Treating addiction has been an important part of medicine and therapy for decades. As the understanding of addiction evolves, approaches to treating it are also evolving. The National Institute on Drug Abuse (NIDA) is clear that addiction is a chronic disease involving changes to the brain caused by the presence of intoxicating substances, which rapidly alter levels of neurotransmitters and trigger the reward system. Addiction’s primary symptoms are compulsive drug abuse and cravings for drugs to get high.
NIDA is also clear that the foundation of treating addiction is detox, which involves medical supervision as the body ends dependence on the substance to feel normal, and rehabilitation, which should involve therapy to change behaviors around drugs or alcohol. However, in NIDA’s Principles of Effective Treatment, the organization clearly states that no single approach to treatment is right for everyone. After detox, rehabilitation and aftercare are necessary, but there are dozens of approaches to therapy, which may or may not involve medication.
Addiction specialists can prescribe or recommend treatment approaches, but everyone should know they have many options for help.
What Happens after Detox Is Complete?
Addiction treatment often begins with medically supervised detox, but after the body no longer relies on drugs or alcohol to feel normal, what are the next steps? Entering a rehabilitation program will begin the therapy process, but there are several types of rehabilitation available. Many insurance programs cover 30 days of inpatient or outpatient treatment while NIDA insists that a minimum of 90 days in rehabilitation is crucial. Understanding different approaches to rehabilitation may help the decision process along with a referral from the detox program, a recommendation from a therapist or physician, or guidance from an addiction specialist.
The American Society of Addiction Medicine (ASAM) has a Continuum of Care, which shows several rehabilitation options. From prevention and education programs aimed at people with greater risks of substance abuse to long-term medically intensive inpatient treatment for those with co-occurring health problems, there are several options. It’s important to find a therapeutic approach that works and supports all the person’s needs on a physical, mental, emotional, and even spiritual level.
The Range of Rehabilitation Programs Available after Detox
- Standard outpatient programs: The foundation of outpatient treatment is group therapy, which began with 12 Steps or Alcoholics Anonymous groups but has now expanded to apply several versions of talk therapy to different size groups. Typically, people who are suited for standard outpatient treatment can safely live at home, and many can continue going to work or school. They are required to attend a certain number of hours of group therapy per week, but this is usually around 10 hours at most. These individuals need help learning better coping mechanisms for stress and understanding their triggers, but they are able to manage otherwise their lives.
- Intensive outpatient programs: This option is similar to standard outpatient treatment, but it requires more hours per week – often 20-30 hours – of attendance at meetings. This means that people in intensive outpatient programs (IOP) can live at home, but they may have to take time off from work or school to meet their treatment obligations. Many IOPs also offer medication-assisted treatment (MAT), too, as there are nurses or physicians available to monitor prescription medications’ effectiveness. A 2015 survey reported that IOPs provided addiction treatment to 141,964 people out of 1.2 million people in treatment, or about 12 percent of that population.
- Partial hospitalization: This is a very short-term approach to inpatient treatment, with the intention of physically stabilizing the person before they are released to a lower level of care like outpatient treatment. Many people with co-occurring mental health and substance use disorders benefit from being temporarily hospitalized to get physical treatment. When they are safe, they can return home and enter an evidence-based outpatient treatment program.
- Residential or inpatient: Options for residential or inpatient treatment range from one month in a luxury resort to intense medical supervision 24 hours a day. People who live in residential rehabilitation facilities need to be away from their original environments because they are at risk of relapsing back into substance abuse if they stay at home. During their stay in the program, clients can participate in a variety of activities, such as group therapy, individual therapy, medication treatments, journaling, complementary therapies like yoga or meditation, nutrition therapy, art therapy, and much more. Residential programs offer the widest variety of treatment options, so nearly anyone can find a facility that suits their needs.
Rehabilitation programs will sometimes publish their treatment success rates on their website, in their newsletters, on social media, or in other places. If they do not have published rates, they can be contacted and asked to provide those to people seeking treatment.
Some facilities state they have high success rates, such as 74 percent of clients maintaining drug and alcohol abstinence for six months after leaving the program. It is important to remember, however, that relapse is a component of addiction. This chronic illness’s symptoms will change with time, just like other chronic illnesses like hypertension, diabetes, or asthma. Between 40 percent and 60 percent of people who struggle with addiction will relapse at some point.
The key to staying on the path of recovery is to go back to active treatment, whether seeing a therapist regularly or re-entering a rehabilitation program, when the relapse begins. Relapse does not mean failure, so relapse statistics from rehabilitation programs do not solely measure success or flaws within the program itself.
Types of Therapy to Engage in after Detox
Each form of rehabilitation provides, at minimum, group talk therapy. Most programs also offer individual therapy, or an individual therapist specializing in addiction treatment can become part of the larger treatment team. Medication may be part of the treatment plan, too, but it is not for everyone. Both therapy and medication can be used on a long-term basis.
Medication-Assisted Treatment (MAT)
There are several medications that are effective for different conditions associated with addiction treatment. For example, buprenorphine-based drugs are used during opioid addiction treatment to taper the individual off physical dependence on opioids while managing the most intense withdrawal symptoms. Bupropion and nicotine patches have been successfully used to ease people off tobacco and cigarettes while Valium has been used to relieve the most intense alcohol withdrawal symptoms. Naltrexone has been used to alleviate cravings after detox for both opioids and alcohol.
People with co-occurring mental health conditions will benefit from individual therapy, and they will likely also benefit from mood-stabilizing medications. Most of these medications are antidepressants, which help to stabilize the amount of serotonin and dopamine in the brain. They do not act quickly, so they are less prone to abuse than benzodiazepines or other psychiatric pharmaceuticals. It is important that psychiatric medications are taken only as directed and used alongside talk therapy.
Both group and individual therapy are very helpful for people overcoming addiction because the focus of these treatments is to change behaviors based on a better understanding of what triggers substance abuse.
- Cognitive Behavioral Therapy: CBT is one of the original approaches to talk therapy for addiction treatment, used as a method to prevent alcohol addiction relapse. Maladaptive behaviors, like substance abuse, develop because they are learned. CBT involves stress-relieving approaches to trauma, grief, mental illness, or other intense stressors. CBT helps people understand these root causes, so they can develop strategies to de-stress in a healthy way and avoid substances.
- 12 Steps: This is one of the original approaches to overcoming addiction, starting with Alcoholics Anonymous (AA) in the 1930s. Using the 12 Steps, people overcome alcohol abuse, learn to make healthier choices, heal relationships with friends and family, and support each other to stay sober. Since it has a Christian basis, the 12-Step model does not work for everyone; however, it has created the foundation to addiction treatment in the US, which led to the development of evidence-based talk therapies like CBT.
- Motivational Enhancement Therapy: This talk-based therapy aims to encourage people who are ambivalent about seeking addiction treatment to participate in rehabilitation. While it works well for some people struggling with specific addictions, like marijuana, alcohol, or nicotine, research shows it does not work well for everyone. However, NIDA is clear that rehabilitation does not need to be voluntary to be effective. For those in treatment involuntarily, MET may work well to encourage them to make healthy behavioral changes.
- Matrix Model: This approach involves a combination of treatment approaches founded in talk therapy, including the 12 Steps, recovery skills education, family education, motivation enhancement, and individual therapy.
- Contingency Management: This approach to treatment uses some talk therapy, but mainly uses rewards to reinforce positive behaviors, like avoiding drugs or alcohol. Incentive-based interventions work particularly well for people struggling with addiction to stimulants, like meth or crack cocaine.
- Family therapy: This form of therapy brings family members into therapy sessions together to heal trauma and emotional damage associated with one or more members abusing drugs or alcohol.
- Mutual support groups: Support groups are an important form of social support for people who have completed rehabilitation, and this form of peer support is most frequently based on the 12-Step model. There are alternatives to the 12-Step approach, however, such as SMART Recovery. Specific peer support groups may cater to certain demographics, such as those with co-occurring disorders, specific religious or spiritual beliefs, family history, medical history, and much more.
Different approaches to medication, therapy, residency, physical treatment, and emotional support can vary between detox and rehabilitation programs. As noted in many surveys involving success of addiction treatment, the key component is continuity of long-term care. People who stay in rehabilitation for at least 90 days; who get ongoing support from therapists, doctors, and mutual support groups; and who have stable, healthy families are less likely to relapse within the first year after treatment. They are also more likely to remain sober for longer and to get help if they do relapse.