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<br /> 06/01/2007 10:24 7753542378 LESYMAE F'C(3E 05
<br /> psychiatric Times P,~;f; 3 ~~f'6
<br /> moderate to severe dependence. The purpose of th,l< is r,:icic
<br /> i is to address the management of the most eX[rer9E' evr I crt F;erardad
<br /> addiction, heretofore not well-delineated or tested ir. F,rychiatri
<br /> j psychiatric settings.
<br /> Although most psychiatrists understand the chro I:: ~ r ab i'r: >f
<br /> severe addiction, they may find it difficult to vies; il: r f I e.
<br /> same light as other psychiatric Illnesses such as rnepntrs! In-
<br /> anxiety disorders or psychosis. This is primarily due ;c iii e
<br /> volitional nature of initial intoxicant use and moil,px'III r ~rtts mitte~~
<br /> ' against dtvg users. substance users are likely to ba !.ter Ir..
<br /> immoral and Irresponsible people who brought thrr
<br /> problems on themselves and, therefore, are lase vr:al •~y
<br /> our sympathy or support. The association betwe'~ i ;I •di: c :;i: I
<br /> and borderline persondlity disorders and addictive r7";ant;~s
<br /> reinforces this idea- Tha political dwmnni~atinn of illirir r r y;
<br /> I users also promotes punitive, rather than therapeut;%;
<br /> measures. New evidence, however, demonstrate!= ionq•
<br /> standing changes in brain function and structure ~Yra+ rr r!e
<br /> drug use compulsive and extremely difficult to ton^.rtd c' str¢
<br /> (Leshner, 1997). Studies have also demonstrated t:hnC L' U:L
<br /> ` Compliance and outcome in drug dependence ar:: e': r, ~r; t .:e
<br /> good as, if not better than, those in other serious psyr;r a:ri:
<br /> i disorders (o'9rien and McClellan, 1996, as cited in
<br /> j Willenbring, 1999). Moreover, ¢ Is pragmanpNy helf`u far
<br /> ' psychiatrists to adopt a chronic illness approach t~ a~f:arllcrr,
<br /> I not only because it helps us puC aside moral judg r acct:;;, I:,II
<br /> i because we can apply the same skills we use to t:Ernt 4'r::r
<br /> illnesses to the treatment of substance dependen :r!
<br /> i'
<br /> Appruachiny dray addiction as a true chronic illness, nryiilreo~
<br /> a different view of goals and outcomes as well, Lcng-:~: ni
<br /> abstinence from drug use is, of course, the optim ~i g::a It s
<br /> a cure with permanent remission from the sympt<~n•: r.1 c r.r3
<br /> dependence. Historically, any goal short of germane rt
<br /> abstinence was considered a failure. Cure is not aWvay ,
<br /> possible, however, and it is not the only outcomr: Deft • c l~
<br /> represent Improvement or response to treatment. '15tr•ip ~r!uy
<br /> cessation or reduction of use, reduction In symptorris oaf
<br /> addiction, or reduction in severity of co-existing prober: a"e
<br /> • all improvements short of cure that are nevertheless ~,uo •:hy
<br /> of pursuit. To accopt a goal short of permanent abzci •~rrr cu i;
<br /> pragmatic, not "enabling," because it is realistic and
<br /> appropriate, considering the natural history of the ~ais::rr,:cr.
<br /> Approaching addiction realistically allows psychizl.-i;ra~ ;lo
<br /> what we can (which is often quite a bit), while ac:aaa~-c :I•~!t
<br /> ~ our treatments are only partially effective.
<br /> In the debate about national and international dn,g pc~lh t',
<br /> harm reduction is an approach that follows something al a
<br /> middle path between harshly punitive prohibitiort And Ili iSe::
<br /> faire legalization (Reuter and Caulkins, 1995). Many i4e; a!ri
<br /> European nations, such as the Netherlands, Swltnz•t;rii i •u:
<br /> Spain, have ufricielly adapted berm reduction pufici,::a hlern-
<br /> reduction is also commonly referred t0 as the public. Ir::irui•r
<br /> model because of its focus on treatment and overall soc tl
<br /> ana nearcn policy, rather than on punishment (orucl<:e ,
<br /> i 1995)- This term is now being applied to dinica4 prac~,:ice srml
<br /> refers to an approach that seeks to minimize harm an a
<br /> I improve health and well-being, without taking an a1:3oluC 5':
<br /> stance regarding an abstinence requirement. It Pence w
<br /> also to dlstingWSh long-term management of a chr~:rnic
<br /> illness from conventional intensive substance abu-:r!
<br /> http://www.psychiattictimes.com/p000255.httnl ' L3 ; 12007
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