How Do I Get My Son Off Drugs?

by Mathea Falco, J.D.

Drug Treatment for Adolescents

Most American youth try drugs and alcohol when they are teenagers; some will develop serious substance use problems.

But treatment for teens is scarce and often hard to find: although more than one million teens need drug treatment, only one in ten actually receive help. Why is adolescent treatment so scarce? Lack of state and federal funding for treatment programs as well as shrinking insurance benefits for drug treatment are two major reasons. Without adequate insurance, many parents simply cannot afford to get the kind of help their children need.

When parents realize their children have drug problems and must find treatment, they frequently do not know where to turn. The family is often in a crisis situation, when decisions must be made quickly. Yet very little information is available about what parents should look for in choosing a program. Most parents are concerned about cost: do their employee benefits cover drug treatment? If so, for how long? If their coverage is limited, will they be able to pay to get the best possible treatment for their teenager? What kind of treatment will work? Should their teen be sent away to a residential program or can he or she be treated in his or her own community while still living at home? How long will treatment take – a few weeks, months or even years? Parents face bewildering questions they don’t know how to answer, or even how to find answers. They may also feel frightened or ashamed that their teen has substance use problems. And they may also recognize that their own alcohol and drug use problems have contributed to the problems their child is experiencing.

In order to help parents and other concerned adults find help for their teens, Drug Strategies, a nonprofit research institute, developed Treating Teens: A Guide to Adolescent Drug Programs. This guide describes nine key elements that are important in successful teen drug treatment and provides reliable information on 144 adolescent drug programs. Treating Teens gives hotline telephone numbers to find treatment in each state; definitions of frequently used treatment terms, and 10 important questions parents should ask when selecting a program for their teen.

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FIVE QUESTIONS PARENTS SHOULD ASK A TREATMENT PROGRAM

1. Is your program specifically designed for teens? If so, how?

Most treatment programs are designed for adults, not teens. Even if programs say they treat teens, they may in fact just be including them in adult programs that have a few activities for younger people. Adolescents have unique challenges, such as relating to their families, dealing with peer groups, getting an education, finding a job. They also are different developmentally than adults. Effective adolescent programs should address not only drug use problems but also the many aspects of a teen’s life.

2. What questions do your staff members ask to determine the seriousness of the teen’s substance use problem and whether the teen will benefit from this particular program?

Good programs usually ask a brief set of initial questions to explore the severity of the youth’s drug use. How long has the teen been using? Is he or she addicted? What other kinds of problems does the teen have? Is he or she involved in delinquent behavior? Answers to these questions will help a program decide if they can provide the kind of help needed. Once the teen is admitted to the program, the teen’s problems will be examined in much greater depth. This kind of assessment should include a physical exam to determine if there are any medical conditions related to the substance use problem; a psychiatric exam to determine if there are mental health problems, such as depression, that must also be treated; a review of the teen’s educational progress, and a review of the teen’s relationships with his peers. Does he have friends? Are they involved in drugs? The program may also ask in-depth questions of the family about how well family members communicate, whether there are discipline problems, whether there is a history of substance use within the family. The program will develop as complete as possible a picture of the adolescent’s problems so that the counselors can design a treatment plan to address them successfully.

3. How does the program involve the family in the teen’s treatment?

Family involvement in the teen’s treatment is critically important. Regardless of how well or badly the teen and the family relate to each other, parents are the dominant reality in the lives of most teens. Parents are also the major source of financial support, including medical insurance, if any. Most teens live at home, and their recovery will depend on how supportive the home environment will be in helping them build new lives free of alcohol and drug use.
Recent studies of adolescents who stop using drugs report that parental involvement, new friends and motivation are keys to success. Programs should encourage parents (or other caregivers) to participate in counseling, group meetings, drug education and other activities offered by the program. Occasional telephone calls between the parents and the program counselors are not enough. Families should also be asked to examine their own alcohol and drug use and to get treatment themselves when necessary. Programs should teach the family how to be more effective parents, including how to discipline children reasonably. The more the family is involved in the treatment process, the more likely the teen will succeed in treatment.

4. How does the program provide continuing care after treatment is completed?

The period after treatment is vitally important: most adolescents relapse in the first three months after treatment. However, continuing care services can greatly increase the likelihood of sustained recovery. Developing follow-up plans while the teen is still in treatment is important in providing a structure for the teen and his family, so that treatment gains continue. These plans may include relapse prevention training, referrals to community resources and periodic check-ups by the program with the adolescent and his family. Twelve-step meetings can also be helpful for some teens in recovery, although finding 12-step meetings specifically for teens can be difficult in some communities. Unfortunately, many programs do not provide continuing care, and parents must try to support the teen’s recovery as fully as possible. Parents can identify services within their community that will help the teen live without drugs, including well supervised recreational programs, counseling, and community service. Parents should stay in close touch with their children every step of the way. Parents who believe that their children can overcome their problems and be successful in school make a powerful difference even when faced with difficult circumstances. (In Treating Teens: A Guide to Adolescent Drug Treatment the help hotline numbers can provide referrals to resources in each state.)

5. What evidence do you have that your program is effective?

Very few programs have formal, scientific evaluations that m

easure their treatment success. However, even without such evaluations, other information can be helpful. For example, completing the entire course of treatment is closely related to success. Retention rate is an important indicator of whether a program is effective. How many teens drop out? How long do they stay in treatment? How many actually complete treatment? Other useful things to ask about are whether teens in the program show improvements in school performance (better attendance and grades) and family relationships (better communications, less aggressive behavior). How does the program monitor drug use among teens in treatment? Do they conduct drug tests? If so, how often do they test? What are the results? Good programs should have test results that show that teens in treatment are staying clean.

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1. Odor of substance in breath and clothes – persons who uses illegal drugs tends to smell bad or unusual if he or she is smoking marijuana, cocaine, or other illegal drugs.
2. Poor physical appearance – major changes in physical appearance if suddenly you find your son or daughter change in his physical appearance, forget to comb his hair, forgets to bathe and takes the fashion sense of other drug abusers.
3. Suddenly covering of his arms and legs – drug users who uses needles always wear clothes that can cover there body wear the needles are been use. they wear clothes like this even if its inappropriate.
4. Sunglasses is his/her best friend – Bloodshot eyes can be seen in drug abusers because of methamphetamine found in drugs.
5. Mood swings – Something might be wrong if a bubbly personality starts to become withdrawn and humorless or a normally reserved person becomes loud and boisterous. Watch out for self-destructive tendencies.
6. Unexplained loss of valuables at home – A dug abuser needs money to support his habit. His school allowance will not be enough.
7. Recent adverse life event – He is going through problems he cant handle like parents separating, losing a girlfriend, or sexual physical abuse.
8. School performance is getting worst – He is good student now getting failing marks. Discipline problems cause school authorities to call him in.
9. Out in school – He is always absent from class and gives false excuses.
10. Drug using group of friends – If his friends have a history of drugs or still using drugs then you should be very concerned. Look into the kinds of social gatherings he attends.
11. Decrease communication with other family members – He stops communicating with a favorite sibling, and he doesn’t consult parents when making important decision.
12. Repeated overt intoxication – Family members and friends actually witness him in high or exhibiting unusual behavior.

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If you think your kid is doing drugs, don’t panic, talk to him. Be gentle and non-violent or confrontational. Discuss the problem and how you can help. Make it clear that you are there to support and not to condemn.

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Drug use in anyone can lead to health problems but these can be so much worse for teenagers who’s bodies have not yet finished growing.I know some people who use drugs every day that have a mental illness because of it,drugs damage the brains ability to function normally and process information normally. they affect the chemical levels in the brain which lead to mental illnesses such as psychosis and schizophrenia these are very serious and if left untreated the psychotic symptoms of schizophrenia (such as paranoia, hearing voices, visual hallucinations, delusions) can become permanent and affect your quality of life. Here are some reasons why teenagers turn to drugs.

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1. Curiosity- They want to experience new things, too bad they want to experience drugs.
2. Rebellion – Because using drugs is rebellious and its illegal and forbidden.
3. Peer pressure – They want to fit in with groups the bad thing is drugs is involve.
4. Copying significant others – If a role model is doing drugs, they might feel justified in trying it too.
5. Experimentation – They don’t realize that an cation today can lead to very bad consequence tomorrow.
6. Feelings of indestructibility – Some teenagers tell themselves that they can control anything, that they can control the use of drugs, but many fails and turn to addiction.
7. Forget problems – Teenagers turn to drugs to escape their problem with the environment he lives in.
8. Increase creativity and productivity – Some interpret altered states as inspiration for creative ideas.
9. Psychiatric problem – Teenagers with mental illness like depression or a personalty disorder are more prone to abuse drugs.
10. Weight loss tool – Some drugs do suppress appetite, but addiction usually pushes the addict to place little important to health.
11. False hope – Some teenagers who losses hope turns to drugs.
12. Substitute to love – Teenagers who don’t feel any love from someone turn to drugs and feel love by himself.

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Summary

• Medical professionals follow certain criteria to determine if a person abuses alcohol or drugs.
• These established criteria also can mark whether the substance abuse has progressed to dependence.
• Alcohol and drug dependence cause people to suffer from withdrawal symptoms when they stop using the substance. Dependence also causes major behavioral changes, such as overwhelming preoccupation with drug or alcohol use.

Some people who start as casual drinkers or drug users will stay that way. But others will become substance abusers or dependent, feeling that they need a drug to feel alive. The difference between abuse and dependence is not always clear to the general public, but medical professionals use a set of criteria to distinguish between these two categories of problem use.

The essential feature of abuse is a pattern of substance use that causes someone to experience harmful consequences. Clinicians diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use:

• Failure to meet obligations, such as missing work or school
• Engaging in reckless activities, such as driving while intoxicated
• Encountering legal troubles, such as getting arrested
• Continuing to use despite personal problems, such as a fight with a partner

Dependence is more severe. Medical professionals will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a twelve-month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral signs occur with every substance.

The physiological factors are:

• Tolerance, in which a person needs more of a drug to achieve intoxication
• Withdrawal, in which they experience mental or physical symptoms after stopping drug use

The behavioral patterns are:

• Being unable to stop once using starts
• Exceeding self-imposed limits
• Curtailing time spent on other activities
• Spending excessive time using or getting drugs
• Taking a drug despite deteriorating health

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FIVE THINGS TO KNOW ABOUT ADOLESCENTS’ BRAIN DEVELOPMENT AND USE

Learn more about the particular ways that substance use threatens the still-developing adolescent brain.

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Concerning Behaviors to Look for in an Adolescent Who Might be Using Drugs

• Changes in school performance (falling grades, skipping school, tardiness)
• Changes in peer group (hanging out with drug-using, antisocial, older friends)
• Breaking rules at home, school, in the community
• Extreme mood swings, depression, irritability, anger, negative attitude
• Sudden increases or decreases in activity level
• Withdrawal from the family; keeping secrets
• Changes in physical appearance (weight loss, lack of cleanliness, strange smells)
• Red, watery, glassy eyes or runny nose not due to allergies or cold
• Changes in eating or sleeping habits
• Lack of motivation or interest in things other teenagers enjoy (hobbies, sports)
• Lying, stealing, hiding things
• Using street or drug language or possession of drug paraphernalia/items
• Cigarette smoking

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Addiction, says Dr. Mark Willenbring, director of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, "is a disorder of young people." The vast majority of people who suffer from addiction encountered the beginnings of their illness when they were teenagers. Ninety-five percent of people who are dependent on alcohol or other drugs started before they were 20 years old.

"The adolescent brain is different from that of an adult," National Institute on Drug Abuse director Dr. Nora Volkow explains. "And that leads to behaviors that definitely put them at much higher risk to want to try drugs than the brain of an adult."

"The brain’s ‘front end,’ the part above the eyes, exists to slow us down or stop our impulsive behaviors," explains Dr. Thomas Crowley, a physician who studies substance use and behavioral disorders among teens. "It considers the risks and benefits of our actions, and it helps us ‘hit the brakes’ when we consider doing things that are too risky. This front part of the brain is still developing connections to the rest of the brain until adulthood, so adolescents’ brains lack some of the wiring that carries ‘brake’ or ‘stop’ messages to the rest of the brain."

At the same time, Dr. Volkow notes, teens are dealing with high levels of stress and widely available drugs.

Thirty-six-year-old Brian, struggling with an addiction, recounted his path to cocaine. "I discovered alcohol when I was 16. And I liked it. From there, it progressed to marijuana, loved it, smoked it, like I always had it on me for, you know, years. And then from there, you know, drinking in the clubs, smoking, I discovered cocaine. And that was the one."

"If you look at it from a kid’s perspective," says Dr. Michael Dennis, senior research psychologist at the Illinois-based Chestnut Health Systems, "There’s a lot of good reasons to use [drugs]…They’re exploring. They’re learning to try different things. They have impulse control problems with their brain where they don’t have very good judgment about how risky something is."

Illinois In-Patient Facility First of Its Kind to Treat Internet Addicts

By AMY JACOBSON and EMILY FRIEDMAN

PEORIA, Ill., Aug. 7, 2008

At the height of his Internet addiction, Ben estimated that he spent at least 16 hours a day surfing the Web.

"Days would pass before I would shower, shave or eat," Ben told ABCNews.com.

The college student, who asked that his last name not be used because of privacy concerns, said that he simply could not get off the computer.

Ben said he would play computer games until the sun came up and then sleep for a few hours during the day. Eventually, he simply lost interest in the world around him and flunked out of college.

It wasn’t until his online obsession drove him to attempt suicide that Ben sought help at the Illinois Institute for Addiction Recovery — the only in-patient facility in the country that treats patients for Internet addiction.

Located 180 miles outside Chicago in Peoria, Ill., Ben said that the rehab saved his life.

The Illinois Institute for Addiction Recovery is the only in-patient facility in the country that treats patients for Internet addiction.

What is a Drug Rehab?
by Jonathan Huttner

Drug rehab — what does it mean? To begin the process of finding the appropriate drug addiction treatment, it is important to understand what drug rehab is and how it works. The term "drug rehab" is synonymous with several different terms such as rehab center, rehab, addiction treatment, alcoholism treatment, alcohol rehab or drug rehabilitation. Currently you can find a rehab center that deals specifically with one kind of addiction:

• Alcohol Addiction Treatment
• Drug Addiction Treatment
• Sex Addiction Treatment
• Gambling Addiction Treatment
• Eating Disorder Treatment Programs
• Internet Addiction

It is important to understand that drug addiction is a deadly illness recognized by the American Medical Association as a disease. For these reasons, a reputable drug rehab must have proper state licensing, accreditation through the Joint Commission on Accreditation of Hospital Organizations (JCAHO), as well as a host of other monitoring regulations.

Drug Rehab Methodology
In drug rehab, the methods of treating addiction vary as widely as the number of drug rehabs in existence. In my opinion, the most basic and common goal of any drug rehab program is to provide you the necessary tools to enable you to live a drug free life, free from any type of addiction. In a drug rehab program, addicts and alcoholics become educated regarding the disease of addiction and the cravings and compulsivity that accompanies it. Therapists are available to lead individual and group sessions where the topic of discussion can range anywhere from childhood and family issues to self-esteem, relationship and psychiatric disorders. Drug rehab becomes more successful the more honest you can be during this therapeutic process. The more honest you are, the more progress you will make, and with progress comes a renewed sense of willingness. Honesty, open-mindedness, and willingness are the keys to a successful drug rehab experience.

Before and After photos of a meth user 

Along with the normal criteria for substance dependence, individuals with methamphetamine dependence often present with dysphoria, insomnia, hostility, irritability, restlessness, and confusion (Sadock, 2003). Symptoms may resemble those of an anxiety disorder, but also include paranoid delusions and hallucinations (2003). A patient that comes with flushing or pallor, headache, fever, grinding of the teeth, shortness of breath, tremor, and/or ataxia may be suffering from methamphetamine dependence (2003). In addition, the increase of insomnia and restlessness, along with the decreased appetite, often induces anorexia.

The DSM-IV-TR includes categories for amphetamine-induced mood, anxiety, sleep, and sexual dysfunction disorders. The criterion for methamphetamine withdrawal is the same as that in cocaine withdrawal, as well as that of intoxication.

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

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Drug rehabilitation, for dependency on psychoactive substances such as alcohol, prescription drugs, and illicit drugs such as cocaine, heroin or amphetamines

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme

Two-fold nature
Drug rehabilitation tends to address a stated twofold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so the desired effect is minimal. Apparently normal functioning of the user may be observed, despite being under the influence of the drug. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal.

 Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Types of treatment
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.[1]

In a survey of treatment providers from three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring the treatment provider’s responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics AA identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider’s responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction).[2]

Pharmacotherapies
Certain opioid medications such as methadone and more recently buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

 Criminal justice
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U. S. Constitution, mandating separation of church and state.[3][4]

 Diseased person model
Some psychotherapists question the validity of the "diseased person" model used within the drug rehabilitation environment. Instead, they state the individual person is entirely capable of rejecting previous behaviors. Further, they contend the use of the disease model of addiction simply perpetuates the addicts’ feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that could be resolved if the addict were to approach addiction as behavior that is no longer productive, the same as childhood tantrums.

Counseling
Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult.

 Historical Approaches to Substance Abuse Treatment

Disease Model and Twelve-Step Programs
The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939 [5]. These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological [6] and legal [7] grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year follow-up [8].

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Client-Centered Approaches
In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the therapeutic relationship could help an individual overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study [9] compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the
two-factor theory to be the most effective, it actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques per se [10]. The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.as in some other cases

 Psychoanalytic Approaches
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also offered an explanation of substance abuse. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesised specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing. [11] Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.

 Cognitive Models of Addiction Recovery

 Relapse Prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. [12]. Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) [12], which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.

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 Cognitive Therapy of Substance Abuse
An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse.[13] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

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Emotion Regulation, Mindfulness, and Substance Abuse
A growing literature is demonstrating the importance of emotion regulation in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, [14] an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. [15] Currently, research is being conducted to determine the efficacy of mindfulness based approaches to smoking cessation, in which patients are encouraged to identify and recognize their negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have developed to deal with them (such as cigarette smoking or other substance use). [16]

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DEA Official Stephen Lovejoy says Matt Lovejoy was found in possession of 1/8th ounce of marijuana and a glass pipe in defiance of the law and his Mother.