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Legal and Ethical Consideration in Alcohol and Drug Treatment

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Some of the service activities now provided within the rubric of recovery support services include activities performed in earlier decades by people working as outreach workers, case managers, counselor assistants, and volunteers

Recovery support services may be provided by clinically trained professionals as an adjunct to their clinical (assessment and counseling) activities, or they may be delivered by people in recovery who are not clinically trained but who are trained and supervised to provide such support services.

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Alcohol and other drug (AOD) research is rife with ethical quandaries and controversy. Particularly polarizing have been studies investigating the use of the addictive agent as a treatment, such as recent research involving heroin (diacetylmorphine) maintenance therapy. Although not permitted in the US, pharmaceutical diacetylmorphine prescription is being studied in other countries, and many of the ethical considerations of those studies are relevant to any research covering sensitive topics and/or enrolling vulnerable populations. This article provides an overview of the ethical issues surrounding diacetylmorphine prescription research and methods to address those concerns that may be applicable to other AOD research. Research testing the agent of addiction as a potential treatment is not novel

Alcohol has been administered to subjects with alcohol dependence to treat withdrawal, and nicotine has been used as a therapeutic agent to decrease smoking. These studies have not generated enough controversy in the US to halt the research, however; alcohol and nicotine are legal drugs in the US, and, in general, accepted by society. Opioid agonist treatment is a related example. Although not exactly the agent of addiction, opioid agonists (methadone and buprenorphine) are among the most efficacious treatments for opioid (i.e., heroin and/or prescription-opioid) dependence. These agonists are also legal medications, which facilitates their study, although many people remain “against” these treatments. Heroin addiction is highly stigmatized in the US. Although heroin was developed as a cough suppressant by Bayer Pharmaceuticals in the 1890s and was prescribed as a treatment for opioid dependence in the early 1900s, its use was restricted by the Harrison Narcotic Act in 1914, and by 1919, doctors risked prosecution for prescribing it to people with addiction. Nonetheless, diacetylmorphine has been used as a therapeutic agent on a limited basis in Britain since the early 1960s, and the first reported controlled clinical trial of diacetylmorphine prescription was conducted there.

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The family has a central role to play in the treatment of any health problem, including substance abuse. Family work has become a strong and continuing theme of many treatment approaches (Kaufmann and Kaufman 1992a ; McCrady and Epstein 1996), but family therapy is not used to its greatest capacity in substance abuse treatment. A primary challenge remains the broadening of the substance abuse treatment focus from the individual to the family. The two disciplines, family therapy and substance abuse treatment, bring different perspectives to treatment implementation. In substance abuse treatment, for instance, the client is the identified patient (IP)—the person in the family with the presenting substance abuse problem. In family therapy, the goal of treatment is to meet the needs of all family members. Family therapy addresses the interdependent nature of family relationships and how these relationships serve the IP and other family members for good or ill. The focus of family therapy treatment is to intervene in these complex relational patterns and to alter them in ways that bring about productive change for the entire family. Family therapy rests on the systems perspective

As such, changes in one part of the system can and do produce changes in other parts of the system, and these changes can contribute to either problems or solutions.

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In brief, the addiction treatment is not therapeutic as many processes psychology for it tends to be base more on faith than the scientific approach. The research being undertaken currently suggests that there is more research on the field of addiction and scientists have almost come into conclusion that addiction is a brain disease. Chemicals and their exposure to the brain is the main cause of addiction. Scott goes further to argue that drunkards recovering from alcoholism are not normal enough since the alcohol affects cognitive reasoning. However, the main problem is that many psychologists are known not to link alcoholism with clinical research to determine the interrelationship.

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Kaufmann, P., and Kaufman, E. From multiple family therapy to couples therapy. In: Kaufman, E., and Kaufmann, P., eds. Family Therapy of Drug and Alcohol Abuse. 2d ed. Boston: Allyn and Bacon, 1992a. pp. 85–93.

McCrady, B.S., and Epstein, E.E. Theoretical bases of family approaches to substance abuse treatment. In: Rotgers, F., and Keller, D.S., eds. Treating Substance Abuse: Theory and Technique. New York: Guilford Press, 1996. pp. 117–142.

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