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90-644: The Crossroads Centre is a substance-abuse rehabilitation centre for drug and alcohol addiction located on the Caribbean island of Antigua in Antigua and Barbuda . It was founded with support from guitarist and singer Eric Clapton in 1998. He has been assisting with its funding by organising the annual Crossroads Guitar Festival since 1999. The centre was founded by guitarist Eric Clapton and Richard Conte, CEO of The Priory Hospitals Group (London), and Transitional Hospitals Corporation (Nevada). All development of

180-470: A 28–30 day program length. The length is based solely upon providers' experience. During the 1940s, clients stayed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. 70% to 80% of American residential alcohol treatment programs provide 12-step support services. These include, but are not limited to AA, Narcotics Anonymous , Cocaine Anonymous and Al-Anon . One recent study suggests

270-504: A definition. The Recovery Model originates in the psychiatric survivor movement in the US, which argues that receiving a certain diagnoses can be stigmatizing and disempowering. Some characteristics of the Recovery Model are social inclusion, empowerment to overcome substance use, focusing on strengths of the client instead of their deficits and providing help living more fulfilling lives in

360-541: A drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use addictive substances. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs but to examine and change habits related to their addictions . Many programs emphasize that recovery is an ongoing process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation , which may lead to relapse —is also emphasized ("One

450-515: A few countries: Madrid (Spain), "Crossroads Antigua: Office in Stockholm" . (Sweden), London (UK), Ottawa (Canada), New York (USA), Lakeville (USA) Crossroads Centre is a structured residential program which follows a 12-step approach modeled after the Betty Ford Center and Alcoholics Anonymous . As of 2013 the facility has 36 beds. Crossroads is the only drug rehabilitation program on

540-471: A form of oxygen starvation called hypoxia , brain damage and a serious vitamin B12 deficiency that can lead to nerve damage. Although dangerous and addictive in its own right, nitrous oxide has been shown to be an effective treatment for a number of addictions. In-patient residential treatment for people with an alcohol use disorder is usually quite expensive without insurance. Most American programs follow

630-608: A form of self-soothing. Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings to regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction. An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt's (1985) Relapse Prevention approach. Marlatt describes four psycho-social processes relevant to

720-438: A group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. Counselors are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It's very common to see them also work with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate

810-567: A lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, instead of continuing the destructive behavior. Once this has been achieved, the counselor coordinates with the addict's family to support them in getting the individual to drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in

900-699: A long process and the duration is dependent upon the patient's needs and history of substance use. Research has shown that most patients need at least three months of treatment and longer durations are associated with better outcomes. Prescription drug addiction does not discriminate. It affects people from all walks of life and can be a devastatingly destructive force. Certain opioid medications such as methadone and more buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone . Methadone and buprenorphine are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use , and

990-454: A permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist's job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunction. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment. A growing literature

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1080-1094: A precursor to addiction. Many rehabilitation centers treat "co-occurring" disorders, which refer to substance abuse disorder paired with a mental health diagnosis. Barriers to accessing drug treatment may worsen negative health outcomes and further exacerbate health inequalities in the United States. Stigmatization of drug use , the War on Drugs and criminalization, and the social determinants of health should all be considered when discussing access to drug treatment and potential barriers. Broad categories of barriers to drug treatment are: absences of problem, negative social support, fear of treatment, privacy concerns, time conflict, poor treatment availability, and admission difficulty. Other barriers to treatment include high costs, lack of tailored programs to address specific needs, and prerequisites that require participants to be house, abstinent from all substances, and/or employed. (See low-threshold treatment and housing first for more context on

1170-446: A professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed. One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled

1260-452: A psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also explained substance use. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesized specific drugs facilitate specific fantasies and using drugs

1350-611: A response to treating addiction as a disease that is enabled by family systems . Adult Children of Alcoholics (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. Co-Dependents Anonymous ( CoDA ) addresses compulsions related to relationships, referred to as codependency . Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Robert Holbrook Smith , known to AA members as "Bill W." and "Dr. Bob", in Akron, Ohio . In 1946 they formally established

1440-547: A rule, in twelve-step fellowships, spiritual awakening occurs slowly over a period of time, although there are exceptions where members experience a sudden spiritual awakening. In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, often as "Hi, I’m [first name only], and I’m an alcoholic". A sponsor

1530-702: A small hole in the skull to insert a tiny 1mm electrode in the specific area of the brain that regulates impulses such as addiction and self-control. This treatment is for those who have failed every other treatment, whether that is medicine, behavioral therapy, and/or social interventions. It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies. The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal well-being while other studies have considered "near abstinence" as

1620-480: A supportive social network that can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939. These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological and legal grounds. Opponents also contend that it lacks valid scientific evidence for claims of efficacy. However, there

1710-479: A very unpleasant reaction when drinking alcohol that includes flushing, nausea and palpitations. It is more effective for patients with high motivation and some addicts use it only for high-risk situations. Patients who wish to continue drinking or may be likely to relapse should not take disulfiram as it can result in the disulfiram-alcohol reaction mentioned previously, which is very serious and can even be fatal. Nitrous oxide , also sometimes known as laughing gas,

1800-780: A worldwide membership of millions have adopted and adapted AA’s 12 Steps and 12 Traditions for recovery . Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency. Demographic preferences related to the addicts' drug of choice has led to the creation of Cocaine Anonymous , Crystal Meth Anonymous and Marijuana Anonymous . Behavioral issues such as compulsion for or addiction to gambling , crime , food , sex , hoarding , getting into debt and work are addressed in fellowships such as Gamblers Anonymous , Overeaters Anonymous , Sexaholics Anonymous and Debtors Anonymous . Auxiliary groups such as Al-Anon and Nar-Anon , for friends and family members of alcoholics and addicts, respectively, are part of

1890-496: Is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome . The drug

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1980-514: Is a legally available gas used for anesthesia during certain dental and surgical procedures, in food preparation, and for the fueling of rocket and racing engines. People who use substances also sometimes use gas as an inhalant. Like all other inhalants, it is popular because it provides consciousness-altering effects while allowing users to avoid some of the legal issues surrounding illicit substances. Misuse of nitrous oxide can produce significant short-term and long-term damage to human health, including

2070-524: Is a long-acting opioid antagonist with few side effects. It is usually prescribed in outpatient medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk in the first three months by about 36%. However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates average 12% at 90 days for naltrexone, average 57% at 90 days for buprenorphine, average 61% at 90 days for methadone). Ibogaine

2160-455: Is a more experienced person in recovery who guides the less-experienced aspirant ("sponsee") through the program's twelve steps. New members in twelve-step programs are encouraged to secure a relationship with at least one sponsor who both has a sponsor and has taken the twelve steps themselves. Publications from twelve-step fellowships emphasize that sponsorship is a "one on one" nonhierarchical relationship of shared experiences focused on working

2250-554: Is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in the consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place

2340-413: Is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered tend to have little oversight and range from motel rooms to one moderately-sized rehabilitation center. A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction. These medications include bupropion and nortriptyline. Bupropion inhibits

2430-413: Is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural, and political factors, encapsulation, traumatophobia, and masturbation as

2520-466: Is demonstrating the importance of emotion regulation in the treatment of substance use. Considering that nicotine and other psychoactive substances such as cocaine activate similar psycho-pharmacological pathways, an emotion regulation approach may be applicable to a wide array of substance use. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco

2610-486: Is described as the cognitive processes that cause the individual to repeat the compulsive behavior after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as "unmanageable" refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again. The illness of

2700-608: Is often encouraged. Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence . Michel Foucault , a French philosopher, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them; relieves them of their burden of wrong, liberating them and promising salvation. The personal nature of

2790-565: Is preferable, with very high rates (79–100%) of relapse within three months of detoxification from levo-α-acetylmethadol ( LAAM ), buprenorphine, and methadone. According to the National Institute on Drug Abuse (NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and Hepatitis C by stopping or reducing injection drug use and drug-related high risk sexual behavior . Naltrexone

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2880-420: Is survey-based research that suggests there is a correlation between attendance and alcohol sobriety. Different results have been reached for other drugs, with the twelve steps being less beneficial for addicts to illicit substances, and least beneficial to those addicted to the physiologically and psychologically addicting opioids , for which maintenance therapies are the gold standard of care. SMART Recovery

2970-479: Is the sole fault of the person for becoming addicted. Supporters of the Moral Model view drug use as a choice, even for those who are addicted, and addicts as people of bad character. Disease Model of addiction frames substance abuse as 'a chronic relapsing disease that changes the structure and function of the brain'. Research conducted on the neurobiological factors of addiction has proven to have mixed results, and

3060-480: Is to enable the patient to confront substance dependence , if present, and stop substance misuse to avoid the psychological , legal, financial, social, and medical consequences that can be caused. Treatment includes medication for comorbidities , counseling by experts, and sharing of experience with other recovering individuals. Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach patients new methods of interacting in

3150-943: Is too many, and a thousand is never enough.") Whether moderation is achievable by those with a history of misuse remains a controversial point. The brain's chemical structure is altered by addictive substances and these changes are present long after an individual stops using. This change in brain structure increases the risk of relapse, making treatment an important part of the rehabilitation process. Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups , extended care centers, recovery or sober houses , addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs. In an American survey by three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and

3240-568: Is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. Acceptance and commitment therapy (ACT), is showing evidence that it is effective in treating substance use, including the treatment of polysubstance use disorder and tobacco smoking . Mindfulness programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts, appear to prevent impulsive/compulsive responses. Research also indicates that mindfulness programs can reduce

3330-499: The criminal justice system . People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There are a great number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding

3420-405: The spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality . This is a group norm , however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack

3510-407: The "eroded relationships" caused by active addiction. Quadrant Four often involves facing the harsh consequences of drug use such as unemployment, legal discrepancies, or eviction. The use of integral theory aims to break the dichotomy of "using" or "not using" and focuses instead on emotional, spiritual, and intellectual growth, along with physical wellness. Drug rehabilitation is sometimes part of

3600-528: The Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. An additional cognitively-based model of substance use recovery has been offered by Aaron Beck , the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse . This therapy rests upon

3690-719: The CA Department of Health Care Services investigating over 2,000 licensed rehab centers. In Afghanistan since the Taliban took power in 2021, they have forced drug addicts into compulsory drug rehab. Twelve-step program As summarized by the American Psychological Association (APA), the process involves the following: Twelve-step methods have been adapted to address a wide range of alcoholism , substance abuse , and dependency problems. Over 200 mutual aid organizations—often known as fellowships —with

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3780-634: The California Insurance Fraud Prevention Act (IFPA) which declares it unlawful to unknowingly conduct such businesses. Under the Affordable Care Act and the Mental Health Parity Act, rehabilitation centers are able to bill insurance companies for substance use treatment. With long wait lists in limited state-funded rehabilitation centers, controversial private centers rapidly emerged. One popular model, known as

3870-792: The Florida Model for rehabilitation centers, is often criticized for fraudulent billing to insurance companies. Under the guise of helping patients with opioid addiction, these centers would offer addicts free rent or up to $ 500 per month to stay in their "sober homes", then charge insurance companies as high as $ 5,000 to $ 10,000 per test for simple urine tests. Little attention is paid to patients in terms of addiction intervention as these patients have often been known to continue drug use during their stay in these centers. Since 2015, these centers have been under federal and state criminal investigation. As of 2017 in California, there are only 16 investigators in

3960-514: The SMART Recovery programs are: This is considered to be similar to other self-help groups who work within mutual aid concepts. In his influential book, Client-Centered Therapy , in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed

4050-650: The Society of Psychologists in Addictive Behaviors) measuring treatment responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics Alcoholics Anonymous identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or

4140-467: The Twelve Steps. According to Narcotics Anonymous: Sponsors share their experience, strength, and hope with their sponsees... A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through

4230-439: The Twelve Steps. Sponsors and sponsees participate in activities that lead to spiritual growth. Experiences in the program are often shared by outgoing members with incoming members. This rotation of experience is often considered to have a great spiritual reward. These may include practices such as literature discussion and study, meditation, and writing. Completing the program usually implies competency to guide newcomers which

4320-670: The Twelve Traditions. A singleness of purpose emerged as Tradition Five: "Each group has but one primary purpose—to carry its message to the alcoholic who still suffers". Consequently, drug addicts who do not suffer from the specifics of alcoholism involved in AA hoping for recovery technically are not welcome in "closed" meetings unless they have a desire to stop drinking alcohol . The principles of AA have been used to form numerous other fellowships specifically designed for those recovering from various pathologies ; each emphasizes recovery from

4410-464: The addiction and relapse processes: self-efficacy , outcome expectancy, attributions of causality, and decision-making processes. Self-efficacy refers to one's ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancy refers to an individual's expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual's pattern of beliefs that relapse to drug use

4500-419: The allergy-like bodily reaction resulting in the compulsion to continue using substances even when it's harmful or the addict wants to quit. The statement in the First Step that the individual is "powerless" over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result. The mental obsession

4590-399: The areas of publicity, politics, religion, and finances. Alcoholics Anonymous' Twelve Traditions are: In the twelve-step program, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics, the physical dimension is best described by

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4680-454: The assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as "I am undesirable," activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs ("I can handle getting high just this one more time") are facilitated. Once

4770-458: The authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in the outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques. The authors note two-factor theory involves stark disapproval of

4860-434: The behavioral issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterized as "friendship". Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioral problem that brought the sufferer into twelve-step work, which reflexively helps

4950-458: The clients' "irrational behavior" (p. 350); this notably negative outlook could explain the results. A variation of Rogers' approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs, such as Arizona's Department of Health Services . Psychoanalysis ,

5040-410: The consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates. People who are diagnosed with a mental health disorder and a simultaneous substance use disorder are known as having a dual diagnosis. For example, someone with bipolar disorder who also has an alcohol use disorder would have dual diagnosis . On such occasions, two treatment plans are needed with

5130-434: The facility was performed by officers and employees of these two companies. Conte and Clapton served as the centre's first two board members, with Conte being chairman. Transitional put up all working capital during the development phase and the facility was initially owned two-thirds by Transitional and one-third by Clapton. Former prime minister Lester Bird of Antigua was integrally involved with Transitional and arranged for

5220-635: The free-will model addiction). Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy , followed by relapse prevention . According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. Whatever

5310-642: The geographical location, gender, race, socioeconomic status, and status of past or current criminal justice system involvement of the person seeking treatment. Despite ongoing efforts to combat addiction, there has been evidence of clinics billing patients for treatments that may not guarantee their recovery. This is a major problem as there are numerous claims of fraud in drug rehabilitation centers, where these centers are billing insurance companies for under-delivering much-needed medical treatment while exhausting patients' insurance benefits. In California, there are movements and laws regarding this matter, particularly

5400-417: The government of Antigua's assistance with roads, utilities and a favourable land purchase price. Conte's wife is credited with naming the facility; his associate Lester Keizer of Transitional was the 'point man' on the project. The Crossroads Centre is located on the island of Antigua . It is a drug and alcohol treatment centre which has a 36-bed design. It opened in 1998. Crossroads have local offices across

5490-448: The importance of family participation in residential treatment patient retention , finding "increased program completion rate for those with a family member or significant other involved in a seven-day family program". Patients with severe opioid addiction are being given brain implants to help reduce their cravings, in the first trial of its kind in the US. Treatment starts with a series of brain scans. Surgery follows with doctors making

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5580-461: The individual, the collective society, along with individual and external factors. The four quadrants corresponding with each in Integral Theory are Consciousness, Behavior, Culture and Systems. Quadrant One deals with the neurological aspect of addiction. Quadrant Two focuses on building self-esteem and a feeling of connectedness, sometimes through spirituality . Quadrant three works on mending

5670-753: The island of 80,000 people. At a time when drug trafficking and addiction rates have been rising in the Caribbean, the facility will treat locals at low cost. Clapton's target is to have one-third of the beds reserved for permanent residents of the Caribbean islands. As of 2013 about 15 percent of the beds go to poor people from Antigua and Barbuda . Eric Clapton personally organises the Crossroads Guitar Festival since 1999, with guests such as Albert Lee , B.B. King , Jeff Beck , Keith Richards , Keith Urban , Robbie Robertson and Robert Cray among many others. The 2013 two-day event at Madison Square Garden

5760-512: The languaging of the third step (which once spoke of making "a decision to turn our will and our lives over to the care of God as we understand Him" ) sometimes occur to avoid gender-specific pronouns or to accommodate non-theistic beliefs. Some Twelve-steppers may adapt references to "God" to refer to a "higher power" or to "HP". The Twelve Traditions accompany the Twelve Steps. The Traditions provide guidelines for group governance. They were developed in AA in order to help resolve conflicts in

5850-465: The latter point.) In certain states, providers due to mandatory reporting methods and guidelines inform Child Protective Services of substance abusing parents for Schedule 1 substances including cannabis/marijuana. If a mother tests positive for using the substance during pregnancy in South Carolina she may be required to forfeit her child. Further, barriers to treatment can vary depending on

5940-422: The majority of twelve-step members are recovering from addiction to alcohol or other drugs. The majority of twelve-step programs, however, address illnesses other than substance addiction. For example, the third-largest twelve-step program, Al-Anon , assists family members and friends of people who have alcoholism and other addictions. About twenty percent of twelve-step programs are for substance addiction recovery,

6030-657: The mental health disorder requiring treatment first. According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder. Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exist for both working with the person using the substance (community reinforcement approach) and their family ( community reinforcement approach and family training ). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on

6120-511: The methodology, patient motivation is an important factor in treatment success. For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like methadone and buprenorphine can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs. Types of behavioral therapy include: Treatment can be

6210-419: The only treatment idea it offers is abstinence. The Socio-Cultural Model tries to provide an explanation of how certain populations are more susceptible to substance abuse than others. It focuses on how discrimination, poor quality of life, lack of opportunity and other problems common in marginalized communities can make them vulnerable to addiction. The Psycho-Dynamic Model looks at trauma and mental illness as

6300-425: The organizations as cults , while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some. Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity , replacing it with the deviant identity. Another study asserts that

6390-582: The other eighty percent address a variety of problems from debt to depression . It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain. A 2020 Cochrane review of Alcoholics Anonymous showed that participation in AA resulted in more alcoholics being abstinent from alcohol and for longer periods of time than cognitive behavioral therapy and motivational enhancement therapy , and as effective as these in other measures. The 2020 review did not compare twelve step programs to

6480-431: The presence of symptoms of addiction. Another key component of the Recovery Model is the collaborative relationship between client and provider in developing the client's path to abstinence. Under the Recovery Model a program is personally designed to meet an individual clients needs, and does not include a standard set of steps one must go through. The Recovery Model uses integral theory: a four-part approach focusing on

6570-470: The presence of these three items, in the therapeutic relationship , could help an individual overcome any troublesome issue, including but not limited to alcohol use disorder . To this end, a 1957 study compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy , and psychoanalytic therapy . Though

6660-421: The public. Counselors should be able to recognize how addiction affects the whole person and those around him or her. Counseling is also related to "Intervention"; a process in which the addict's family and loved ones request help from a professional to get an individual into drug treatment. This process begins with a professionals' first goal: breaking down denial of the person with the addiction. Denial implies

6750-543: The re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant which has been used to aid in smoking cessation it has not been FDA approved for this indication. Acamprosate , disulfiram and topiramate (a novel anticonvulsant sulphonated sugar) are also used to treat alcohol addiction. Acamprosate has shown effectiveness for patients with severe dependence, helping them to maintain abstinence for several weeks, even months. Disulfiram produces

6840-400: The relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as

6930-772: The requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U.S. Constitution, mandating separation of church and state. In some cases, individuals can be court-ordered to drug rehabilitation by the state through legislation like the Marchman Act . Traditional addiction treatment is based primarily on counseling. Counselors help individuals with identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it's more common to find it in

7020-948: The researchers behind the review noted the weakness of most of the studies analyzed, which may lead to interpretations of their results that did not accurately reflect the actual picture. In the past, some medical professionals have criticized twelve-step programs as "a cult that relies on God as the mechanism of action" and as lacking any experimental evidence in favor of its efficacy. Ethical and operational issues had prevented robust randomized controlled trials from being conducted comparing twelve-step programs directly to other approaches. More recent studies employing non-randomized and quasi-experimental studies have shown twelve-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches. The Twelve Traditions encourage members to practice

7110-509: The result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek

7200-409: The risks associated with it, such as disease, arrest, incarceration , and death, in line with the philosophy of harm reduction . Both drugs may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids. All available studies collected in the 2005 Australian National Evaluation of Pharmacotherapies for Opioid Dependence suggest that maintenance treatment

7290-534: The specific malady which brought the sufferer into the fellowship. The following are the twelve steps as published in 2001 by Alcoholics Anonymous: Where other twelve-step groups have adapted the AA steps as guiding principles, step one is generally updated to reflect the focus of recovery. For example, in Overeaters Anonymous, the first step reads, "We admitted we were powerless over compulsive overeating—that our lives had become unmanageable." Variations in

7380-462: The spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness. The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action. In twelve-step groups, this is known as a "spiritual awakening." This should not be confused with abreaction , which produces dramatic, but temporary, changes. As

7470-575: The sponsor recover. A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts is associated with sustained abstinence for the sponsor, but suggested that there were few short-term benefits for the sponsee's one-year sustained abstinence rate. Alcoholics Anonymous is the largest of all of the twelve-step programs (from which all other twelve-step programs are derived), followed by Narcotics Anonymous;

7560-458: The twelve traditions to help deal with the issues of how various groups could relate and function as membership grew. The practice of remaining anonymous (using only one's first names) when interacting with the general public was published in the first edition of the AA Big Book. As AA chapters were increasing in number during the 1930s and 1940s, the guiding principles were gradually defined as

7650-463: The use of disulfiram or naltrexone , though some patients did receive these medications. These medications are considered the standard of care in alcohol use disorder treatment among medical experts and have demonstrated efficacy in randomized-controlled trials in promoting alcohol abstinence. A systematic review published in 2017 found that twelve-step programs for reducing illicit drug use are neither better nor worse than other interventions, though

7740-465: The use of problem-solving techniques as a means of helping the addict to overcome his/her addiction. The way researchers think about how addictions are formed shapes the models we have. Four main Behavioral Models of addiction exist: the Moral Model, Disease Model , Socio-Cultural Model and Psycho-dynamic Model. The Moral Model of addiction theorizes that addiction is a moral weakness and that it

7830-463: The user in a high-risk situation. For example: As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual can employ successful coping strategies , such as distracting himself from his cravings by turning on his favorite music, then he will avoid

7920-474: The workplace environment with colleagues instead of family. One approach with limited applicability is the sober coach . In this approach, the client is serviced by the provider(s) in his or her home and workplace—for any efficacy, around-the-clock—who functions much like a nanny to guide or control the patient's behavior. The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displays addicted individuals are

8010-519: Was founded by Joe Gerstein in 1994 by basing REBT as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. It does not subscribe to disease theory and powerlessness. The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of

8100-647: Was the fifth such benefit concert. Also supported are two halfway houses for recovering addicts, on Antigua for local residents, and in Delray Beach, Florida , for others. 17°02′20″N 61°43′33″W  /  17.0390°N 61.7258°W  / 17.0390; -61.7258 Substance-abuse rehabilitation Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol , prescription drugs , and street drugs such as cannabis , cocaine , heroin , and amphetamines . The general intent

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