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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.
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.
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.
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.
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.