What You Should Know About Kants Ethics in a Nutshell

Immanuel Kant (1724-1804) is generally considered to be one of the most profound and original philosophers who ever lived. He is equally well known for his metaphysics–the subject of his Critique of Pure Reason—and for the moral philosophy set out in his Groundwork to the Metaphysics of Morals and Critique of Practical Reason (although Groundwork is the far easier of the two to understand). A Problem for the Enlightenment To understand Kant’s moral philosophy, its crucial to be familiar with the issues that he, and other thinkers of his time, were dealing with. From the earliest recorded history, people’s moral beliefs and practices were grounded in religion. Scriptures, such as the bible and the Quran, laid out moral rules that believers thought to be handed down from God: Don’t kill. Don’t steal. Don’t commit adultery, and so on. The fact that these rules supposedly came from a divine source of wisdom gave them their authority. They were not simply somebody’s arbitrary opinion, they were Gods opinion, and as such, they offered humankind an objectively valid code of conduct. Moreover, everyone had an incentive to obey these codes.  If you â€Å"walked in the ways of the Lord,† you would be rewarded, either in this life or the next. If you violated the commandments, youd be punished. As a result, any sensible person brought up in such a faith would abide by the moral rules their religion taught. With the scientific revolution of the 16th and 17th centuries that led to the great cultural movement known as the Enlightenment, these previously accepted religious doctrines were increasingly challenged as faith in God, scripture, and organized religion began to decline among the intelligentsia—that is, the educated elite. Nietzsche famously described this shift away from organized religion as â€Å"the death of God.† This new way of thinking created a problem for moral philosophers: If religion wasn’t the foundation that gave moral beliefs their validity, what other foundation could there be? If there is no God—and therefore no guarantee of cosmic justice ensuring that the good guys will be rewarded and the bad guys will be punished—why should anyone bother trying to be good? Scottish moral philosopher Alisdair MacIntrye called this â€Å"the Enlightenment problem.† The solution moral philosophers needed to come up with was a secular (non-religious) determination of what morality was and why we should strive to be moral. Three Responses to the Enlightenment Problem Social Contract Theory—One answer to the Enlightenment Problem was pioneered by English philosopher Thomas Hobbes (1588-1679) who argued that morality was essentially a set of rules that human beings agreed upon amongst themselves in order to make living with one another possible. If we didn’t have these rules—many of which took the form of laws enforced by the government—life would be absolutely horrific for everyone.Utilitarianism—Utilitarianism, another attempt to give morality a non-religious foundation, was pioneered by thinkers including David Hume (1711-1776) and Jeremy Bentham (1748-1742). Utilitarianism holds that pleasure and happiness have intrinsic value. They are what we all want and are the ultimate goals that all our actions aim toward.  Something is good if it promotes happiness, and it is bad if it produces suffering. Our basic duty is to try to do things that add to the amount of happiness and/or reduce the amount of misery in th e world.  Kantian Ethics—Kant had no time for Utilitarianism.  He believed in placing the emphasis on happiness the theory completely misunderstood the true nature of morality.  In his view, the basis for our sense of what is good or bad, right or wrong, is our awareness that human beings are free, rational agents who should be given the respect appropriate to such beings—but what exactly does that entail? The Problem With Utilitarianism In Kant’s view, the basic problem with utilitarianism is that it judges actions by their consequences.  If your action makes people happy, it’s good; if it does the reverse, it’s bad.  But is this actually contrary to what we might call moral common sense?  Consider this question:  Who is the better person, the millionaire who gives $1,000 to charity in order to score points with his Twitter following or the minimum-wage worker who donates a day’s pay to charity because she thinks its her duty to help the needy? If consequences are all that matter, then the millionaire’s action is technically the better  one. But that’s not how the majority of people would see the situation.  Most of us judge actions more for their motivation than by their consequences.  The reason is obvious: the consequences of our actions are often out of our control, just as the ball is out of the pitcher’s control once its left his hand.  I could save a life at the risk of my own, and the person I save could turn out to be a serial killer.  Or I could accidentally kill someone in the course of robbing them, and in doing so might unwittingly save the world from a terrible tyrant. The Good Will Kant’s Groundwork opens with the line: â€Å"The only thing that is unconditionally good is a good will.† Kant’s argument for this belief is quite plausible. Consider anything you think of in terms of being good—health, wealth, beauty, intelligence, and so on. For each of these things, you can also likely imagine a situation in which this so-called good thing is not good after all. For instance, a person can be corrupted by their wealth. The robust health of a bully makes it easier for him to abuse his victims. A person’s beauty may lead her to become vain and fail to develop emotional maturity. Even happiness is not good if it is the happiness of a sadist torturing unwilling victims. By contrast, goodwill, says Kant, is always good—in all circumstances. What, exactly, does Kant mean by goodwill? The answer is fairly simple. A person acts out of goodwill when they do what they do because they think it is their duty—when they act from a sense of moral obligation. Duty vs. Inclination Obviously, we don’t perform every little action from a sense of obligation. Much of the time, were simply following our inclinations—or acting out of self-interest. Theres nothing intrinsically wrong with that, however, no one deserves credit for pursuing their own interests. It comes naturally to us, just as it comes naturally to every animal. What is remarkable about human beings, though, is that we can, and sometimes do, perform an action from purely moral motives—for example, when a soldier throws himself on a grenade, sacrificing his own life to save the lives of others. Or less dramatically, I pay back a friendly loan as promised even though payday isnt for another week and doing so will leave me temporarily short of cash. In Kant’s view, when a person freely chooses to do the right thing simply because it is the right thing to do, their action adds value to the world and lights it up, so to speak, with a brief glow of moral goodness. Knowing Your Duty Saying that people should do their duty from a sense of duty is easy—but how are we supposed to know what our duty is? Sometimes we may find ourselves facing moral dilemmas in which its not obvious which course of action is morally correct. According to Kant, however, in most situations are duty is obvious. If were uncertain, we can work out the answer by reflecting on a general principle that Kant calls the â€Å"Categorical Imperative.† This, he claims, is the fundamental principle of morality and all other rules and precepts can be deduced from it. Kant offers several different versions of this categorical imperative. One runs as follows: â€Å"Act only on that maxim that you can will as a universal law.† What this means, basically, is that we should only ask ourselves, How would it be if everyone acted the way I’m acting? Could I sincerely and consistently wish for a world in which everyone behaved this way? According to Kant, if our action is morally wrong, the answers to those questions would be no. For instance, suppose I’m thinking of breaking a promise. Could I wish for a world in which everyone broke their promises when keeping them was inconvenient? Kant argues that I could not want this, not least because in such a world no one would make promises since everyone would know that a promise meant nothing. The Ends Principle Another version of the Categorical Imperative that Kant offers states that one should â€Å"always treat people as ends in themselves, never merely as a means to one’s own ends. This is commonly referred to as the â€Å"ends principle.† While similar in a way to the Golden Rule: Do unto others as you would have them do unto you, it puts the onus for following the rule on humankind rather than accepting the strictures of divine influence. The key to Kant’s belief regarding what makes humans moral beings is the fact that we are free and rational creatures. To treat someone as a means to your own ends or purposes is to not respect this fact about them. For instance, if I get you to agree to do something by making a false promise, I am manipulating you. Your decision to help me is based on false information (the idea that I’m going to keep my promise). In this way, I have undermined your rationality. This is even more obvious if I steal from you or kidnap you in order to claim a ransom. Treating someone as an end, by contrast, involves always respecting the fact that they are capable of free rational choices which may be  different from the choices you wish them to make. So if I want you to do something, the only moral course of action is to explain the situation, explain what I want, and let you make your own decision. Kant’s Concept of Enlightenment In his famous essay â€Å"What is Enlightenment?† Kant defines the principle as â€Å"man’s emancipation from his self-imposed immaturity.† What does this mean, and what does it have to do with his ethics? The answers go back to the problem of religion no longer providing a satisfactory foundation for morality. What Kant calls humanity’s â€Å"immaturity† is the period when people did not truly think for themselves, and instead, typically accepted moral rules handed down to them by religion, tradition, or by authorities such as the church, overlord, or king. This loss of faith in previously recognized authority was viewed by many as a spiritual crisis for Western civilization. If â€Å"God is dead, how do we know what is true and what is right? Kant’s answer was that people simply had to work those things out for themselves. It wasnt something to lament, but  ultimately, something to celebrate. For Kant, morality was not a matter of subjective whim set forth in the name of god or religion or law based on the principles ordained by the earthly spokespeople of those gods. Kant believed that â€Å"the moral law†Ã¢â‚¬â€the categorical imperative and everything it implies—was something that could only be discovered through reason. It was not something imposed on us from without. Instead, its a law that we, as rational beings, must impose on ourselves. This is why some of our deepest feelings are reflected in our reverence for the moral law, and why, when we act as we do out of respect for it—in other words, from a sense of duty—we fulfill ourselves as rational beings.

The Psychological Disorder Of John Nash - 1782 Words

1. The psychological disorder portrayed in character of John Nash in the film A Beautiful Mind is schizophrenia. The most prominent symptoms were hallucinations, grandiose delusions, paranoia, a persecutory complex. Beginning with DSM-V, two or more symptoms from the list of schizophrenic criteria must be present for at least six months and active for at least one month. John Nash certainly qualifies for another DSM-V criterion of diagnosis, social/occupational dysfunction, due to his apparent abandonment of relevant mathematical work in favor of conspiracy analysis/obsession. Nash is given the official diagnosis of schizophrenia during his admission to the mental hospital. 2.The most highly visible aspects of Nash’s condition are of course his elaborate delusions and hallucinations (creating friends and relationships that don’t in fact exist) and his paranoia (for example, his belief that the hospital is run by the Soviets). DSM-V lists negative symptoms--alogia, anhedonia and avolition--that we don’t see in the film. When Nash is medicated and flailing in his life--unable to focus on his work and unable to respond to his crying child--he asks his wife, â€Å"What do people do?† It’s then that we see the most mood disorder-related aspects: avolition, defined as a lack of will and self-direction, and anhedonia, an inability to experience pleasure. Alogia may be indicated when Alicia says to Nash on their picnic date by the lake, â€Å"You don’t talk much, do you?† and Nash responds,Show MoreRelatedMental Health : A Psychological Disorder922 Words   |  4 Pageswhich many individuals quietly struggle wit h in their daily lives. Psychological disorders, although extremely common, are often misunderstood by those who are not educated on the subject, even those who may be suffering from a mental disorder themselves. 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Of course the producers of theRead MoreSchizophrenia Paranoid Personality Disorder ‚Äà ºa Beautiful Mind‚Äà ¹1034 Words   |  5 PagesRunning head: TWO PSYCHOLOGICAL DISORDERS FROM THE MOVIE â€Å"A BEAUTIFUL MIND†: SCHIZOPHRENIA AND PARANOID PERSONALITY DISORDER Two Psychological Disorders from the Movie â€Å"A Beautiful Mind†: Schizophrenia and Paranoid Personality Disorder Your Name Your School Name, State (Country) â€Å"A Beautiful Mind,† which is based on the novel by Sylvia Nasar, is the story about the mathematic genius called John Nash. He enters Princeton University in the 1940s to start his studies in the fields of calculusRead MoreSymptoms And Treatment Of Schizophrenia1171 Words   |  5 Pages Schizophrenia is a mental disorder often characterized by abnormal social behavior and failure to recognize what is real. 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Methadone Maintenance Free Essays

string(81) " does not impair a person’s ability to work, drive a car or operate machinery\." Southwestern Assemblies of God University School of Distance Education Methadone Treatment Programs are Effective in Stopping Heroin Use A Paper Presented to Professor Loyd Uglow, Ph. D In Partial Fulfillment of The Requirements for the Course THE 5113 Research Literature and Technology Sharon Pete November 28, 2012 THESIS STATEMENT: To investigate Methadone maintenance is found to be more effective in treating heroin addiction than 180 day detoxification. The objective is how methadone maintenance, a widely used but controversial method of weaning heroin addicts off the drug—with counseling has psychosocially enriched 180 day methadone assisted detoxification. We will write a custom essay sample on Methadone Maintenance or any similar topic only for you Order Now OUTLINE I. INTRODUCTION A. History of Heroin B. History of withdrawals II. How Methadone is used to treat Heroin? III. Research Findings IV. CONCLUSION V. Work Cited Methadone Treatment Programs are Effective in Stopping Heroin Use Substitution treatment or maintenance pharmacotherapy programs using methadone are today the most sought after and effective form of treatment for opiate addiction and dependence. Because methadone is a long-acting opiate whose dosage can be stabilized, it is well suited for daily administration and has proven effective in the elimination of narcotic craving, a driving force behind continued heroin use. And, because it can be administered orally, methadone dramatically reduces heroin injecting frequency and, with it, associated risks for HIV and other blood-borne pathogens. Methadone Treatment Effectiveness The clinical effectiveness of methadone is most commonly measured by its retention of patients in care and by reductions in heroin use as well as improvements in social outcomes, for example, employment, family integration, and reduced arrests and incarceration for criminal offenses [00]. Both randomized trials and observational studies [5,48-59] have determined that methadone maintenance retains patients at levels two to four times that of other treatment modalities (in other words,75%, 12-month retention) [16], and the longer patients remain in treatment, the better the results. For example, for those in treatment more than 24 months, methadone reduces the use of heroin to levels below 15% of those in the period immediately before treatment [16]. Conversely, even among those who have greatly reduced their heroin use while in methadone treatment, over 80% relapse to heroin use when they leave treatment [13]. The most basic public-health benefit of methadone treatment can be seen in the reduction of mortality rates among Intravenous Drug Users, who remain in treatment, observed in randomized clinical trials [11], and later follow-up [18]. History of Heroin Heroin has been around for a long time, and is currently grown around the world, with most of the largest supply coming from the Middle East, Asia, and Latin America. The drug had been a problem in the United States for decades, causing the Nixon administration to actively tried to diminish supplies of heroin, when he declared a war on drugs in the 1970s. It was during this time that methadone maintenance treatments came to light, and experiments were done to measure its effectiveness. However, incomplete data recording, complex situations of treatment, and inconclusive evidence have all aided in the difference of opinions that some studies have today. Heroin Withdrawal What we do know is that heroin is a hard drug to beat. The addict’s body quickly becomes so dependent on the substance that to go without it would mean a severe withdrawal. The withdrawals can start as soon as the next day without any heroin use. Nausea, vomiting, pain, sweating, fatigue, depression and insomnia are what an addict goes through when trying to quit. But, if a patient is put on methadone when stopping the heroin, the symptoms are not nearly as bad. The patient will need to work to withdraw from the methadone, but that can often happen over weeks or months. Another thing we know is that addicts that are required to quit heroin without the use of medication are less likely to stay in treatment than those that are assisted by drugs such as methadone. Perhaps it gets to be too big of a task before them to be rid of drugs completely, but whatever the reason, more heroin users will stay in treatment if it involves using methadone or another medication. How Is Methadone Used to Treat Heroin Addiction? For more than 30 years methadone has been used to treat addiction to heroin and other opioid drugs, including morphine. Like other narcotics, heroin releases dopamine into the bloodstream which activates the brain’s pleasure receptors producing a state of high euphoria. To maintain the same level of pleasure, heroin addicts must take increasing amounts of the drug to maintain a continuous supply of opioid to brain receptors. This produces extreme swings in mood and behavior as the drug peaks and ebbs in the bloodstream. A synthetic opioid, methadone does three things that allow the cycle of heroin addiction to be broken: 1. Methadone’s effects are fast-acting and long-lasting. By maintaining a constant level of opioid in the bloodstream, methadone acts as a stabilizing influence, eliminating the frighteningly high and low swings in mood and behavior that characterize heroin addiction. 2. Taken orally, methadone blocks the high, or â€Å"rush,† associated with heroin injection, allowing addicts to â€Å"get off the needle. † 3. Methadone reduces drug cravings and suppresses narcotic withdrawal for 24 to 36 hours. This allows heroin addicts to detoxify without undergoing acute withdrawal symptoms. Administered orally and daily under a doctor’s supervision, methadone maintenance treatment (MMT) reduces opiate cravings, relieves withdrawal symptoms, and produces a biochemical balance in the body. While being treated with methadone, typical street doses of heroin no longer produce a feeling of euphoria, making heroin less desirable to users. MMT is a maintenance program which means that methadone is gradually substituted for heroin in the body. While the patient will need to continue taking methadone, he is freed of the uncontrolled, compulsive and disruptive behavior caused by heroin. Administered under a physician’s care, methadone does not impair cognitive function and does not adversely affect intelligence, mental capability or employability. Methadone does not create feelings of sedation or intoxication and does not impair a person’s ability to work, drive a car or operate machinery. You read "Methadone Maintenance" in category "Essay examples" Patients are able to feel pain and emotion. When prescribed and administered under a physician’s care, studies show that long-term MMT is medically safe, allowing former heroin addicts to become normal, productive members of society. Methadone maintenance is more Effective in Reducing Heroin Use Methadone maintenance is more effective in reducing heroin use among addicts than a 180 -day detoxification program that included an array of counseling services, a UC San Francisco study has found. The objective of the study was to compare methadone maintenance, a widely used but controversial method of weaning heroin addicts off the drug—with an alternative treatment of psychosocially enriched 180 day methadone assisted detoxification. Methadone maintenance resulted in lower heroin use rates and fewer drug- related HIV risk behaviors, such as sharing needles. â€Å"Methadone maintenance is controversial,† said Sharon Hall, PhD, lead author of the study and UCSF professor in residence and vice-chair of psychiatry. [08] â€Å"People don’t like it because it is continued provision of an addicting drug. When people come on methadone maintenance, they may stay on it for several years. The idea of the study was to do a comparison to find a method that was as effective but didn’t involve indefinite treatment with an addicting drug. †[00] Methadone maintenance has been used to treat heroin addiction since 1964, Hall said. Heroin is a short- acting opiate, Hall explained, meaning it produces a high and a withdrawal effect rapidly. Methadone is a slower acting and legal, synthetic-opiate. It works by stabilizing heroin users so that they do not have a heroin -induced euphoria or suffer from severe withdrawal symptoms. Those in the 180 -day detoxification program received 120 days of methadone treatment, followed by 60 days of methadone dose reduction until they were no longer taking methadone. They also received a host of drug counseling services. During the first six months, participants were required to attend two hours per week of substance abuse group therapy, one hour per week of cocaine group therapy if they were found to also be addicted to that drug, and a series of one- hour substance abuse education classes held weekly. They also attended weekly individual therapy sessions. During the last seven months of the study,participants were offered aftercare treatment that included weekly individual and group psychotherapy and liaison services with the criminal justice system, medical clinics and social service agencies. Methadone maintenance was found to retain more patients and be more effective in decreasing heroin use, though use was still high in both groups. Also, the study found that those addicted to cocaine were more likely to drop out of the 180-day program than the methadone maintenance program. I think the results came out the way they did because heroin is a very addicting drug and we need pharmacological tools at this point to fight that addiction,† Hall said. [08] â€Å"It’s not enough to just provide psychosocial services when we lose methadone. There are two ways the field could change. One is to develop more sophisticated pharmacological treatments for heroin addiction that have less addiction potential. Another thing we need to think about is developing psychosocial interventions targeting what methadone patients need like legal and vocational services. Hall added that one of the reasons the counseling services offered as part of the 180- day detoxification program did not lower heroin use might be because they were too general. Dr. Hall points out that the study points out is that a long time ago methadone maintenance clinics had many more services than they do now. She also said. â€Å"And perhaps that’s one of the reasons the 180 day detoxification didn’t work. The services were limited in scope and they didn’t have legal or vocational services or family therapy. Many methadone programs have lost funding for these types of services and we have yet to see what a methadone program looks like that has them. † Methadone Treatment Facilities Many drug treatment facilities have built their programs around these pieces of information. By using medications such as methadone, physicians are able to ease the withdrawal symptoms and to keep the addict in treatment. Facilities may not be able to come up with statistics that say their patients have completed their program and are clean and drug-free, but that they are heroin-free. According to many, this is a better alternative. Many facilities work to help their patients become responsible members of society, by keeping a job or taking care of their family, something heroin addicts find almost impossible. For those patients that require the use of methadone to achieve those goals, the benefit of living a normal life is worth it. Question 1: Is methadone maintenance treatment effective for opioid addiction? Answer: Yes. Research has demonstrated that methadone maintenance treatment is an effective treatment for heroin and prescription narcotic addiction when measured by Reduction in the use of illicit drugs Reduction in criminal activity Reduction in needle sharing Reduction in HIV infection rates and transmission Cost-effectiveness Reduction in commercial sex work Reduction in the number of reports of multiple sex partners Improvements in social health and productivity Improvements in health conditions Retention in addiction treatment Reduction in suicide Reduction in lethal overdose Recent meta-analyzes have supported the efficacy of methadone for the treatment of opioid dependence. These studies have demonstrated across countries and populations that methadone can be effective in improving treatment retention, criminal activity, and heroin use (09). An overview of 5 meta-analyzes and systematic reviews, summarizing results from 52 studies and 12,075 opioid-dependent participants, found that when methadone maintenance treatment was compared with methadone detoxification treatment, no treatment, different dosages of methadone, buprenorphine maintenance treatment, heroin maintenance treatment, and L-a-acetylmethadol (LAAM) maintenance treatment, methadone maintenance treatment was more effective than detoxification, no treatment, buprenorphine, LAAM, and heroin plus methadone. High doses of methadone are more effective than medium and low doses (10). Patients receiving methadone maintenance treatment exhibit reductions in illicit opioid use that are directly related to methadone dose, the amount of psychosocial counseling, and the period of time that patients stay in treatment. Patients receiving methadone doses of 80 to 100 mg have improved treatment retention and decreased illicit drug use compared with patients receiving 50mg of methadone (11). A systematic review conducted on 28 studies involving 7,900 patients has demonstrated significant reductions in HIV risk behaviors in patients receiving methadone maintenance (12). A randomized clinical trial in Bangkok, Thailand, included 240 heroin-dependent patients, all of whom had previously undergone at least 6 detoxification episodes. The patients were randomly assigned to methadone maintenance versus 45-day methadone detoxification. The study found that the methadone maintenance patients were more likely to complete 45 days of treatment, less likely to have used heroin during treatment, and less likely to have used heroin on the 45th day of treatment (13). In the Treatment Outcome Prospective Study(TOPS), methadone maintenance patients who remained in treatment for at least 3 months experienced dramatic improvements during treatment with regard to daily illicit opioid and cocaine use. These improvements persisted for 3 to 5 years following treatment, but at reduced levels (14). In a study of 933 heroin-dependent patients in methadone maintenance treatment programs, during episodes of methadone maintenance, there were (1) decreases in narcotic use, arrests, criminality, and drug dealing; (2) increases employment and marriage; and (3) diminished improvements in areas such as narcotic use, arrest, criminality, drug dealing, and employment for patients who relapsed (15). In a 2. 5-year followup study of 150 opioid-dependent patients, participation in methadone maintenance treatment resulted in a substantial improvement long several relatively independent dimensions, including medical, social, psychological, legal, and employment problems (16). A study that compared ongoing methadone maintenance with 6 months of methadone maintenance followed by detoxification demonstrated that methadone maintenance resulted in greater treatment retention (median, 438. 5 vs. 174. 0 days) and lower heroin use rates than did detoxification. Methadone maintenance therapy resulted i n a lower rate of drug-related (mean [SD] at 12 months, 2. 17 [3. 88] vs. 3. 73 [6. 86]) but not sex-related HIV risk behaviors and a lower score in legal status (mean [SD] at 12 months, 0. 5 [0. 13] vs. 0. 13 [0. 19]) (17). In Conclusion: Between 750,000 and 1 million people in the United States are addicted to heroin, a semisynthetic opioid made from the seeds of opium poppies. This highly addictive, illegal drug is converted in the brain into morphine, which binds to opioid receptors to produce a euphoric rush or heroin â€Å"high. † Repeated heroin use causes drug dependent and its removal rapidly produces unpleasant withdrawal symptoms that can last for several days to months. Users become addicts when their desire to take heroin outweighs the negative health, social, financial, and legal consequences of their drug habit. For more than 30 years, the synthetic narcotic, methadone has been used to treat heroin addiction. Methadone, a powerful pain-relieving drug, binds to the same receptors as heroin but without producing the euphoric rush. Because it lasts much longer in the body than heroin, patients trying to abstain from heroin need to take only a single daily dose of methadone to avoid withdrawal symptoms. Although patients become physically dependent on methadone, the reduction in withdrawal symptoms, together with a reduction in drug cravings, helps heroin addicts in methadone maintenance treatment programs stop using illicit drugs and lead normal lives. The minimum maintenance dose of methadone recommended in these programs,60mg/day—is derived from randomized trials that have tested the ability of different doses of methadone to wean populations of addicts off heroin. However, many clinicians report that lower doses of methadone are effective in some patients. The clinicians reports that setting a standard dose will not optimize therapy for all patients, and recommend that methadone doses be titrated on an individual basis to achieve heroin abstinence. Overall, 168 volunteers achieved heroin abstinence for at least a month, as measured by the absence of illicit opioids in their urine. The median effective daily dose of methadone taken by these successful volunteers was 69mg, but doses ranged from 1. 5 to 191. 2 mg. Of those who abstained, 16% took daily doses of more 100mg methadone, 38% remained abstinent on less than the recommended minimum daily dose, and almost half of the patients who did not achieve abstinence received more than 60mg/day of methadone. How long a patient had taken heroin and the amount taken per day did not correlate with the methadone dose associated with abstinence. However, patients who had previously been through drug detoxification treatments appeared to need higher methadone doses, as did those recently diagnosed with depression or posttraumatic stress disorder and those living in areas with lower average heroin purity. In addition, patients who were abstinent on higher doses were more likely to have stayed in treatment longer or attended a clinic where dose reductions were discouraged. Taken together, these factors predicted 40% of the variance in methadone dosage associated with heroin abstinence. The results suggest that only patients with lower methadone needs achieve abstinence in the early titration phase of treatment or at clinics that encourage use of lower doses. These results provide scientific confirmation that the dose of methadone required to achieve heroin abstinence varies greatly between patients, and indicate that effective and ineffective dose ranges overlap substantially. The researchers suggest that clinicians should be allowed some flexibility in determining methadone dosing and call for research into the most effective way to determine the optimal dose for a particular patient. For now, they suggest, given that patients attending clinics that routinely give at least the recommended minimum dose of methadone do better on average than those attending clinics where lower doses are often given 60mg/day should be the benchmark for dose titration, which should occur early during treatment. However, patients who had previously been through drug detoxification treatments appeared to need higher methadone doses, as did those recently diagnosed with depression or posttraumatic stress disorder and those living in areas with lower average heroin purity. In addition, patients who were abstinent on higher doses were more likely to have stayed in treatment longer or attended a clinic where dose reductions were discouraged. Taken together, these factors predicted 40% of the variance in methadone dosage associated with heroin abstinence. The results suggest that only patients with lower methadone needs achieve abstinence in the early titration phase of treatment or at clinics that encourage use of lower doses. These results provide scientific confirmation that the dose of methadone required to achieve heroin abstinence varies greatly between patients, and indicate that effective and ineffective dose ranges overlap substantially. The researchers suggest that clinicians should be allowed some flexibility in determining methadone dosing and call for research into the most effective way to determine the optimal dose for a particular patient. For now, they suggest, given that patients attending clinics that routinely give at least the recommended minimum dose of methadone do better on average than those attending clinics where lower doses are often given 60mg/day should be the benchmark for dose titration, which should occur early during treatment. ? Notes [01] Karen Sees, DO, UCSF assistant clinical professor of psychiatry; [02] Kevin Delucchi, PhD, UCSF assistant professor of psychiatry; [03] Carmen Masson, PhD, UCSF adjunct professor of psychiatry; [04] Amy Rosen, PsyD, UCSF research coordinator; [05] H. Westley Clark, MD, MPH, on leave from position as UCSF associate clinical professor of psychiatry; Helen [06] Robillard, RN, MSN, MA, research nurse practitioner at the Veteran Affairs Medical Center in San Francisco; [07] Peter Banys, MD, associate clinical professor and vice chair, psychiatry at the Veteran Affairs Medical Center in San Francisco. [08] Sharon Hall, PhD, lead author of the study and UCSF professor in residence and vice-chair of psychiatry. [09] Marsch, 1998. [10] Amato, Davoli, Perucci, et al. 2005. [11] Simpson, 1993. [12] Metzger, Woody, McLellan, et al. , 1993. 13] Vanichseni, Wongsuwan, Choopanya, et al. , 1991. [14] Hubbard, Marsden, Rachal, et al. , 1989. [15] Powers and Anglin, 1993. [16] Kosten, Rounsaville, and Kleber, 1987. [17] Sees, Delucchi, Masson, et al. , 2000. [18] Dole, Nyswander, and Kreek (1966) Works Cited Amato L, Davoli M, Perucci C, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance t herapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment 2005;28(4):321-29. Gowing L, Farrell M, Bornemann R, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. The Cochrane Database of Systematic Reviews, Issue 4, 2004. Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM. Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill: University of North Carolina Press, 1989. Kosten TR, Rounsaville BJ, Kleber, HD. Multidimensionality and prediction of treatment outcome in opioid addicts: 2. 5-yr follow-up. Comprehensive Psychiatry 1987;28:3-13. Marsch LA. The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction 1998;93(4):515-32. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane Database of Systematic Reviews, Issue 2, 2003. McGlothlin WH, Anglin MD. Shutting off methadone: cost and benefits. Archives of General Psychiatry 1981;38:885-92. Metzger DS, Woody GE, McLellan AT, O’Brien CP, Druley P, Navaline H, et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of- treatment: an 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndrome 1993;6:1049-56. Powers KI, Anglin MD. Cumulative versus stabilizing effects of methadone maintenance. Evaluation Review1993;17(3):243-70. Sells SB, Simpson DD (eds. ). The Effectiveness of Drug Abuse Treatment. Cambridge, MA: Ballinger, 1976. Simpson DD. Drug treatment evaluation research in the United States. Psychology of Addictive Behaviors1993;7(2):120-28. Simpson DD, Sells SB. Effectiveness of treatment for drug abuse: an overview of the DARP research program. Advances in Alcohol Substance Abuse 1982;2(1):7-29. Strain EC, Bigelow GE, Liebson IA, Stitzer ML. Moderate- vs high-dose methadone in the treatment of opioid dependence. A randomized trial. JAMA 1999;281:1000-05. Vanichseni S, Wongsuwan B, Choopanya K, Wongpanich K. A controlled trial of methadone maintenance in a population of intravenous drug users in Bangkok: implications for prevention of HIV. International Journal of the Addictions 1991;26(12):1313-20 How to cite Methadone Maintenance, Essay examples Methadone Maintenance Free Essays string(110) " and offer as much assistance as possible is enough to get them headed on the right path \(In My Own Words\)\." Opiate addiction is a chronic disease that affects millions of people in the Unites States. This deadly epidemic is one that in most cases requires some form of medical treatment. There are many treatment options available to those struggling with addiction. We will write a custom essay sample on Methadone Maintenance or any similar topic only for you Order Now The three most well-known options are rapid detect, jukeboxes, and methadone maintenance (Medication-Assisted Treatment for Podia Addiction Facts for Families and Friends). Though each form of treatment has its own advantages and disadvantages, they all have one common goal; drug freedom. Research has shown that those receiving treatment are nearly twice as likely to achieve their goal of drug freedom (Mayo Clinic). Opiates are highly addictive powerful drugs that are derived from the poppy plant and are generally used to relieve pain (mayo clinic). There are two types of opiates, natural and man-made. Though both are prescribed by physicians with the exception of heroin, often times when dealing with someone that has become addicted they are obtained illegally. Because of the potential for prescribed opiates to end up being sold or traded on the streets, stricter regulations have been put in lace for physicians to prescribe them (samara). Where they were once a little quicker to write a prescription for a schedule II narcotic, they are now telling patients to â€Å"take a Ethylene or Motoring† (Levied). These regulations have become a necessity in the war against opiate addiction. Deciding to enter into treatment for opiate addiction is one that requires much thought. Generally when one decides that it is time for them to enter treatment, they have hit rock bottom (Levied). However, rock bottom is different for every person. For some, treatment may be court ordered and they are in a situation where their form of retirement is being chosen for them. For some, they are on the verge of losing everything that is important to them, or they may have already lost it. Whatever the reason may be, getting the treatment needed is a life changing decision. The best form of treatment varies from person to person. For some, the idea of a rapid detect would be the best. It is a quick process that only requires a short stay of usually 2-4 days in a detect facility or a hospital (mayo clinic). In most cases, the person will be given medication to assist them in dealing with the side effects of withdrawing from opiates. During a rapid detect, patients are monitored around the clock for a period of time for signs life-threatening withdrawal symptoms such as cardiac distress and seizures (ASSAM). Those that choose a rapid detect can expect to be sedated to keep them as comfortable as possible during this time period. Prior to sedation, they are generally given Maltreatment, to block the effects of opiates. Other medications may also be given during this time as withdrawal symptoms increase. In many cases medication to help control blood pressure and seizures become necessary. Jukeboxes has become popular because it does not require one to report to a clinic lily, but rather are given a prescription to be filled at a pharmacy. Jukeboxes comes in two forms, a tablet and a film, both are administered subliminally (jukeboxes). Though there are regulations governing the prescribing of jukeboxes, they are not nearly as strict as those in place for methadone (FDA). In order for a physician to begin prescribing jukeboxes, they are required to complete online training that is very limited (Manson). For many, that is the only training they have in addiction. Methadone is a synthetic drug that acts in a similar way to narcotics. Methadone moms in the form off tablet, powder, or liquid. The tablet and powder form are dissolved prior to administering the medication. When methadone is taken on a regular schedule, it will build up in the tissues making the effects last longer (samara). Methadone will not provide the same effects of opiates such as sedation or euphoria; it will instead block these effects if other opiates are used (Catatonia 8). A stable dose will vary from person to person. Generally once someone achieves a stable dose of methadone it will hold them for 24-48 hours without them feeling dope sick (Levied)† Medication-assisted treatment has proven to be the most successful form of treatment for someone wishing to become drug free. However, these forms of treatment face tough criticism. It has been said that treating opiate addiction with medication is simply trading one addiction with another. However for those dealing with the daily struggle of addiction, they depend on these forms of treatment to gain control of their lives. For those people, the daily routines, the counseling, the referrals, the support of others and the consequences is what gives them hope; the pop that they will beat this disease that plagues them (in my own words). Methadone Maintenance treatment is the one form of treatment available that offers all of those things and more. When properly used, I feel that methadone maintenance treatment is the safest and most effective way to treat opiate addiction. There are many reasons that I feel methadone maintenance is the safest form of treatment available to someone battling opiate addiction. Contrary to what some may think, or some of what has been reported, these facilities can have a life changing effect on those who are committed to the program (Methadone Maintenance Treatment Facts). These programs are not only a place for someone to come in, pick up a prescription and leave. Instead these programs require patients to report daily for their medication, at least until they are able to meet all requirements for take home privileges. While there, patients interact with office staff, nursing staff, and clinical staff on a daily basis. Patients are monitored for any changes in their appearance, attitude, alertness, and overall demeanor (Levied). This helps to ensure that if someone is having an issue that staff is there to offer assistance right away. For many that battle addiction, Just knowing someone is there to listen and offer as much assistance as possible is enough to get them headed on the right path (In My Own Words). You read "Methadone Maintenance" in category "Papers" The guidelines set by the federal and state governments are much stricter for methadone maintenance that those set for jukeboxes (samara). For instance, in jukeboxes clients walk into a clinic to sign up and within a matter of a couple of hours they are able to walk out with at the very least medication that should last them a week. When people struggling with addiction first make the choice to enter into a retirement program, they are scared, sick, and in many cases about to lose everything important to them (In My Own Words). These patients are still using illicit drugs daily, and are at this point willing to do whatever it takes to avoid being â€Å"dope sick. Jukeboxes often ends up being sold illegally on the streets because people that have been lying, cheating, and stealing for a long period of time are now given a large amount of medication to take home with them (Levied). Methadone maintenance has a lengthy set of requirements before one is able to obtain the privilege of taking home medication (Blanchard and Crappy). One must be in treatment for 90 days, and produce at least 3 illicit free urine drug screenin gs before earning the privilege of one dose of medication to take home. In order for someone to have a full week worth of medication to take home with them at one time as they do in jukeboxes treatment after one day, they must be enrolled in the program for a minimum of three years and produce at least 12 illicit free urine drug screenings (SMASH). That is Just one of many requirements for one to earn the privilege of taking home their medication. They also have to participate in regular counseling sessions. The amount of time required for each session varies from patient to patient depending on the amount of time they have been enrolled in the program as well as their use of illicit substances. Patients are required to sign releases for every physician that they see so that care can be coordinated properly. It is very important that medication that physicians prescribing other medications are aware of the patient being on methadone. By the time patients in methadone maintenance are able to start taking home doses of their medication, they have started on the right path (Levied). They are on a stable dose that effectively holds hem without the use of opiates, and they like the freedom of not having to report to the clinic to be dosed for the day. These take home bottles that are so hard to obtain, are so easy to have revoked as well. If someone produces an illicit urine drug screening, or does not get their required amount of counseling time in for the month among other things, they will have to start earning their take home privileges all over again. Those that receive take home bottles are also subjected to â€Å"call backs (Medication-Assisted Treatment for Podia Addiction. )† This is when the client is allied and given a short notice of when they will have to report to the clinic with all of their used and unused take home bottles. At this time, the bottles are thoroughly inspected to be sure that their medication is in fact being administered the correct way (SAMARA). Because of these guidelines being as strict as they are, less methadone is sold illegally in the streets making it a safer choice. Methadone is also the safest form of treatment for pregnant women who happen to be struggling with opiate addiction (Practical Approach). In fact, it is currently the only FDA approved medication for treating opiate addiction during pregnancy Methadone Maintenance Treatment (MET): A review of Historical and Clinical Issues. When properly prescribed, methadone has proven to provide an environment that is less stressful on a developing fetus (Catatonia, 19). While a proper dose of methadone will help to prevent miscarriage and pre-mature labor, other forms of treatment seem to cause these issues. The use of maltreatment has been proven to cause spontaneous abortion, fetal distress, premature labor, and stillbirth Issues . ) Because methadone is a long acting medication, it is able to provide the fetus with an environment that promotes development. Though methadone during pregnancy is considered to be the safest of the options available, it comes with side effects (About Methadone). Babies born to mothers prescribed methadone are at risk for low birth weight. This is a very small risk to take when compared to risks faced with other forms of treatment such as jukeboxes or rapid detect. Some of those risks include fetal distress and miscarriage. During pregnancy, women are monitored very closely by the physician at the clinic and are also required to provide proof of prenatal care from an BOGGY (Levied). Studies have shown no long term effects on babies that are born to mothers prescribed methadone during their pregnancy. At birth, these babies will test positive for methadone in their systems, however are able to be weaned in a timely manner (Catatonia, 20). When compared to a rapid detoxification and jukeboxes, methadone maintenance is the safest choice. When a rapid detect lasting 2-4 days in most cases is completed, the patient is left without any aftercare other than what they obtain on their own. They are given a stack of paperwork that in most cases will contain a few referrals for mental health providers and a list of AN meetings. At this time, the patient may be wrought the worst part of the withdrawal process, but they are still unstable (ASSAM). These patients still need the support of clinical and medical personnel, but sadly many will not get that support. Those that do not will most likely find themselves in the same situation they were in previous to the rapid detect. Though patients in jukeboxes treatment have more of a clinical and medical support than those choosing rapid detect, they still do not have the same support as those in methadone maintenance. Those Just starting out in treatment, whatever option they may choose, are at the lowest points in their lives. It is because of that I feel that they are in need of the most support that is available to them. To me, that support comes from a friendly smile when they walk into the clinic every day that reminds them that they are Just another Junkie, they are a person. They are a person that deserves to be monitored daily, given referrals for housing, food, clothing, medical care, and anything else that they could possibly need. For many addicts, the clinic is the safest place that they are in all day (In My Own Words). The goal of any form of treatment is to improve the patient’s health as well as their laity of life (Marion). For many struggling with addiction, their health has come last while obtaining opiates in order to avoid feeling â€Å"dope sick† has come first. For many, this low point in their lives will lead them to participate in high risk behaviors. Those that find themselves addicted to opiates will often turn to theft or prostitution in order to fund their habit, while others will share needles used to administer drug such as heroin. These high risk behaviors not only put them at risk for many other infectious diseases such as Hepatitis and HIVE, but for legal troubles as well (Marion). Though the long term results of any treatment lays largely on the person in treatment, studies show methadone maintenance to be the most effective form available at this time (Medication-Assisted Treatment for Opiate Addiction). Drug freedom is a long term commitment that has to first be taken seriously by the person in treatment. If the dedication on their part is not there, the efforts of clinic staff will not be enough to help them (Pogo). Research has shown that that rapid detect treatment has a high rate of relapse (Medication- Assisted Treatment for Podia Addiction). Those that choose a rapid text as a form of treatment often have difficulty transitioning into a lifestyle of recovery. Often times, they are still living in the same places, with the same phone numbers, and associating with the same people making abstinence from opiates even harder to maintain (Mayo Clinic). For most choosing this form of treatment, it only takes one poor decision to be back in the same situation they were before. These poor decisions have devastating effects on their sobriety making this form of treatment the least effective of the three most well-known forms of medication assisted treatment. Psychosocial counseling has proven to be very beneficial to those dealing with addiction. Those enrolled in both Jukeboxes and Methadone Maintenance is required to participate in counseling. However for those that has chosen a rapid detect, this counseling is not a requirement. . Referrals are given to the patients upon discharge from the facility, but not everyone follows through with it . For some it is simply because they feel they do not need it, for some it is because they are unable to afford it (Mayo Clinic). Jukeboxes treatment does require some counseling though the guidelines for this is not nearly as strict as those set for ethanol maintenance. For those enrolled in a methadone maintenance treatment program, there are strict rules for clients to obtain this counseling (Pogo). Clients enrolled in a methadone maintenance program are required by state and federal regulation to have a minimum of 2. 5 hours of counseling time per month (ASSAM). Clients will usually meet with their counselors once or twice each week to discuss progress in treatment as well as the goings on in their lives. By discussing issues that the client is dealing with, the counselors are able to teach them skills that will be useful to the client as they continue on the path to drug freedom. During this counseling, clients are taught many ways to recognize triggers that were once their excuse to use illicit substances so that they are able to refrain from using (Pogo). Counselors discuss in depth the things that seem to be holding the clients back from achieving their goal of drug freedom. By doing this, they are able to form treatment plans for the client. These treatment plans list goals as well as steps needed in order to achieve the goals. If needed, clients are given referrals during this time. When referrals are given to a client, the counselor will check in with the client to see if they ere able to get the assistance they were in need of (Pogo). The fact that the counselors take the time to follow-up on things discussed during these sessions hold the client accountable for their treatment. Because they are held accountable, I feel that it helps to make methadone maintenance a more effective form of treatment. The goal of methadone maintenance treatment is to stabilize the patient. A stable dose of methadone with effectively block the craving for one to use illicitly while avoiding withdrawal symptoms which in turn permits one to function â€Å"normally. † When taken properly, methadone will not create sedation or euphoria. It should have no adverse effects on mental capacity, motor skills, or the ability for one to maintain employment. A stable dose of methadone will hold a person for 24-48 hours which will allow them the time and energy to devote to making improvements in their lives. However, methadone maintenance treatment is a long term commitment. It can take up to a month to achieve a stable dose in order for a patient to get the most benefits out of treatment. A stable dose of methadone varies from person to person (Levied). There are many factors that will affect the dose that one would require to become stable. For many, the tolerance that they have built up over years of illicit use will require them to have a much higher dose of methadone in order to remain stable. For others, health factors and other medications will affect the way their body is able to metabolize the methadone requiring them to have a higher or lower dose. Once a stable dose is achieved, one is usually able to begin the process of getting their lives back on track by dealing legal obligations, following up on medical care that has been pushed to the side, and mending broken relationships with family members (Pogo). The longer one remains committed to treatment; they will have a greater success rate for maintaining their goal of drug freedom. It is recommended that one remain in a methadone maintenance program for a minimum of one year. For many, once they achieve a stable dose and they are able to provide illicit free urine drug screenings, they feel that they will be able to effectively remain drug free on their own. In these cases, the rate of relapse is much higher than those who remain committed to the program for a year or in many cases longer (Methadone Is an Effective Treatment for Heroin Addiction). Those who remain in treatment for at least year are nearly three times as likely to remain drug free than those who are only in treatment for a short period of time. In a methadone maintenance program, the patient along with the influence of clinical and medical staff decide when they have reached a point in their treatment that they are ready to begin decreasing their dose in order to discharge from the treatment program. There is no set time frame to this process. When one decides they are ready to begin decreasing, they have generally been on a stable dose for an extended period of time and have shown that they are able to effectively manage heir new abstinent lifestyle. Patients that decrease their doses slowly have proven to have the most success in remaining drug free. The slow taper allows their bodies time to adjust to the change in medication so that they are able to refrain from having withdrawal symptoms. These withdrawal symptoms are what will push a person into illicit opiate use again. Once a decrease in a person’s methadone dose is taken, they are encouraged to remain at that lower dose for a period of at least 2-4 weeks. During this time, the clinical and medical staff is able to monitor the patient o ensure that they are handling the decrease in medication with no adverse effects. This process for tapering will continue until the patient has reached a dose of OMG when they will be able to â€Å"walk off’ from the treatment. After the patient has been able to discontinue the use of methadone, they will still receive after care. Clinical staff will make phone calls to check in on the patient and offer them resources that will assist them in remaining drug free. Methadone and Jukeboxes clinics face tough criticism from many. People living in communities where these clinics are located are often unpleased with having a clinic n their neighborhood. Many feel that it will bring drug addicts and crime into their otherwise peaceful neighborhoods (Swisher). What they fail to realize is that these addicts are a part of their communities regardless of if they are enrolled in a treatment facility or not (In My Own Words). It is a common misconception that it is very easy to â€Å"pick out† an addict (Mayo Clinic). However, that could not be more untrue. There are people everywhere that struggle daily with addiction. Some of these are doctors, lawyers, teachers, actors and actresses, and professional sports figures to name a few (Mayo Clinic). These are people that are clean, well dressed, well groomed and well spoken. Not every addict lacks personal hygiene and an education. There are certain risk factors that may be a factor in opiate addiction. For many who suffer from addiction, the environment that they are in plays a large role in them remaining dependent on illicit substances. There are also inherited traits that will influence one’s addiction. Those that have immediate family that suffers with addiction are at a higher risk of also having addiction issues themselves. Research has also shown that males are nearly twice as likely to have addiction problems as males (Mayo Clinic). Methadone was approved by the FDA in 1972 for the treatment of opiate addiction. Methadone is considered to be the most effective treatment available to those addicted to opiates (Methadone Maintenance Treatment (MET): A Review of Historical and Clinical Issues). It is estimated that upwards of 170,000 individuals in the United States currently are enrolled in a methadone maintenance program. It has been proven that illicit drug use has decline by over 60% for those that have been enrolled in a methadone maintenance program for a year. For those that main committed to the program for at least two years, the use of illicit opiates declines by nearly 85% (Accreditation Of Methadone Maintenance Treatment: Assuring Quality of Care. ) Furthermore, crimes committed by these individuals are also significantly reduced. After lengthy research, I am confident is saying that methadone maintenance treatment is not only the safest method of medication assisted treatment available to those battling opiate addiction, but it is also the most effective Accreditation of Methadone Maintenance Treatment: Assuring Quality of Care). The regulations overriding methadone maintenance are much stricter than those for other forms of treatment. Methadone maintenance is the only form of medication assisted treatment that is approved by the FDA for pregnant women. It also remains the form of treatment that has the most thorough requirements for admission, and for supplemental and after care. As with any form of treatment, there are pros and cons, however it has been proven that for someone struggling with this disease that the pros far outweigh the cons. This form of medication has assisted thousands of people in getting their lives back. It has made it possible for patients to function successfully in society. These people will be able to maintain employment and be productive. The counseling that they receive will help them to recognize triggers and effectively avoid them. How to cite Methadone Maintenance, Papers