Addiction Treatment

When you’ve tried and failed to stop using or drinking on your own, it’s time to start thinking about getting addiction treatment.

Why Do We Need Addiction Treatment?

It can be hard to explain to someone who has never experienced an addiction, but once we get addicted, it’s very tough to quit using. We feel intense cravings and we fight temptation constantly. Unfortunately, addiction creates structural changes in the brain (why it’s called a brain disease) that reduce our ability to concentrate, maintain focus and fight temptation.

Not surprisingly, this combination of constant cravings with an impaired ability to resist temptation is rarely a recipe for lasting abstinence!

Although the brain will heal in time, the first period of abstinence or reduced substance use is a difficult period and this period can last for months or even years. To make it out of this first period - most people need some help.

Addiction treatment teaches you how to break free from compulsive and harmful substance use.

Addiction treatment can teach us:

• How to avoid temptation
• How to deal with cravings
• How to restructure our thinking, behaviors and environment to reduce the risks of relapse
• How to develop better relationships with family and friends, which can protect against relapse
• How to take better care of our physical and mental well being
• How to deal with stress or past trauma, so that it doesn’t provoke relapse

In some, ideal cases, behavioral interventions are combined with medications which reduce cravings or withdrawal symptoms.

Addiction Treatment Works!

Addiction treatment works about as well as treatment for other chronic medical conditions, like diabetes or hypertension.

Addiction treatment works best when people get appropriate care and when they stick with it to completion. Addiction treatment does not always induce a full lifetime of sobriety, it is better at producing periods of remission, which can be quite lengthy.

Relapse is a normal part of the addiction experience, and many if not most people will relapse at some point in life. A relapse does not mean that previous treatments were failures, simply that treatment is once again necessary!

The Principles of Effective Addiction Treatment

The National Institute on Drug Abuse (NIDA) has compiled a list of some the most important concepts of addiction treatment, such as:

• No one form of addiction treatment works for everyone
• Addiction is a complicated disease that causes changes in the brain, but addiction treatment works
• Addiction treatment works best when it endeavors to treat the person as a whole, rather than focuses simply on a single pattern of behavior, such as drug use
• Addiction treatment takes time – there are no quick fixes
• Treatment should be individualized, with treatment plans changing as necessary to meet the evolving needs of the individual
• People do not need to want treatment for it to work. Involuntary treatment is effective
• Because slips and relapses are common during recovery, drug testing is an important part of a continuing treatment program
• Counseling and other behavioral interventions are effective elements in an addiction treatment program. Certain medications may be helpful for some people, but medication should always be used in conjunction with counseling

How Long Does Addiction Treatment Take?

The duration of an addiction treatment program very much depends on the needs and desires of the individual – there are no set time limits for the entire process. However, it is important to remember that addiction treatment is not a quick fix treatment and that addiction is a serious brain disease.

The 3 Stages of Treatment

According to the American Psychiatric Association (APA)  there are three main phases to the addiction treatment process:¹

1. Detoxification/Stabilization
2. Rehabilitation
3. Continuing Care

Stage 1, Detox

The first stage is the shortest of the three, lasting just until a person has stabilized enough from the effects of drug or alcohol withdrawal (or intoxication) to be able to participate effectively in the rehabilitation phase of treatment. Some people will not require any detox and may proceed immediately into the rehab phase. Typical detox durations can range from a couple of days to about 10 days.

Stage 2, Rehabilitation

During the residential phase of treatment, recovering addicts and alcoholics are taught or encouraged to:

• Keep making health and well being gains already begun through the detoxification stage
• Maintain abstinence (or maintain a reduction in use)
• Make positive changes in ways of thinking or functioning, to reduce a likelihood of a return to use
• Make behavioral or environmental changes to reduce the likelihood of a return to use

The duration of the rehabilitative phase can vary greatly, for example:

• Drug rehab - 30-90 days
• Outpatient addiction treatment program - 3-6 months
• Therapeutic community a year or longer
• Methadone maintenance program – can be indefinite

NIDA recommends that people spend at least 90 days in the rehabilitation phase, or at least a year, in the case of methadone.²

Phase 3, Continuing Care

People who have met the treatment goals of the rehabilitation phase will move into the third and final phase, the continuing care phase. During this phase, which should last for up to a year, the gains of the rehabilitation phase are maintained through a continuing but low intensity involvement in outpatient counseling or through other contact with professional addiction treatment staff. Many people choose to find community support during this final stage, such as involvement in a 12 steps group. Involvement in community support organizations can extend beyond the end of continuing care.

Different Types of Addiction Treatment Services

No one form of addiction treatment is best for all people – treatment works best when it’s matched to the needs and wants of the individual.

Here is a brief overview of some of the more commonly available types of addiction treatment programs:

• Private Counseling – Some people find working individually with a community based counselor or psychologist helpful in overcoming moderate substance abuse

• Support Groups - Community based support groups, such as Alcoholics Anonymous (AA), can be found in most American communities. Research shows that people who maintain a participation in community addiction treatment after a period of primary care are more likely than those who don’t to maintain a successful recovery.

• Outpatient Addiction Treatment Programs – Outpatient addiction treatment programs typically offer a structured mix of therapeutic elements (group counseling, relapse prevention education, 12 steps work, addiction education etc.) offered during evening and weekend sessions.

• Intensive Outpatient Programs – More intensive versions of a typical outpatient addiction treatment program, at the most intensive level, these programs can be whole day programs for weeks or months in duration.

• Residential Detoxification – Specialty medical clinics (sometimes inside larger hospitals) offer nursing care and medication to those requiring stabilization during the initial withdrawal period. People dependent on alcohol, benzodiazepines and opiates will often need a brief period of detoxification prior to entry into a residential or outpatient rehabilitation program.

• Residential Addiction Treatment Programs (Drug Rehabs) – Residential addiction treatment programs offer lengths of stay that typically range from 28 days to 3 months in duration. The addiction treatment offered can vary greatly, but would be similar in nature to that offered in a day treatment program.

• Hospital Based Inpatient Addiction Treatment – Hospital inpatient care is the most intensive level of addiction treatment, typically for people who need stabilization from a co-occurring mental health disorder. Once stabilized, people in inpatient treatment programs will typically ‘step-down’ to residential care.

• Therapeutic Communities – These long duration residential programs are best suited for people with long and severe histories of addiction, often people who have tried and failed at alternate addiction treatment programs in the past. Therapeutic communities consider a re-socialization necessary for complete recovery (like a child needs to learn how to live in the world – so to does a long using addict need to re-learn how to live without the use of drugs or alcohol) and so the community works, plays and lives together for treatment durations that can last for as long as 2 years.

• Sober Living Houses - Also called halfway houses, sober living houses are supportive living environments for people who are new to recovery. People entering into a sober living home will typically have first completed a period of primary care addiction treatment. These home environments offer low cost, safe and sober living to people trying to remain abstinence during the tough initial months of post rehabilitation recovery.

Addiction Treatment Statistics²

• In 2008, according to the National Survey on Drug Use and Health, 23.1 million people required substance abuse treatment (people who were classified as either substance dependent or substance abusers). Of these people, only 2.3 million received treatment.  (SAMHSA)
• Every dollar spent on addiction treatment yields a $4 - $7 savings in eventual social costs (reduced crime, increased productivity, decreased social assistance, etc). Experts estimate that if lifetime healthcare costs are factored in, every dollar spent on addiction treatment saves $12 in eventual expenses.

Components of Addiction Treatment Programs

While no two addiction treatment programs will offer an identical array of services, some of the more typical addiction treatment services are listed and briefly explained below:

• Detoxification Services – Some people will require medical assistance for a safe and comfortable detox and stabilization period, particularly people dependent on alcohol, benzodiazepines and opiates.

• Group Counseling – One of the most commonly offered modes of addiction treatment; group counseling helps those in recovery understand the commonality of the addiction experience. Group sessions can vary greatly, but can cover life skills or education based topics, or be more supportive in nature.

• Individual Counseling – Some addiction treatment programs will offer individual counseling as an adjunct to other modalities. An individual counselor can be useful in helping you understand and overcome the life factors that contribute to your use and compulsions to use.

• Motivational Interviewing (MI) – Working with a counselor to crystallize your reasons for wanting to quit or reduce drug or alcohol use. MI is a proven effective way to overcome feelings of ambivalence about the treatment process and a future without drug or alcohol use.

• Contingency Management – Drug addiction can harm the brain, and in early recovery while the brain heals, it can be tough for some people to feel internal rewards (a sense of satisfaction for meeting a goal, for example). Unfortunately, when meeting goals fails to make us feel good, we can lose motivation to work towards these goals. Contingency management is a technique that helps recovering drug users (particularly stimulant users) stay motivated during early recovery by providing external rewards that compensate for a lack of internal reward feelings. Under a program of contingency management, for example, a person who passes a drug test for cocaine might earn an external reward, such as a gift certificate to the movies or to a local restaurant. Contingency management is an evidence based proven technique.

• Relapse Prevention Classes – Most addiction treatment programs will offer at least some form of relapse prevention training. Relapse prevention involves seeking to minimize your exposure to threats to sobriety and preparing for moments of temptation. Relapse prevention classes can also help people learn how to manage small slips so that they don’t turn into full blown relapses. Relapse is an unfortunate part of the disease of addiction that can be minimized through careful preparation.

• Addiction Education – Most addiction treatment programs provide at least some minimal education about the nature of addiction. Understanding what you’re up against and why you feel and act the way you do can be comforting and beneficial.

• Cognitive Behavioral Therapy (CBT) – The way we think and feel influences what we do. Through CBT, we learn to recognize how negative thoughts and behaviors that can lead to unwanted outcomes and we learn how we can correct negative thinking to produce desired outcomes. CBT is one of the most proven techniques of effective addiction treatment.

• Family Counseling – Family counseling can be very useful during the early stages of addiction recovery. Whole family involvement in the addiction treatment process helps family members learn how to support and encourage the recovery process and it also helps family members from every generation recover and heal from the negative influence of substance abuse on the family.

• The 12 Steps – 12 steps of Alcoholics Anonymous and other support groups are frequently used as philosophical framework for treatment programs. If you are introduced to the 12 steps in a recovery program you may be more likely to take support from a continued involvement in the community.

• EMDR – Eye Movement Desensitization and Reprocessing (EMDR) therapy is a technique used to help people overcome the legacy of past traumas and traumatic memories. It can work very quickly, and so can be offered in short duration addiction treatment programs (like drug rehabs)

Holistic/Alternative Methods of Addiction Treatment

Alternative treatments can play an important complementary role in any addiction treatment program. What's most important, is finding treatment interventions that feel right for you!

Some of many alternative methods of addiction treatment include:

• Animal Assisted Therapy – Therapist assisted interactions with horses or dogs.

• Acupuncture - Acupuncture is one the most widely offered alternative therapies. Acupuncture advocates say that the ancient Chinese technique can ease withdrawal symptoms and reduce drug and alcohol cravings. Acupuncture as addiction treatment is widely offered in the criminal justice system.

• Sweat Lodge Therapy – Addiction recovery is a holistic process that includes a spiritual element. Native American sweat lodge ceremonies tap into this spiritual side and offer those in recovery a powerful, rebirthing experience.

• Yoga – Studies have shown that yoga can work as well as counseling when offered in an addiction treatment program. Yoga enhances mindfulness, physical well being and a mind-body connection.³
  

• Meditation – Meditation can increase mindfulness (which can guard against relapse) and it can also promote lasting feelings of peace. Since the way we handle life stresses impacts on our ability to resist temptation, learning effective ways to manage our moods is of real benefit.

Medications Used in Addiction Treatment

Although medications cannot cure addiction, they can, in some cases, increase the odds of successful recovery by reducing drug cravings or reducing the severity of withdrawal symptoms.

Certain medications can help those new to recovery a great deal, particularly when these medications are combined with professional therapies for addiction.

A great deal of research continues for medications and vaccines that scientists believe will eventually help people to overcome addiction for good. At present, there are no such ‘curative’ medications, only drugs that can reduce withdrawal symptoms and drug cravings (the FDA has approved medications only for the treatment of alcoholism and opiate dependence).

The 12 Steps (AA, NA, etc.)

12 steps groups like alcoholics anonymous and others can provide very beneficial community support to those in early recovery. Studies show that people who maintain a significant involvement in a 12 steps program for the first year of recovery are less likely to relapse.

Much of modern addiction treatment is built on the disease model of addiction, an ideal presented originally by the group Alcoholics Anonymous, which has been in operation since the 1930s.

Today, addiction professionals recognize the real worth of an ongoing participation in a 12 steps community group as an adjunct to professional addiction treatment. Because of this value, and because the 12 steps provide a good framework for recovery, the 12 steps are often introduced and studied in addiction treatment programs.

The Original 12 Steps of Alcoholics Anonymous

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

These original 12 steps have been modified for use in countless self-help organizations, such as Narcotics Anonymous (NA), Cocaine Anonymous (CA), and many others.

Harm Reduction

Although abstinence is the ideal, in some cases the best that can be achieved is a minimization of harm. Harm reduction programs strive to reduce the harms of addiction at the individual and community levels.

At the public health level, some people tackle the problem of substance abuse and addiction in the community from a harm reduction framework, rather than an abstinence philosophy.

A harm reduction counselor might not insist that you quit drugs or drinking entirely (although she would certainly support that idea if it was desired) but would certainly encourage you to minimize the harms of your risky behaviors, to yourself, to your family and to your community.

For example, needle exchange programs and safe injection clinics work from a harm reduction philosophy.

From a harm reduction philosophy, treatment that does not induce complete abstinence is not a failure, so long as treatment reduces use or the negative consequences of use.⁴

Addiction Treatment in the Criminal Justice System

Drug courts and other alternative to incarceration programs have made the criminal justice system the single largest referent into the addiction treatment network. In all, 37% of people getting addiction treatment today are referrals from the criminal justice system.

Criminal justice system referents are more likely than those from any other source to complete a period of treatment (treatment completion rate is one of the greatest predictors of recovery success).

The success of criminal justice system clients in addiction treatment programs clearly reinforces the concept that entry into a treatment program does not need to be voluntary to be worthwhile.⁵