Self Help

Self help groups can complement and extend the effects of professional treatment. The most prominent self help groups are Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous. These help groups operate on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community and social support to help people achieve and maintain abstinence and other healthy lifestyle behaviors over the course of a lifetime.

Effective Treatment Principles

Addiction is a complex but treatable condition that affects brain function and behavior. The abuse of drugs alters the structure and function of the brain, resulting in changes that persist long after drug use. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. No single treatment is appropriate for every user in recovery. Matching treatment settings, interventions and services to the particular problems and needs of a patient is critical to achieving success in returning to productive functioning in the family, workplace and society. Treatment needs to be readily available. Because individuals addicted to drugs may be uncertain about entering treatment, it is critical to take advantage of available services the moment people are ready for treatment. Patients can be lost if treatment is not immediately available or readily accessible. As with other chronic conditions, the earlier the user seeks treatment, the greater the likelihood of positive outcomes. Effective treatment addresses the multiple needs of the individual, not just drug abuse. To be effective, treatment must address the drug abuse and any associated medical, psychological, social, vocational and legal problems. It is also important that treatment be appropriate to the age, gender, ethnicity and culture of the user. It is critical that the user remain in treatment for an adequate recovery period. The appropriate duration for an individual depends on the type and degree of problems and needs. Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop drug use. Studies also suggest that the best recovery outcomes occur with longer durations of treatment. Recovery from drug addiction is a long process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and signifies that treatment should be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. The most commonly used forms of drug abuse treatment are counseling in individual and or groups and other behavioral therapies. Behavioral therapies vary in focus and may involve addressing a the motivation of a user to change, providing incentives for abstinence, building skills to resist drug use, replacing activities involving drugs with constructive and rewarding activities, improving problem solving skills and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence from drugs. Medications can be an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize and reduce illicit drug use. Naltrexone is also an effective medication for some individuals addicted to opioids and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram and topiramate. For persons addicted to nicotine, a nicotine replacement product such as patches, gum or lozenges or an oral medication such as bupropion or varenicline can be an effective component of treatment when part of a comprehensive behavioral rehab program. Doctors must modify and monitor the treatments and services for each patient to ensure that the rehabilitation meets the changing needs of the addict in recovery. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to changing needs. Many individuals addicted to drugs also have other mental disorders. Because drug abuse and addiction, which are both mental disorders, often occur together with additional mental illnesses, doctors should carefully assess patients that present with one condition for the other. When these problems occur together, treatment should address both by the use of medication. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change the effects of drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective addiction treatment in the end, detoxification alone is rarely sufficient to help addicted individuals achieve a new lifestyle of abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. Specialists must continually monitor drug use during treatment, as patients can lapse during treatment. Another powerful motivator to get clean is if patients know that doctors monitor the drug intake of each patient. Monitoring also provides an early indication of a return to drug use, signaling the possible need to adjust the treatment plan of an individual to better meet changing needs. Drug abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV and other infectious conditions. Specialists should encourage and support HIV screening and inform patients that highly active antiretroviral therapy can be effective in combating HIV. Treatments vary, depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

Gambling Problems

Pathological gambling is being unable to resist impulses to gamble, which can lead to severe personal or social consequences. Pathological gambling usually begins in early adolescence in men, and between ages 20 and 40 in women. Pathological gambling often involves repetitive behaviors. People with this problem have a hard time resisting or controlling the impulse to gamble. Although it shares features of obsessive compulsive disorder, pathological gambling is likely a different condition.

People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as having five or more of the following symptoms:
Committing crimes to get money to gamble
Feeling restless or irritable when trying to cut back or quit gambling
Gambling to escape problems or feelings of sadness or anxiety
Gambling larger amounts of money to try to make back previous losses
Having had many unsuccessful attempts to cut back or quit gambling
Losing a job, relationship, or educational or career opportunity due to gambling
Lying about the amount of time or money spent gambling
Needing to borrow money due to gambling losses
Needing to gamble larger amounts of money in order to feel excitement
Spending a lot of time thinking about gambling, such as remembering past experiences or ways to get more money with which to gamble
A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions can help with the diagnosis.
Treatment for people with pathological gambling begins with recognizing the problem. Pathological gambling is often associated with denial. People with the illness often refuse to accept that they have a problem or need treatment.

Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Poker Jacks Back

Draw Poker Jacks Back

Draw Poker Jacks Back is played with a standard 52-card deck and one Joker. The Joker may be used as an Ace or as any card that completes a straight, flush, or a straight flush. All players place their ante in the pot.

Players are dealt five cards face down, one at a time, in rotation. A round of betting begins (check, bet, call, raise, or fold). If no player has a pair of Jacks or better (higher) after the initial deal, the game converts to the game of Lowball, i.e., California or Kansas City Lowball.

If a player has a pair of Jacks or better after the initial deal, the remaining players may discard any number of their original cards and have the same number of cards replaced by the dealer. Another round of betting occurs. The player with the highest ranking five-card poker hand wins. Five Aces is the best possible hand (four Aces and the Joker). In the event of a tie, the pot is split equally.