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Friday, February 10, 2006

LAW: Treatment For Substance "Use"

It is now being refered to as the DUI Industry and it is a billion dollar a year business. You can expect $6000 to come right out of your pocket and that does not include, future insurance rates, loss of work, inability to work, or the court ordered substance abuse treatment. What is wrong with substance abuse treatment you ask, first everyone that gets a DUI is not an alcoholic, in fact with the .08 per se laws I imagine the percentage is lower than one could expect. Second, the certificate to make an evaluation requires a fee and a short class, and the person fills out a form, no medical or psycological training is needed. Third, treatment should be retained for those in need, but the DUI industry continued to lower the evaluation standards until the net was big enough to catch every one.
Researchers and clinicians in the United States usually rely on the DSM diagnostic criteria. The evolution of diagnostic criteria for behavioral disorders involving alcohol reached a turning point in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (14). In DSM-III, for the first time, the term "alcoholism" was dropped in favor of two distinct categories labeled "alcohol abuse" and "alcohol dependence" (1,2,12,15). In a further break from the past, DSM-III included alcohol abuse and dependence in the category "substance use disorders" rather than as subsets of personality disorders (1,2,12).

The DSM was revised again in 1987 (DSM-III-R) (16). In DSM-III-R, the category of dependence was expanded to include some criteria that in DSM-III were considered symptoms of abuse. For example, the DSM-III-R described dependence as including both physiological symptoms, such as tolerance and withdrawal, and behavioral symptoms, such as impaired control over drinking (17). In DSM-III-R, abuse became a residual category for diagnosing those who never met the criteria for dependence, but who drank despite alcohol-related physical, social, psychological, or occupational problems, or who drank in dangerous situations, such as in conjunction with driving (17).

This conceptualization seems to allow the clinician to classify meaningful aspects of a patient's behavior even when that behavior was not clearly associated with dependence. Quote,"...who drank in dangerous situations, such as in conjunction with driving." All DUI convicts have substance use disorders, or are alcohol dependant, or simply put can shell some of their money out to the medical side of the DUI industry, don't believe me-"Diagnostic criteria allow clinicians to plan treatment and monitor treatment progress; health care insurers to decide whether treatment will be reimbursed; and allow patients access to medical insurance coverage (1-3)."

Linda Grant, executive director of treatment provider Evergreen Manor Inc. in Everett, said," "It's not that we don't want to see good quality work, and everybody tries for that,". "The vast majority of treatment providers really do want to do the right thing, but this is not a science. It's an art..."
Defined Art is - 1)Human effort to imitate, supplement, alter, or counteract the work of nature.
2) Skill that is attained by study, practice, or observation: the art of the baker; the blacksmith's art.
My opinion, this is much like the art that allows the NHTSA to defy the Data Quality Act!
The study from Columbia University's National Center on Addiction and Substance Abuse (CASA) claims that adults who drink excessively and youths who drink illegally account for over half of the alcohol consumed in the United States..."Excessive drinking" sounds like it refers to people that have a serious alcohol problem. But the study significantly lowers the bar on "excessive," by defining it as any more than two drinks per day. That means that one glass of wine or beer at lunch and dinner and a brandy at bedtime makes you an "excessive" drinker.

Tough love, more punishment, this is one of the most pernicious myths about dealing with drug problems. Confrontational and humiliating "attack therapy" — often used in rehabs — actually increases the chances of relapse and treatment drop-out. People threatened with prison if they don’t quit drugs are no more likely to succeed in treatment than those who seek help on their own, according to a summary of the research published by the National Institute on Drug Abuse. Tough interventions — which threaten loss of employment or relationships if the person doesn’t shape up immediately — have resulted in suicides as well as recovery. "There is no doubt that aggressive, hostilely confrontational treatment protocols do more harm than good,"

Even though a client may be innocent they probably feel it necessary to plead guilty in hopes of a lighter sentence, one where the defendant may resume daily life with added treatment as opposed to incarcaration. I have seen this all too often! A vicious circle, and punishment for a disease that one may or may not have...




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