Things that doesn’t work

• Will power?
• ‘I can do it myself’
• ‘I need no one to help me’

Things that work

Given below are list things extracted from research books, journals, evidence based studies etc:

1. Prolonged regular treatment in the community 

A) Regular attendance at the Out Patient clinics
B) Random urine drug testing for drugs using clients
C) Compliance with care plan

2. Supervised abstinence

A) Parole
B) Probation

3. Aversive experience

A) Painful health conditions e.g, chronic pancreatitis, gastritis
B) Medications – Antabuse / Naltrexone – which prevents one from drinking / taking drugs; gives an aversive unpleasant reaction if one drinks / takes drugs on top of it

4. Substitute dependency 

A) Replace alcoholic drinks with soda or lemonade
B) Methadone maintenance for heroin dependant clients
C) Nicotine patches / inhalators for smokers

5. New drug free social network 

Total avoidance of old social network – one of the main reasons for relapse

6. Inspirational groups

AA – Alcohol Anonymous / sponsors
NA – Narcotic Anonymous
CA – Cocaine Anonymous
Voluntary organisations

7. Cognitive Behaviour Therapy (CBT) 

A) Abstinent focused CBT
B) Self esteem building

8. Life style change

A) Regular job – (“Routine disrupts Addiction”)
B) Exercise
C) Voluntary work
D) Avoid old network of ‘friends’
E) Faith in God (“You will tread upon the lion and the cobra; You will trample the great lion and the serpent” Psalm 91:13) – Lion, cobra & serpent – figuratively refers to the powerful addictive substances – alcohol, cocaine.
F) Develop new hobbies or rediscover your hobbies which you used to do passionately when you were young.

Progression to Stable Abstinence

1st week in the community – most difficult

3 – 6 months – highest chance of relapse

6 months – 1-year – high chance of relapse

1-3 years – moderate chance of relapse

3- 5 years – less chance of relapse

> 5 years – Stable Abstinence – little chance of relapse

Note: Stable Abstinence– No drink or drugs for at least 3 year period whilst living in the community

Reference: ASAM – American Society of Addictive Medicine, 1998
Written by Dr J J Kumar MD, MRCPsych (Consultant Addiction Psychiatrist)

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