Drug therapy
Drug therapy is a term used to describe therapeutic methods used to treat addictions. In addition to the effects of the substances on the body, in particular on the sensitive hormone balance (e.g. on the limbic system and the dopamine balance ), there are also psychological problems, most of which have only led to an attempt at self-medication or addiction that has gotten out of control , treated.
Goal setting
The aim of long-term therapy is to build a stable personality , which means learning to live with “real”, ie. H. to enable endogenous feelings without the influence of drugs. Developmental steps that are missed due to drug consumption in adolescence can be made up for. The therapeutic community enables various learning steps to cope with everyday life and to build sustainable interpersonal relationships, which greatly improves the chances of leaving. The life stories of alumni show that there is always a chance of getting rid of the drug, even after several relapses, as well as with so-called "therapy-resistant" severely addicts, although usually only after many years. It must also be mentioned, however, that even long-term chronic drug use is much more often stopped without drug therapy, usually from the age of around 40.
Treatment process
- The drug addict contacts a doctor or a psychosocial counseling and treatment center (psbb).
- There is a physical withdrawal with subsequent recovery in a withdrawal ward or a hospital (duration: approx. 2 weeks)
- Mental weaning takes place in a clinic specializing in addictions or in a therapeutic community (previously for 12 to 18 months, now rarely more than 10 months approved by the payers). While a seven-month (sometimes more) long withdrawal treatment could be carried out in a therapeutic community / therapy center up to January 2006, the German Pension Insurance (LVA, BfA and Knappschaften until October 2005) now sets the duration of treatment to a maximum of six months.
- So-called adaptation phase therapy can then take place in a corresponding facility, so that a total of 10 months can be achieved. The adaptation phase follows on from the master phase, i.e. it goes beyond the possibilities of a therapeutic community and primarily aims at reintegrating the patient into the labor market and society. (Job, work trials, internships etc. and own apartment). According to the requirements of the German Pension Insurance , which often bears the costs for such treatment, the adaptation phase lasts three to four months. As a result of the highest court rulings, the health insurance companies only cover the costs of adaptation treatment in exceptional cases in facilities with an integrated adaptation phase.
- The reintegration into society and the world of work takes place step by step and is initially accompanied, for example in an outdoor living group as a stopover, or in an adaptation phase house. The institutions are usually non-profit organizations (registered associations) or corporations under public law.
- Follow-up care takes place individually or in groups, in a doctor's practice or an advice center.
- There are also so-called aftercare facilities . These offer a long-term phase of integration (school / job, psychotherapy, issues relating to the family and personal development, etc.), in some cases for up to two years , within therapeutic residential communities , especially for adolescents and young adults who have already been drug users . The responsible youth welfare office, which finances the measure for a limited period on the basis of the KJHG (§§ 35, 35a in conjunction with 41), is the cost bearer. The local social welfare providers are also responsible for paying. Even adults can work on their integration in such an institution, which can be found in almost every major city in Germany, for up to two years. The aftercare facility is a drug and alcohol-free facility. She completes the institutionalized treatment and pursues a permanent abstinent lifestyle. It cooperates with the important area of organized self-help.
Success rate
It is difficult to make statements about the success rate of abstinence-oriented therapies. First of all, it is hardly possible to establish a causal connection between the therapeutic effects and any abstinence. In addition, the vast majority of the figures for this come from the representations of the respective houses and none of the German drug therapy facilities has so far allowed an external review. Surveys of former clients have shown that around 5% of opioid addicts have changed their consumption behavior due to therapy and only a good one percent have been treated “successfully in the sense of permanent abstinence”. Finally, the definition of drug-free is difficult (does alcohol belong to it?). Many former addicts still have a "slip" that does not necessarily have to turn into a serious relapse. Today's drug policy has clearly moved away from the idea of total abstinence, rather the clients are substituted in order to minimize the massive consequential damage of a long history of addiction as far as possible. Thus, the success rate of clients who have gone through one or more long-term therapies can be quantified as very low.
According to the first independent study in Italy, carried out by a multidisciplinary team of researchers from the Universities of Urbino and Pavia , 72% of people who finished long-term therapy in San Patrignano , the largest drug rehabilitation center in Europe, no longer use drugs. You are fully integrated into society, both socially and professionally.
Legal situation
Drug addiction is the cause of numerous criminal offenses. Sections 35 ff. BtMG give convicted narcotics-dependent offenders the opportunity to “serve” part of their forfeited punishment by receiving therapy. A postponement of the enforcement is only possible if the imprisonment sentence does not exceed two years or a corresponding partial serving has taken place. In principle, several convictions, each within the limit, can be postponed at the same time. The prerequisite is that the drug addiction offense has been committed. This is the case, for example, with procurement crime. The background to the regulation is that punishment does not replace therapy and that eliminating the cause of the crime is the best crime prophylaxis. The convicted offender is either temporarily removed from the prison system or the law enforcement authorities initially refrain from summoning him to begin his sentence. The offender should on the one hand be motivated by the pressure of the imminent execution of sentences in the event of failure, on the other hand by the possibility of acquiring early suspension for probation and offsetting the sentence after successful completion of therapy.
literature
- Bernhard van Treeck (2008): BSG judgment Az B1 KR 36/06: adaptation phase, no benefits from statutory health insurance, SUCHT 54 (1), 43
Web links
- Self-management therapy: interventions in inpatient rehabilitation for alcohol addiction . Dissertation, 2007 (Peter Sadowski, University of Greifswald)
Individual evidence
- ↑ Giorgio Manfrè, Giuliano Piazzi, Aldo Polettini, Oltre la comunità - studio multidisciplinare di ritenzione in trattamento e follow-up su ex-residenti di San Patrignano , Franco Angeli editore, 2005
- ↑ Patzak, Jörn and Dr. Wolfgang Bohnen: Narcotics Law , Verlag CH Beck: 1st edition, ISBN 978-3-406-58639-2 , Chapter 4 marginal note 1
