Principles Of Drug Addiction Treatment – Scott F. – PhD

Author: Scott F. – PhD

Addiction is a powerful disease that impacts millions of American families every year. In fact, experts estimate that over 20 million Americans are addicted to drugs or alcohol (samhsa.gov).

Adolescents, young adults, and older adults are all prone to substance abuse. Examining addiction rates in these groups demonstrates the impact of addiction across the lifespan (americanaddictioncenters.org):

While the most common drug of abuse is alcohol, many addicts use multiple substances, with approximately 1 in 8 abuse both drugs and alcohol. Other common illicit drugs include prescription drugs, marijuana, heroin, cocaine, and methamphetamine.

Harmful Effects of Substance Abuse

Individuals who are addicted to substances are more likely than their peers to have a mental health disorder, consider or attempt suicide, and have serious legal troubles. Combined, these issues damage relationships and reduce quality of life for both the person abusing drugs as well as his or her loved ones.

The most serious concern is the risk of overdose. Drug overdoses have become the single highest injury-related cause of death in the United States (cdc.gov). Opioids are particularly prone to overdose. The CDC estimates that opioids killed 33,000 people in 2015, which is four times the rate in 1999 (cdc.gov). The danger is so great that the CDC has called opioid overdoses a “public health epidemic.”

In addition to the effects on individuals and families, drug addiction has large-scale societal consequences. It is estimated that over $200 billion are spent every year on drug-related costs. This includes money spent on healthcare, incarceration, lost productivity at work, and other related issues.

Substance Abuse Treatment Can Help

If you or a loved one suffer from drug or alcohol addiction, please know that there is hope. You are not alone, and help is available. Through careful research and decades of clinical effort, effective treatments have been identified, and treatment centers across the country utilize them every day to help addicts recover and live normal lives.

Your next step is to learn about the many different treatment options available to you. By understanding these treatment options, you can make an informed choice and decide which is the right fit for you and your family.

Why Seek Treatment for Addiction?

Drug and alcohol addiction is multifaceted. It arises from a complex combination of biological, social, emotional, genetic, and behavioral factors that ultimately predispose a person to abuse substances.

For many addicts, drug use has become a central part of their lives. It is what they do when they social with friends. It is how they unwind from a challenging day. It is how they cope with grief, anxiety, or despair. That’s why quitting without support, cold turkey, is so rarely successful: effective treatment must address all areas of the addict’s life – not just the substance abuse itself.

There is no single drug abuse treatment that works for every patient. One of the challenges of addiction therapy is matching the appropriate treatment to meet the unique needs of every patient. Moreover, drug addiction treatment takes time – often, at least three months of treatment is needed for lasting change (drugabuse.gov). If the patient and the chosen treatment are not a good match, the patient becomes likely to drop out before the end of this crucial three-month window.

Drug addiction also rarely occurs alone. It is typically accompanied by other mental health concerns, such as depression, anxiety, PTSD, ADHD, or personality disorders (drugabuse.gov). In order for treatment to be effective, the patient must be assessed for the presence of these disorders, and the treatment approach must address them in addition to substance abuse.

Medication is available for those who are addicted to drugs, and can be an important means of reducing cravings and preventing withdrawal symptoms. However, medication alone is often not enough to make lasting change. The combination of medical treatment and psychological care is much more likely to be effective (drugabuse.gov).

Core Components of
Effective Care

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Substance abuse treatment comes in many shapes and sizes. With so many options, selecting the right treatment facility can be challenging. Experts recommend that you select a facility that uses the following five core components of substance abuse treatment (centeronaddiction.org):

  • Comprehensive Assessment. A full assessment by a trained clinician is required for accurate diagnosis, understanding the severity of the addiction, identifying triggers, and uncovering co-occurring mental health, physical health, or social problems. Data from a comprehensive assessment is critical in informing an effective treatment plan.
  • Stabilization. The patient must be assisted in stopping all current substance use. Withdrawal symptoms must be carefully monitored, and in many cases medican should be used to reduce them. This stage is often called “detoxification.”
  • Acute Care. Select a treatment facility in which qualified health professionals implement evidence-based treatments. In addition to targeting substance abuse, treatment should address environmental conditions that make substance use more likely to occur (such as triggers to use), as well as health conditions and mental disorders that are present (e.g., depression).
  • Chronic Disease Management. Once the patient is stable and progress has been made in treatment, the patient must learn strategies to maintain positive changes and prevent relapse outside of the treatment environment.
  • Support Services. Substance abuse negatively impacts all aspects of a person’s life. It causes problems with employment, finances, the law, relationships, healthcare, and nutrition. Effective substance abuse treatment addresses the “whole person” by providing support services, such as legal counseling or access to affordable nutrition counseling, that assist the patient in overcoming these issues.

Substance Abuse Treatment Settings

Substance abuse treatment is undertaken in many different settings. The severity and type of addiction will determine which setting is appropriate for a particular patient. For many patients, the most effective treatment plan requires a combination of several different settings.

Outpatient Treatment

Outpatient treatment is any treatment that does not require the patient to live or stay at the treatment facility. Instead, outpatient treatment relies on the patient to come in for regular appointments and check-ups, while still living at home. A typical outpatient treatment program requires 10 to 12 hours per week at the treatment center.

Many patients prefer outpatient treatment because it is much less disruptive to their daily lives. They can live at home, go to work, and spend time with their families while receiving treatment. Outpatient treatment is also typically less expensive than inpatient treatment, because there is no need to pay for food and other living expenses.

However, avoiding the disruption of life’s routines can serve as a double-edged sword. Substance abuse often occurs as a part of daily routines. The triggers in the environment that lead to substance use will still be there during outpatient treatment, which can predispose the patient to relapse (drugabuse.gov). Indeed, living at home with access to the same friends, substances, and routines may prevent the patient from making the drastic life changes that are often needed to successfully overcome their addiction.

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Inpatient Treatment

More severe substance addiction often needs a level of care that can only be provided in inpatient settings. An inpatient setting is one in which the patient stays full time at the facility for a period of time. Inpatient stays vary widely, but typically range from one to six months.

An inpatient program begins by assisting the patient with managing withdrawal symptoms. This is commonly known as “detoxification.” Withdrawal symptoms are stressful and can be physically and emotionally draining. To address this, inpatient programs provide around-the-clock support by trained medical professionals, as well as access to medications that can ease withdrawal symptoms (drugabuse.gov).

Following detox, inpatient programs provide intensive counseling, medical services, and psychological services designed to build the patient’s resilience to relapse. Once the clinical staff feels that the patient is ready, they are discharged back to their home. Often, continued outpatient care is necessary following an inpatient stay.

Inpatient care, by its very nature, disrupts the patient’s life. The patient must make arrangements with work and must make sure that children and pets are taken care of. Visitation is sometimes limited, which can be hard for family members, especially young children. However, for some patients, the intensive and fully-immersed nature of inpatient treatment is necessary to overcome their addiction.

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Sober Living Homes

Addicts often have environmental triggers that make them much more likely to relapse. For some, it is stress. For others, it is friends or family members who continue to use. Following treatment, a return to the same environment with the same triggers can lead to a return to the same behavior: substance abuse.

Sober living homes offer an alternative environment for those who wish to avoid these triggers during recovery (Polcin et al, 2010). Sober living homes provide a safe, substance-free living situation with trained staff. This allows patients to transition from treatment to full recovery in a more controlled environment. Sober living homes are also known as:

  • Half-way houses
  • Recovery homes
  • Sober homes
  • Recovery residences

Every sober living home has different rules, regulations, and expectations. They typically require a signed contract or agreement from every resident that reflects these expectations. It is very important to carefully research the level of care provided at each home, as well as its unique culture, in order to find one that matches the individual needs of the recovering patient.

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Support Groups

Despite its high prevalence, drug addiction can be an isolating disease. Many patients struggle with loneliness, depression, and social isolation during recovery.

Support groups provide an opportunity for recovering addicts to share their stories, learn from others, and meet people who are going through the same challenges. Participation may grant an increased sense of control over addiction, practical advice from those who have “been there,” and improved use of coping skills (mayoclinic.org).

Support groups have many different approaches, which makes it challenging to determine their effectiveness. While support groups alone are not likely to be enough to change addictive behavior, many recovering addicts credit them with their continued sobriety after completing other forms of treatment. The following strategies are recommended by the May Clinic to find a support group near you:

  • Ask a treatment provider for a referral
  • Search the internet for support groups in your area
  • Ask others who are in recovery
  • Contact community centers, libraries, and churches to inquire about support groups they host
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12 Step Programs

12 Step Programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are a popular and well-known family of support groups. AA and NA are featured heavily in media, including books, television, and Hollywood movies.

AA and NA both feature regular weekly meetings where group members are encouraged to share their stories, their challenges, and seek fellowship with like-minded individuals. They famously follow a 12-step program of recovery (available at aa.org). Participation is anonymous, and the only requirement to join is having a desire to stop using (na.org).

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Treatment in Prison

Approximately half of inmates in federal prisons have a substance abuse disorder (prisonerhealth.org). To address this glaring need, the Federal Bureau of Prisons has instituted a multifaceted approach to providing substance abuse treatment for its prisoners.

Select inmates with short sentences may receive Nonresidential Drug Abuse Treatment. This program provides 12 weeks of Cognitive Behavior Therapy in a group setting, and focuses on changing thoughts, feelings, and behaviors that lead to criminal lifestyles and drug addiction (bop.gov).

A more intensive program is the Residential Drug Abuse Program (RDAP). RDAP is an immersive treatment protocol. Inmates are separated from the general population, and receive a full day of treatment activities every day, including drug addiction programming, work, and school. The program lasts approximately 9 months (bop.gov).

Research evaluating these programs is promising. Inmates who go through RDAP have been found to be less likely to commit additional crimes upon leaving prison (bop.gov). They are also less likely to relapse into substance abuse than prisoners who did not go through the program.

Treatments for Substance Abuse

Just as important as the physical setting is the philosophy and research behind the interventions being used. No single treatment program works for everyone. Therefore, it is important to understand what is available so that you may select the treatment or treatments that are right for use. Use these brief summaries to learn more about the most common treatment approaches for alcohol and drug addiction.

Behavioral Therapies

Behavioral therapies have emerged over the past three decades as perhaps the most promising treatment family for substance abuse Many different varities of behavioral therpay have been developed, including Cognitive Behavior Therapy (described in more detail below), Dialectical Behavior Therapy (described in more detail below), contingency management, and family behavior therapy (drugabuse.gov).

In general, behavioral therapies address treat addiction as being an interaction between the patient and his or her environment. By teaching the patient to modify their environment, they become less likely to use. This is accomplished by providing incentives for staying clean, assisting the patient in restructuring their lives to reduce exposure to triggers, and teach coping skills to use in place of drugs. While these treatments do not work for everyone, they are considered an effective first-line treatment for substance abuse (apa.org)

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Cognitive Behavior Therapy

One of the most common therapeutic treatments for a wide variety of disorders is Cognitive Behavior Therapy (CBT). A member of the behavioral family of treatment, CBT is an evidence-based therapeutic approach that combines cognitive interventions (those that assist the patient in changing negative thought patterns) and behavioral interventions (those that assist the patient in changing problematic behaviors and the patient’s environment).

Drug abuse often results from these negative thought patterns or maladaptive behaviors (americanaddictioncenters.org). During therapy, the patient learns to identify signs of their own cravings as well as common patterns that lead to abusing drugs or alcohol. For example, the patient might come to realize that they are prone to using drugs when they are feeling a certain way or when they spend time with certain friends.

A major goal of CBT is for the patient to understand the connection between their thoughts, behaviors, and emotions, and how each influences the other (drugabuse.gov). Changing harmful patterns in any one of these can have a domino effect that leads to positive changes in the others. To this end, CBT seeks to provide patients with practical strategies and coping skills to help manage negative thoughts and emotions (abct.org).

CBT is a goal oriented treatment. This means that the therapist and the patient work together to identify short-term and long-term priorities that are personally meaningful for the patient. Patients should know that therapists will likely expect them to complete “homework” – for example by practicing the strategies learned in session in real life, and reporting back on the results. Research shows that this homework is an important component of CBT’s success (psychologytoday.com).

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Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is an evolution of CBT. It was originally created by Marsha Linehan for suicidal patients with Borderline Personality Disorder. In the last several decades, it has been applied to a much wider population of patients.

DBT involves individual and/or group therapy, in-the-moment phone coaching during crisis, and skill building (abct.org). Patients learn mindfulness skills that build their awareness of their own thoughts, feelings, and actions. Additionally, DBT focuses on distress tolerance and emotional regulation.

Applied to substance abuse, patients undergoing DBT learn strategies to reduce withdrawal symptoms, reduce cravings for their drug of choice, and techniques to avoid situations that trigger abuse.

Additionally, the therapist assists the patient in building and repairing relationships with friends and loved ones, which helps bolster the social support system that is so crucial to relapse prevention. The patient is encouraged to adopt hobbies and obtain enjoyable and meaningful work, which together help build life satisfaction and reduce the need for using drugs as a coping mechanism.

DBT is a powerful treatment modality that has been demonstrated to be a promising practice for substance abuse treatment (abct.org). DBT may be a good fit for patients who have co-occurring depress, personality disorders, or anxiety. It may also be helpful for patients who would benefit from building or rebuilding their social support system in addiction to treatment for addiction.

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Biofeedback

Biofeedback is a treatment paradigm designed to grant understanding of your body and how it responds to stress and coping. In biofeedback treatment, patients are hooked up to sensors that detect physical changes in the body. Then, the clinician monitors the biological changes and gives in-the-moment feedback to the patient. Ultimately, this allows the patient to learn how to control their physiological symptoms. There are three common types of biofeedback for addiction treatment):

  • Electromyography (EMG) – sensors attached to the skin measure muscle tension
  • Thermal biofeedback – sensors attached to the skin measure skin temperature
  • Neurofeedback – sensors attached to the scalp measure brain waves using electroencephalography (EEG) technology.

Stress is an extremely common factor in substance abuse. Your body responds physiologically to stress. Stress leads to tense muscles, a speeding heart rate, rapid breathing, and other physical signs. During biofeedback, the patient learns coping skills, such as deep breathing, progressive muscle relaxation, guided imagery, and meditation, each of which is clinical proven to reduce stress. By getting instantaneous biofeedback, the patient can literally watch these skills work for them.

Similarly, withdrawal symptoms are often biological in nature. Withdrawal often manifests itself in physical and psychological symptoms that can be measured and controlled using biofeedback.

Biofeedback, particularly using neurofeedback, has been found to be effective in treating substance abuse (National Institutes of Health). It is a potent tool, especially when combined with other forms of treatment.

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Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) is a therapeutic approach dedicated to building internal motivation for change. MET prioritizes identifying reasons for quitting drugs or alcohol that are personally meaningful to the patient (goodtherapy.org).

MET begins with careful psychological assessment by a trained clinician. The assessment provides information on attitudes towards drug use, type and frequency of use, and other important psychological variables. Then, the clinician holds a feedback session with the patient explaining the results of the assessment and how to use them in treatment planning (drugabuse.gov).

Following this, the patient joins the clinician in two to four individual therapy sessions that utilize motivational interviewing. Motivational interviewing is a nonjudgmental approach to learning about a patient’s personal priorities and values (motivationalinterview.net). The clinician asks questions that help the patient learn about him or herself and what benefits they would personally derive from changing their behavior.

Research on MET is mixed. It is more effective for patients who abuse alcohol or marijuana than it is for those who smoke or are addicted to hard drugs (such as cocaine or heroin). It has been found to be particularly effective in engaging patients in the treatment process and reducing treatment resistance (drugabuse.gov). This makes it an excellent fit for those who have been unwilling to give treatment an honest try in the past. However, it is less effective in reducing actual substance use (drugabuse.gov). This means it may be best to combine MET with other evidence-based treatments such as CBT.

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Holistic Treatment

Holistic therapy is a broad term that encompasses many different treatment approaches. The commonality these strategies share is that they seek to integrate physical, mental, and spiritual treatment, with the overall goal of treating the “whole person” rather than the superficial symptoms of drug addiction (americanaddictioncenters.org). In other words, treating the mind, body, and spirit will lead to decreased substance abuse.

Many patients value holistic approaches because they believe them to be more natural than medical intervention, and they are often less expensive. For others, holistic therapies may be similar to cultural traditions that the patient personally values.

Some of the more common holistic approaches to drug addiction include:

  • Therapeutic massages
  • Acupuncture
  • Yoga
  • Herbal medicines
  • Meditation
  • Energy therapies, such as Reiki

Collectively these treatments can sometimes promote motivation to stay in treatment, increase self-confidence, and build life satisfaction. These factors can play a role in reducing the appeal of drug abuse.

Because holistic therapies are incredibly varied, it is difficult to determine exactly how effective they may be. However, research has generally supported the conclusion that they should not be relied upon alone to treat substance abuse. Instead, patients should view them as supplements or compliments to evidence-based therapies: use them in addition to rather than instead of other approaches.

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Experiential Therapy

Experiential therapy is another nontraditional approach to substance abuse recovery. It promotes hands-on experiences that help the patient to cope with underlying trauma or buried emotions that may be causing addictive behaviors.

For some patients, experiential therapy may include a trip to the rock climbing wall. For others, it involves painting or drawing a scene from their past. For still more, it means acting out painful conversations with loved ones from the perspective of both parties. The central theme is that patients use activities they enjoy to learn to cope with stressors and become less guarded about discussing their past.

Other common examples of experiential therapy include:

  • Art therapy
  • Equine-assisted therapy
  • Adventure therapy
  • Gestalt therapy

Similar to holistic treatments, experiential therapy does not have the same research support as CBT, DBT, and other evidence-based practices. However, it may be beneficial for some patients who appreciate a hands-on approach to treatment. It may be most useful as a supplement to other forms of treatment.

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Faith-Based Treatment

Many people prefer to receive counseling and other psychological services from clinicians and treatment centers with a faith-based lens. Faith-based drug rehabilitation offers a spiritual element that can be beneficial for those who value their religious beliefs.

Like other treatment programs, faith-based treatment should use evidence-based practices as their core. However, they may layer on additional treatment strategies that address the patient’s spiritual needs. They may also promote worship, engage in prayer, or openly ask the patient o call upon a higher power for support during treatment.

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Medications for Drug and Alcohol Addiction

Many medications are now available to aid in recovery for drug addiction. It is important to understand that medication alone is unlikely to lead to a full recovery. Instead, medication should be used in combination with behavioral and/or therapeutic treatment that helps the patient change their behaviors that lead to substance abuse.

Medication assists recovery in three ways:

  • Ease Withdrawal. Withdrawal symptoms are mentally and physical stressful. Medications are available to ease these symptoms, which can help patients push through this important initial stage. Approximately 80% of detoxifications are assisted by medication (SAMHSA, 2014).
  • Prevent Relapse. Substance abuse changes the brain. Medications can help the patient re-establish normal brain function, which help sin decreasing cravings.
  • Treat Co-occurring Mental disorders. Substance abuse commonly co-occurs with other mental health conditions, such as depression, ADHD, anxiety, mood disorders, eating disorders, or personality disorders. In some cases, medications are prescribed to help manage symptoms of these disorders, which ultimately allows the patient to focus on their recovery from addiction.

Different drug classes are treated with different medications (drugabuse.gov). Your doctor will conduct an assessment to determine if medication is right for you, and if so, which medication is appropriate. Some commonly prescribed medications include:

  • AOpioid addiction (e.g., heroin): Methadone, buprenorphine, and naltrexone
  • Tobacco addiction: Bupropion and varenicline
  • Alcohol addiction: Naltrexone, acamprosate, and disulfiram

Rehab Success Rates – Does it Work?

It’s the critical question that everyone asks themselves before they or a loved one begins treatment. How likely is rehab to work?

Overall, it is estimated that 40-60% of patients will relapse after undergoing treatment (drugabuse.gov). This relapse rate is in line with other chronic illnesses, such as diabetes and hypertension (drugabuse.gov). While this rate is high, relapse should not be viewed as a complete failure. Instead, it should be considered a part of the treatment cycle (centeronaddiction.org).

Unfortunately, information on effectiveness beyond relapse rates are incredibly difficult to establish. Experts do not agree on the best way to measure success rates. Some facilities measure substance use at the end of the program. Some measure it several months after treatment ends. Others prefer to measure the quantity of substance use, even if patients still choose to use after treatment. Still more do not count patients who leave treatment early, which artificially inflates their success rates.

Researchers have identified some treatment practices that are consistently effective (such as behavioral therapies). This research is critically important; however, these studies are conducted under very carefully controlled conditions, often with highly qualified treatment professionals implementing a very strict and powerful intervention. Results obtained in these studies may not be reflective of all populations and all treatment settings.

Other factors that make success rate so hard to estimate include:

  • Individual differences, such as age, sex, genetic history, and social history
  • Severity of substance abuse
  • Attrition rates (i.e., the percentage of patients who leave the program early)
  • History of previous treatments
  • Differences between treatment facilities
  • Differences in individual staff members within a treatment facility
  • Varying treatment philosophies
  • Use of evidence-based treatments

Many treatment centers cite a nation-wide 30% success rate, though it is not clear where this estimate comes from (americanaddictioncenters.org). Often, treatment centers will estimate their own success rate as being much higher than 30%. Given the difficulty in measuring these outcomes prospective patients are strongly encouraged to use healthy skepticism when evaluating these claims.

Finding Help

Once you have learned about the many different treatment settings and treatment approaches, the next step is to select a treatment facility that is right for you or your loved one. With many thousands of facilities across the country, selecting the best fit can feel as overwhelming as finding the proverbial needle in a haystack. Many resources are available to assist you in finding a strong program:

  • The Patient Guide from the National Center on Addiction and Substance Abuse (centeronaddiction.org) provides a comprehensive list of questions to ask potential treatment facilities.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a free and confidential hotline and anonymous treatment finder.
  • OnTheWagon.org allows you to easily search for treatment in your area specifically for the types of treatment, insurance coverage, and individual needs that you may have.

Don’t Suffer Alone

Substance abuse can be devastating. It has a unique ability to take over the lives of not just the user, but also his or her family, friends, and loved ones.

Yet beginning treatment is the fertile soil in which hope grows anew. You don’t have to suffer the pains of addiction any longer. If you think you or a loved one might have an addiction, the safest decision is to immediately seek help from a trained professional. Whatever the outcome, you will be glad you had the courage to take the first step towards recovery.

Author Biography

Scott F. is a licensed psychologist with a PhD in School Psychology. He has implemented psychological and behavioral treatments for a variety of disorders in residential treatment facilities, detention centers, public schools, and psychiatric inpatient hospitals. He is passionate about promoting behavioral health, especially for children and adolescents with emotional and behavioral disorders.

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