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Abstract

第119巻第4号

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Outpatient Treatment for Drug Addiction within Anyone's Reach
Nobuya NARUSE
Saitama Prefectural Psychiatric Hospital
Psychiatria et Neurologia Japonica 119: 260-268, 2017

 Drug addiction is a "mental disorder". However, a tendency to regard it as a "crime" rather than an "illness" persists, leading to the avoidance of providing psychiatric care. There are only 10 organizations for special treatment in Japan, which does not even come close to meeting the current demand.
 The reasons for shunning patients with drug addiction include difficulty in continuing treatment, low motivation for treatment, non-compliance with instructions or rules, and issues of violence and offensiveness. However, these problems can potentially be managed and even resolved if therapists understand the characteristics of the disorder and provide appropriate medical treatment.
 Treatment for drug addiction relies on:(1) therapeutic relationships, (2) motivation for treatment, (3) drug therapy for psychological symptoms, (4) detoxification and treatment of toxic psychosis, (5) education on illness and information provision, (6) behavior modification programs, (7) connection to self-help groups and rehabilitation facilities, (8) assistance with resolving problems, and (9) family support and education. These are not highly specialized areas or issues. Treatment can thus be conducted without special wards or programs. Treatment effectiveness can be expected even on an outpatient basis within a short period of time, while avoiding the negative feelings that lead to the shunning of these individuals.
 The use of drugs by patients with drug addiction is generally considered to be their own fault, resulting from seeking pleasure out of curiosity, but it is in fact appropriate to regard such substance abuse as a form of lonely "self-treatment by those who have difficulty in living without being healed by others." Most of these individuals have been deeply hurt due to their experiences of abuse, bullying, or victimization due to sexual violence. What patients with addiction, who have an "illness", need is neither "punishment nor discipline" but, rather, "treatment and support."
 The major cause of difficulty treating those with drug addiction is the negative and avoidance-prone feelings of therapists toward these patients. It is important to establish a relationship of trust by not coercing them into drug withdrawal or blaming them for drug reuse when they seek medical attention. It was reported that continuous involvement with a sincere desire to "welcome" these individuals increases the treatment persistence and drug use cessation rates.
 <Author's abstract>

Keywords:drug addiction, outpatient treatment, recovery support, negative and avoidance-prone feelings, treatment outcome>
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