The field of addiction treatment has evolved significantly in response to scientific research and cultural shifts. Today’s quality addict rehabilitation centers offer multiple approaches to treatment, each backed by research and evidence. There is quite a bit of misunderstanding about what constitutes evidence-based treatment. People seeking addiction treatment in Delaware should understand what evidence-based treatment is and how it can be part of an effective rehab program.
The Most Abused Substances in Delaware
What substances affect Delaware the most? The Drug Enforcement Agency (DEA) lists the following as the most readily available and widely abused drugs in the state.
Powdered and Crack Cocaine
Cocaine in powdered form is easily obtainable in Delaware, as indicated by law enforcement reports. Demand has historically been high and remains high. The primary source of powdered cocaine is Mexican drug cartels that operate in Philadelphia and New York City. In recent years, a further supply has developed through Arizona, Texas and California.
People also abuse crack cocaine, the crystal form. The main user base is different, with crack use most prevalent among African American men ages 20 to 40. Production of crack takes place mainly in “cook houses” inside state borders.
Although marijuana is still illegal for recreational use in Delaware, the state has passed a law decriminalizing its possession. Since December 2015, adults in Delaware have been able to possess small amounts of marijuana, with the consequences being only a fine. Decriminalization, combined with a medical marijuana program, has made it more accessible in Delaware than ever before. Public attitudes have long treated marijuana as less addictive than other types of drugs, and widespread availability increases the likelihood of more residents developing a marijuana addiction.
Although methamphetamine is not in especially high demand, the DEA indicates that its availability is on the rise. Meth in Delaware is popular in both powdered and crystalline forms. It most commonly comes from cartels in Mexico, although some small operations run out of individual homes.
In terms of illicit drugs, heroin is Delaware’s most significant threat. Reports from multiple law agencies continue to show increases in use every year, as trafficking and seizures of meth also rise. Delaware is near several national hubs for cheap, high-purity heroin. The opioid crisis is also causing users to switch from painkillers to heroin due to its low cost and easier availability.
While heroin is an illicit opioid, legally prescribed opioids are just as much of a threat. For the better part of a decade, Delaware has consistently ranked near the top of the charts for high-dosage opioid prescriptions. In 2018, providers in Delaware wrote 60.6 opioid prescriptions per 100 residents, compared to the nationwide rate of 51.4 per 100. Between heroin and prescription painkillers, 88% of the state’s overdose deaths involved opioids in 2018.
Delaware Drug Use Laws
The formal name for drugs of all types is controlled dangerous substances (CDS). When crimes involve possession of a CDS for personal use rather than distribution, the legal ramifications are less severe. Delaware drug laws are such that these crimes typically do not result in felonies. The Delaware Classification of Offenses Section 4202 categorizes drug-related crimes under these parameters.
- Class A misdemeanors: Individuals may receive fines up to $2,300, go to jail for up to one year and any other penalties deemed appropriate.
- Class B misdemeanors: Individuals may receive fines up to $1,150, go to jail for up to six months and any other penalties deemed appropriate.
- Unclassified misdemeanors: These crimes can result in fines up to $575, up to 30 days of incarceration, restitution and other penalties as long as the law does not indicate any specific punishments.
Crimes involving CDS may have “aggravating factors” that result in harsher punishment for the defender. According to the Delaware Controlled Substance Act Section 4751A, aggravating factors are present when:
- The crime involves a minor as an accomplice in the crime or the party receiving the drug, and the defendant is more than four years older than the minor.
- The crime occurs in a school zone, recreation area, place of worship or protected park.
- The crime takes place in the confines of a vehicle.
The consequences of drug possession in Delaware can be devastating. The solution is to abide by the law and stop abusing drugs, and the only way to do so successfully is to investigate Delaware rehab centers to find one that offers a range of treatment methods.
What Is Evidence-Based Treatment?
Principles of Evidence-Based Addiction Therapy
To fall under the classification of evidence-based treatment, the method must:
- Have published research citing it as evidence-based or recognition from reputable organizations as an evidence-based treatment.
- Have been researched and scientifically studied.
- Have evidence published in a peer-reviewed journal.
- Have delivered the desired outcome based on the objectives of the addiction treatment.
- Be standardized and repeatable — in other words, there are published instructions stating how to use the method and with which clients, what the goals are and any materials needed for a successful treatment.
- Have consistently provided results in multiple environments.
- Have measures in place to evaluate the effectiveness of implementation compared to the initially researched protocol.
Types of Evidence-Based Clinical Treatments
- Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy, or CBT, is a type of psychotherapy prevalent in addiction treatment due to its efficacy. CBT is a one-on-one therapy and is typically very structured. The goal of CBT is to help the client identify patterns of negative thinking and change them. These changes promote the ability to trigger healthy responses to the stress and challenges of everyday life.
- Medication-assisted treatment (MAT):The NIDA considers pharmacotherapy an evidence-based approach that helps people live healthy lives once again. It is a particularly useful approach in overcoming opioid, tobacco or alcohol addiction. Medication-assisted treatment usually works best in conjunction with behavioral therapy, which is why it is only one of the treatments we use here at Gateway. MAT can reduce the risk of relapse by blocking a drug’s effects or satisfying a craving without the unwanted side effects of the harmful substance.
- Contingency management interventions:You might hear the contingency management approach referred to as a motivational incentive. The idea behind this practice is to reward clients for living a drug-free lifestyle. One method uses voucher-based reinforcement (VBR). Clients receive a voucher with monetary value for every drug-free urine sample. The reward goes up with each consecutive negative test result. When combined with MAT methadone treatments, VBR is effective at helping people avoid opioids and cocaine. The other method is prize incentives, where clients can enter a drawing to win a reward. With each consecutive negative drug test or counseling session attended, they get more entries in the raffle. This method isn’t standard in 24-hour rehab centers where residents don’t have access to drugs in the first place. Instead, it rewards clients for choosing to live a drug-free lifestyle in outpatient care.
- Community reinforcement approach (CRA): Another outpatient treatment is CRA plus vouchers, an intensive 24-week program. It intends to help clients maintain sobriety as they develop new life skills to sustain abstinence. Clients attend counseling sessions, where they focus on improving family relationships and minimizing drug use. They also receive career counseling, learn new recreational activities and build new social networks. In combination with these approaches, clients also receive vouchers for drug-negative urine samples.
- Motivational enhancement therapy: Also called motivational interviewing, this approach aims to resolve ambivalence toward treatment. Clients learn to develop an intrinsic motivation for fighting addiction. Rather than guiding people step-by-step through the process, motivational interviewing helps clients discover, strengthen and harness their internal motivation for quitting substances. The NIDA recommends this approach primarily for alcohol, marijuana and nicotine dependencies. It is an effective strategy for engaging clients in the recovery process, opening up further treatment options.
How Gateway Foundation Uses Evidence-Based Medicine
Evidence-based, science-backed treatments set clients up to end the suffering brought by substance abuse. Gateway Foundation and other leading rehabilitation centers in Delaware employ the following common evidence-based treatments.
Counseling: Individual and Group
Counseling is a central pillar of addiction medicine. It can and should occur in both individual and group settings to allow clients to learn how to express themselves to others in healthy ways. Counseling is an excellent opportunity to build recovery skills and sort out the tangled roots of addiction.
Gateway’s CBT program is a short-term treatment to help change thought and behavioral patterns. We use CBT in both group and one-on-one therapy sessions. Our goal is to refocus on the present, away from the past. We use CBT to help identify the root cause of clients’ stresses that have led them down the dark path of addiction. Once we can identify these factors, we can help them adopt coping skills to deal with these stressors safely and healthily.
CBT’s goal-oriented approach helps clients manage the symptoms of anxiety and depression through planned coping mechanisms. Clients may focus on specific techniques in sessions designed to build resilience, increase healthy assertiveness and improve stress management.
Dialectical Behavioral Therapy
Psychologists developed dialectical behavioral therapy, or DBT, in the 1980s, primarily to treat borderline personality disorder. DBT relates to CBT, but does not derive directly from it. DBT’s focus is to help the client develop behavioral skills that make managing recovery possible. The techniques DBT uses prompt clients to learn how to manage their emotions, have healthier relationships, learn conflict resolution and deal with stress. DBT takes place in one-on-one and group settings. The sessions focus on developing four skill areas.
- Mindfulness: Accepting current circumstances and emotions in the moment.
- Distress tolerance: Actively managing negative emotions, rather than trying to run from them.
- Emotion regulation: Recognizing, managing and changing high-intensity emotions.
- Interpersonal effectiveness: Becoming appropriately assertive and increasing self-respect.
Acceptance and Commitment Therapy
Motivational interviewing originates from the person-centered approach to therapy developed by Carl Rogers. It acknowledges that although someone has decided to seek treatment, their feelings may change and they may become ambivalent or hostile at any point. Motivational interviewing asks clients to identify their goals and change behaviors that are harmful to their health. For those who have trouble finding the internal motivation to continue recovery, this type of therapy is essential.
While relapse prevention as a concept forms the heart of addiction treatment, it is also crucial as a service. This intervention approach is skills-based, teaching clients what to do in response to a variety of situations. The first key is to learn how to identify relapse triggers, and the second is to develop a plan to respond to them. A comprehensive relapse prevention plan will help clients:
- Learn how to say “no” when necessary.
- Plan for emergencies when sudden, intense cravings arise.
- Improve confidence in their ability to remain sober.
- Recognize distorted thinking and find clarity.
Relapse prevention provides clients with concrete steps to take during challenging cravings outside of treatment.
Science-Backed Healing at Gateway Smyrna
If you are looking for rehabilitation centers in Delaware, consider the Gateway Foundation Network. Gateway Smyrna is a residential, 24-hour rehab facility that serves men in Delaware. Through evidence-based therapy and treatment methods, we create an environment where men can feel safe and affirmed in exploring their emotions as they recover from addiction.
If you’re ready to stop living in the shadow of addiction and want to give yourself the advantage of scientifically proven treatment, contact Gateway Foundation and find out more about the next steps toward recovery.