An Overview of the Alcohol/Drug Rehabilitation Program by Shelley L. Beckmann, Ph.D

The Rehabilitation Program

Scientific/Medical - Beckman

NARCONON
An Overview of the Alcohol / Drug Rehabilitation Program

Prepared by Shelley L. Beckmann, Ph. D.
Presented at the 123rd Annual Meeting of the American Public Health Association

INTRODUCTION

The widespread abuse of drugs continues to plague American society. Although national surveys document encouraging trends towards decreased drug use, these "decreased levels" are still unacceptably high. In 1991, 37% of the general household population in America had used an illicit drug in their lifetime, with 6% having used illicit drugs in the last month.1

In the same year, a third of young adults reported the use of illicit drugs in the last year, with around 17% having used drugs in the last month.2

The pattern of drug use varies with race, age, and socioeconomic factors.1,5 The use of drugs by children is especially disturbing. Indeed, in national surveys the use or abuse of drugs has consistently been rated as one of the biggest problems faced by public schools.6 This concern is well founded. In a survey conducted between 1992 and 1993 by PRIDE, Inc., students were asked to report on their use of drugs in the last year. Among 6th grade students, over 20% had drunk beer, 1.2% had used cocaine and 1.3% had used hallucinogens in the past year. These students are eleven years old.

The percentage of students using drugs increased steadily from 6th through 12th grades. By 12th grade, 64% of students had drunk beer, 4.5% had used cocaine and 8% had used hallucinogens in the past year. The number of students using drugs frequently also rose steadily. By 12th grade, 2% of students were using cocaine and 2% were using hallucinogens from one to seven times a week.7

Crime is an area greatly influenced by drug abuse. A 1992 report by the United States Dept. of Justice pointed out that, in most cities, more than 50% of arrestees tested for the presence of drugs were found to have used drugs recently. Cocaine was the most prevalent drug found.3 Surveys of various incarcerated populations support this view. In 1991, two of three State prison inmates reported having used drugs regularly at some time in their lives and 36% had used drugs daily in the month before their current offense. 31% were under the influence of drugs at the time of the offense, with 17% committing their offense to get money for drugs.4

These incarcerated populations are roughly twice as likely as the general household population to have used drugs in their lifetimes and around six times as likely to have used drugs in the month prior to arrest.

The abuse of drugs is rampant in America, especially in the youth. The effects of this abuse are felt at all levels of society -- with ill health, illiteracy, disrupted schools and families, vastly increased crime, and drug-related injuries. Each of these is attributable in whole or in part to drug abuse. Effective methods of reducing drug abuse are clearly warranted.

B. THE NARCONON PROGRAM:

DEVELOPMENT

Narconon is an international network of drug treatment centers. The first Narconon was started in 1966 inside Arizona State Prison by an inmate, and former heroin addict named William Benitez. Mr. Benitez had been addicted to hard narcotics since the age of 15. He decided to start Narconon after utilizing techniques from a self-help book titled " fundamentals of thoughts " (Hubbard) which would improve ones own ability level, so he could now successfully overcome his drug addiction.

He obtained permission to start a drug rehabilitation program on a pilot basis in the Arizona State prison. The Narconon drug rehab began with 20 interested inmates. It expanded by word of mouth and eventually there were over 160 men on the program. The focus of the Narconon program, both then and now, was on increasing abilities. In the initial program, specific drills were used to increase a person's abilities to communicate, to handle things that he started, to confront things in life.

In 1972, the first residential program opened in Los Angeles. Initially, this was a halfway house for inmates but it gradually developed into a full residential program for substance abusers. The program has evolved and expanded over the years. Narconon has always promoted an approach to drug rehabilitation without recourse to alternative drugs. Early programs did not however, deal directly with withdrawal. In 1973, the Narconon program expanded to include drug-free withdrawal. Using vitamin and mineral supplements, along with simple assists, to help the individual, eased withdrawal.8-10

A second innovation in the program was initiated in 1978 with the addition of the detoxification (sauna sweat-out) program.11

This component was designed to handle effects arising from the accumulation of drugs in the body. Further innovations continued through the years and in mid-I991 the basic course materials for the Narconon program were published in a series of easy-to-read volumes.12 This resulted in a major improvement in delivery of the Narconon program. The clarity and ease of reading of these materials made it easier for clients to understand exactly where they were on the program, how to do their current step, and what steps were to be done next.

In 1970, Narconon was incorporated as a non-profit, public benefit corporation in the State of California and it received its 501(c)(3) Federal tax exemption in 1975. Today there are 34 Narconon centers in Canada, Denmark, France, Germany, Holland, Italy, Sweden, Switzerland, Spain, the United Kingdom and the United States.

C. PROGRAM DESCRIPTION

The overall goal of the Narconon program is to fully rehabilitate drug and/or alcohol abusers so that they are free of drugs and able to achieve their goals. To accomplish its goals, this program must address not only the craving for drugs but also a plethora of associated ills. The physical effects of drug abuse are well documented and include both toxic effects from the drugs themselves and increased incidence of communicable diseases due to related behaviors. In addition, chronic drug abuse is associated with poor communication skills, financial difficulties, a detrimental system of values and attitudes, criminal behavior, and poor comprehension of long-term goals. Effective treatment would ideally address each of these points in a manner that considers the particular needs of the individual client.

Narconon services are delivered in a residential setting. The services offered include drug-free withdrawal, detoxification, and specific courses designed to increase the client's communication skills, study skills, control over his own environment, understanding of moral principles, ability to set goals, preparation for work, and abilities to handle any emotional problems past and present.

1. Medical Evaluation:

Drug abuse puts the health of the individual at risk, with increased susceptibility to disease and malnutrition. In addition, the prevalence of sexual favors in exchange for drugs leads to increased levels of sexually transmitted diseases and increased risk for HIV infection. Pre-treatment medical exams are therefore necessary for the proper treatment of drug abusers.

Clients undergo complete physical examinations prior to program participation. Physicians and/or clinics that collaborate with Narconon in the treatment of substance abusers provide these and other medical services. Narconon is a drug-free program. In general, clients are either approved for drug-free withdrawal and returned to Narconon following the medical exam or treated with medically managed drug withdrawal, if required, and returned to Narconon later. In some cases the client is not approved for the Narconon program. In such instances, Narconon works with the individual to find another drug rehabilitation center able to provide more appropriate treatment.

2. Steps of the Narconon Drug Rehabilitation Program:

The Narconon drug rehabilitation program is composed of several components aimed at sequentially addressing key needs of the substance abuser. The basic components of this program are:

1. Drug-Free Withdrawal.

2. Communication Course

3. Narconon New-Life Detoxification Program

4. Learning Improvement Course

5. Communication and Perception

6. Ups and Downs in Life

7. Personal Values and Integrity

8. Narconon Changing Conditions in Life

9. Narconon Way to Happiness

10. Discharge and Aftercare Planning

11. Family Services (as needed)

Each component of this program is tailored to specific needs of the individual client. For most steps, clients pair up and work with each other-- under the direction of a trained supervisor -- to complete the program step. Each step involves both training and practical application to the individual's life.

Prior to completion of the program, the client develops a plan for establishment of a productive and ethical lifestyle that aligns with his/her goals. Implementation of this plan is closely monitored by Narconon staff following graduation. Staff keeps in contact with clients and assist them with any difficulties they have in implementing the plan or in maintaining a drug-free lifestyle.

3. Detailed Description of Program Components:

A.

Drug-Free Withdrawal:

The aim of this step of the program is to assist the individual through the difficult period immediately after he/she ceases to take drugs. Approximately 25% of Narconon's clients require this step. Narconon is a drug-free program. Upon physician approval, clients are assisted through withdrawal without drugs. Two key elements are utilized to ease the client through this phase:

1. Vitamin and mineral supplements and

2. Particular techniques that ease the mental and physical discomfort that can accompany the drug withdrawal process.

Staff provides a 24-hr/day watch throughout this phase.

Vitamin Supplementation: Deficiencies in specific vitamins, minerals and amino acids are known consequences of alcohol and drug abuse, due either to poor nutrition or to the action of the drugs themselves. Alcohol abuse, for example, is known to lead to deficiencies in thiamin (Dl), vitamin C, vitamin A and some minerals 8,10,13 while cocaine abuse leads to deficiencies in thiamine (B1), pyridoxine (B6), vitamin C, and tyrosine.9 Thus, nutritional deficits are an expected consequence of drug and alcohol abuse.

Research in animals has demonstrated that vitamin deficiencies retard the metabolism of drugs. This reduced metabolism appears before clinical signs of vitamin deficiency are apparent.14 In addition, dietary factors have been shown to affect the craving for drugs in animals.15 L-tryptophan, for example, was shown to reduce cocaine use when the drug was freely available.16 If these results are applicable to humans, then vitamin deficiencies caused by drug or alcohol abuse may be anticipated to lead to poor metabolism of the drugs and, in some cases, to increased craving for drugs.

Supplementation with vitamins and minerals during drug withdrawal has been recommended by researchers and employed in practice for over 40 years.17 Tyrosine, specifically, has been shown to help during withdrawal for cocaine and heroin addicts.9 A combination of nicotinic acid and vitamins C, B6 and B12 helped patients to cease methadone18 use. Two mixtures of nutritional supplements were shown to reduce relapse and enhance the recovery of alcohol and cocaine users.19 Supplementation with vitamins during withdrawal is anticipated to assist the individual in several ways. It will certainly assist in correction of nutritional deficiencies. It might also be expected to aid in the metabolism of drug residuals and it appears to reduce the craving for drugs.

Over the 27 years of Narconon's operation, vitamin supplementation during drug withdrawal has been found to be a vital component for the client's well being.

Techniques to Assist in Withdrawal: Several techniques are used in the Narconon program to ease physical discomfort during the withdrawal process. They are simple techniques designed to relieve accumulated stress and to get the individual back in communication with and in control of his/her own body.

A "locational", wherein the individual is asked to look at various things in the environment, helps orient the client to the present environment. A walk will also put his attention on the environment instead of his body.

When in pain, a "touch assist" is often helpful. This assist brings the client's attention to the affected body areas. The withdrawal supervisor runs this assist until the pain is gone and the client is doing well. Using a simple command such as "feel my finger, thank you." The supervisor touches various spots on both sides of the body, focusing on the extremities, the areas of pain, and the spine. This assist puts the individual back in communication with his body.20

These techniques may be compared to the breathing techniques used in the LaMaz or Bradley forms of natural childbirth to assist the mother to bear the pain of delivery. Simple in nature, they nonetheless result in a more comfortable transition through the discomfort of withdrawal. They have been shown empirically to assist the individual as he/she comes through this withdrawal phase.

Communication Course: Communication skills are frequently poor in drug users. In fact, drugs are often being taken to avoid confronting life or communicating with others. Yet drugs themselves further reduce the ability to confront and communicate.

This course consists of a series of drills, which increase the student's ability and desire to confront life and communicate freely. The course is designed to assist the individual to communicate better and to recognize where communications have broken down so that he/she can improve his/her ability to communicate.

This course would be included in the program due to the frequent deficit in this area by drug users. It is delivered at this point, as it is a vital prerequisite to the balance of the program. Improving communication skills early in the program aids in delivery of the rest of the program, as it is important that students inform the staff of occurrences during subsequent steps.

Narconon New Life Detoxification Program:
Rationale: The detoxification program is aimed at mobilizing and eliminating drugs and their metabolites that have accumulated in the body. Other drug rehabilitation approaches include attempts to flush toxins from the body.21 The detoxification program utilized at Narconon is a more comprehensive approach to this issue.

Many substances are known to store in human adipose (fat) tissue.22 In addition to commercial compounds, many drugs -- both pharmaceutical and so-called recreational -- can remain in the body for an extended time. Drugs such as LSD, 22, Opiates,24,PCP,25 cocaine,26 marijuana 27 and diazepam28 are found in fat.

These drugs can be retained for extended periods, especially under conditions of chronic use, 26, 29-31. For example, marijuana metabolites are found in urine up to 77 days subsequent to last use of marijuana.32, 33 It is hypothesized that these metabolites are stored in adipose tissue prior to excretion.32

Cocaine is generally considered to be a rapidly metabolized drug and, indeed, the majority of the drug is metabolized and excreted within 2 hours.34 However, cocaine is a lipophilic substance and is expected to accumulate in body tissues.26 Studies of urine and saliva in cocaine users show that unmetabolized cocaine is found for 5-10 days after the last use of the drug.29

Frequently reported subjective effects of long-term drug abuse include feelings of disorientation, fatigue, and lack of motivation. Certain drugs, most notably LSD, are reported to cause "flashbacks" long after the last ingestion of the drug.

The detoxification component of the Narconon program is based on the premise that these adverse consequences of drug abuse arise from small amounts of drugs or their metabolites stored in the fatty tissues of the drug user. When fats are mobilized during times of stress or hunger, the drug residuals are mobilized as well. This may lead to reactivation of drug effects, a "flashback" type experience or, in the case of the recovering drug abuser; this may lead to reactivation of the craving for his original drug of abuse.

This hypothesis is supported by the results from treatment with the detoxification program. Clients often report feeling the effects of drugs while on this program, apparently as they are mobilized and eliminated from the system. Following treatment they report increased mental acuity, less disorientation, greater energy and reduction or elimination of drug cravings. Initial findings of a current research project at Narconon, in collaboration with Community Health Projects, Inc., show that drugs, including cocaine, are eliminated during the detoxification program.35

Components of the Detoxification Program:
The Detoxification component of the Narconon program is a truly unique aspect of this rehabilitation program. This procedure is designed to mobilize and enhance the elimination of fat stored foreign compounds. It was specifically developed to reduce levels of drug residues as proven effective in the reduction (of other fat-stored compounds as well.36,37

This is an intensive program and, as such, requires physician approval to participate. Physical illness, ongoing physical problems such as anemia, heart disease, high blood pressure diabetes, digestive ailments, kidney disorders, malnutrition physical infirmities relating to drug and/or alcohol dependence may result in restriction this program while these medical conditions are addressed or may result in a medically-supervised modification of the program to fit particular needs.

Briefly, the program consists of the following components:

A. Exercise, preferably running, to stimulate circulation.
B. Prescribed periods in a low temperature sauna promote sweating.
C. An exact regimen of vitamin, mineral, and oil taken.
D. Sufficient liquids to offset the loss of body fluids through sweating.
E. Regular diet supplemented with plenty of fresh vegetables, which are not overcooked.
F. A properly ordered personal schedule, which provides the person with the normally required amount of sleep.

Students are on this program up to 5 hours per day, every day, until program completion. Daily aerobic exercise is followed by frequent periods of low-heat (60-80 C) sauna. Niacin and polyunsaturated oil are administered to sustain the mobilization and elimination process. Vitamins and minerals are supplemented and the daily liquid losses are replaced. Body weight kept constant throughout the program. The program is pursued individually until a stable clinical improvement is achieved, generally from 21 to 30 days of treatment.

The Narconon detoxification program has resulted in marked improvements in clients. They consistently report increased mental acuity, greater energy, greater awareness of their surrounding, an increased feeling of general well being and a notable decrease or elimination of drug cravings following the program.

Learning Improvement Course: Drug abuse is positively correlated with poor performance in school.38-41 Regardless of the reason for poor performance, direct observation shows that most Narconon students lack basic study skills.

This course teaches the student study skills that increase his/her ability to study and retain knowledge and to recognize and overcome barriers to study and learning. Students learn the importance of defining the words used in their studies, of learning by an appropriate gradient, and of applying what they learn as they study it so that it becomes practical rather than rote or theoretical knowledge. Each client practices these skills.

Graduates of this course are more able to study and apply the materials they read. This is a vital skill for future training, both at Narconon and in later life.

Communication and Perception: Drugs often result in a persistent disorientation from the actual environment; this section gives the student the ability to get into full communication with others and his/her environment.

Students are twinned up in this section, each pair helping one another through the exercises. Good communication skills are necessary at this level. Therefore, the students first repeat the drills included in the earlier communication course, achieving a higher standard of quality in this second round. The students then do a series of new exercises which extrovert them and get their attention off of themselves and onto the environment.

The twinning arrangement required on this course helps address the responsibility level the client. Students must help each other through each step. This twinning arrangement is required in most steps of the Narconon program. It demands that each client develop some responsibility for the well being of another.

Ups and Downs of Life: Most drug abusers are associated with others who take drugs and promote anti-social activities. Often these individuals have strongly influenced the drug abuser to continue his/her drug-taking behavior

This section is designed to help clients spot and handle those influences in their environments that might cause them to lose any gains made. (Clients frequently identify specific individuals who have adversely influenced them in the past and develop ways of either handling them so that they are no longer effective or programs to disconnect from them in the future. Completing this section makes the students less susceptible to those who would influence them to revert to drugs or crime.

Personal Values and Integrity: This section gives the client some basic data he needs to improve his life. It covers topics such as personal ethics, honesty and integrity and shows the client how to correct negative behavior by addressing past harmful actions. The client spots ways that these data might have been used in the past to improve his life and how they may be used in the future. The result of this section is a client who understands the basic principles of ethical behavior.

Changing Conditions in Life: This section teaches the Narconon student how to evaluate his performance and improve it so that he is producing valuable products and worthy of trust. The course also covers how to repair previous poor conditions and how to apply what has been learned to keep winning in life. The client does extensive work applying these principles to his own life. The goal of this section is to teach the student how to evaluate his own performance and take steps to improve it.

The Way to Happiness: The moral level of drug abusers has often been severely compromised. Many do not follow guidelines that promote social interaction. This section covers 21 precepts that comprise a non-religious moral code. Each precept is studied and drills are done so that the student understands how these may apply to his own life. This basic set of principles is often the first set of morals that the client has truly studied and applied. Many clients have eye-opening realizations on this section regarding what it means to be a functioning member of a group and how this might contribute not only to the happiness of others but to their own well-being as well.

Discharge and Aftercare Plan: Over the course of his/her program, each client progressively develops plans for his/her own release and pursuit of gainful activities. In this final stage of the in-patient program, Narconon staff work with the client to further define his/her goals and to develop specific steps to get the client started on these goals. Clients are not approved for graduation until a workable plan is developed with specific steps that the client can do immediately.

Family Services: More often than not once the addiction problem is fixed all prior family problems "just disappear", However sometimes it is difficult for the family of a client to understand the problems of alcohol and drug abuse. While the primary goal of the Narconon Program is to rehabilitate the substance abuser, our staff also works with family members so that they are able to understand and contribute to the rehabilitation press of the individual. Some family members participate in this process by taking courses offered to the Narconon clients.

4. Summary:

The Narconon rehabilitation program sequentially addresses the physical, mental, and spiritual liabilities of drug abuse. Each component of the program increases the client's ability to function as a productive member of society. The order of components is carefully laid out to utilize prior tools and prepare the student for the next step.

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