CHAPTER 2

REVIEW OF RELATED LITERATURE

Drug abuse is a complex, multidimensional, chronic condition. Several theoretical models have

been proposed to explain the causes of drug abuse (13,169,367). They range from theories of

genetic predisposition and metabolic deficiencies to theories based on psychoanalytic principles

and social learning. The lack of agreement on a single cause of drug abuse has been likened to

Voltaire’s saying that, “A long dispute means that both parties are wrong.” It might be more

appropriate, however, to conclude that both parties are right. The empirical evidence does not

exclusively support one model over the others, but rather suggests that elements from all the

models play a role in the initiation and maintenance of abusive behavior.

The enormity of the problem lies, in part, in the fact that drug abuse is a condition that has a long

course, in most cases lasting a decade or more. A simple framework highlights the necessary

ingredients in the making of a drug abuser, namely “a susceptible person, an abusable drug, and

some mechanism to bring the two together” (169). These three factors interact during the whole

course of drug abuse. Multiple paths lead in and out of this career, which is characterized by four

stages: initiation, maintenance, cessation, and relapse (65,158,267,268). Findings of a landmark

study on drug abuse showed that the average length of time from first use to last daily opiate use

was almost 10 years, and that over the course of a 12-year followup, over two-thirds of clients

had relapsed one or more times to daily opiate use (157,267,268). Individual susceptibility to

relapsing into drug use is at the core of this cycle and can be explained by a variety of factors

that may interact or operate independently (169). These factors may stem from biological,

psychological, or socioeconomic conditions, and their roles may vary during the different stages
of the abuse career. Not everyone who experiments with drugs will become a casual user, and

not all casual users will escalate into full-fledged abuse or dependence (addiction) (13,104).

Abuse refers to a pattern of use that results in harm to the user; the user continues use despite

adverse consequences. Dependence, on the other hand, is characterized by compulsive behavior

and the active pursuit of a lifestyle that centers around searching for, obtaining, and using the

drug. Dependence refers to the most severe state in the drug-use spectrum; the patterns of use of

psychoactive substances range from experimental, occasional, and recreational use to abuse and

to compulsive use, which characterizes dependence. Although treatment is intended for those

dependent on drugs, the term drug abuse as used in this report encompasses both abuse and

dependence. Not all substances have the same potential for dependence, and individual

biological differences may affect whether particular individuals become dependent on a drug.

There is inadequate research to determine precisely the likelihood that a casual user will become

addicted to various substances. Some experts hypothesize that upper estimates may be 1 out of

10 persons for alcohol or marijuana, about 3 to 5 out of 10 persons for intranasal use of cocaine

and about 8 to 9 out of 10 for those who smoke or inject heroin or cocaine or smoke crack (169).

Drug addiction is a worldwide phenomenon which generates problems not only affecting

families but the society as well. Addictive substances are rampant among our societies today and

minors are easy victims. It is in thispremise why the government provides rehabilitation and

treatment to this at risk population well. Addictive substances are rampant and accessible leaving

the young population easy victims. Addiction can trap anyone. It can lead to harming one’s body,

causing problems in family structure, and contribute delinquency to society. Treatment enables

people to counteract addiction’s influential disturbing effects on their brain and behavior and
recover control of their lives. Addiction cannot always be cured, but like other chronic diseases,

addiction can be managed successfully.

It is estimated that 1 in 20 adults, or a quarter of a billion people between the ages of 15 and 64

years, used at least one drug in 2014. Roughly the equivalent of the combined populations of

France, Germany, Italy and the United Kingdom, though a substantial amount, it is one that does

not seem to have grown over the past four years in proportion to the global population.

Nevertheless, as over 29 million people who use drugs are estimated to suffer from drug use

disorders, and of those, 12 million are people who inject drugs (PWID), of whom 14.0 per cent

are living with HIV, the impact of drug use in terms of its consequences on health continues to

be devastating. With an estimated 207,400 drug-related deaths in 2014, corresponding to 43.5

deaths per million people aged 15-64, the number of drug-related deaths worldwide has also

remained stable, although unacceptable and preventable. Overdose deaths contribute to between

roughly a third and a half of all drug-related deaths, which are attributable in most cases to

opioids. The time period shortly after release from prison is associated with a substantially

increased risk of death from drug-related causes (primarily as a result of drug overdoses), with a

mortality rate much higher than from all causes among the general population. In many

countries, prisons remain a high-risk environment for infectious diseases, which is a significant

concern for prison health. A number of studies report high levels of drug use in prison, including

the use of opiates and injecting drug use. In addition, the prevalence of HIV, hepatitis and

tuberculosis among persons held in prison can be substantially higher than among the general

population. However, despite the high-risk environment and scientific evidence for effective

health interventions, there are significant gaps in prevention and treatment services in many

prisons around the world. Several studies have examined the course of drug abuse careers. Most
of them, however, are over 20 years old and may not reflect current patterns. The majority

studied samples of predominantly heroin abusers who received treatment for drug problems that

in most of the cases started before 1%0 (268). Similar studies are not available for those who

abuse cocaine. Some of the reported studies on heroin use suffer from a variety of

methodological problems, including presenting the findings in general descriptive form and

rarely employing sophisticated quantitative analyses, such as multivariate analysis.

Evaluating the effectiveness of a drug abuse treatment program involves understanding many

facets of the treatment modality. The need for efficient treatment is something which we, as

Americans, can no longer defer to another day or time. Drug dependence results in thousands of

lives being tormented and forever changed (National Research Council and Institute of

Medicine, 2004). Be it an alcohol-related automobile 7 accident, a heroin overdose, or a death

related to exhaustion from an amphetamine binge, this epidemic is killing people in hoards,

many of whom have never stepped foot inside a treatment facility. Along with quantifying what

is or is not an effective treatment modality, one must first understand the facts about the drug and

alcohol dilemma which have permeated our society as a whole. Drug abuse treatment is provided

in distinct program settings, each having arisen from and being inseparably tied to distinct

philosophical traditions and treatment 22

orientations. Over the past 30 years, these settings have evolved as major treatment modalities

(Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997, p. 244). According to Etheridge et al.

(1997), the major modalities of drug treatment have significantly changed in both structure and

approach since their inception in the 1960s.

Moreover, the setting for alcohol and drug treatment has significantly changed in the past two

decades. In the 1980s and early 1990s, the principal treatment modality typically consisted of a

28-day inpatient stay. Currently, most treatment programs only provide inpatient treatment for 3–

14 days, followed by a variation of outpatient treatment services. Both the 28-day and outpatient

programs have been determined more by financial considerations than with empirically based

research (Adinoff, Scannell, Carter, & Dohoney, 1999).

According to Fletcher, Tims and Brown (1997), research has shown that existing behavioral,

psychosocial, and pharmacological treatments can effectively reduce drug use and help manage

drug dependence and addiction. According to Gossop (2003), the behaviors underlying substance

dependence are the most frequent reasons for drug users to seek treatment. In their research

pertaining to treatment types, Finney, Hahn, and Moos (1996) found that outpatient treatment is

most suitable for those with a social network suitable for recovery and for those lacking serious

mental and/or medical conditions. Residential rehabilitation treatment programs should be the

treatment method desired for those without a strong recovery environment and with serious

mental and/or medical conditions.

In many countries, residential rehabilitation treatment programs are the most predominant

forms of treatment modalities to date. Residential forms of treatment are 23

 programs aimed at supporting the substance dependent individual primarily through

abstinence and social stability, with the main goal of treatment being to shorten the course of the

addict’s dependence as early as possible (Berglund, 2003).

According to the Substance Abuse and Mental Health Services Administration

(Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004)

long-term residential treatment is defined as treatment that lasts more than 30 days. It does not

include detoxification or residential treatment of less than 30 days. Short-term residential

treatment is defined as treatment that lasts no more than 30 days. The rising popularity of the 28-

day program can be attributed to its early financial success for treatment programs. As public

awareness of substance dependence increased and insurers and company programs provided

economic incentives for programs of lesser duration, the demand for these programs peaked in

the early 1980s (Adinoff, Scannell, Carter, & Dohoney, 1999, p. 374)

Long-Term Residential (LTR) and/or extended care programs include traditional therapeutic

communities, modified therapeutic communities, and other programs requiring residential

treatment, generally lasting nine months or longer. Short-Term Inpatient (STI) programs

generally kept clients in-residence for up to 30 days, with a focus on medical stabilization,

abstinence, and lifestyle changes. They include free-standing non-profit and for-profit short-term

programs, public and non-profit hospital programs, and county-managed programs (The Drug

Abuse Treatment Outcome Studies, 2001).

According to NIDA, there are several types of drug dependence treatment programs which are

effective. Short-term treatment programs tend to last less than six 24

months and include residential therapy, medication therapy, and drug-free outpatient therapy.

Long-term treatment generally lasts more than six months and includes methadone maintenance

outpatient treatment and residential therapeutic community treatment (NIDA, 2005).

Short-term residential programs are often based on the Minnesota Model of treatment and

involve a three to six week inpatient treatment plan followed by participation in a 12-step group.

Alcoholics Anonymous, Narcotics Anonymous, and Rational Recovery serve as models for

recovery once the addict has successfully completed any given treatment modality (NIDA,

2005). According to Etheridge et al. (1997) short-term inpatient programs are derived from a

blend of the Alcoholics Anonymous society and the Hazelden Treatment Center model which

served as the first in-patient delivery system dealing with chemical dependency.

According to NIDA, the most reputable of all long-term treatment modalities is the therapeutic

community. Therapeutic communities (TCs) serve as highly structured substance dependence

programs ranging in length of stay from six to twelve months. The primary focus of the TC is

introducing the individual into a drug-free, crime-free lifestyle. Often individuals residing in TCs

have long histories of drug dependence, criminal association, and social functioning deficits

(NIDA, 2005).

According to De Leon (1999, p. 323) what distinguishes the therapeutic community from other

treatment approaches is the purposive use of the peer community to facilitate social and

psychological change in individuals. Therapeutic communities are highly structured, residential

treatment programs which promote recovery by having 25

addicts and alcoholics live in the same setting. Hence, the community is both the context

in which change occurs and the method for facilitating the change.
While in the Philippines, a total of five thousand four hundred-two (5,402) admissions are

reported by the different facilities nationwide. Of this number, four thousand three hundred

twenty-five (4,325) are new admissions, one thousand seventy-seven (1,077) are relapsed or re-

admitted cases from either the same or different facilities. There are, however, no reported out-

patient cases for this year. These are based from the reports submitted by thirty-one (31)

residential facilities nationwide. An increase of thirty percent (29.86%) admission compared

from the previous year was noted which may be brought about by the following: Intensified

advocacy program of the government to convince families to love and support those who have

drug problems and need to undergo treatment and rehabilitation; the continuous improvement of

treatment and rehabilitation programs, methodologies, facilities and service; and conduct of In-

houseseminars and dialogues to better serve those who need interventions. On the other hand, the

intensified operations conducted by the law enforcement that led to the increasing arrests of users

for rehabilitation may also be attributed to the increase of admission to the treatment and

rehabilitation facilities Around ninety-three percent (93.32%) of the admitted cases are males

and seven percent (6.68%) are females. The ratio of male to female is 14:1 with a mean age of 31

years old. The youngest is 10 years old while the eldest is 67 years old, and the highest

percentage belongs to age group of 30 – 34 years old with one thousand ninety-three cases

(1,093) and with an equivalent to twenty percent (20.23%). Almost half of the total admitted

cases are single, with forty-nine percent(49.13%) followed by married with a total percent of

thirtyfour (34.08), while the rest is almost seventeen percent (16.79%) represents live-in,

widow/er, separated and divorced. Based on the educational attainment, twenty-eight percent

(28.34%) of the center clients comprised those who have reached college level, followed by

those who reached high school with twenty-three percent (23.12%) and those who have finished
high school at eighteen percent (18.35%). The average monthly family income among center

clients is ten thousand one hundred seventy-two pesos (Php10,172.00). Of the total admission

from various treatment facilities, fifty-three percent (53.20%) are unemployed, twenty percent

(19.77%) are skilled/unskilled workers, and seven percent (6.94%) are out–ofschool youth.

Almost forty-four percent (43.89%) of the reported cases are residing in the National Capital

Region (NCR) prior to their rehabilitation, while eighteen percent (18.59%) and seventeen

percent (17.27%) come from Region IV-A and Region IV-B respectively. As to the age when the

client first tried to use drugs, around fortynine percent (48.85%) of the reported cases belong to

the age group of 15-19 years old. Almost fifty-nine percent (58.52%) have taken drugs 2 – 5

times a week while twenty-one percent (20.64%) take it on a daily basis. Methamphetamine

Hydrochloride (shabu) remains to be the primary drug of abuse among center clients with ninety-

seven percent (96.74%) of the total admission, followed by Cannabis (Marijuana) at around

twenty-five percent (24.94%) and Cocaine with one percent (1.11%). The nature of drug taking

remained to be poly-drug user. The routes of administration are inhalation/sniffing and oral

ingestion.