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Destination Hope is an agency in Fort Lauderdale, Florida, which is useful for diagnosing and treating men, suffering from dependence. Individuals receive treatment in comfortable surroundings, and a great deal of patients has recovered fully from substance abuse and dependence. It is usual that individuals start abusing drugs during the stage of adolescence until their adulthood. The program deals with people whose ages range from 13 to 44 years old. This program is unique from other programs that deal with substance abuse and dependency because it operates on a small scale. IOP provides individual and group services of about 10 hours a week. This program enables the victims of substance abuse and dependence to take part in their daily activities, and, then, earlier in the morning or late in the evening, the victims should take part in treatment.  

Holland & Stewart (2005) define screening as the testing of members of particular population, such as those individuals, affected with substance abuse and dependence, to estimate the possibility that they have specific disorders. Therefore, screening enables clinicians to identify individuals who are likely to possess disorders, as determined by the way such individuals respond to certain key questions. Individuals with positive screening results undergo a thorough diagnostic testing to unquestionably rule out or confirm the disorder. Screening, as well as a brief intervention, can help both individuals who meet the criteria for substance abuse or dependence and those individuals who do not meet the criteria for substance abuse or dependence, but who are at risk for more problems because of excessive consumption.

Levels of care are the different treatment programs for substance abuse and dependence at Destination Hope that are appropriate for the addicted individuals. Owing to the fact that each individual is different from each other, the clinicians, and therapists must tailor the level of care to make it appropriate to a particular circumstance. The levels of care that guide the available programs include Medical Detox, Drug and Alcohol Rehabilitation, and Intensive Outpatient. The goal of Medical Detox is to eliminate dangerous substance due to substance use from the body. Detox is the topmost step in the process of treating substance abuse and dependence, and it represents body stabilization through withdrawal from substance. Clinicians have considered withdrawal process as among the hardest parts during the treatment of substance dependence and recovery process, because the functions of the body depend on the consumption of drugs and alcohol. At Destination Hope, withdrawal becomes possible through the assistance from several experienced and licensed Detox centers that aim at minimizing the harmful effects of substance withdrawal, which will make an individual’s Detox experience comfortable and safe.

At Destination Hope, Drug and Alcohol rehabilitation is a residential style dependence treatment program, in which clinicians supervise addicts for 24 hours on a daily basis. It is a requirement that patients need to be sober before entering residential care and will not be dangerous or violent both to themselves and to other people. Therapists involve addicts in daily activities such as behavioral therapy, group and individual therapy, family therapy, AA meetings, and relationship therapy. Destination Hope provides up to a 90-days program for those men, suffering from substance dependence. Lengths of stay depend on the responsiveness and needs of an individual patient to dependence treatment. The goal of alcohol and drug rehabilitation program at Destination Hope is to help patients for long-term soberness in supportive and safe environment. 

Another level of care is Intensive Outpatient Program (IOP). IOP refers to a kind of support program and treatment service that is useful primarily in the treatment of chemical dependency, and which does not depend on detoxification. Therefore, the target population includes those individuals, who abuse and depend on substances such as marijuana and heroin. IOP at Destination Hope is a restrictive alcohol and drug treatment program; and residential and Detox treatment for those patients with school obligations or full-time work and supportive home environments for their recovery. Patients receive various treatment plans from therapists that include individual therapy, family therapy, and group therapy. At Destination Hope, the therapists hold IOP program three days in a week for the most convenient hours, especially three or four hours until about six weeks are over. Most patients attend the IOP program in the evening, while others attend the program during the day. IOP program is suitable for those patients, who are looking for an addiction recovery support, and at the same time, executing various functions in their communities.                 

Assessment refers to a more individualized and comprehensive examination of the psychosocial problems and needs that clinicians identify in the course of early screening, which includes the type and degree of substance abuse disorders, associated issues, and the recommended interventions for treatment (Matthews, 2010). Assessment requires more individualized data collection, usually including clinical interviewing, obtaining the previous relevant records from various agencies, and psychological testing. Therefore, assessment is more expensive as compared to screening.

Intervention is the strategy that clinicians use to enable addicts accept that they have a problem and begin the healing process (Matthews, 2010). The psychological nature, concerning substance abuse and dependence, is when the addicts fail to recognize themselves as drug addicts. Chronic addicts are not able to relate to anything, but they desire to use drugs. It is impossible for healing to start until addicts admit that they have a disorder, or before the systems of addicts have become free of both drugs and the byproducts of drugs. Drug intervention is vital precursor to the dependent recovery process, and addicts can achieve permanent sobriety. The objective of an intervention is to ensure that substance addicts get the help they need from qualified therapists at competent rehabilitation centers. Substance addicts start to get clean, once they understand the extent of their problems in the course of an intervention. Given the metabolic and psychological dependencies due to substance abuse and withdrawal can be traumatic to the addict. After complete recovery, therapists discharge substance addicts from the rehabilitation centers.

Theoretical approaches

Various theories such as cognitive-behavior, social, humanistic, client-centered, and bio-psychological theories are useful in addressing the problem of substance abuse and addiction. From the viewpoint of cognitive-behavior theory, substance abuse and dependence are learned behaviors that individuals acquire through experience (Corey, 2009). This theory also provides a basis for formulating appropriate interventions for dealing with substance abuse and dependence. Learning takes place through associations, such that neutral stimuli can increase the feelings of individuals to use drugs and alcohol. Triggers may be internal events such as emotions, physiological changes, or thoughts, or they may be external to the victim, such as objects in the surroundings, locations and settings, or other people who use drugs and alcohol. The associations strengthen gradually, following repeated occurrences. The cognitive-behavior can undergo modification with learning based interventions (Corey, 2009).      

Client-centered therapy is the form of psychotherapy that helps patients to develop a sense of self, so that they can be fully aware of how their feelings, behavior, and attitudes have undergone a negative change, and make an effort to bring back their true positive potential (Corey, 2009). The therapist must create an environment that is comfortable and non-judgmental by demonstrating empathy, unconditional positive regard, and congruence. In client-centered therapy, the therapist enables the client to understand the negative impacts of using drugs as well as the outcomes of withdrawal from drugs. An effective interaction between the therapist and client will change the client’s addictive behavior, as he or she will understand that withdrawal is far better than continued substance use (Corey, 2009). 

Humanistic theory states that a person’s mind depends on the ongoing influencing forces that exist in their unconscious and in the surrounding world (Durand & Barlow, 2006). Humanistic therapy is a therapeutic approach that holds a constructive, hopeful view of human beings as well as the substantial capacity of an individual to be self-determining. This therapeutic approach deals with the current attitudes and occurrences with an aim of client fulfillment and growth. Humanistic therapy is an effective element of treatment program for teens and adults, who are undergoing a wide range of conditions and issues, including substance abuse and dependence, depression, compulsive gambling, sex addiction, just to mention a few. Therefore, humanistic therapists apply the humanistic theory to ensure that drug addicts recover fully from substance dependence (Durand & Barlow, 2006).  

Bio-psychosocial perspective shows that the actions and effects of drugs may result in biological reactions that account for drug-specific withdrawal and tolerance symptoms (Plante, 2011). These reactions may have either reinforcing or adverse properties. Initially, withdrawal symptoms are painful, but taking more drugs can relieve the situation, and this can strengthen the response of drug taking. Repeated withdrawal experiences can lead to the activation of a classical conditioning process, through which neutral stimuli arouses withdrawal symptoms, and lead to continued drug use (Plante, 2011). Individuals increase their involvement with others who use and support drug use. On the other hand, involvement of individuals who might be against drug use may reduce the likelihood of using drugs. However, successful withdrawal must take place in rehabilitation centers so that clinicians can administer medication in case of severe effects of withdrawal.

Critical analysis of treatment

Matthews (2010) defines the treatment on demand as stated goal of harm reduction movements and drug policy reform. Treatment on demand ensures that a great deal of treatment options is available to the drug users on request. The aim of treatment on demand is to enable all those individuals, seeking treatment of substance abuse and dependence, immediate entry into the rehabilitation program. On the other hand, long waiting list does not allow patients immediate entry in the rehabilitation program. Therefore, long waiting lists lead to inefficiency of health care services across the world. The long waiting lists cannot be effective in the treatment of drug addicts. Once an individual has decided to withdraw from substance use, it is necessary for clinicians in the rehabilitation centers to allow him or her immediate entry into the rehabilitation program.   

Cultural dependency refers to a situation, when a culture relies on the use of a specific drug (Forrest, 1996). Members of the culture become fully dependent on the drug as they continue using it on a daily basis. For instance, most people, who belong to the American culture, use caffeine in the form of caffeinated drinks. They rely on caffeine to reduce the sleeping time because of a great deal of commitments. According to the Americans, caffeine wakes them up, gets them going, and helps them stay focused on a daily basis. Caffeine is an addictive drug and shares withdrawal symptoms with other addictive drugs such as marijuana, heroin, and others. Destination Hope accepts substance addicts from various cultures, which encourages cultural diversity. Different cultures can share lifestyle, such as the type of drugs they use.     

Dual disorders refer to the existence of both substance dependence and a mental health disorder, such as depression, or anxiety (Daley & Moss, 2002). Oftentimes, the pre-existing psychological condition drives an individual to abuse drugs so that to cope with it. Sometimes, the psychological conditions may occur because of substance abuse and dependence. Irrespective of how an addict acquires dual disorders, specialized counseling is necessary for their intervention and treatment. Destination Hope offers the diagnosis program for the dual disorders. Clinicians treat the disorders separately, allow for multiple comprehensive examinations, and offer a healthy plan for recovery (Phillips, 2009). It is imperative that once addicts enter treatment program with co-occurring disorders, clinicians provide treatments for both disorders to ensure that the addicts undergo an effective recovery. Destination Hope ensures that there is an individualized plan for all clients, who enter the treatment and rehabilitation program. It is possible for the dual-disorders to take long for complete recovery because clinicians must treat each disorder separately. Therefore, addicts should be patient, while the clinicians are overcoming the chemical dependency and related disorders.          

Destination Hope offers the rehabilitation program for treating a family system. Substance use and dependence affect both the addicts and his or her family members; thus, there is a need for relieving both the addicts and the affected family members of the problems of substance use and dependence. The effects of alcohol and drugs can make an addict to behave desperately, irrationally, potentially harming themselves and other people. Destination Hope has received clients who have cut off ties with their families because of various reasons. Some clients have left their families because of feeling unwanted, unloved, or rejected, or the family has cut off the bonds with the addict because of anger, anxiety, and stress. Clinicians believe that a family can feel broken and bruised because one of the family members is an addict to the extent of asking for a healing and strengthening program. This requires channeling anger and resentment of the family to support and love, as they repurpose their emotions. Finally, the non-aggressive, controlled environment can enhance the reformation of the broken family bonds.

Case management refers to a collaborative process of planning, assessment, advocacy, and facilitation for services and options to meet a person’s holistic needs through available resources and communication to enhance quality and cost effective results (Powell & Tahan, 2009). Therefore, the objective of case management is to ensure that the rehabilitation and treatment program meets the health needs of the client effectively.

Destination Hope allows for the evaluation of its techniques of success. This takes place as an aftercare service. Destination Hope is committed to all clients, even after they have left the normal course of treatment. Some treatment techniques may lead to partial recovery of the clients. Partial recovery may lead to relapse, earlier or late, and this can show that the treatment method was not effective. Therefore, clinicians continue to treat patients until they fully recover. In an effective recovery, there is no relapse, but an individual regains his or her original health. Evaluation of the treatment techniques is very important because it ensures that only effective methods are available for use. 

Implications for social work practice

It is apparent that the treatment of addicts starts with diagnosis in order to ensure that the clients have actually undergone addiction. Once a clinician finds that the client is an addict, treatment starts immediately. Appropriate therapeutic approaches and medications are necessary for effective recovery. Medication alleviates the painful experience of substance withdrawal. The treatment methods also need to undergo evaluation in order to ensure that only effective methods are available for treatment. Therefore, a clinician must be aware of all steps towards effective recovery of the patient.  

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