The Arkansan City of Van Buren, in Crawford County, faces a
serious epidemic of prescription drug abuse. The city, in the Fort Smith,
Arkansas-Oklahoma Metropolitan Statistical Area has demographic profile fairly
typical of many southern, small to midsize towns. The population of more than
20,000 is predominantly white with a modest median household income of about
$35,000. Many residents work in low paying jobs at local food processing and
According to local prosecutors, in recent years,
prescription drug prosecutions in the county have surpassed both a chronic
problem with methamphetamines and also marijuana prosecutions. The trend is
linked to the Arkansas’ high rate of opioid prescriptions. In a 2017 report,
the Centers For Disease Control and Prevention (CDC) ranked Arkansas second
only to Alabama for its rate of opioid prescriptions. The figures showed
Crawford County’s prescription rate as among the worst in the state and at 158
per 100 people more than twice the national average. The problem of
prescription drug abuse is especially serious among teenagers. The attorney
general, Leslie Rutledge, says Arkansas ranks first in the nation for misuse of
painkillers among children aged 12 to 17.
Some efforts to combat the prescription drug problem could
be starting to impact the city. State legislation passed in 2017 mandates that
doctors enter the information on the drugs they prescribe to patients into the
state’s Prescription Drug Monitoring Program (PMP) database. Several high schools
in the Fort Worth metropolitan area are taking part in a prescription drug
abuse education program launched in 2017 by the attorney general. The Crawford
County Sheriff’s Department, head-quartered in Van Buren, also participates in
Operation Drug Take Back and has a box for returning old prescription drugs.
An addiction assessment is used to determine if a person has
an addiction, its extent and if there are other issues present. A range of
professionals are able to conduct these assessments, including doctors, nurses,
social workers and psychologists. The information provided is kept confidential
and can consist of a questionnaire, an interview and a physical exam.
The questionnaire asks about drug or alcohol use, medical
history, general health and the impact any drug use may have had on the
person’s daily life. This is followed by a personal interview with a health
professional that together with the questionnaire helps to form a diagnosis.
Assessment tools used by clinicians during this process
include the National Institute on Drug Use Screening Tool (NIDA), the Alcohol
Use Disorders Identification Test-C (AUDIT-C) and the CAGE assessment.
The person may have to provide a urine sample to test for
drugs consumed. A blood sample can also be requested to help establish any
health impacts from drug abuse.
The pre-intake process is the step before a person actually
starts a more formal intake process to actually enroll in a drug rehabilitation
program. Pre-intake procedures might involve a questionnaire or an informal
The intake process determines if the rehabilitation center
selected by the person seeking treatment is the right option for their
addiction. The person and the center’s representative will discuss the
treatments offered by the facility to decide if it’s a good fit for their stage
of addiction. The rehabilitation center will ask about the seriousness of the
addiction, drug use history, any relevant family history and also discuss
financial options if the rehabilitation at the center goes ahead.
Recovering from drug and alcohol addictions usually involves
a detoxification phase at the start of the rehabilitation process. The detox
phase aims to completely remove the drugs from the body. In the case of opiate
prescription drugs, maintenance medication can be administered to reduce
withdrawal symptoms. Various factors impact how difficult this process is for
the person experiencing the detox, including:
– The person’s metabolism and general health
– The amount and frequency the drug was being taken
– The length of time the drug was taken
– The existence of any other addictions.
Under medical supervision the process is usually safe.
However, due to the severity of the process in certain situations it’s not
advisable to undertake a process of drug detoxification in your own home.
During the process a person’s body experiences withdrawl
symptoms which usually appear within 24 hours of taking the last dose of drugs.
The person can experience a range of withdrawl symptoms, including: nausea,
fatigue, depression, cramping and increased heart rate.
Some addictions, for example, to heroin, opiates, and
alcohol, can require medications to ease the severity of the withdrawal process
during detox. The medications can include:
This drug is often used during detox from opiate
prescription medications or heroin. The dose is reduced over time and may
continue beyond the actual detoxification process.
Buprenorphine is another option for treating heroin and
prescription opioid addictions. The drug’s advantage over methadone is that it
doesn’t give the patient a ‘high’ making abuse and possible addiction less
These medications help to relieve anxiety, general discomfort
and irritability during the detox process. Barbiturates can also act as a mild
A clinical professional will determine the appropriate level
of care. The highest level is inpatient (IP) treatment and consists of 24-hour
nursing care in a hospital setting. Individuals suffering from serious and
unstable medical or psychiatric issues generally opt for an acute level of IP
care. Acute care is maintained until the person is stable.
Residential treatment care (RTC) is one level below IP
treatment. RTC facilities are referred to as sub-acute facilities and rather
than 24 hour nursing attention, provide 24-hour monitoring. Diagnostic services
are also provided that aim to help people overcome any severe drug related
symptoms that significantly impede day to day functioning. Residents typically
receive intensive treatment through about 30 group sessions per week and seven
individual sessions per week, including about three therapy sessions involving
dietary consultations and individual consultations with the program’s
psychiatrist and physician). Each week, a weekly family treatment allows anyone
from the person’s main social network can participate. The typical length of
stay ranges from 30-60 days.
Partial hospitalization (PHP) treatment, also referred to as
day treatment, is an intensive care program that typically lasts four to eight
hours per day, three to seven days per week. The care is time limited and appropriate
for a person that lives in close proximity to the care program’s location and
whose drug related behaviors and medical issues can be treated without a more
structured treatment process. Partial day treatment programs include group,
individual and family or primary support network therapy. Medications is also
monitored and the duration of the treatment varies from two to twelve weeks.
Intensive outpatient treatment (IOP) can require individuals
to have a minimum of nine hours of therapy per week. A clinical professional
determines if this is the appropriate level of care through screenings and
other assessments. IOP is often a mixture of group and individual therapy. The
nine hours of treatment are usually divided into three-hour sessions, three to
five evenings a week for 12-16 weeks duration. Once the program is successfully
completed, the individual steps down to what’s called a “maintenance”
therapy group that may meet weekly. The average size for a group undertaking a
mental health intensive outpatient treatment program is eight to 15 people.
Outpatient Care (OC)
Outpatient treatment is regarded as the lowest care level
and is usually offered once a week. Outpatient settings can vary greatly but
they all involve office visits with no overnight stays. Some OC facilities are
located in community mental health centers and others are based in hospitals or
Aftercare for people recovering from drug addiction is
continuing treatment immediately following a defined period of addiction
treatment care like inpatient treatment or outpatient care.
Continuing treatment of this kind is essential for
recovering addicts because substance abuse can alter normal brain function and
change mental and physical health. These changes do not necessarily reverse
themselves, even after detoxification and a treatment program, and may last
many years after a person ends their substance abuse.
The aims of an aftercare program include:
– Stopping a relapse into drug addiction
– Maintaining a sense of purpose in life
– Ensuring a person’s mental and physical recovery from
Sober living homes are used by people recovering from
addiction and provide a transition between their rehabilitation and move back
into mainstream society. These homes are a drug and alcohol free environment
and many are certified by Sober Living Coalitions or groups. Sober living
facilities often have these key features:
– Residents are encouraged to take part in group therapy
– Residents are drug tested periodically to ensure
– Residents are required to carry out chores, prepare meals
and follow other house rules.
– Residents are supported in their efforts to work towards
goals like finding a job or completing school.
– Residents must pay lodging fees punctually.
Most sober living homes are single sex but co-ed facilities
are easy to find. Other sober living facilities are sober colleges and cater
solely for young people’s recovery from drug addiction and function not unlike
a college dormitory. Many establishments combine as outpatient treatment
centers so they are staffed 24 hours by medical professionals and social
workers. These facilities also have personnel that take care of cooking and cleaning.
These sober living centers tend to cost more but can provide a cheaper
alternative to often expensive inpatient treatment.
Some health professionals say sober living homes do increase
the likelihood of a sustained recovery from drug addiction especially when a
program based on the 12 Step model is followed. According to the Substance
Abuse and Mental Health Services Administration (SAMSHA) the majority of drug
addiction treatment centers use the model at least occasionally.
The 12 Step model was developed by Alcoholics Anonymous
founder Bill Wilson and is based around the idea that sharing personal stories
of addiction has a positive effect. Wilson believed that people can sustain
abstinence from their addictions if they help one another. This help comes in
the form of regular meetings where participants share their feelings about
their addiction and support each other through the recovery process.
The 12 Step process can be summarized as follows:
– The addict admitting that they cannot control their addiction.
– The addict recognizing that a higher power can provide
– The addict examining their past errors with the help of an
experienced member of the group.
– The addict making amends for this past mistakes.
– The addict learning to live by a new code of behavior.
– The addict helping others who suffer from addiction.