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Combining Therapies are More Effective

After reviewing and discussing the ground rounds, presentations, lectures, assigned readings and other course materials, I believe it is a valid and accurate assessment to say addiction is a most complex disease with many variables and components which require many different therapeutic modalities in which to treat. The combined therapy philosophy has markedly shown to improve outcomes compared to the one-dimensional, single-treatment option program ideology. There is a foundation within this argument for a variety of reasons.

As mentioned in earlier discussions, the biopsychosocial model we have studied provides a broadly encompassing modality in which to begin a specifically tailored treatment plan for patients in addiction programs. When this modality is coupled with pharmacotherapy and Cognitive Behavioral Therapy, recovery statistics provide us with a accurate and valid proof for a combined therapeutic approach in the treatment model of addiction. Although, there is no quick and easy algorithm for providers to follow, the combined therapies available provide us with statistically significant results as being being most successful.

As presented in earlier modules, the five pillars of addiction treatment provides further foundation for the combining therapies system being utilized presently within Addiction and Recovery Medicine. Currently, it is this foundation which now appears to be the providing the long term successes in recovery programs. Additionally, it is providing a valid starting point in which this multidisciplinary approach begins. The results are most beneficial and positive, when this systematic approach is properly outlined and followed. With these principles in mind, the resultant creation of a tailored, individualized treatment plan has its most efficacy where it is proven to exponentially increased a patients probability of being both effective and successful in their


The 5 essential pillars of addiction discussed in lecture are as follows: 1. A comprehensive assessment of the stage, scale and severity of the disease as well as testing for co-occurring disorders and a tailored treatment plan. 2. Stabilization of the patient’s condition through complete cessation of substance use and medically-supervised detoxification for those who are dependent. 3. Access to acute care such as evidence-based pharmacotherapy as well as psychosocial treatment. 4. Chronic disease management to help in relapse prevention and maintain positive milestones in recovery 5. Mutual support services such as self-help programs which provide social and emotional support.

In practice, effective addiction treatment programs take a multidisciplinary, multifaceted approach, Typically the treatment team includes addiction medicine specialists, psychiatrists, counselors, and therapists. Initially, the patient is typically admitted to a drug detoxification facility for medically supervised drug detoxification which is not considered as therapeutic from an addiction standpoint.

According to the National Institutes of Drug Addiction, detox is not a treatment and proves to do virtually nothing in successful long-term outcomes. Although not a stand-alone therapy, this facet to the initial patient stabilization is essential to the recovery process especially in cases with alcohol, benzodiazepine, and barbiturate detoxification as the withdrawal symptoms from these substance classes can be life-threatening.

On stabilization, the specific work up process begins with a complete medical evaluation with comprehensive mental status examinations added to the complete history and physical examination. Multidisciplinary healthcare specialists are many times called in to help with other internal pathological processes such as; Gastrointestinal liver and pancreatic problems, Neurological presentations, Hematological Derangements, Nutritional Consults for severe nutritional deficiencies, and other coexisting individual medical issues. There are many examples of combined treatments and combined therapeutics for patients being treated with addiction. One treatment example type which has proven quite successful is in pharmacotherapy. This therapy has shown significant efficacy with patient compliance in recovery from the detox phase well into the cognitive phases of recovery. This example uses crucial, specific pharmaceutical approaches to reduce unpleasant withdrawal symptoms that otherwise might cause a patient to drop out of psychosocial therapy. A second combined therapy example, details different treatment modalities for each substance found in a patient's history. This is thought to target different addiction mechanisms within the brain centers found to be responsible in the biological reward mechanisms in the primitive midbrain structures. For example, nicotine cessation pharmacotherapy can address physical dependency, while psychosocial treatment to the physical habitual factors can help the recovering addict develop skills and coping mechanisms to achieve long term cessation as well as avoid relapse. A third example of combined therapeutics is found in patients with a comprehensive treatment plan put in place for in-patient treatment. Usually, the patients do best in a long-term specialized residential facility with a multidisciplinary treatment arm. It was in my personal experience that I submit this valid case. From the outset, I was given an individual and comprehensive combined treatment plan. First, I was properly assessed medically both physically and mentally. Then I was stabilized with pharmacology for three weeks in the short-term plan and for 6 months within the long-term plan. Included in the short-term assessment plan a schedule of 8 hours of daily, mandatory groups and class curriculum was implemented all of which occurred in a strictly, monitored therapeutic environment were daily and nightly readings, homework and evening group discussions.

Individual and Group Cognitive Behavioral Therapy was provided from day 0 with a strong emphasis placed on behaviors within my presenting addiction to alcohol, my drug of choice. Within days, more support groups were added to my regime where a daily 12 step AA mutual support groups were attended in addition to my recovery case plan. My individualized treatment plan added a psychologist, a psychiatrist, an internist, licensed counselors which was added to awareness programs with others in recovery.

Lastly, my obligatory aftercare exit plan included Intensive Outpatient Therapy 3 times per week for 9 hours with mandatory urinalysis and nightly exercises for 6 months after my release from in the in-patient center. My recover was not limited there however as I was offered spiritual guidance sessions in pray and meditation which fit into the choice of my belief system.

The healthcare environment where my spiritual malady as treated its core in truing my life over to the care of God, my higher power, in which to start and end each day in this new life long journey in sobriety.

I submit, testify and witness, that after 15 years of doing all ways possible, that,

"There is no real recovery without spiritual, God Centered Practices,

Regardless of Religion!"

It is well known in the recovery community and to me personally, the best treatment programs provide individualized evidence-based treatment plans.

“These plans more times than not, offer detailed addiction education, group, individual and family therapy, treatment of coexisting psychiatric and medical conditions, stress management, relapse prevention strategies, 12-step recovery, reentrance exit planning, neuropsychiatric testing, and, as needed, ongoing medication therapies with drugs” (Principles of Addiction).

It has also been shown that treatment duration of 90 to 120 days of a strictly controlled therapeutic environment yields the best outcomes. With long-term post-treatment drug testing improves outcome dramatically, and can be viewed as a part of treatment.

I testify to this treatment modality as my DUI Court Program offers long term CBT and requires two random Urinalysis Tests per week for 9 months. The bottom line or end point is, this program works! The DUI Court diversion program boasts a 80% success rate for those remaining in recovery but more importantly is providing the means for people to change their lives.

Personally, this program has been a crucial and instrumental part to my long-term recovery success thus far in my new found life in recovery and in part responsible for my new found life in recovery as well as my new found career endeavors in the field Addiction and Recovery Medicine.

It is proven in research and in practice that no single treatment is optimal for all patients. Combining treatment programs increase the chance for long term success in recovery. No one part of therapy or therapies has been proven to be effective standing Prospectively speaking, the probability of success stands to be exponentially higher with more tailored facets added into the treatment plan. Although not absolute, the laws of averages are proven in this case.

As with any therapeutic protocols there will be limitations as it is my belief that no science is a perfect science. It is, in fact, true many such centers lack properly trained professionals who administer evidence-based treatment strategies safely and effectively but the field of addiction and recovery is shown to be most effective in combining therapies.

I have observed first-hand the safety and efficacy with a diverse, specific treatment plan. One day like myself, many of the treatment providers are themselves in recovery where I hope to provide an excellent level of career coupled with the proper theory and clinical training as well as personal experience in addiction.

With proper therapeutic exposure experiences in my training, I am hopes to continue the combining therapeutic model to other addicts in need. Some may offer a “one size fits all” or “my way or the highway” type program based on whatever method they used to achieve sobriety but I find this therapeutic approach be deleterious to the science of addiction medicine as well as to the life blood of the therapeutic model of recovery.

It is my firm belief when an individual is ready and willing for a lifelong commitment to recovery as the combined therapeutic model in practice is the most effective and successful for long term sobriety.

Referrence: Principles of AddictionRies, Richard K.Fiellin, David A.Miller, Shannon C.Saitz, Richard AN: 01412562/4th_Edition/3 Edition Statement 4th Edition


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