There’s no single treatment that’s right for someone trying to overcome a substance addiction. Treatment for a substance use disorder (SUD) usually begins with detoxification or “detox” – a process during which the patient is medically supported while the substance(s) is removed from the person’s system. When someone enters treatment, one of the first things he/she may experience during the detox process is withdrawal, which can include physical symptoms such as nausea, diarrhea, shaking, fever, insomnia and sweating and/or psychological symptoms such as depression, anxiety, anger and upset. In some cases, a drug rehabilitation center will use FDA-approved medications to help counteract withdrawal symptoms with the goal of weaning the patient off the medication as soon as possible; although sometimes medication-assisted therapy is needed on a long-term basis to prevent cravings that can trigger drug-seeking behavior and relapse. While detox is the first step to any kind of treatment, counseling is also typically needed to achieve lasting results.
Whether a substance use disorder is mild, moderate or severe, some kind of treatment is usually necessary, which makes it tragic that only a small number of those who need help actually get it. According to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (2013), only 2.5 million people out of the 22.7 million people who needed treatment for drug or alcohol use actually received help at a specialty facility While there’s no cure for drug addiction, for most (though not all), abstinence or giving up the substance entirely is necessary.
Below are some of the most common treatment options for substance use disorders. If you or a loved one seek treatment for drug addiction, it’s likely that a combination of several of these approaches will be recommended and used:
Drug rehabilitation programs use a variety of counseling approaches to help people experience lasting recovery. Types of counseling include:
- SMART Recovery® (Self-Management and Recovery Training): This community-support program has a four-point plan to teach self-reliance, and clients using SMART Recovery benefit from online support groups, message boards and chat rooms as well as in-person meetings to stay motivated in their recovery efforts.
- BRENDA: BRENDA combines psychosocial counseling and pharmacotherapy (prescription drugs) to help patients deal with substance addiction. The acronym refers to the steps a counselor takes in treating a client using this method:
Report to the patient on evaluation findings
Needs identified by both the patient and therapist
Direct advice to the patient
Assessing the patient’s reaction to advice; modifying the plan when needed
This treatment model uses a type of psychotherapy called cognitive-behavioral therapy (CBT) in which a therapist will help clients examine their thinking and feelings in an effort to change negative and unproductive thoughts and beliefs that may lead to drug use.
Other types of counseling:
- Motivational incentives: For gains made in treatment, drug and alcohol counselors may offer a reward system to encourage patients to work hard in recovery. Rewards might be for a special privilege, outing or voucher.
- Motivational Interviewing (MI): Therapists who use MI help clients feel inspired and empowered to make needed life changes and to reach recovery goals.
- Multidimensional Family Therapy (MDFT): Sometimes the whole family needs to be willing to evaluate its dynamics in order to help one or more member(s) overcome an addiction and/or another mental health issue. MDFT involves the whole family in the healing process to improve relationships, end enabling behavior and create harmony.
Sometimes the right option for treating drug addiction may be going to an inpatient or residential treatment center to live for a period of time. How long depends on the severity of the addiction, the kind of addiction(s) and the patient’s progress. These specialized facilities offer medically-supervised detox, which is a process to get drugs out of the bloodstream and tissues. In rehab, patients also receive intensive counseling to cope with triggers, cravings and any co-occurring mental health disorders. It’s helpful to think of rehab as a kind of retreat where the addict lives and works on learning to overcome triggers of addiction and manage any underlying mental disorders that require treatment along with the substance use disorder.
There are also outpatient rehab programs where patients live at home but attend a drug treatment (or partial hospitalization) program during the day, which may last for seven or eight hours. Or you or your loved one may attend an evening program that meets several times a week for several hours in the evenings only. With outpatient day or evening programs, patients sleep at home, which can be successful as long as drug networks, old haunts and triggers don’t interfere with the progress of treatment. While in treatment, patients in these programs, too, work on understanding their addiction and any mental health issues through counseling.
When selecting a program, be aware that there are customized programs tailored to groups of people who are like-minded; by bringing together people from similar backgrounds who are grappling with the same or similar issue, members can effectively work together as a group. Program alumni may even meet up later for special weekends and offer one another ongoing support in recovery. Read on for several examples of custom-tailored programs now being offered by some treatment centers:
- Christian programs address drug addiction with a Bible-based approach, so attendees can find strength through faith. Treatment may include counseling and 12-step or other community-support programs, yet the focus on scripture allows members of these programs to be guided to recovery in large part through their beliefs.
- Women-only programs address both the substance use disorder as well as any past history of abuse or trauma or mental illness that may underpin a drug addiction.
- Adolescent programs tend to be gender-specific and allow teens a safe place where they can work to overcome drug addiction while also attending classes, so they don’t fall behind in school during treatment.
- Spanish-speaking programs make treatment more relatable for those who speak English as a second language. Counselors, too, speak Spanish, and all written materials are printed in Spanish.
Medication-Assisted Therapy (MAT)
The Food and Drug Administration (FDA) has approved several prescription medications for the treatment of substance use disorders. Medication-assisted therapy proves most effective when used in conjunction with other approaches, such as counseling. Pharmacological approaches designed to help substance abusers detox and reduce the chances of relapse include these medications:
- For opioids: The FDA has approved several prescription medications for opiate addiction to heroin, morphine or prescription painkillers like oxycodone and hydrocodone. There are a variety of prescription drugs that are used in treating opioid use disorders with active ingredients that either reduce withdrawal symptoms, like cravings, or block the effects of opiates altogether. These include:
Buprenorphine – (brand name: Subutex): An initial treatment to prevent or reduce withdrawal symptoms such as drug cravings
Methadone – (brand names: Dolophine or Methadose): Used to prevent withdrawal symptoms and to block the high from taking illicit opiates. Only authorized, specially licensed facilities can administer methadone maintenance.
Naltrexone – (brand names: Depade, Revia, and Vivitrol): All three block the effects of opioids; Vivitrol is an extended-release injection, given once a month.
Naloxone – (brand name: Suboxone): Prescribed as a maintenance medication that contains buprenorphine as well, Suboxone blocks or reverses the effects of opioids. For opioid overdoses, Evzio, an auto-injector containing naloxone, is available for emergency home use.
- For tobacco/nicotine: For tobacco products containing highly addictive nicotine, several nicotine replacement therapies are available over-the-counter at drugstores. These include nicotine patches, sprays, gums and lozenges that alleviate drug cravings. Prescription drugs such as bupropion (brand names: Wellbutrin, Zyban) and varenicline (brand name: Chantix) are also FDA-approved.
While there are other prescription medications in the drug pipeline and now being tested, there are no drugs currently available for the treatment of cocaine, methamphetamine, cannabis (marijuana) or hallucinogen use disorders.
The original 12-step program is one you’ve undoubtedly heard of before: Alcoholics Anonymous (AA), which has been around since 1935. AA has been helping alcoholics get and stay sober for decades with meetings available in big cities and small towns across the globe. Over time, this community of support, in which alcoholics help each other, has inspired other, similar programs for a wide variety of drug addictions that people grapple with:
- Cocaine Anonymous
- Crystal Meth Anonymous
- Heroin Anonymous
- Marijuana Anonymous
- Narcotics Anonymous
- Nicotine Anonymous
- Pills Anonymous
These 12-step programs borrow at least in part from the AA model, which is based on 12 consecutive processes (each step building on the one(s) preceding it). The steps include minimizing self-centeredness, providing support to others in the group and making amends to those whom the substance abuser has hurt, among others. For a full list of the 12 steps, go to the Get Help section.
While some addicts rely solely on 12-step programs to treat and recover from their drug addiction, others use it in conjunction with counseling. And often 12-step programs are included as part of inpatient and outpatient drug rehabilitation.
For more information on ways substance abuse and other addictions are being treated today, visit the Get Help section.
Sources: Alcoholics Anonymous; American Psychological Association; CASA Columbia; Centers for Disease Control & Prevention; Diagnostic and Statistical Manual of Mental Disorders (5th ed.); Multidimensional Family Therapy (mdft.org); National Institute on Drug Abuse; Food and Drug Administration, National Institutes of Health; National Survey on Drug Use and Health 2013; Psychiatric Quarterly; SMARTRecovery.org; Substance Abuse and Mental Health Services Administration, SAMHSA’s Center for the Application of Prevention Technologies (CAPT); Swiss Medical Weekly; United States Department of Health and Human Services National Health Statistics Reports; World Health Organization.