Elizabeth Barrette (ysabetwordsmith) wrote,
Elizabeth Barrette
ysabetwordsmith

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Addiction Care in Terramagne

I got to thinking about addiction care in Terramagne while doing research, and figured that folks might find my notes helpful...


T-America still has a variety of conventional programs for substance abuse such as self-help, 12 Step Programs in communities, and inpatient services at hospitals. However, they also treat substance abuse problems by removing the driving forces behind that abuse. The supervillain Ras el Hanout, the world's best smuggler, has contributed to this practice -- especially in the Maldives after President Latheef asked for his help. A typical progression goes:

* Survival needs. A healthy life requires regular access to essentials such as food, water, shelter, health care, and so on. These needs must be met before attempting to solve other problems, or else the lizard brain will drag attention back to the unmet essentials. Trying to fix other issues first is unlikely to succeed. A challenge of addiction care is that substances can hijack this routine and falsely classify themselves as survival needs. It is vital to understand this process before trying to solve the problems, and this hijacking explains why therapeutic drugs like methadone are so helpful in treating addiction: they pacify the urge until the substance can be reclassified in the body's awareness through counseling or other means. The satisfaction of survival needs may be broken down into separate categories for detailed exploration.

* Emergency care. If someone experiences an overdose or other crisis of health and safety, then they will enter the support system through the emergency room or other crisis intervention services. The goal here is to keep the victim alive and comfortable. After the crisis has passed, they should receive assistance in stabilizing their life through subsequent supports.

* Adequate housing. If someone enters the support system outside of an emergency, it is best to begin meeting survival needs with shelter, as substance abuse often causes housing insecurity. Fixing any serious problem requires a stable base of safe, comfortable, and secure housing appropriate to the individual's needs. Often it's an apartment, but it can be a private house, group home, or other configuration. Further support includes teaching skills such as budgeting, cooking, cleaning, and other homemaking proficiencies for interested individuals who did not acquire those skills growing up. A hospital room, homeless shelter, or other temporary housing is a start, but does not really fulfill this requirement. It may be used as a preliminary step to get the process going, while longer-term housing is sought. Sober villages are available to people in recovery who wish to avoid exposure to intoxicants in their everyday lives.

* Health care for contributing causes. If an addict has housing, the next point of contact is often through other care services. Physical and mental support is necessary to treat any complaints that drive people to abuse substances, such as chronic pain or depression. Background issues, such as growing up in a dysfunctional family, may be addressed with counseling and/or medication. At this time, treatment may also be offered for subsidiary problems caused by the substance abuse.

** Education about the risks of substance abuse and benefits of stopping it, harm reduction tools and techniques, habit reduction methods, and quitting methods. Clients need to know the range of options available to them, and the pros and cons of each. They typically know that substance abuse is "bad" but often don't know exactly why or all the things that can be done to address the problem. It is important to support personal agency and decision-making skills, rather than pressuring an addict to quit immediately. Reiterate that it's their choice as often as necessary, because most of them have been nagged excessively. Forced treatment rarely works and can actively make matters worse.

Invite users to choose any products or services that seem helpful to them. For example, many smokers will happily take substitutes such as nicotine gum or suckers for use in places where smoking is not allowed -- and that means they aren't inhaling toxic smoke as often, a useful harm reduction step. Narcotic addicts should be encouraged to carry Naloxone in case they or their friends overdose, and indeed, programs promoting this practice save many lives because addicts frequent places where overdoses happen and are not viewed with suspicion like medics or other outsiders. Safer shooting galleries and overdose care centers are among the infrastructure for harm reduction. T-America also has Rat Parks where addicts can hang out in a safe space without pressure toward sobriety, inspired by an experiment about lab rat habitat influence on addiction.

** Coping skills. Before a person can quit using a maladaptive coping method, they need positive ones to replace it which work as well or better. Therefore, part of mental health care should include teaching the use of coping skills. This can at least be done with modeling, even if the person doesn't want regular counseling appointments, but it is better to follow an active plan of studying the coping skills that seem useful to the client. As in any counseling case, the therapist may make a profile of what is bothering the client and then suggest coping skills or other treatments commonly effective for solving those problems. Someone who overuses alcohol to get along with people will benefit from learning more social skills, whereas someone who abuses narcotics to deal with a bad back will benefit from relaxation and pain management techniques (and medical care for the back problem). Emphasize that, like drugs, coping skills come in a wide range and it may take trying several of them before finding ones that work well enough.

* Companionship of people who don't misuse substances. People are communal creatures, and most people are significantly influenced by those around them -- some more than others. An addict who spends time with other addicts is much less likely to quit than one who spends time with non-addicts. People who don't abuse substances offer other activities to enjoy, along with moral support. Therefore the better treatment programs in T-America organize activities for addicts in recovery such as book clubs, crafts, gaming groups, movie nights, hiking or jogging groups, bicycling trips, bowling teams or other sports, and so on. Sober companions are available to those who want one. Unlike their use in L-America, over in T-America they are available from the beginning to give addicts an example of sober life, even before quitting becomes a goal. They may be intended as a temporary or permanent support. Developing a good support network helps people make healthier choices.

* A job with a living wage; or if someone is unready or unable to work, public assistance plus volunteering and/or hobbies. People need something to do in order to be happy; feeling bored or useless can drive people into substance abuse. Poverty is a leading cause of substance abuse, so relieving that is an essential step toward a successful life. T-America puts considerable effort into finding work that people can do, even if they have limitations; frex, many wheelchair users go into talking professions such as receptionist or counselor. People who are not yet ready to work, or permanently unable due to disability or retirement, benefit from alternative activities such as volunteering or hobbies. This gives structure to their time, fosters a sense of accomplishment, and boosts interaction with other people. Disabled and elderly people are especially vulnerable to isolation, the housebound most of all, and so services exist to assist them in finding activities they enjoy and can do.

* Once the person feels ready to break their addiction and expresses interest in stopping, they need health care support for that process of change. It is vital to support the addict in reaching their own decision to reduce or stop misusing substances, because force doesn't work and may do more harm. When they are ready to quit, they need both physical and mental assistance. Severe addiction often requires medical support during detoxification. Substitute medication such as methadone can help narcotic addicts. T-America has more options than L-America in this regard, such as the NoAlc implant for alcohol. A sober sponsor can offer support born of experience. Counseling during the recovery process improves the chances of success. People who wish to reduce or eliminate their use of substances need to help in understanding the range of options available for their condition and how to choose which one(s) would best suit their individual needs. Realize that the first solution may not work, or may have untenable drawbacks. People also need support in recognizing when and how to change course so they can try a new treatment that may work better.

This angle of approach can't solve all problems associated with addiction, but working from the ground up and planning for the long term does have a much higher success rate than L-America's mostly victim-blaming approaches.
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