Reference no: EM133407759

The goals of treatment: In the United States, the vast majority of treatment programs profess that total abstinence from alcohol or drugs is their goal. They do so with the knowledge that only a minority of those who complete treatment remain abstinent from further alcohol or illicit drug use. In virtually every other disease state, the patient's wishes are discussed with the patient by the health care provider, and a course of treatment is decided upon. If the patient should wish only palliative care, this wish is accepted as the appropriate treatment goal. If the patient should desire that intravenous fluids not be administered after a certain point, this wish is accepted by the health care professionals. Should the patient not wish to be resuscitated[1] or have "extreme measures" used to extend their lives, or should there be no hope of recovery, the patient's desires are used to guide treatment.

However, substance rehabilitation programs are different in that the goal of total abstinence from continued alcohol or illicit drug use is identified as the only appropriate treatment goal by the treatment staff, usually without consultation with the patient, and in many cases even before the patient enters the treatment program. For the sake of discussion, let us assume that only 5% of those who complete treatment will eventually achieve lasting abstinence. This means that 95% of those individuals who enter treatment will eventually relapse.

Before answering this question, consider a comparison to a hypothetical form of cancer. In spite of the best of treatment, 95% of those patients afflicted with this hypothetical condition die within a year. Should the physician work toward the goal of a complete cure? This hypothetical problem parallels the state of SUD treatment at this time: It is imperfect and most patients relapse after treatment, but the time between discharge and the relapse, and the intensity of chemical use following discharge, are often markedly reduced. Post-treatment assessments to demonstrate the effectiveness of substance rehabilitation are based on the assumption that it is possible to produce a lasting elimination of subsequent substance use: a "cure" (McLellan, 2009, p. 1220). For many medical disorders, such as congestive heart failure or chronic obstructive pulmonary disease, for example, a cure is only rarely possible. In the majority of cases, treatment can slow the progression of the disorder, adding months or years to the patient's life. This is considered acceptable, at least until new therapies are developed to reverse the disease. Yet the SUDs are held to a different standard: One treatment exposure should produce a "cure" rather than to slow the progression of the disorder, or perhaps cause periods of remission interspaced with periods of continued substance misuse. By these standards, rehabilitation programs offer patients a 5% chance to a total cure.

Questions

1. Should total abstinence be a goal of treatment? Why or why not? How should treatment goals be determined, and by whom? Why?

2. What would you consider to be important goals for a patient entering treatment? How would these goals vary between patients?