environment do play a vital role in the life of persons to develop against or supportive attitude towards addiction. Relearning or change in attitude would make constructive move in the life of a person with addiction. Individual, family and group based structured social interventions were found to be an effective element in addiction treatment.

Gravity of problem

Addiction has been identified as a social problem in India. The use and abuse of drug causes social, economical, physical and psychological problem in the society (Murthy, 2008; Benegal, 2005).. Prevention is primary goal or policy in India. But due to various reasons it could not be achieved. Drugs have been classified as licit and illicit drugs. Licit drugs like alcohol and nicotine were identified as one of the prominent source of income for government. Also considering easiness in production of such drugs and wide use prevented legislative force to ban those drugs. Illicit drugs like cannabis, opium, cocaine were produced, transported and distributed by antisocial forces to meet their financial needs. Some of drugs are prescriptive medicines which are abused as a source of relaxing or stimulant agent. Not surprisingly street children are not spared from drug abuse majority initiate their drug use with less costly solvents.

Social aspects of addiction

Society perceives addiction as a source of pleasure as well as a cause of physical and psychological problem. This situation induces ambiguity in the mind of individual members of every society. A part of society through their socialization process develops anti drug use attitude and save themselves. Other part of society due to curiosity and peer pressure experiments the use. Last part of society accepts drug use as part of their culture and resumes their use. Society has been defined as a web of relationships. The same relationship chain help few of them to lead a drug free life and for another few same kind of relationships chain them in regular pattern of use.

Social Interventions

Major social interventions are divided based on target groups.

Individual based interventions

Family based interventions

Group based interventions

Community based interventions

Structured Contents for group and individual sessions

Individual based interventions would help to specific and confidential issues. Group based interventions (Karen & Murthy 1998) have been seen as a source of support, information and stage for attitude change and skill training (Moos.R.H. et.al, (2008)). Following contents would be dealt in both individual and group sessions.

Psychoeducation

Individuals and family who seek treatment are not aware fully about nature of problem, process of treatment, stages of change and prognosis. This might lead to early drop out from treatment. Psycho education from mental health professionals would motivate persons to continue treatment which has been shown better out come in clinical experience.

Motivational interview

It is a style of interviewing individuals with addiction with out raising resistance or denial of problem to enhance motivation to stop. Precisely motivational interview do two kind of work creating a discrepancy in the thought and assisting them to move ahead till maintains abstinence or treatment goal. Though motivational interview is sophisticated psychological intervention, this style of interaction would guide all professional to help individual with addiction.

Myths and misconceptions

Drug use is associated with certain myths and misconceptions. Few of them are “it relaxes me” “creativity can be enhanced” “I get confidence to do things, I wont get fear if I use and do” “I can do work much more time with high concentration” “Night for sleep it is helpful” “drinking is good for heart” “little drug use is a booster in sexuality” and “for my bad mood this is a solution”. These are few sample conversation which have been shared by patients in group. Current understanding of addiction show that chronic drug use would give adverse effect in all most all above mentioned expectations of use. Peer interaction based learning and experience of abstinence may change these misconceptions.

High risk situations

Peer group interaction (Martino, et.al, (2006)) has been reported as a main precipitating and maintaining factor of addiction. Even after the treatment old drug use friends may force the individual to use again. Individual gets environmental cues related feeling to use. It may be during the celebration of festivals, family gathering or in the occasion of major life events like marriage, child birth or death. Problems or difficult life situation are being identified as a risk situations of restarting use. Identifying various high risk situations along with individual, family and group would help individuals to prepare themselves to prevent post treatment relapse.

Craving management

Craving has psychological and social dimension though it is defined as an intense urge to use substance. Social cues are one among reasons of craving. Avoiding such cues would reduce risk of relapse. Usually patients are helped to identify the flagging thoughts of craving such as “only for today, let me take my last drink” “now I am Ok, I can manage with one drink” “I have stopped for 2 years so let me” “I wont take let me just sit with my friends while they are having” “beer is a soft drink, it is not harmful”. Individual must see the psychological and physical cues. Then they can use 4-D distraction techniques with the awareness of sea wave nature of craving. Like a wave in sea side craving would come and go and they need balance in that time. Distraction, Deep breathing, Drinking water and Delay (4-D techniques) would help individual to manage craving.

Drink refusal skills

Role plays are used to train drink refusal skills. It is basically training of assertive skills. This would empower individual to say “No” when friend, relative or others force him to use. Tone of voice and nonverbal expressions are vital part off assertive skills. These would be trained in a role through enacting a party scene or road side scene. Individuals are encouraged to leave that place as early as possible while others force to use.

Coping skills

Coping skills are trained in two aspects, emotion based coping and problem based coping. In emotion based coping individuals are taught temporary nature of emotion, how it can be reduced using relaxation techniques. Individuals are educated not to take any hasty decisions or to negotiate with others while they are in emotions. The need of waiting while they are emotionally up would be discussed with life examples. Problem solving techniques has been used in problem based coping.

Problem solving structure

Addiction has been a cause and result of problems. So it is important to teach problem solving pattern to break this vicious cycle. Problem solving is a process, which includes identifying the main problem, understanding the problem, identifying the resources, identifying solutions, implementing the best possible solution considering personal resources and social support, evaluating the result, and if problem is not solved try again or attempt next best solution. This training can be done with analyzing their any one of the problems. It would help individuals not to resort drugs as a solution in their difficult situations.

Positive addiction and life style change

Lifestyle change need to be promoted through diverting individuals attention to positive addiction such as sports and games, exercises, yoga, meditation, social activities, spiritual activities, and hobbies like watching T.V.. Positive addiction would give alternative pleasure as well as keep individual engaged in some sort of activities. In turn it reduces the risk of relapse.

Sleep, money, and time management

Difficulty in sleep, money and excessive free time are some of the factors for relapse. So it is necessary to teach sleep hygiene and money management skills in terms of saving. Free time needs to be planned in advance to avoid boredom which has been reported as a primary reason of restart of use.

Relapse management and follow up

Relapse is a possibility in addiction treatment. Anticipating relapse in advance and be prepared to deal in a supportive medical model as early as possible would ensure recovery. Long term follow up has been rated as major factor in the success of treatment. Family should be trained to help individual in non critical manner during relapse.

Family based interventions

Family dynamics and related factors are important in addiction treatment. As a victim of addiction they ought to be helped to ventilate their suppressed emotions in the absence of individual. Proper training and supportive psycho-education can change the attitude of family. Quality of marital and family life (Pandian, 1999) and family rituals (Shankaran 2007) are found to be positive factors in family dynamics of recovered or resilient individuals. This would promote the quality of social support to individual. It has been documented social support is a crucial factor in recovery (Gifford, et.al, 2006).

Community based interventions

Community based interventions (Pandian & Sinu, 2007) are found to be effective in ensuring the long term abstinence. Training of PHC doctors, NGO staff, volunteers, counselors, College, school and preprimary teachers, strengthening self help groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) and having an effective network with various service organizations in the community can be useful in addressing substance use disorders in case identification, diagnosis, referral to treatment, providing long term care and rehabilitation services.

Evidence

Social support system (Ashok, 2008, Kiran & Muralidhar, 2004), self motivation (Lilly, 2001), healthy family interaction (Shankaran, 2007, Pandian, 1999, Thirumoorthy, 1995, Veela, 1994) and regular treatment follow up (Rajaram, 1990) are found to be the major protective factors of abstinence after treatment.

Practice implication

Bio psycho social aspects of addiction support the need for multidisciplinary treatment efforts. Psychiatric nurses play a vital role to reduce the risk of relapse due to social factors through empowering patient to face social and environmental risks.

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