Addiction to alcohol or other drugs is a chronic disease that affects both brain and behavior. While the path to addiction begins as a voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised due to physical/chemical changes that take place in the brain. As addiction alters the parts of the brain involved in reward, motivation, learning, memory and self-control, behavior becomes compulsive – the desire to acquire and use drugs begins to take over the person’s life.1
Drug treatment has been proven to help addicted individuals stop compulsive drug seeking and use. Treatment may take place in a variety of settings, come in many different forms, and continue for varying lengths of time. Because drug addiction is a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many individuals, treatment is a long-term process that involves multiple interventions and regular monitoring.
There are a variety of evidence-based (that is, clinically/scientifically proven) approaches to treating addiction. Treatment may include behavioral therapy, medications, or a combination of both. The specific type of treatment or combination of treatments will vary depending on the individual’s needs and the types of drugs he has been using.2
What Are the Customary Steps in Successful Treatment?
To achieve its objective (abstinence), treatment usually follows these basic phases:
- Detoxification – the process by which the body rids itself of a substance.
- Behavioral therapy (e.g., cognitive-behavioral therapy and case or care management) – services provided by a trained clinician, such as a counselor, therapist, psychologist or psychiatrist.
- Medication – particularly useful for opioid, tobacco and alcohol addictions.
- Evaluation and treatment for co-occurring mental health issues (e.g., depression and anxiety).
- Long-term follow-up (to prevent relapse) – while most challenging at first, recovery is usually a lifelong process, so 12-Step fellowship, peer support and other recovery support services are important follow-through and follow-up measures.1
Detoxification Is Where It All Begins
Accompanied by unpleasant and sometimes potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician (as such, it is often referred to as “medically managed withdrawal”).2
Length of withdrawal and symptoms vary with the type of drug and the amount and duration of use. For example, physical symptoms of heroin withdrawal may include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. These physical symptoms may last for several days, but the general depression, or dysphoria (opposite of euphoria), that often accompanies heroin withdrawal may last for weeks. In many cases, withdrawal can be easily treated with medications to ease the symptoms, but treating withdrawal is not the same as treating addiction.3
Detoxification is designed to manage the acute and potentially dangerous physiological effects of stopping drug use.
Counseling can take a number of forms depending on the type of therapy being used, the goals of the treatment, and other factors in the life of the person receiving help. Some counseling series last for months or even years, while others can be brief. Individual and/or group counseling may be used.4
Behavioral therapies can help motivate people to participate in drug treatment, offer strategies for coping with drug cravings, teach ways to avoid drugs and prevent relapse, as well as support individuals if/when relapse occurs. Behavioral therapies can also help people improve communication, relationship and parenting skills, and family dynamics.
In a group setting, therapy can provide social reinforcement and help enforce behavioral contingencies that promote abstinence and a non-drug-using lifestyle. However, particularly with adolescents, there can be a danger of unintended harmful effects in group settings; some group members might actually reinforce drug use and derail the purpose of the therapy. Thus, trained counselors should be aware of, monitor for, and nip such effects in the bud.
Some therapy settings are better suited to serve certain individuals. For instance, young people need a different set of treatment services to guide them towards recovery; treatments for youth often involve a family component, such as that found in family therapy.2
Peer supports are a critical component in substance use disorder treatment; they can play a powerful role in therapy. (Peers are individuals in recovery who use their own experiences to help others work toward recovery.) Many people who work in the treatment system as counselors or case managers are actually in recovery themselves. Their influence can be felt throughout the recovery process, such as in Alcoholics Anonymous, Narcotics Anonymous and other 12-Step programs.5
A social support network – particularly of recovering peers – provides hope, coping strategies and role models, which help nurture the strength that is needed in trying times along the road to recovery.6
Treatment medications can vary greatly, again depending on the patient’s circumstances. For instance, methadone, buprenorphine and naltrexone may be given to individuals addicted to opioids. Disulfiram and naltrexone are medications available for treating alcohol dependence – which commonly co-occurs with other drug addictions, including addiction to prescription medications.
Treatments for prescription drug abuse tend to be similar to those for illicit drugs that affect the same brain systems. For example, buprenorphine – used to treat heroin addiction – can also be used to treat addiction to opioid pain medications. Addiction to prescription stimulants – which affect the same brain systems as illicit stimulants like cocaine – is usually treated with behavioral therapy, as there are not yet medications for treating addiction to these types of drugs.2
A Combination of Treatment Tools Usually Works Best
Since they work on different aspects of addiction, behavioral therapies and medications are generally more effective when used in tandem. For instance, psychoactive medications – such as antidepressants, anti-anxiety agents, mood stabilizers and antipsychotic medications – may be necessary in order for successful counseling to occur when patients have co-occurring mental disorders, such as depression, anxiety disorder, bipolar disorder or schizophrenia. In addition, most people with a severe addiction are using multiple drugs and require appropriate, individualized treatment for all factors involved.2
Whichever approach is implemented, an individual’s treatment plan must be assessed continually – and modified as necessary – to ensure that it meets the changing needs of the individual.
Treatment Must Be Regularly Monitored and Reevaluated
Whichever approach is implemented, an individual’s treatment plan must be assessed continually – and modified as necessary – to ensure that it meets the changing needs of the individual. Varying combinations of services and treatment components may be appropriate at various stages of recovery.
In addition to behavior therapy and medication, comprehensive treatment considerations may include other medical services, therapy for the entire family, parenting instruction, vocational rehabilitation and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to the individual’s progress.2
Treatment Settings: Geared to Meet Varying Complexities of Need
Long-Term Residential Treatment – provides care 24 hours a day, usually in a non-hospital setting. The best-known residential treatment model is the therapeutic community (TC), with a 6 to 12 month stay. Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is highly structured and can be confrontational at times, with activities designed to help residents examine damaging beliefs, self-concepts and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others. Oftentimes, comprehensive services are offered, which may include onsite employment training and other support services.
Short-Term Residential Treatment – provides intensive but relatively brief treatment based on a modified 12-Step approach. The original residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as AA. Following stays in residential treatment programs, it is important for individuals to remain engaged in outpatient treatment programs and/or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.
Outpatient Treatment Programs – Outpatient treatment varies in type and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs or extensive social supports. It should be noted, however, that low-intensity programs may offer little more than drug education. Other outpatient models – such as intensive day treatment – can be comparable to residential programs in services and effectiveness, depending on a patient’s characteristics and needs.2
Long-established Principles of Effective Treatment
Based on scientific research since the latter half of the 20th century, the following key precepts should lay the foundation for any treatment program in order to be effective:
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single, cookie-cutter treatment plan is right for everyone.
- People need to have quick access to treatment.
- Effective treatment addresses all of the patient’s needs, not just her drug use.
- Staying in treatment long enough (sufficient duration) is critical.
- Counseling and other behavioral therapies are the most commonly used forms of treatment.
- Medications are often an important part of treatment, especially when used with behavioral therapies.
- Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
- Treatment should address other possible mental disorders.
- Medically assisted detoxification is only the first stage of treatment.
- Treatment doesn’t need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously.
- Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as teach them how to reduce their chances of acquiring these illnesses.1
The Brain – as well as Body – Must Rebuild Over Time
Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells send, receive and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain.
Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.
Other drugs (e.g., cocaine or methamphetamine) can cause the nerve cells to release abnormally large amounts of natural neurotransmitters – mainly dopamine – or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signaling between neurons. The result is a brain awash in dopamine – a neurotransmitter present in brain regions that control movement, emotion, motivation and feelings of pleasure. The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that “teaches” people to repeat the rewarding behavior of abusing drugs.7
Does Relapse Indicate that Treatment Won’t Be Successful?
The answer, in most cases, is “No.” Since drug addiction is a chronic disease, relapses are not only possible, but likely. Relapse rates (i.e., how often symptoms recur) for people with addiction and other substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses, such as diabetes, hypertension and asthma – which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, so relapse may simply indicate that treatment should be reinstated or adjusted, or that another treatment strategy should be implemented.8
Treatment for More than Just Addiction May Be Needed
With respect to scope, recovery goes beyond overcoming just substance use for most patients. This is consistent with the 12-Step tenet “…but sobriety is not enough.” For individuals to realize their authentic self (that is, reclaiming who they were before drugs or, for some, entering a never-before-known healthy life), a process of growth and change must occur – in attitudes, thinking and behaviors.9
When more than one condition is affecting an individual, that’s referred to as co-occurring disorders; all such mutually impacting conditions should be identified for concurrent treatment in a “dual diagnosis.”
Oftentimes, this process is challenged by more than just the drugs. Many of those who are addicted to drugs also suffer from other mental or physical health conditions (e.g., depression, HIV/AIDS) that should be addressed concurrently. When more than one condition is affecting an individual, that’s referred to as co-occurring disorders; all such mutually impacting conditions should be identified for concurrent treatment in a “dual diagnosis.” The best programs provide a combination of therapies and other services to meet the specific needs of the total individual. Left untreated, one disorder – such as a mental health condition – may complicate the treatment of another disorder – such as addiction, thereby delaying or possibly defeating successful recovery of any or all of the disorders.2
In some cases, mental disorders (e.g., anxiety, depression, or schizophrenia) may precede addiction; in other cases, drug abuse may trigger or exacerbate such mental disorders, particularly in people with specific vulnerabilities.8
For millions of Americans, substance use and mental health conditions progress to the point where the efforts of the individual and his family, friends and other social network may not be sufficient to bring matters under control. In these cases, access to addiction treatment can be a critical – even lifesaving – resource.10
Skywood specializes in services that treat all co-occurring health conditions via dual diagnosis. Our integrated approach to treating the whole person is recognized for its success in more than ten independent studies. Postured in professionalism and discretion, we believe that treatment should be a process that is as unique as the individuals we serve.
1 “DrugFacts: Treatment Approaches for Drug Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction , (January 2016).
2 “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/ , (December 2012).
3 “Frequently Asked Questions”, National Institute on Drug Abuse, https://www.drugabuse.gov/frequently-asked-questions, (August 2015).
4 “Behavioral Health Treatments and Services”, Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/treatment , (October 19, 2015).
5 “Treatments for Substance Use Disorders”, Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/treatment/substance-use-disorders , (September 28, 2015).
6 “Pathways to Long-Term Recovery: A Preliminary Investigation”, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852519/ , (April 17, 2007).
7 ”DrugFacts: Understanding Drug Abuse and Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction , (November 2012).
8 “Drugs, Brains, and Behavior: The Science of Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery , (July 2014).
9 Laudet, Alexandre B., Ph.D., “What Does Recovery Mean to You? Lessons from the Recovery Experience for Research and Practice”, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083562/ , (October 2007).
10 “Treatment and Recovery”, Office of National Drug Control Policy, https://www.whitehouse.gov/ondcp/treatment-and-recovery .