The decision to seek help for drug abuse and addiction requires a great deal of courage from the individual battling addiction. Sometimes individuals seek treatment after an event that served as a wake up call, like a DUI arrest or a broken relationship. Others are motivated to get help after loved ones stage an intervention. Other people simply realize that their substance use has gotten out of control.
Whatever the reason help is sought, comprehensive addiction treatment can guide a person down the path to a healthier, more balanced life.
According to the National Institute of Drug Abuse, addiction is a chronic and complex brain disease caused by drugs or alcohol changing how the brain functions. Although loved ones may have good intentions by telling the individual to simply stop using drugs, even the most strong-willed individual is often unable to stop due to these brain changes.
Scientifically, the chemicals that drugs produce in the brain can “hijack” the communication system. When doing this, the drugs cause abnormalities in how the brain sends, receives, and processes information. The substances do this by imitating the chemical messengers in the brain and tapping into the brain’s reward center. When drugs imitate the messengers, certain nerve cells begin to send messages that are incorrect. Some drugs can cause dopamine, which is a neurotransmitter, to build up in the brain, which then causes the individual to feel the need to repeat the drug use to achieve euphoria. Eventually, this activity makes it difficult for the individual to enjoy
anything without the substance.
When abuse continues, cognitive function begins to decline. In brain imaging that has been done on individuals affected by drug abuse and addiction, there were changes noted in the parts of the brain that affect memory, judgment, learning, behavior control, and decision-making. This causes the individual to continue to abuse drugs, even if there have been consequences for that use in the past.
According to the Substance Abuse and Mental Health Services Administration, there are criteria in DSM-5 that must be met for an individual to be diagnosed with a substance use disorder, including:
- Impaired control
- Social impairment
- Risky use
Other considering factors for substance abuse disorders can include:
- Health problems
- Failure to meet major responsibilities at home, work, school, etc.
Some types of addiction seem to be more prevalent in the United States. The most common substance use disorders include:
- Alcohol use disorder
- Tobacco use disorder
- Cannabis use disorder
- Stimulant use disorder
- Hallucinogen use disorder
- Opioid use disorder
While the terms drug abuse and addiction are often used interchangeably, they are not the same.
As stated above, addiction is a chronic brain disease with the potential for relapse. It is characterized by the individual compulsively seeking and using drugs, even though there may be consequences, sometimes very detrimental ones. This compulsion is the characteristic that separates addiction from abuse. Also, with addiction, changes in the individual’s brain are present.
Drug abuse, however, develops when an individual begins to use either illicit, prescription drugs, or even over-the-counter drugs improperly. People may abuse drugs for many reasons, including to relieve or reduce stress, to avoid or alter reality, and/or to experience pleasure or euphoria. In the case of prescription drugs, abuse can be characterized by individuals using a prescription drug that was prescribed to another person.
When the American Psychological Association updated its DSM in 2013, addiction was grouped into the substance use disorder category. Certain criteria were created within four groups: impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal). To receive the diagnosis of a substance use disorder, the individual must meet two of the following within a 12-month period:
- Impaired control:
- The drug is taken longer than intended or in larger doses than intended.
- There is a persistent effort to cut down or control use of the drug, with unsuccessful efforts.
- The individual spends a great amount of time attempting to obtain the drug, using the drug, or recovering from the effects of the drug.
- Cravings, or a very strong desire to use the drug, are present.
- Social impairment:
- Recurrent use of the drug results in the individual failing to meet obligations at home, school, or work.
- The person continues to use the drug, although it has caused problems with social and personal relationships.
- The individual cancels or cuts back on social, work-related, and recreational activities due to using the drug or recovering from its use.
- Risky use:
- The individual continues to use the drug although it is physically hazardous.
- The individual continues to use the drug although it has caused or exacerbated physical or mental health issues.
- Pharmacological criteria:
- Tolerance, defined either by a need to increase the amount of drug used to achieve the desired effect or a greatly diminished effect with the same dosage or amount of the drug, is present.
- Withdrawal, which can be manifested by either the characteristic withdrawal for a particular substance or a need to take the drug or one that is very similar to reduce withdrawal symptoms, is present.
Addiction may also cause medical problems, such as cardiovascular disease, stroke, cancers, HIV/AIDS, hepatitis, lung disease, and mental health disorders.
Mental health disorders often go hand in hand with addiction, and treatment will need to address all co-occurring issues, no matter which issue came first.
Neither drug abuse nor addiction discriminate against age, sex, gender, socioeconomic
status, or race. This means that anyone – young or old, male or female, and rich or poor
can become dependent on drugs or alcohol.
In individuals 12 years of age or older, according to results of the National Survey on Drug Use and Health from 2013, an estimated 24.6 million Americans had used illicit drugs within the past month. This translates to roughly 9.4 percent of the population. For the purpose of the survey, illicit drugs include marijuana and hashish, cocaine, crack cocaine, heroin, hallucinogens, inhalants, and prescription medications used inappropriately.
Marijuana is the most commonly used illicit drug – 19.8 million individuals aged 12 or older stated they had used marijuana during the month prior to the survey. Of those, 5.1 million individuals used
the drug daily (defined as 20 or more days in the past month).
The second most commonly used illicit drug is cocaine, which over 1.5 million individuals used in the month before their interview.
In 2013, approximately 21.6 million individuals 12 and older had been diagnosed with either drug abuse or addiction. Of those, 2.6 million were misusing or addicted to both alcohol and illicit drugs, 4.3 million were involved with only illicit drugs, and 14.7 million were classified as having abused or been dependent on alcohol.
Not everyone interviewed received assistance with substance abuse. Of 20.2 million individuals aged 12 or older who had a need to seek treatment (but did not), 4.5 percent stated that they agreed they did need assistance. Of those 908,000 individuals, only 34.8 percent (316,000 individuals) made the effort to seek treatment. The number one reason that treatment was not pursued was the lack of insurance that would cover the treatment and an inability to pay for the needed care.
There are many situations where it is unclear if nature or nurture – or both – is responsible for the issue, and drug abuse and addiction disorders are no exception. While drug abuse and addiction are still being heavily researched, it’s believed that a combination of genetics and environment factor into the likelihood of addiction. In fact, there are many factors that contribute to drug abuse and addiction, including:
- Genetic predisposition
- Family history of addiction
- Impulsive or “thrill-seeking” nature
- Presence of other mental health disorders
- Psychological factors, such as stress
- Experimenting with drugs or alcohol at a young age
- Physical, sexual, or emotional abuse
- Environmental factors, such as peer pressure
- Poor social or coping skills
- Unstable family model: inconsistent parenting, poorly supervised, little discipline, or lack of nurturing
- Easy access to drugs and alcohol
- Academic problems
In order to assist a person in working toward recovery, treatment must be a multidimensional approach. No one treatment works for all individuals, and individuals will each need more than one type of treatment. When a person first decides to accept treatment, a counselor should be assigned to help the individual determine what type of treatment will be most beneficial.
All treatment options should have the same principles in mind, which include:
- Addiction is a complex yet treatable disease that affects brain function and behavior.
- No single treatment is appropriate for every individual.
- Treatment needs to be readily available.
- Effective treatment helps the individual with not only the addiction, but other aspects of life as well.
- Remaining in treatment for the course of the treatment plan is a critical step in the individual’s recovery.
- Therapies – whether they are individual, group, or another type – are the most common components for treatment of addiction.
- Medications are an important element in treatment for some individuals, and they should be used along with therapies on a case-by-case basis.
- Treatment plans should be assessed frequently and changed as the needs of the individual change.
- Many individuals with addiction also have mental health disorders.
- Medical detox is not effective by itself, but it is often the first stage of treatment.
- Treatment can be effective even if it is not voluntary.
- Since lapses in treatment may occur, the individual’s drug use must be monitored closely.
- Individuals’ health records should be reviewed for infectious diseases such as tuberculosis, HIV/AIDS, hepatitis B and C, and others. Risk-reduction counseling should be included in treatment plans so that individuals may address behaviors that have put them at risk.
The longest inpatient treatment option is a residential treatment program. Residential treatment is usually not in a hospital setting, although it does provide care 24 hours a day. Therapeutic communities are the best-known form of residential treatment, and these often involve care that lasts for 6-12 months. Every part of the community, including the staff and other residents, is considered part therapy. Residential treatment is highly structured, and treatment includes individuals coming to terms with – and changing – their thoughts and behaviors. This type of therapy can be modified if an individual has special circumstances; there are programs targeted to treat adolescents, a specific gender (for example, men-only or women-only treatment), those struggling with homelessness, those with severe mental health disorders, and individuals who are currently incarcerated. These facilities often include services, such as employment training and skill-building workshops.
Inpatient treatment, which may also be described as short-term residential treatment, has an average stay of 3-6 weeks, though care frequently lasts up to 90, or even more, days. Treatment may come in a variety of forms, such as individual, group, or holistic therapy. Upon discharge, the individual may transition to outpatient treatment to ensure continued support.
For outpatient treatment, there are options such as partial hospitalization or intensive outpatient care. These treatments are generally more affordable since they don’t include room and board costs, but they still offer intensive treatment. Such programs require individuals to attend treatment for the majority of the day for a set period of time before they are discharged to a less intense outpatient program.
When individuals reach the point of less frequent outpatient treatment, they may, by that time, only require weekly therapy. Some treatment programs offer both individual and group therapy sessions, as well as self-help groups, for alumni. A clear and supportive aftercare program is key to ongoing sobriety.
Individual counseling may help the client work toward certain, set short term goals, and may also help with referrals for needed medical, psychiatric, and employment services. One of the most important parts of individual counseling is to assist the client in addressing and changing behaviors that are related to drug abuse. This includes
tweaking individuals’ coping skills, so they can work through triggers and stress without
relapsing to drug use.
In certain cases, medication may be involved in an individual’s recovery process. Medication is never given without being accompanied by therapy, and it is not a first line of treatment. Medications may be utilized to reduce withdrawal symptoms and keep clients comfortable during medical detox. The use of medication may also help individuals stay in treatment as they will be able to better focus on their therapy and goals if their cravings are curbed by the medication. The risk of relapse is also often lowered by the use of medication, as clients will be less likely to seek out and use substances if they can work through triggers successfully. In all circumstances, medical professionals determine the use of medication on a case-by-case basis.