a long journey from inebriate asylums
DESCRIPTION
TRANSCRIPT
Gina de Peralta Thorne, MSDirector of Business
Development
A Long Journey from Inebriate Asylums
Objectives:
• Provide a historical overview of the treatment of alcohol.
• Discuss events that prompted changes to alcohol/addiction treatment.
• Discuss current levels of care available for addiction treatment services.
Early Addiction Medicine
Non-specialty institutions
that could do little for their
conditions:• Jails• County farms• Almshouses• Water cure institutions • Insane asylums
Pioneers in Addiction Medicine
• 1774, Anthony Benezet’s - Mighty Destroyer Displayed is published. It is the earliest American essay on alcoholism.
• 1784, Dr. Benjamin Rush’s - Inquiry into the Effects of Ardent Spirits on the Human Mind and Body, argued that the condition was a disease that should be treated by physicians.– Rush’s writing marked beginning of
American temperance movement.
1800’s
• 1810 -Dr. Benjamin Rush called for creation of a “Sober House” for the care of the “confirmed drunkard”.
• 1825, Rev. Lyman Beecher’s Six Sermons on Intemperance described the presence of an “insatiable desire to drink,” and described warning signs of addiction to distilled spirits.
Medically Oriented Inebriate Asylums
• Inebriety (alcoholism wasn’t coined until 1849), could and should be cured within special institutions.
• Medically-oriented inebriate asylums -New York State Inebriate Asylum in 1864
Methods of Treatment
Utilized physical methods of treatment:
– Drug therapies– Aversion therapy– Hydrotherapy– Electrical stimulation.
Inebriates could be legally committed to such institutions for periods ranging from one year to “until the patient is cured.”
Temperance Influenced Inebriate Homes
• Recovering Alcoholics founded mutual aid societies– Native American Temperance Societies– Washingtonians– Reform Clubs– Leaders from these groups formed
inebriate homes
Inebriate Homes
• Short voluntary stays and non-physical methods of treatment.
• Alcoholism recovery in most of these homes was viewed as a process of moral reformation.
Religiously Sponsored Missions & Recovery Homes
• Jerry McAuley opened the Water Street Mission in 1872
• Redeemed alcoholics• Weekly Advertisements stating: “Everyone
welcome, especially drunkards.” • New York Christian Home for Intemperate Men
– religiously oriented.• viewed recovery from addiction as a process of
religious conversion--a process of spiritual rebirth.
Addiction Treatment Franchises
• Private for-profit sanataria and addiction treatment institutes
• Home cures – Promoted alcohol, opium and cocaine-
laced products.• Hangover cures and alcoholism cures
Collapse of Early Addiction Treatment
• Internal Threats • Ethical
Breaches • Economic
Threats• Political Threats
- Prohibition
20th Century Addiction Treatment
• 1906 - Courtenay Baylor – 1st lay therapist
• 1940 – AA Bill Wilson & Dr. Bob• Minnesota Model – distinguished
between 12 step and Professional counseling.
What is Treatment?
American Society of Addiction Medicine
Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism
or from another drug dependency designed to enable the affected individual to achieve and
maintain sobriety, physical and mental health, and a maximum functional ability.
Types of Treatment
• Physical and Psychiatric evaluations• Detoxification• Counseling• Self-help support (12 – step)• Treatment for co-morbid physical or
behavioral complications• Medication assisted therapy
Principles of Effective Treatment
• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
Principles of Effective Treatment
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
• • An individual's treatment and services plan must be assessed continually
and modified as necessary to ensure that it meets his or her changing needs.
• Many drug-addicted individuals also have other mental disorders.
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
Interventions
Detoxification
Detoxification is the process by which the
body clears itself of drugs and is oftenaccompanied by unpleasant and
sometimeseven fatal side effects caused by
withdrawal.
Medically Assisted Treatments
Medically assisted treatment (MAT) is a type of pharmacotherapy that describes any type of treatment that's used for substance use disorders that includes a pharmacologic intervention as a part of their treatment plan. • The goal is for the patient to recover and to be able to fully function in society.
• Methadone (Opiate/Heroin)• Buprenorphine (Opiate/Heroin) • Disulfiram (Antabuse)• Naltraxone (Vivitrol) - alcohol• Acamporsate (reduces WD symptoms)
Long-Term Residential Treatment
• Long-term residential treatment – 24 hours a day, – Non-hospital settings– Therapeutic community (TC)– lengths of stay between 6 and 12 months. – Treatment is highly structured- confrontational
at times
Short-Term Residential Treatment
• Short-term residential programs– Intensive but relatively brief treatment
based on a modified 12-step approach.– 28-32 day model
Outpatient Treatment Programs
• Treatment costs less than residential or inpatient treatment
• More suitable for people with jobs or extensive social supports
• Intensive Outpatient Treatment (IOP)– Group counseling can be a major
component
Individualized Drug Counseling
Individualized drug counseling • Focuses on reducing or stopping illicit
drug or alcohol use• Addresses related areas of impaired
functioning such as employment status, illegal activity, and family/social relations
• Content and structure of the patient's recovery program.
Group Counseling
Recovery Coaching
Recovery coaching is a form of strengths-based support for persons with addictions or in recovery from alcohol, other drugs, codependency, or other addictive behaviors. Recovery coaches work with persons with active addictions as well as persons already in recovery.Recovery coaches do not:• Offer primary treatment for addiction• Diagnose• Associate with any particular method or means of
recovery
Farley Center at Williamsburg Place
What is the Farley Center at Williamsburg Place?
• Partial Day Hospitalization Program. (Varying length of stay with a treatment experience averaging as short as a few days to 12 weeks)
• Treat Adult Alcohol and Drug Addiction and/or Dual Diagnosis patients. (18 yrs and up)
• 72 bed capacity• FC/WP is accredited by the Joint Commission on Accreditation of Healthcare
Organizations
Where is the Farley Center at Williamsburg Place?• Located on 10 acres outside of Historic Colonial Williamsburg, VA.
(Mooretown Road)• 40 minutes from Richmond Airport (International)
We Treat FamiliesNot Just the Addict/Alcoholic
Goals of WP Treatment
• Safe medical withdrawal “Detox”• Development of abstinence-based lifestyle• Nurture identity apart from professional lifestyle.• Exposure to and assimilation into 12-step
programs• Developing and practicing recovery skill set under
stressful and unpredictable circumstances• Identify and address relapse warning signs• Internalize need for surrogate decision making
across Psychosocial domains
Programs Offered
• Addiction Treatment/Dual Diagnosis
• Addiction Treatment/Chronic Pain
• In-Resident and Outpatient Evaluations
• Family Program
• Addicted Professionals• Physicians• Dentists• Attorneys• Pharmacists• Business Executives
References
White, W. L. (1999). A lost world of addiction treatment. Counselor, 17(2), 8-11.
Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry 1:42-52, 1996.
Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential drug treatment programs: Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches in the Treatment of Drug Abuse, Westport, CT: Greenwood Press, pp. 45-60, 1993.
http://www.asam.org/