Successful treatment of substance use disorders begins with the recognition that addictions are chronic diseases, requiring long-term, comprehensive care - care that touches on addictions' disruptive and problematic behaviors that impact almost all areas of individuals' lives.
Similar to other chronic conditions, a "cure" simply does not exist. Addictions are complex, never disappearing but only becoming better controlled. Effective treatment programs help individuals stop using drugs, despite intense cravings, and stop compulsively seeking them out. For more information refer to Process of Addiction Recovery. Individuals can regain healthy functioning within their families, work, and community environments, by learning how to manage and take charge of the disease.
Because addictions are chronic, substance abuse professionals continually "monitor" individuals' treatment plans, and modify them when necessary. As in other chronic conditions, relapse often occurs, but instead of viewing relapse as treatment's "failure," substance abuse counselors view relapse as a time for treatment readjustment, updating, and revising.
A variety of facilities exist for seeking treatment, both inpatient and outpatient, but regardless of the type of facility, the first step in addiction treatment begins with withdrawal, also known as detoxification.
Individuals addicted to any drug or alcohol will experience withdrawal because bodies and brains become habituated to the substances, and when removed, react adversely to the absence. According to Michael's House, a residential addiction treatment facility in Palm Springs, California, individuals must deal with both emotional and physical withdrawal symptoms:
Emotional Withdrawal Symptoms Include:
- Extended periods of depression
- Volatile mood swings
- Suicidal thoughts
Physical Withdrawal Symptoms Include:
- Nausea and vomiting
- Chills and sweats
- Cramps and muscle aches/pains
- Runny nose or fever
These are only a few of the more common symptoms, but many - even hundreds - exist. Detox programs help individuals rid their systems of toxins, stabilizing their health and reducing their chance of immediate relapse. Medically supervised inpatient detox programs exist, but all forms of detox should be carefully monitored by health care professionals.
Those who have been taking large amounts of opioids, (heroin, OxyContin, or codeine), barbiturates or sedatives, pain medications, or alcohol might require inpatient withdrawal services - in hospitals, detox centers, or other residential substance abuse centers. Detox can take several days, to several weeks.
Detoxification is necessary before beginning recovery, but it's only the first step. Research has proven that those who only go through detox and skip any structured substance treatment program will likely relapse and start using again.
Substance use professionals develop an individualized substance treatment program for clients, and these programs all include behavioral counseling and therapy components. Many of these programs also include pharmaceuticals, or medicines designed to ease withdrawal symptoms, and cravings for drugs and alcohol.
Those individuals with more serious addictions require medications to ease off of drugs. In some cases, those addicted to opioids might have to stay on methadone the rest of their lives, but those who live successful, productive, lives. The following are approved medicines for specific drugs:
- Methadone, buprenorphine, and naltrexone, are available for individuals addicted to opioids.
- Disulfiram, acamprosate, naltrexone, and topiramate are available for treating alcohol addictions.
- Patches, gum, lozenges, nasal spray, and the medications varenicline and bupropion are available for tobacco addictions.
For drugs such as cocaine, methamphetamine, and cannabis, researchers are still trying to develop effective, safe medications.
And for those with emotional and mental disorders, such as depression, anxiety, bipolar disorder or schizophrenia, other medications might also be a necessary part of drug and alcohol treatment programs. Antidepressants, anti-anxiety medications, mood stabilizers and antipsychotic medications are examples of medications to treat co-occurring mental health disorders.
Treatment programs employing medications to help individuals know that it's the combination of the medicine with counseling that enhances an individual's success at recovery. By combining these two forms of therapy, attitudes change more readily, and behaviors related to drug abuse start to change. This also provides a more comprehensive approach to substance addictions, addressing all key areas of an individual's lifestyle.
The first phase in any behavioral treatment program involves getting patients to stop using drugs. Medications help curb uncontrollable cravings, but a large part of substance abuse counseling and therapy requires establishing a new, recovery lifestyle and habits. This often means using a cognitive-behavioral approach.
Cognitive-behavioral therapy (CBT) focuses on the individuals' thoughts that lead to addictions. This type of therapy trains individuals to examine how their feelings and emotions cause them to behave a certain way, rather than letting other people, situations, and events control their actions. CBT helps individuals come up with distractions during times of cravings, for example, or helps identify and avoid situations or people that surround the use of drugs. CBT also teaches relaxation techniques to help individuals dispel anxiety or stress during tense situations.
Other behavioral therapies employed during treatment focus on educating individuals on how to better communicate,, improve relationships, and develop better parenting skills and family dynamics.
For example, some addicted individuals might struggle with healthy communication patterns in dealing with others who cause stress, pressuring them to use drugs, or generally instigating negative behaviors. Treatment will help individuals develop assertive and appropriate communication strategies to handle themselves in times of stress, rather than turning to drugs.
Many individuals enter treatment programs angry, angry at themselves, their families, and friends. Behavioral therapy will help them address this anger, teaching them how to express themselves constructively, as well as find healthy, creative outlets that release stored up anger and emotions.
These and many other behavioral therapies are handled in individual counseling sessions in addition to group counseling. Group therapy provides social reinforcement, as others share their experiences in non-judgmental and compassionate settings. Abstinence and non-drug-using lifestyles are reinforced through group therapy by others sharing tips and techniques, or strategies that work or don't work for them.
The support of family and friends during drug treatment is critical. Family therapy especially strengthens an individual's treatment program by helping family members learn appropriates behaviors and responses to keeping a recovering addict on track, as well as to identify any of their own "enabling" behaviors that might affect an individual's addiction.
Principles of Effective Treatment*
Based on this scientific research, key principles have emerged that should form the basis of effective treatment programs:
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
- Remaining in treatment for an adequate period of time is critical.
- Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
- Many drug–addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
- Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
* Cited on the National Institute on Drug Abuse, National Institutes of Health website.
Substance Abuse Counselors as Treatment Providers
Substance abuse and behavioral counselors develop, design, and monitor treatment plans for those addicted or chemically dependent on drugs and alcohol. To work as a counselor, most organizations require a master's degree and certification, and some states require licensing. Request information from schools offering master's degrees in psychology, and inquire about any specialized classes or certificates in this field.