The central issue in the American dilemma on substance abuse is the conflict between two approaches; one that considers substance abuse as immoral and socially destructive, where people are forced to surrender their capacity for self control; and the other that believes in individual prerogative to abandon the self control, as long it doesn’t harm others. The society, government and legal circles are torn by internal disputes on identification of drug abuse problem as a criminal or a legal issue.
The current drug policy in United States almost completely ignores the social programs, concentrating specifically on methods to reduce the abuse rates. Social programs, with the aim to determine the cause of substance abuse are pushed to periphery. The bureaucratic and legislative complexity on the issue of drug policy is immensely complicated and lacks a general direction or impetus and result is manifest in government’s inability to tackle the drug trafficking problem and its hazardous outcomes despite spending billions of dollars annually in law enforcement.
This has given rise to the demand of legalizing the distribution of some or all of the drugs to negate the costs they generate by law enforcement. However this argument is fought with the concern that legalization of drug would create a public health disaster that would involve huge expenditure, thereby negating any economic gains obtained by legalization. The current approach is on prevention that is eradicating social conditions, such as poverty, racial discrimination, prejudice and disparate urban growth to check the influence of substance abuse.
As suggested by Moore, under this program the over expenditure on drug law enforcement should be balanced by investment in preventive measures to meet the issue judiciously. The primary goals in any treatment plan related to substance abuse and are: to initiate abstinence and to prevent lapse. The treatment plan should be sensitive to withdrawal effects suffered by patient and therefore should develop strategies that provide cocaine users with alternatives along with motivation and skill to maintain abstinence and prevent relapse.
As cocaine addicts are prone to use a wide variety of drugs including marijuana, treatment plan of cocaine users should also consider the addiction to other drugs. Outlines three general strategies in treatment after the abstinence phase has passed and stabilization has been achieved. First strategy is development and maintenance of high level of motivation for abstinence in the patient. It includes providing education to patients on dangers of substance abuse contrasted against the benefits of a drug-free lifestyle.
Family members are sought to help the patient from relapsing and models are used to overcome substance abuse problems. Second strategy is encouraging and helping the patient towards a drug free life. Here patient is given individual counseling and encouraged to be part of self help groups. It educates the patient to deal with stress of daily life without drugs. It also helps in discovering useful avenues to utilize free time, develop social interaction and focus on a healthy life free from stress of mere survival and drug dependence.
Findings have revealed that self help groups have been useful in preventing relapse in the aftercare phase of post treatment. The third step is prevention of relapse. It requires identification of the factors that promote stimuli that can cause relapse and appropriate strategies established to create and cope with such impulses. This strategy requires intense treatment for two to four weeks followed by continued involvement of counseling, self help group and other support mechanisms.
It is important to realize that any treatment in nonpharmacological approach should focus on helping the patient change his/her drug taking behavior through carefully designed interventions. Other nonpharmacological approaches are chemical dependency treatment, twelve step self help approach, psychotherapy, behavioral interventions and neuroelectric therapy. The pharmacological treatment of drug abuse works with the goal to promote complete abstinence from all mind altering drugs.
There are four classes of pharmacological agents that are used in treatment of cocaine addiction 1. Agents: They block the effect of drugs, such as euphoria, ecstasy, and depression 2. Aversive agents: Drugs that produce adverse reaction when taken with cocaine. 3. Drugs for treatment of premorbid coexisting psychiatric disorder: Drugs that can alleviate disorder that may enhance patient’s vulnerability to cocaine abuse. 4. Drugs that treat cocaine induced states including withdrawal and craving.