Substance Abuse Treatment

Substance Abuse Treatment

Summary

Substance abuse treatment is a type of behavior modification therapy designed to help people quit using alcohol, illegal drugs or prescription medications for non-prescribed purposes.

Substance abuse is the habitual misuse of alcohol or drugs. Drug abuse may involve using illegal drugs or misusing prescription medications.

There are several different types of substance abuse treatment programs, including inpatient programs, residential programs and outpatient programs.

Because substance abuse is often accompanied by denial (refusal to admit truth or reality), some patients refuse to seek treatment. Others seek treatment only after friends, family members, coworkers or others have urged them to do so. Some patients enter treatment only after it is ordered by a judge or other means.

Before treatment begins, a clinical assessment is performed by a physician or non-physician mental health professional to determine the most appropriate course of treatment for the patient.  Some information that may be sought during an assessment includes:

  • Type and amount of substance(s) abused
  • Length of time patient has abused substance(s)
  • Effects of substance(s) on patient’s life

Substance abuse treatment typically begins with detoxification (a process that helps the body rid itself of alcohol or drugs). Patients may be treated with medications that reduce physical symptoms of substance withdrawal, such as nausea and shakiness. Sudden withdrawal from certain substances (e.g., alcohol, benzodiazepines) can be life-threatening.

After detoxification, patients should receive rehabilitation services, such as individual and group counseling, life skills training and training to prevent relapse (using alcohol or drugs after a period of abstinence).After completing treatment, patients may receive follow-up care to avoid relapse. Follow-up care may consist of self-help programs (such as Alcoholics Anonymous or Narcotics Anonymous), halfway houses or transitional housing.

About substance abuse treatment

Substance abuse treatment is a type of behavior modification therapy that assists people in breaking the cycle of abusing alcohol, illegal drugs or prescription medications that are being used improperly.

Substance abuse is the habitual misuse of alcohol or drugs. Drug abuse may involve using illegal drugs or using prescription medications for non-prescribed purposes. The main symptom of substance abuse is the continued use of alcohol or drugs despite negative consequences, such as being arrested for driving while under the influence of alcohol. Symptoms may also include tolerance (needing larger amounts of a substance to achieve the same effect) and withdrawal (physical symptoms, such as shaking or nausea, which are experienced after discontinuing use of a substance).

Substance abuse treatments are designed for patients who abuse alcohol or drugs and cannot stop using these substances without receiving assistance. The long-term goal of treatment is to help the patient stop abusing alcohol or drugs on a permanent basis. Short-term treatment goals include reducing substance use, improving the ability of patients to function without using substances and minimizing the medical and social complications related to substance abuse. Treatment may also include services that address problems caused by substance abuse, such as relationship difficulties.

Patients may be treated by a team of professionals that may include physicians (e.g., psychiatrists), psychologists, nurses, social workers, substance abuse counselors or other professionals. Different members of the team address different patient needs. For example, a psychiatrist may prescribe medications used during treatment whereas a psychologist or substance abuse counselor may address emotional issues associated with substance abuse, such as depression.

There are several different types of substance abuse treatment programs. They include:

  • Inpatient treatment. Special units in hospitals or medical clinics that offer detoxification and rehabilitation services.
  • Residential programs. Living environments that offer treatment services. There are several types of residential programs in existence. One such example is therapeutic communities. These long-term residential treatment programs focus on behavioral change and personal responsibility in all areas of a patient’s life, not just in addressing substance abuse. Residential programs usually last for one month to a year or longer.
  • Outpatient programs. Services are provided in a variety of settings, such as mental health clinics, hospital clinics and local health department offices. Patients receive services on-site, but live at home. Some programs require daily attendance. Others require attendance one to three times a week. Programs typically last from two months to a year. There are several different types of outpatient programs including:
    • Partial hospitalization or day treatment. Services that are provided in hospitals or free-standing clinics. Patients receive treatment for four to eight hours a day, but live at home. Programs typically last for at least three months.
    • Intensive outpatient programs. Outpatient program with rigorous attendance requirements, such as nine to 20 hours a week. Programs typically last from two months to a year.
    • Methadone clinics (also called methadone maintenance treatment programs for opioid addiction).  Clinics that provide medication-assisted outpatient treatment for people who are addicted to opioid drugs, such as heroin. Programs use medication (e.g., methadone, burprenorphine) to help patients avoid using drugs and also provide counseling and other services. Patients may be treated on a long-term basis.

There are approximately 1.8 million admissions to substance abuse treatment centers each year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The vast majority of people entering programs seek treatment for addiction to alcohol, opiates (primarily heroin), cocaine, marijuana and stimulants (primarily methamphetamine).

Before substance abuse treatment

Some patients try to manage substance abuse treatment on their own. However, substance abuse is often accompanied by denial (refusal to admit truth or reality), which causes patients to resist treatment even though they consistently abuse alcohol or drugs.

Some patients seek treatment only after friends, family members, coworkers or others have urged them to do so. This is sometimes accomplished through an intervention, an orchestrated attempt by friends and family members to convince a patient to seek help for addiction or similar problems. Other patients enter treatment only after it is ordered by a judge or other means.

Research indicates that men are more likely to enter substance abuse treatment than women. However, women who do receive substance abuse treatment achieve outcomes and success rates comparable to those of men.

Before treatment, patients will be given a clinical assessment by a physician or mental health professional to ensure that appropriate treatment is received. Some information that may be sought during an assessment includes:

  • Type and amount of substance(s) abused
  • Length of time patient has abused substance(s)
  • Effects of substance(s) on patient’s life
  • Medical history
  • Current medications (including pain medications)
  • Mental health issues
  • Family and social issues
  • Legal or financial problems
  • Educational background and needs
  • Current living situation
  • Employment history
  • Previous treatment experiences or attempts to quit using substance(s)

After the assessment, a patient is assigned a team of professionals that may include physicians (e.g. psychiatrists), psychologists, nurses, social workers, or substance abuse counselors who devise an appropriate treatment plan, which may include problems to be addressed, treatment goals and methods for accomplishing treatment goals.

During substance abuse treatment

The first step in most substance abuse treatment programs is detoxification (a process that helps the body to rid itself of alcohol and/or drugs). Patients undergoing detoxification are often treated with medications to help reduce the physical symptoms of substance withdrawal, which may include nausea, sweating, shakiness and extreme anxiety. However, not all patients receiving substance abuse treatment experience withdrawal symptoms, and the nature of symptoms depends on the substance that is being abused. In those that do experience symptoms, the severity varies. In severe cases, patients may experience hallucinations or convulsions during withdrawal. Sudden withdrawal from certain substances including alcohol and benzodiazepines can be life threatening.

Detoxification may occur in an inpatient program or in an outpatient program. Detoxification may take several days to a week or more. During this time, patients receive medical supervision and begin to receive information about the substance abuse problem.

After detoxification, substance abuse treatment may include the following:

  • Counseling. Patients may receive individual or group counseling. Counseling usually begins with a focus on motivating a patient to stop using alcohol and/or drugs. It then shifts to a focus on helping patients to change behavior, repair damaged relationships or build new friendships with people who do not use alcohol or drugs. Family members may receive couples therapy, family therapy or other services to assist in the recovery process. Support from family members and others is a critical component of successful substance abuse treatment.
  • Education. Patients may be instructed to read books or listen to tapes with information related to substance abuse and recovery. Written assignments may be required. Patients may also receive information about substance abuse issues, such as the impact of alcohol and drugs on the body and methods for managing a substance abuse problem.
  • Training. This may involve life skills training, to learn a variety of skills, such as social skills, employment skills, anger management and money management. It may also include relapse prevention training, which teaches patients to identify and cope with circumstances that may trigger a relapse (using alcohol or drugs after a period of abstinence). These may include seeing a person with whom the patient once used alcohol and/or drugs or being in a place where the patient used alcohol and/or drugs.
  • Alcohol or drug testing. Patients are sometimes required to take breathalyzer or urine tests to determine whether they have been using alcohol and/or drugs.
  • Orientation to self-help groups. Patients are introduced to self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, which are designed to help people recover from substance abuse problems. People meet and share personal stories about recovery in an attempt to remain alcohol- and drug-free.
  • Treatment for mental health disorders. Many people with substance abuse problems may also have other psychiatric disorders, such as depression or anxiety. Treatment may include counseling and/or medication such as antidepressants or anti-anxiety medications.
  • Medication. Programs sometimes use medications to assist with substance abuse treatment. Medications do not cure addiction, but assist patients by helping them refrain from alcohol and/or drug use. Methadone, LAAM and buprenorphine are medications used to treat opioid addiction. They prevent withdrawal symptoms and allow patients to function normally. Naltrexone is a medication that reduces the craving for alcoholand disulfiram is a medication that causes a bad reaction when alcohol is ingested. Both of these help patients avoid drinking. The medication acamprosate helps to reduce the relapse rate in patients with alcoholism.

After substance abuse treatment

After completing a substance abuse treatment program, it is important that patients receive follow-up or continuing care. Successfully addressing substance abuse problems typically requires a life-long commitment to recovery.

After patients return to their usual work, home and school environments, they will likely face many temptations and cravings for alcohol and/or drugs. Relapse (using alcohol and/or drugs after a period of abstinence) is common among patients who have received substance abuse treatment. It is important for the patient to return to treatment after relapse.

Some ways in which patients may receive continuing care after treatment include:

  • Self-help programs. Alcoholics Anonymous and Narcotics Anonymous are two popular programs for patients recovering from substance abuse problems. Patients meet and share personal stories in an effort to provide support and refrain from alcohol and/or drug use.
  • Halfway houses or sober houses. Alcohol and drug-free living environments for people who previously attended prison-based or residential programs. Patients usually remain in these facilities for three months to one year. Counseling is provided on-site or at an outpatient facility.
  • Supportive living or transitional apartments. Small group alcohol- and drug-free living environments. Residents support each other and attend counseling and self-help groups.
  • Counseling. Many patients continue to seek group or individual therapy to address substance abuse problems and other problems, such as depression.

Potential benefits and risks

The greatest benefit of substance abuse treatment is that it may result in patients’ remaining alcohol and/or drug-free on a permanent basis. It may also help to solve problems caused by substance abuse, such as relationship issues and financial problems.

However, patients who receive substance abuse treatment always face the risk of relapse (using alcohol and/or drugs after a period of abstinence). In fact, many patients must receive repeat treatments to successfully address substance abuse problems. Some treatment programs tend to be most successful for particular types of substance abuse or particular patients. For example, opioid abuse may require treatment in a methadone program. Outpatient programs may be most effective for patients with a brief history of substance abuse. Patients who do not have a stable residence or employment, have limited family support or are mentally ill may respond best to residential treatment programs.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding substance abuse treatment:

  1. What type of substance abuse treatment program is appropriate for me?
  2. Should I be treated in an inpatient or outpatient facility?
  3. If I receive outpatient treatment, how frequently will it occur?
  4. How can I urge my family member/friend to seek substance abuse treatment?
  5. What information will I be required to provide before beginning treatment?
  6. Will I receive medication while undergoing detoxification?
  7. What other types of services will I receive during treatment?
  8. Is it necessary for me to attend self-help groups?
  9. What are the most effective ways to prevent relapse?
  10. What should I do if relapse occurs following treatment?
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