Introduction
Substance abuse has long been one of the major concerns for practitioners and psychotherapists. A great number of research works have been dedicated to the study of this affliction and strategies of overcoming it. There is no universal approach to this problem and many treatment methods have been developed. Some of them are used internationally, while some are typical only of one country or region. The models, currently adopted in the United States are considered to be one of the most effective. However, there are techniques which are not frequently employed by US healthcare professionals, but they may prove very helpful. This paper aims to investigate the approaches utilized in foreign countries and identify the most beneficial ones. In particular, it is necessary to focus on such aspects as inpatient and outpatient treatment, holistic approach, the difference between drug and alcohol addiction etc. Prior to doing this task, it should be pointed out that these methods are not entirely unique or unfamiliar to the US therapists, but for some reason they do not enjoy popularity in America.
Treatment Methods in Foreign Countries
Inpatient Treatment methods
While discussing inpatient or residential treatment, we need to pay attention to such parameters as setting, methods, and duration. As regards dependence on drugs, we can say that the process of rehabilitation is usually conducted either in hospitals or therapeutic communities, for instance, in such countries as the United Kingdom, France, Netherlands, Germany and so forth (EMCDDA, 2002). Patients receive different medicaments and psychological help, strengthening their resistance to drugs. However, in several Asian countries, for example, Thailand or China medical workers often select a different setting. Their strategy is frequently called “cold turkey method” (Ray et al, 2002, p 8). Its essence lies in abrupt withdrawal from all doses. Normally, the patients are placed in detoxification camps. Furthermore, in India, residential treatment is given temples or shrines (Ray et al, 2002). The prudency of this approach has always been debated because abrupt and complete withdrawal from drug can cause pain shock, intolerable for patients with weak health. It should be borne in mind, this technique may not always be applicable, much would depend on the patients state and the nature of his or her addiction. This technique can hardly be ethically permissible, unless the person consents to live through this torturous experience and in Thailand this procedure is often compulsory (Ray et al, 2002).
In China and other Asian regions, acupuncture is believed to be an effective treatment method for drug addiction. Acupuncture belongs to the domain of alternative medicine, and it is not very popular in the United States or Europe, but the evidence-based practice shows that it yields results and with its help patients can conquer even the most severe addiction (Mitchell, 1997). It may be advantageous for the patients to resort to acupuncture at different stages of recovery process but it is mostly used as a means of abating withdrawal pains. Another non-traditional way is the use of saunas, during detoxification and residential treatment. Moreover, doctors can recommend it for the prevention of relapse (Gibson et al, 2003).
Practitioners, who render assistance to substance abusers, must also make the choice between the following options: drug-free or substitution treatment. Medical workers in European and Australia countries medical workers try to alternate them. Buprenorphine, methadone and LAAM are usually administered to the patients as a substitute to the substance (EMCDDA, 2002). Similar approach is taken by American healthcare professionals (NIDA, 2009). More than that, special emphasis is placed on psychotherapy which includes Christian counseling as it is in Great Britain, and 12 step or Minnesota model. Psychological is arguably the most important component of inpatient but it is accompanied by the use of pharmaceutical products.
In this respect, we should mention the so-called semi-residential treatment, which is very widespread in the Netherlands (EMCDDA, 2002). Certainly, the patient has to stay in the hospital or therapeutic center for twenty-four hours, but on some days he or she can go home to see family and friends. Again, the efficiency of this approach is heatedly disputed. On the one hand, there is a great risk of relapse, but on the other, this patient will be able to better adjust oneself to the society and receive emotional encouragement of people close to him or her. The duration of inpatient treatment varies and it is hardly possible to give exact data. The most approximate timelines range from thirty days to half a year. But the eventual outcome is determined by state of the person.
Dependence on alcohol requires medical workers to take slightly different measures; they carry out the procedure of detoxification and provide medicaments alleviating the craving for alcohol. However, in the vast majority of cases, this disease does not entail constant stay in the hospital. As a rule, hospitalization period lasts from ten to twenty days. Most of people undergo outpatient treatment. It is rather difficult to single out some national peculiarities at least at the stage of hospitalization (Raistrick et al, 2006). Again, we may remember “cold turkey” methods, utilized in Asian countries, and this demands complete rejection of alcohol without any receiving substitute medicaments and it is practically insurmountable for some people.
Outpatient treatment methods
Outpatient treatment can be subdivided into two broad categories: pharmacological and psychosocial. In theory, it must not involve the use of medicaments like pain-relievers or any other chemical substances. It is predominantly based on various forms of counseling and psychotherapy. Yet, it has to be admitted that practitioners throughout the world have to prescribe them to their patients. They can be of several kinds either substitutes or antagonists which subdue the craving for drugs, for example methadone, naltrexone or clonidine. This policy is quite widespread in European Union, particularly in such country as Italy (EMCDDA, 2002, p 44). Still, health care professionals attach primary importance to psychological help, which can be extremely diverse: group or individualized counseling, 12-step model, applicable for both drug abuse and alcoholism, Christian counseling, which is quite popular in the United Kingdom as well in the US. These techniques may vary in terms of their duration and implementation. Yet, their task is to prove to the individual that his or her illness is curable. Most importantly, the patient is quite capable of doing it but this takes considerable effort. In addition to that, the role of psychotherapy becomes immense at the moment when physical dependence weakens. The therapists in Western Europe and the United States attempt to convince patients that drugs are completely worthless in comparison with other aspects of their lives such as relationships with family, friends, intellectual pleasures etc. On the whole, it is quite possible for us to say that in Western cultures, counseling methods are similar to one another.
At this point of this discussion, we should speak about the policies adopted in Italy, Norway, and Finland, where social services monitor and assess the behavior of former drug or alcohol addicts so that to avoid the possibility of relapse (EMCDDA, 2002). The ethical aspect of this approach is very dubious. Certainly, it aims to help people but at the same time, it is a very rude intrusion into patients privacy.
In Eastern countries like Japan, China or Thailand, the role of counseling is slightly different. Traditional methods employed either in Europe or in the US are not fully applicable in these regions mostly because these techniques are relatively new. Many of them, for example, psychotherapy or group counseling have not become popular up to now. As it has been previously noted a great number of patients seek this aid in religion in Buddhist temples, as it is done in India or Thailand (Mitchell, 1997).
However, it can be observed that irrespective of the country patients undergoing drug addiction treatment should be well-disciplined; they must change their conduct and accept a drug-free and healthier lifestyle. Treatment modes may not always be successful for all patients, but their effectiveness is determined by the circumstances: type of addiction; severity of the disease, the strengths of persons will, the condition of his or her health. This rule is applicable to both residential and outpatient treatment.
Holistic treatments
Holistic health is a relatively new notion in European and American healthcare systems. This philosophy relies on the belief that a persons physical and spiritual health are closely intertwined with one another. The main objective of holistic treatment is to give a natural alternative to drugs (Einstein S, 1988, p 189). Such methods have to solve mental, physiological, cultural, social or spiritual problems of the person who is prone to substance abuse. If we are speaking about Asian or Islamic countries, we should first focus on the use of herbs, for instance, valerian root or hops which give relaxation and sedation. Herbal therapy is mostly used in China and India. The sphere of its application is not very wide, mostly in cases opiate addiction (Einstein S, 1988). Certainly, this method is sometimes adopted in the US and Europe but it is still classified as alternative medicine. Another form of treatment which has already been presented is the acupuncture and acupressure (a form of massage). Of course, their usefulness has always been known to physicians throughout the world. Yet, they were seldom used as a therapy for substance dependence. The pioneer was a Hong Kong doctor, H. L. Wen (Einstein S, 1988). In this way, he relieved withdrawal pains of his patients. But this approach is extremely demanding because any mistake like insertion of a needle tip into the wrong place may prove disastrous for the person.
Furthermore, we need to examine such method as yoga, which was developed more two thousand years ago in India. It consists of appropriate bodywork and mental training. In point of fact, it is a philosophy rather than treatment mode but it is frequently employed for the needs of former drug or alcohol abusers. This is helpful to that extent that it offers guidelines for pain management and this is vital for recovery. Most importantly, it enables a person to subdue craving for drug or alcohol. Medical workers in India suggest that the patients should train themselves in this way so that they could avoid relapse. Yet, there is a very significant disadvantage, the novelty of this method in Western cultures (Jilek, 1994). First, many practitioners do not have sufficient skills to teach yoga. Moreover, its effectiveness should be subjected to thorough examination.
The situation in European countries and Australia is slightly different. Christian counseling and 12 step model are the most widespread approaches to treatment. They may also be regarded as holistic methods because they are also based on the tenet that body and mind are interconnected and that the Holy Scripture is a powerful means of relieving persons emotional distress and the desire to consume either drugs or alcohol. However, it should be taken into account that these approaches are widely adopted by American counselors. In fact, they were originated in the United States.
Alcoholism vs. drug treatment methods
Physicians and practitioners throughout the world often apply similar strategies in order to conquer substance addiction. If we are speaking about dependence on alcohol, we should point out that in the majority of European countries as well as in Australia the process of treatment usually consists of such stages as detoxification and rehabilitation that can be either inpatient or outpatient. But there are some distinctive features, for example, in the United Kingdom psychologists use the so-called network therapy in order to help people suffering excessive drinking (Raistrick et al, 2006, 98). To some extent, it is based on Ecological Systems Theory developed by Urie Bronfenbrenner. According to this model, it is necessary place a person in an environment where people are intolerant of abusive alcohol consumption and they are able to find healthier pastimes. Yet, this strategy is beneficial only if patients family and friends are willing to collaborate with the therapist.
Moreover, the authorities of many European countries emphasize the role of appropriate training for medical and social workers. For instance, an educational program was launched in Poland in late nineties. It aimed to teach those skills which are necessary for recognition of alcoholism symptoms at early stages and prevention of this disease (Murray & Fleming, 1996). These courses are very popular now because they give clear and concise tips about the behavior of these people and the ways of dealing with them. In the United States, practitioners are also required to undergo extra training if they intend to treat and prevent alcoholism-related problems. The program which is now implemented in Poland is the result of close cooperation between American and Polish therapists.
As a rule, the difference between drug and alcoholism treatment methods lies in the following: the dependence on chemical substances necessitates extensive use of medicaments, either substitutes of the drug or antagonists, as it is done in Europe, Australia and the United States while alcoholism is cured only by means of psychological. But in Asia both drug and alcohol addiction may be treated by “cold turkey” methods, requiring abrupt and complete withdrawal from substance but such technique is not common.
Views of 12 step recovery support systems
It is rather difficult to assess the use of 12 step program and its applicability to drug and alcohol abuse. First, we should note that this approach is culturally-marked. The patients must admit that there is a higher power that can offer support or consolation and this Supreme Being will assist the person during his or her struggle with the disease. This technique proved to be effective but most with people who belong to Judo-Christian religious tradition. 12 step recovery system may of no use with people who profess Buddhism or Shinto because these religions have different concepts of God or higher power.
This approach was first advocated by Alcoholic Anonymous (AA) groups in the US in late thirties (Lines, 2006). Later, Western-European physicians began to utilize it. This technique is widespread in the United Kingdom, Denmark, Germany etc. However, in post-Soviet countries, therapists seldom employ it because in this region spiritual and psychological counseling are distinctive notions and they are seldom incorporated into a single entity.
12 step recovery systems must be viewed in much broader context of religious therapy which has an age-old tradition. The major benefit is the combination of psychological knowledge and spirituality. Even in spite of the differences existing among cultural and religious traditions, practitioners and counselors acknowledge that this treatment method offers invaluable guidelines for self-help, especially, if a person must overcome psychological desire for chemical substances or alcohol. Apart from that, it can take different forms: either interaction in anonymous groups, family therapy or even individual self-assessment and self-training. Usually, scholars regard 12 step support systems as a mechanism which can be adjusted to different cultural and religious setting (Lines, 2006).
Legalization of drugs
There has been a brisk international discussion of such question as legalization of drugs. The opponents of this policy argue that this policy will drastically increase substance abuse, because illegal chemicals will be made more accessible. While the advocates of legalization believe that in this way drug addicts will have a better opportunity to receive assistance of highly-qualified professionals. The thing is that many of them are even afraid of seeking medical aid due to possible legal consequences and most importantly stigmatization of the society.
The opposing sides of the argument draw the examples, which contradict one another. For instance, such country as Holland is notorious for the legalization of marihuana and psilocybin mushrooms. Surprisingly, this policy has yielded some fruits: first people consuming these soft drugs can be sure that these “goods” are produced in compliance with all safety standards, and this reduces mortality rate health risks. Yet, the most crucial advantage is that cannabis is no longer viewed as something forbidden and appealing to the public. Adolescents and adults gradually lose interest in it. It should be noted that the number of drug addicts in the Netherlands is much smaller than in the US (UN, 2006)
However, the authorities of other Western-European countries believe that by giving legal status even to soft drugs the government would inevitable increase their consumption because they will become more available to the general public. It will open new prospects to drug dealers who would no longer be outlaws. Marihuana or other soft drugs will turn into commonplace products which will be promoted in the market by means of advertisement or PR campaigns and this may threaten the health of the nation. Swedish government does not approve of the policies pursued in Holland. Swedish legislation demands severe penal sentences for any drug-related crimes irrespective of the substance status, either soft or hard. Finally, during the last two decades, the rate of drug abuse has dropped in this state and the UN officials believe that this is an example to be followed by others (UN, 2007). Eastern European and Asian countries are also characterized be zero tolerance towards legalization of drugs. In Thailand, dependence on opiates can entail even imprisonment (Ray et al, 2002).
Hence, we can conclude that the legalization of drugs still remains a contentious issue. The hypothetical after-effects of this policy have yet to be fully identified. On the one hand, it raises safety standards and reduces the risk of health problems and mortality among drug addicts. But at the same time, it may remove the fear of punishment associated with drug taking and selling; more people would be induced to consume chemical substances. The most dangerous thing is that such behavior can be even encouraged by the producers of marihuana.
Socialized medicine and addiction
Socialized medicine is the term, which was primarily originated in the United States. It denotes a network of medical institutions, mostly funded by the state, where doctors are usually paid for their services by the government. As far as Western Europe is concerned, we can say that the policies vary from one country to another. In Sweden people dependent on drugs or alcohol can seek professional help in a large number of public hospitals or therapeutic communities which are financed from the state budget. As a matter of fact, they constitute the larger part of all medical institutions, approximately 63 % (EMCDDA, 2002, p 79). The patients can receive consultations and various forms treatment. In turn, in the United Kingdom, private hospitals play the most crucial role. Similar situation can be also be observed in the US and Australia. In Russia and Chine, drug and alcohol addicts can refer to public and private institutions. However, there is a glaring discrepancy between the services. Public hospitals offer only a very range of options, substitution therapy or “cold turkey methods”, while private treatment units are frequently unaffordable for many layers of the society. It is believed that Swedish socialized medicine is the most efficient. Nevertheless, we should not forget that the total number of Swedish population does exceed 10 millions and it is a highly advanced country (UN, 2007).
Addiction Professional Qualifications
In well-developed countries inpatient and outpatient therapy of drug and alcohol addiction is undertaken by highly qualified and experienced professionals normally with Master or even PhD degree. Yet, medical science is constantly evolving and every physician must make full use of the most recent research findings. For that purpose, various refresher courses are launched practically in every country. We have already discussed one of such programs, implemented in Poland (Murray & Fleming, 1997). It has turned to be extremely beneficial for assessing the risks of alcohol abuse, recognition of early symptoms, prevention, and therapy of this illness.
Similar strategies are employed by the governments of other European countries. Extension courses can cover such aspects as the use of newly-created medicaments, their hypothetical side-effects. During such seminars physicians and psychologists are acquainted with new methods of treatment, new technologies etc. Such situation can be observed practically in all countries: Australia, Middle East, Asia, Russia, China, and the United States. The differences, which exist among them, can be explained only by the state of economy. The representatives of various national health associations are unanimous in the belief that continuums learning and utilization of research findings are vital for the treatment of substance addiction but occasionally the lack resources to implement these policies.
HIV and Drug Addiction Correlation
Currently, several regions of the world are practically engulfed by the AIDS epidemic. The correlation between HIV infection and drug abuse has long been established. This spread of this disease is caused a host of factors such as unsafe sex, blood transfusion etc. The governments of various countries carry out action plans to curb the risk of receiving this virus. Very often the methods are similar to one another. They include raising awareness of the population, especially adolescents, who can possibly consume drugs, especially opiates which are usually taken intravenously. Secondly, national health associations encourage people to undergo HIV tests in order to diminish the possibility of infection. The use of disposable syringes is by far the most common precaution that drug addicts should take. Moreover, medical workers, physicians and educators promote tolerance and empathy towards people suffering from substance addiction and HIV. It is quite possible for us to say that the strategies employed in different countries are very reminiscent to one another. Nonetheless, statistical data indicate that the results are not the same. In South Africa 15 % of total population has HIV, while in the United Kingdom or Australia, this number constitutes less one percent (UN & WHO, 2007). The origins of this phenomenon can be traced in economic difficulties of African countries, namely underdeveloped infrastructure, low quality of education, high accessibility of drugs and so forth. Yet, the approaches taken in different regions resemble one another. The key problem is that occasionally medical workers do not have sufficient resources to implement methods of prevention drug abuse and the spread of HIV.
Criminal Penalties for Drug Possession
In one of the previous sections we have touched upon the legal status of drugs in different countries. Now we need to overview criminal penalties imposed on people, possessing drugs. Such concept as “drug possession“consists of two elements, consumption and sale. In European countries, Australia, and the United States, these notions are usually distinguished; one of them leads to compulsory or voluntarily treatment, while the other entails criminal punishment (Fortson, 2005). In Thailand and China the situation is dramatically different because addiction can result in imprisonment (Ray et al, 2003). Under some circumstances, people engaged in drug smuggling and sale may be sentenced to death.
In Western Europe, Australia as well as the United States, the penalties are more lenient. Usually, they involve jail sentence and confiscation of property. Only in some cases if drug sale is organized on a grand scale, the culprit will condemned to life imprisonment. In Russia, there are minimum quantities of different drugs that are legally permissible this quantity does not usually exceed 1 or 2 grams, yet possession beyond these limits attracts fines and penalties. All of the aforesaid laws and restrictions are intended to reduce the efforts reduce consumption of drugs in the society.
The efficiency of these laws can be assessed only by quantitative data. According to the report issued by the UN, Sweden has the lowest rates of substance dependence (UN, 2007). However, this can be accounted not only by strict penalties for drug sale, but also by heavy investments into medical institutions, hospitals and other treatment centers. In addition to that, we can say that only severe penalties are not likely to yield any fruits if these measures are not supported by educators, social workers and therapists. Legalization of soft drugs like cannabis should not be perceived as something negative because the experience of Holland shows that this substance is no longer so popular in the society and the level of its consumption gradually declines (UN, 2006).
Similarities to United States Treatment Approaches
The survey of treatment methods used in various countries demonstrates that the approaches taken by medical workers in the United States enjoy considerable popularity in other regions of the world. There are several common features: first, in-patient and outpatient treatment of drug addiction heavily relies on the use of pharmaceutical products which abate the craving for drug, act as its substitute and relieve withdrawal pains. It can be observed that physicians carefully avoid the use of “cold turkey” methods and set stress on gradualness of recovery process. This approach is taken in the US, Europe and Australia.
Finally, in many countries of the world psychologists emphasize the role of spiritual therapy: Christian Counseling or 12 Step recovery programs. Traditional psychological methods are also widely adopted, such as cognitive and behavioral therapy, family counseling etc. The US health care system bears strong resemblance to that one of the United Kingdom, where medical serviced are provided mostly by private institutions rather than public organizations, which means that appropriate treatment is not always affordable for the patients who have lower income. Physicians and psychotherapists are normally required to undergo extra training in order to raise their professional level. This is standard, established in the US, Europe and Australia.
Like the authorities of the UK, Sweden, and Germany, American government is rather conservative in its attitude towards drugs. None of them has yet received legal status, and there is very little likelihood that this will ever happen. Still, penalties for possession of drugs are rather moderate, particularly in comparison with Asian countries. The US legislation does not make a distinction between soft and hard drugs because these two types can be equally harmful and addictive. Probably, this is the reason why the policy-makers of such states as Germany, France, or Italy are reluctant to legalize marihuana. On the whole, we can draw parallels between the United States, Australia and European Nations.
Successful approaches and methods that should be noted
Although treatment methods used in the United States are considered to be very effective, it is quite prudent to consider alternative approaches used in foreign countries. Their experience can be of great assistance to American health care. We need to discuss not only treatment modes but also attitude of the state toward drug abuse, trafficking and legalization of some substances, funding of medical institutions etc.
The first method that should be noted is the use of acupuncture acupressure. Chinese experience shows that it may be helpful for alleviating withdrawal pains. The main advantage is that it enables physicians to do without drug substitutes and this significantly accelerates the process of recovery. Certainly, medical workers in the US as well as in Europe have apprehension of its usefulness. Partially, such attitude is due to the novelty of acupuncture in Western countries. Finally, it may be prudent to make assessment of its usage and hypothetical risks. Moreover, practitioners should consider the use acupressure another example of Chinese traditional methods. Of course, no one can expect them to bring benefits immediately but scholars should at least try to apply them.
Secondly, medical workers should take a closer look at saunas as a means of relaxation and sedation. People who pass through the process of rehabilitation from drug dependence or alcoholism face almost insurmountable difficulties trying to overcome their withdrawal sufferings. Saunas may help them to achieve emotional peace. Yoga is another treatment method which may be employed for the needs of the patients because it gives guidelines for pain management. It enables people to achieve the state of tranquility, and this is essential component of rehabilitation.
Medical workers in the United States should pay attention to the strategy developed by their Dutch colleagues, in particular, semi-residential treatment. American therapists seldom practice this technique, because it incurs the risk of relapse. But at the same time, it gives a chance to stay close with the family and friends whose support and encouragement may be more important that any medicaments or counseling.
Struggle against drug addiction and alcoholism demands sufficient funding from the state. Currently the US patients seek aid mostly in private institutions, while in Sweden community hospitals make the largest contribution and Sweden is the country with the lowest rate of substance abuse. Hence, the treatment should be made more affordable. Undoubtedly, the country will have to incur great expenses but economy of the United States has the capacity to do it.
Finally, American policy-makers may review their attitude towards soft and hard drugs. Holland, Belgium and Luxemburg legalized cannabis and their consumption of this substance decreased. The thing is that it has become quite commonplace and its attraction is no longer so powerful. Besides, the governments of these countries no longer have to spend money on the struggle with the producers and sellers of hashish. In fact, these former criminals have become tax-payers; therefore more money is spent on funding of medical institutions. The opponents of this policy can argue that teenagers or even children may become accustomed to it. This is the task of parents, educators, and social workers to prevent them from doing it. Legal restrictions are virtually useless, unless there are not supported by people, who surround the teenagers.
Conclusions
In this paper, we have endeavored to survey foreign methods of treating drug addiction and alcoholism. This analysis has demonstrated that the US approaches are rather effective and widespread especially in Europe and Australia. The methods used in other parts of the world are not entirely revolutionary or unique. They have been known to American practitioners for a very long time. But due to several reasons they have not found widespread application: they effectiveness and risks have not been fully evaluated, and they are relatively new in the United States. We can single out acupuncture, acupressure, saunas, yoga, semi-residential treatment. Moreover, American legislators assume take conservative stand toward legalization of some soft drugs. In order to map out the most effective strategies of curbing substance abuse, physicians and psychotherapists from various countries must establish working partnership and utilize achievements of each other.
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