Describe the process and effectiveness of pharmacological approaches to substance-use treatment
Explain cognitive and behavioral approaches to treating substance-related disorders
Drug addiction can be treated, but it’s not simple. Most patients need long-term or repeated care to stop using completely and recover their lives. Addiction treatment must help the person do the following:
stop using drugs
stay drug-free
be productive in the family, at work, and in society
Depending on the severity of substance use disorder, and the given substance, early treatment of acute withdrawal may include medical detoxification. Of note, acute withdrawal from heavy alcohol use should be done under medical supervision to prevent a potentially deadly withdrawal syndrome known as delirium tremens.
Therapists often classify people with chemical dependencies as either interested or not interested in changing. About 11% of Americans with substance use disorder seek treatment, and 40–60% of those people relapse within a year. Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that affect addictive behavior, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.
Principles of Effective Treatment
Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program:
Addiction is a complex but treatable disease that affects brain function and behavior.
No single treatment is right for everyone.
People need to have quick access to treatment.
Effective treatment addresses all of the patient’s needs, not just his or her drug use.
Staying in treatment long enough is critical.
Counseling and other behavioral therapies are the most commonly used forms of treatment.
Medications are often an important part of treatment, especially when combined with behavioral therapies.
Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
Treatment should address other possible mental disorders.
Medically assisted detoxification is only the first stage of treatment.
Treatment doesn’t need to be voluntary to be effective.
Drug use during treatment must be monitored continuously.
Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.
What Are Treatments for Drug Addiction?
There are many options that have been successful in treating drug addiction, including:
behavioral counseling
medication
medical devices and applications used to treat withdrawal symptoms or deliver skills training
evaluation and treatment for co-occurring mental health issues such as depression and anxiety
long-term follow-up to prevent relapse
A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems. Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups, extended care centers, recovery or sober houses, addiction counseling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs.
Drug or Addiction Counseling
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and cease substance abuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the person new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with peers who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized (“One is too many, and a thousand is never enough.”) Whether moderation is achievable by those with a history of abuse remains a controversial point.
Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.
Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself “treatment,” but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80% of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Also, in May 2018, the FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.
Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for the treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all the substances they use.
Opioids: Methadone (Dolophine® and Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine® , and Sublocade™), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.
Figure \(\PageIndex{1}\): Some people are able to quit cold turkey and never pick up their addiction again, but for most people, drug rehabilitation and treatment is a process with several ups and downs utilizing a variety of treatment methods, including medications and therapy.
Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The FDA has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quit lines. A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction. These medications include bupropion and nortriptyline. Bupropion inhibits the re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant that has been used to aid in smoking cessation but has not been FDA approved for this indication.
Alcohol: Three medications have been FDA approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:
Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.
Acamprosate (Campral®) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.
Disulfiram (Antabuse®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.
Below are common treatments for various types of disorders:
