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Biomedical subjects

J E Zweben

Publications and source records attributed to J E Zweben.

At least 19 recordsLinked to original sources
PubMed1990

Methadone maintenance in the treatment of opioid dependence. A current perspective.

We describe the historical underpinnings of negative attitudes towards methadone and how these affect medical decisions. Current developments have increased the understanding of the origins of opioid addiction, such as how receptor system dysfunction may affect the ability to remain abstinent once out of treatment. Specialized topics include the pregnant addict, the role of methadone maintenance in limiting the spread of the acquired immunodeficiency syndrome, and patients with a dual diagnosis. We also describe issues that arise when methadone is used in conjunction with prescribed or abused drugs, noting pharmacologic alternatives and adjuncts to methadone treatment. Finally, we comment on treatment issues such as methadone patients in 12-step programs and the growing legitimacy of this treatment method.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Recovery-oriented psychotherapy: patient resistances and therapist dilemmas.

This paper examines patient resistances, especially in early recovery, and explores some therapist's dilemmas and hazards arising from personal issues and gaps in professional training. To some extent, these vary according to the route by which the practitioner became involved in treating addiction. The vulnerabilities of the conventionally trained mental health therapist are contrasted with difficulties often seen among those whose training and primary experience base is in substance abuse treatment. Emphasis is given to the patient in denial and in early recovery and to the frustrations and power struggles common at those stages. The paper briefly addresses problems manifested by insulated treatment systems and other obstacles to open inquiry and dialogue among professionals.

Alcoholism↗
PubMed1989

The use of visualization as a means of integrating the spiritual dimension into treatment: Part II. Working with emotions.

This paper describes additional visualizations intended to foster the integration of the spiritual dimension into the treatment of addiction. An earlier paper described visualizations derived from Jungian principles, aiming particularly at calming, centering, and strengthening the spiritual connection. This paper focuses on work with feelings that arise in recovery. It describes the differing stance towards emotions in psychotherapy and in spiritual disciplines, and how these can be unified using visualizations.

Alcoholism↗
PubMed1988

The use of visualization as a means of integrating the spiritual dimension into treatment: a practical guide.

A recognition of the importance of the spiritual dimension in recovery is evident among many substance abuse practitioners, particularly those with strong ties to 12-Step programs. This paper describes visualization techniques derived from Jungian principles, as a practical means for the recovery-oriented psychotherapist to foster a spiritual connection. They are also useful in work on the psychological and interpersonal issues that emerge as the client establishes abstinence and progresses from there. This approach does not require allegiance to any specific religious beliefs, but allows the client to build on an inner experience as a way to develop resources in recovery.

Alcoholism↗
PubMed1986

Recovery oriented psychotherapy.

Professionals disagree about the role of psychotherapy in the treatment of drug and alcohol problems. This paper defines psychotherapy in terms of the changing ways the professional can assist in the tasks of recovery. These are examined in an evolutionary sequence: dealing with the client in the active abuse cycle; breaking the addiction cycle; consolidating abstinence and changing life styles; addressing recovery-related psychological issues; and undertaking long term psychological exploration. Differing applications of behavior shaping and insight oriented techniques are discussed.

Family Therapy↗
PubMedDate not supplied

Treating cocaine dependence: new challenges for the therapeutic community.

The basic treatment principles for addiction are consistent, regardless of whether the drug of choice is alcohol, heroin or cocaine. However, attention to the distinctive characteristics of both a particular class of drugs, such as stimulants, and the populations that use them, gives counselors and programs a distinct advantage in treatment. This advantage is particularly powerful in the early stages of treatment, in which simply increasing the time of retention improves the possibility of a positive outcome. Programs that wish to address the needs of the newer cocaine-abusing population seeking treatment need to focus more on the outpatient phase of treatment. In this model, the residential stage is seen as the launching platform for the recovery process, rather than the time period when the major transformations will occur. The task is to find ways to build structure in the outpatient treatment that is adequate to the changing needs of recovering clients. By so doing, programs will enrich their offerings to their existing components and most likely improve the potential of a long-term successful outcome for everyone.

Adult↗
PubMedDate not supplied

Considerations in using psychotropic medication with dual diagnosis patients in recovery.

This article addresses some of the issues that arise when chemically dependent patients with coexisting psychiatric disorders require medication. A history of chemical dependence may alter prescribing practices, as certain medications may have a higher abuse potential or may enhance the danger of relapse to the primary drug of abuse. Recovering patients have complex attitudes and feelings toward medications that need to be explored, particularly as they affect compliance with prescribed regimens. Issues arising in the treatment of anxiety disorders, depression, and attention deficit disorders are discussed. Guidelines are provided for therapists working with prescribing physicians, and for handling problems that may arise in conjunction with 12-Step program participation.

Adult↗
PubMedDate not supplied

Legal vulnerabilities in the treatment of chemically dependent dual diagnosis patients.

Substance abusing patients with significant psychiatric disorders can present unique legal vulnerabilities for treatment professionals. The tendency within the chemical dependency community to treat patients uniformly can militate against the individualized treatment planning that satisfies legal obligations to act in the best interest of the patient. The failure to adequately consider both the psychiatric disorder and substance abuse problem may create legal vulnerabilities that issue from the failure to refer a patient in need of medication or the failure to prevent the suicide of a patient in a situation where suicide is preventable. Patients suffering harm from acts of commission or omission of a chemical dependency treatment specialist have recourse through laws regarding negligence. Variations in the backgrounds and training of care providers create problems for the harmed patient in establishing a standard of care for the treatment of chemical dependence. However, the psychological symptoms of the dual diagnosis patient make it easier to establish a standard of care that may be legally cognizable. The chemical dependency specialist--of whatever discipline--has a duty to patients that requires sound assessment and disposition.

Adult↗
PubMedDate not supplied

Psychotic conditions and substance use: prescribing guidelines and other treatment issues.

This article examines several circumstances in which psychotic symptoms coexist with substance abuse. It reviews psychotic states that may occur as a result of alcohol and other drug use, including intoxication, overdose and withdrawal, offering medication guidelines for managing these situations. It also examines psychiatric disturbances in which psychotic symptoms are recurrent features, exploring patients' self-medication practices and some strategies to address them, as well as difficulties commonly encountered with prescription medications. It briefly discusses other psychosocial interventions that play a significant role in the treatment of the dual diagnosis patient.

Clinical Protocols↗
PubMedDate not supplied

Methadone maintenance treatment: a primer for physicians.

The doctor-patient interaction in the methadone maintenance treatment clinic is qualitatively different from general medical settings. The patient presents with a specific request for treatment of opioid dependence, most often having already selected the methadone treatment modality, and the initial contact is centered around obtaining methadone. Addiction and needle use increase susceptibility to life-threatening illnesses, such as syphilis, endocarditis, tuberculosis, and AIDS. The physician is working with counselors, nurses, therapists and 12-Step programs, incorporating the best of the medical, psychodynamic, behavioral, and recovery models into treatment. Federal and state governments also control and regulate methadone treatment. Given this complex picture, the basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methadone maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.

Female↗