The Arkansan City of Van Buren, in Crawford County, faces aserious epidemic of prescription drug abuse.
The city, in the Fort Smith,Arkansas-Oklahoma Metropolitan Statistical Area has demographic profile fairlytypical of many southern, small to midsize towns. The population of more than20,000 is predominantly white with a modest median household income of about$35,000. Many residents work in low paying jobs at local food processing andmanufacturing industries. According to local prosecutors, in recent years,prescription drug prosecutions in the county have surpassed both a chronicproblem with methamphetamines and also marijuana prosecutions. The trend islinked to the Arkansas’ high rate of opioid prescriptions.
In a 2017 report,the Centers For Disease Control and Prevention (CDC) ranked Arkansas secondonly to Alabama for its rate of opioid prescriptions. The figures showedCrawford County’s prescription rate as among the worst in the state and at 158per 100 people more than twice the national average. The problem ofprescription drug abuse is especially serious among teenagers.
The attorneygeneral, Leslie Rutledge, says Arkansas ranks first in the nation for misuse ofpainkillers among children aged 12 to 17.Some efforts to combat the prescription drug problem couldbe starting to impact the city. State legislation passed in 2017 mandates thatdoctors enter the information on the drugs they prescribe to patients into thestate’s Prescription Drug Monitoring Program (PMP) database. Several high schoolsin the Fort Worth metropolitan area are taking part in a prescription drugabuse education program launched in 2017 by the attorney general. The CrawfordCounty Sheriff’s Department, head-quartered in Van Buren, also participates inOperation Drug Take Back and has a box for returning old prescription drugs.
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AssessmentAn addiction assessment is used to determine if a person hasan addiction, its extent and if there are other issues present. A range ofprofessionals are able to conduct these assessments, including doctors, nurses,social workers and psychologists. The information provided is kept confidentialand can consist of a questionnaire, an interview and a physical exam.The questionnaire asks about drug or alcohol use, medicalhistory, general health and the impact any drug use may have had on theperson’s daily life.
This is followed by a personal interview with a healthprofessional that together with the questionnaire helps to form a diagnosis.Assessment tools used by clinicians during this processinclude the National Institute on Drug Use Screening Tool (NIDA), the AlcoholUse Disorders Identification Test-C (AUDIT-C) and the CAGE assessment. The person may have to provide a urine sample to test fordrugs consumed.
A blood sample can also be requested to help establish anyhealth impacts from drug abuse.Pre-intake The pre-intake process is the step before a person actuallystarts a more formal intake process to actually enroll in a drug rehabilitationprogram. Pre-intake procedures might involve a questionnaire or an informalinterview.IntakeThe intake process determines if the rehabilitation centerselected by the person seeking treatment is the right option for theiraddiction. The person and the center’s representative will discuss thetreatments offered by the facility to decide if it’s a good fit for their stageof addiction. The rehabilitation center will ask about the seriousness of theaddiction, drug use history, any relevant family history and also discussfinancial options if the rehabilitation at the center goes ahead.DetoxRecovering from drug and alcohol addictions usually involvesa detoxification phase at the start of the rehabilitation process. The detoxphase aims to completely remove the drugs from the body.
In the case of opiateprescription drugs, maintenance medication can be administered to reducewithdrawal symptoms. Various factors impact how difficult this process is forthe person experiencing the detox, including: – The person’s metabolism and general health- The amount and frequency the drug was being taken- The length of time the drug was taken- The existence of any other addictions.Under medical supervision the process is usually safe.However, due to the severity of the process in certain situations it’s notadvisable to undertake a process of drug detoxification in your own home.During the process a person’s body experiences withdrawlsymptoms which usually appear within 24 hours of taking the last dose of drugs.The person can experience a range of withdrawl symptoms, including: nausea,fatigue, depression, cramping and increased heart rate.Some addictions, for example, to heroin, opiates, andalcohol, can require medications to ease the severity of the withdrawal processduring detox. The medications can include:Methadone.
This drug is often used during detox from opiateprescription medications or heroin. The dose is reduced over time and maycontinue beyond the actual detoxification process. BuprenorphineBuprenorphine is another option for treating heroin andprescription opioid addictions. The drug’s advantage over methadone is that itdoesn’t give the patient a ‘high’ making abuse and possible addiction lesslikely.BarbituratesThese medications help to relieve anxiety, general discomfortand irritability during the detox process. Barbiturates can also act as a mildsedative.
InpatientTreatment (IP)A clinical professional will determine the appropriate levelof care. The highest level is inpatient (IP) treatment and consists of 24-hournursing care in a hospital setting. Individuals suffering from serious andunstable medical or psychiatric issues generally opt for an acute level of IPcare. Acute care is maintained until the person is stable.Residential TreatmentCare (RTC)Residential treatment care (RTC) is one level below IPtreatment.
RTC facilities are referred to as sub-acute facilities and ratherthan 24 hour nursing attention, provide 24-hour monitoring. Diagnostic servicesare also provided that aim to help people overcome any severe drug relatedsymptoms that significantly impede day to day functioning. Residents typicallyreceive intensive treatment through about 30 group sessions per week and sevenindividual sessions per week, including about three therapy sessions involvingdietary consultations and individual consultations with the program’spsychiatrist and physician). Each week, a weekly family treatment allows anyonefrom the person’s main social network can participate.
The typical length ofstay ranges from 30-60 days. Partialhospitalization (PHP)Partial hospitalization (PHP) treatment, also referred to asday treatment, is an intensive care program that typically lasts four to eighthours per day, three to seven days per week. The care is time limited and appropriatefor a person that lives in close proximity to the care program’s location andwhose drug related behaviors and medical issues can be treated without a morestructured treatment process. Partial day treatment programs include group,individual and family or primary support network therapy. Medications is alsomonitored and the duration of the treatment varies from two to twelve weeks.
Intensive outpatienttreatment (IOP)Intensive outpatient treatment (IOP) can require individualsto have a minimum of nine hours of therapy per week. A clinical professionaldetermines if this is the appropriate level of care through screenings andother assessments. IOP is often a mixture of group and individual therapy. Thenine hours of treatment are usually divided into three-hour sessions, three tofive evenings a week for 12-16 weeks duration. Once the program is successfullycompleted, the individual steps down to what’s called a “maintenance”therapy group that may meet weekly.
The average size for a group undertaking amental health intensive outpatient treatment program is eight to 15 people. Outpatient Care (OC)Outpatient treatment is regarded as the lowest care leveland is usually offered once a week. Outpatient settings can vary greatly butthey all involve office visits with no overnight stays. Some OC facilities arelocated in community mental health centers and others are based in hospitals oroutpatient clinics.
Aftercare Aftercare for people recovering from drug addiction iscontinuing treatment immediately following a defined period of addictiontreatment care like inpatient treatment or outpatient care.Continuing treatment of this kind is essential forrecovering addicts because substance abuse can alter normal brain function andchange mental and physical health. These changes do not necessarily reversethemselves, even after detoxification and a treatment program, and may lastmany years after a person ends their substance abuse.The aims of an aftercare program include:- Stopping a relapse into drug addiction- Maintaining a sense of purpose in life- Ensuring a person’s mental and physical recovery fromaddiction continues. Sober livingSober living homes are used by people recovering fromaddiction and provide a transition between their rehabilitation and move backinto mainstream society. These homes are a drug and alcohol free environmentand many are certified by Sober Living Coalitions or groups. Sober livingfacilities often have these key features:- Residents are encouraged to take part in group therapy – Residents are drug tested periodically to ensureabstinence.- Residents are required to carry out chores, prepare mealsand follow other house rules.
– Residents are supported in their efforts to work towardsgoals like finding a job or completing school.- Residents must pay lodging fees punctually.Most sober living homes are single sex but co-ed facilitiesare easy to find. Other sober living facilities are sober colleges and catersolely for young people’s recovery from drug addiction and function not unlikea college dormitory. Many establishments combine as outpatient treatmentcenters so they are staffed 24 hours by medical professionals and socialworkers. These facilities also have personnel that take care of cooking and cleaning.
These sober living centers tend to cost more but can provide a cheaperalternative to often expensive inpatient treatment.Some health professionals say sober living homes do increasethe likelihood of a sustained recovery from drug addiction especially when aprogram based on the 12 Step model is followed. According to the SubstanceAbuse and Mental Health Services Administration (SAMSHA) the majority of drugaddiction treatment centers use the model at least occasionally.The 12 Step model was developed by Alcoholics Anonymousfounder Bill Wilson and is based around the idea that sharing personal storiesof addiction has a positive effect. Wilson believed that people can sustainabstinence from their addictions if they help one another.
This help comes inthe form of regular meetings where participants share their feelings abouttheir addiction and support each other through the recovery process.The 12 Step process can be summarized as follows:- The addict admitting that they cannot control their addiction.- The addict recognizing that a higher power can providestrength.
– The addict examining their past errors with the help of anexperienced member of the group.- The addict making amends for this past mistakes.- The addict learning to live by a new code of behavior.- The addict helping others who suffer from addiction.
