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Understanding Treatment
Understanding Treatment 2018-07-26T09:39:09+00:00

Understanding Treatment for Drug and Alcohol Dependency

Spontaneous remission of addiction is not a realistic expectation. Nor is banishment of chemical dependency through willpower alone. When people develop a substance use disorder, their best hope for recovery is through a formal treatment program offered by a licensed drug and alcohol rehabilitation center.

In 2016, approximately 21 million Americans needed treatment for substance abuse, but only 2.2 million, or 10.6 percent of that total, actually received treatment services at a specialized facility[1]. Treatment programs for addiction have helped millions of people overcome their chemical dependency, but these programs remain a significantly underutilized resource.

Types of Treatment

Residential treatment facilities offer multiple treatment programs suitable for a broad range of clients. These programs are designed for first-time and returning clients, in recognition of the fact that relapse is common among people in recovery and it may take more than one visit to rehab for long-term sobriety to take hold.

Inpatient treatment programs generally last from 30 to 90 days, although longer stays can be arranged as necessary. Clients remain in residence on facility grounds throughout the duration of their treatment programs, and their recovery schedules may extend throughout the day, depending on the complexity and extensiveness of the services they require.

Partial hospitalization programs are a rigorous form of treatment designed to meet the needs of those who need extensive care and monitoring but are not able to enroll in traditional inpatient programs. Those who choose PHP can spend from three to six days each week receiving treatment at the rehab facility, for a period of four-to-eight hours each day.  Clients live in housing that is separate from the treatment facility, and are provided transport to and from the rehab center each day. PHP is a good option for men and women who need some separation from turbulent home environments in order to concentrate more fully on their recovery.

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Intensive outpatient programs generally require a minimum of nine hours per week of onsite treatment services (three days a week, three hours each day), and more hours can be added to the schedule based on client need. Intensive inpatient programs are flexible and customized for people who have daily work or family responsibilities they cannot neglect, or who have supportive families that can be an asset in the recovery process.

In one study, 43 percent of people diagnosed with substance use disorders also had co-occurring mental health disorders that required treatment[2]. In cases such as these, dual diagnosis programs that provide treatment services for each condition offer the most reliable path to a sustainable recovery.

Because of the complexity of their conditions, inpatient treatment programs are strongly recommended for those with co-occurring disorders.

Drug and Alcohol Treatment Plans: A Closer Look

Despite their differences, inpatient and outpatient rehab programs share a similar structure. The components of a traditional treatment menu include:

Detox

People who are dependent on drugs and alcohol may go through powerful withdrawal symptoms when they stop consuming, and medical detox services can help them pass through this stage with a minimum of risk and discomfort.

Detox takes place in a clinical facility where 24-hour medical monitoring and supervision from physicians, nurses and addiction specialists is provided, along with any specialized health care that might be needed. Medications may be administered during detox to help ease withdrawal, especially if the person is dependent on alcohol or opioids.

Detox usually takes up to a week to complete, although no one will be removed from detox until their condition is stabilized and they are truly prepared to begin therapy.

Individual Therapy

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During private, individual therapy sessions, therapists will lead clients through in-depth discussions about their personal histories, substance use patterns, psychological and emotional issues, and any other subjects that seem relevant to the drug and alcohol abuse. In private therapy clients should feel free to be completely open and honest about their lives, and therapists will work hard to create bonds of trust that make meaningful revelations possible.

Group Therapy

In group therapy, people in recovery are encouraged to share personal experiences and insights and general advice with their peers, who understand better than anyone what it means to battle against addiction. Mutual aid and support is the goal of group therapy, which complements the more individualized approach of private therapy.

Family Therapy

Family therapy recruits loved ones as active participants in the recovery process, and through honest discussion attempts will be made to help heal any breaches that may have occurred because of the recovering person’s past use of drugs and alcohol.

Despite the best efforts of therapists and peers to make people in recovery feel at ease and at home, the call of family remains strong, and family therapy helps people stay in touch with their loved ones during their hour of greatest need.

Medication

When a dual diagnosis for an anxiety or mood disorder has been given, people in rehab for substance use may be prescribed medications that will help them manage their mental health symptoms. People recovering from alcohol abuse may be given short-term prescriptions for antipsychotic drugs or anti-anxiety medications called benzodiazepines, which can help reduce the intensity or the incidence of the side effects associated with alcohol withdrawal (agitation, insomnia, panic attacks, seizures, etc.)[3].

For some people in recovery, maintenance medications that function as substitutes for mind-altering, addictive substances may be prescribed. These substances can counteract physical or psychological cravings and withdrawal symptoms, and use may continue long after formal treatment has ended.

Addictions to alcohol and opioids are most frequently treated with maintenance medications. The two medications given to those recovering from alcohol use disorders are naltrexone, which blocks the intoxicating effects of alcohol in the brain, and acamprosate, which can relieve the intensity of cravings and withdrawal symptoms[4]. Naltrexone is especially useful following the cessation of formal treatment, when people in recovery are exposed to alcohol, while acamprosate may be introduced at any time, including during detox.

Despite some record of success, methadone and buprenorphine are controversial because they do not promote abstinence if they are used indefinitely. Addiction can only be broken if the person is recovery is able to taper off maintenance drugs gradually, and that requires a customized plan tailored to the physical, psychological and emotion needs of each individual.

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In one comprehensive study, only about 10 percent of users had been able to transition off maintenance drugs to full sobriety, while more than three-fourths were still taking them six years after finishing their treatment programs[5]. Maintenance medications may have a constructive role to play in recovery in some situations, but they don’t have to be used forever if a sensible tapering plan is adopted.

Complementary Treatment Services

While in treatment, clients will be exposed to a number of practices that promote health and wellness. These may include holistic healing techniques such as biofeedback, meditation, yoga, Tai Chi, art and music therapy and wilderness therapy. Life skills classes and other educational initiatives may be offered as well, to help people in recovery manage their addictions and their lives.

Aftercare and Relapse Prevention

People in recovery are always at risk of relapse, especially in the first few months after finishing treatment. Consequently, all addiction treatment plans will include aftercare or continuing care services once treatment ends, primarily in the form of individual, group and family therapy and medication (if prescribed). Aftercare programs are designed to reinforce the lessons and insights learned during treatment, which is essential if temptation is to be resisted.

Finding Sobriety through Drug and Alcohol Treatment

The primary goal of addiction specialists is to help clients achieve a sustainable recovery. Not to stop drinking or using drugs for a while, but to embrace a drug- and alcohol-free lifestyle without reservation or compromise.

To accomplish this mission, they teach clients practical strategies for handling temptation, recognizing and resisting triggers, and maintaining their commitment in the face of stress, disappointment, frustration and persistent relationship problems, all of which are risk factors for drug and alcohol abuse.

Therapists also place a great emphasis on self-understanding. They encourage their clients to shine a spotlight into the shadows, to confront the past traumas, present stressors or recurrent feelings of guilt and low self-esteem that have made them vulnerable to the lure of drugs and alcohol. With greater self-understanding comes clarity, and once people in recovery recognize the origins of their self-destructive behavior they can learn to make smarter decisions.

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For recovery to succeed, the challenge of maintaining sobriety must be accepted. The person with the substance use disorder must be fully committed to changing, and ready to face any obstacles that might arise throughout the treatment process and beyond.

People who put their drug and alcohol use behind them are able to do so because they can finally imagine, and create, better ways of thinking, reacting and engaging with the world and with the people around them. The road to sobriety can be long and arduous, but with consistent effort and a hopeful attitude success can be achieved.

[1] Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#adults

[2] Ibid.

[3] WebMD. What is Alcohol Withdrawal?
https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#2

[4]Maisel, Natalya C., et al. Meta-analysis of Naltrexone and Acamprosate for Treating Alcohol Use Disorders: When are these Medications Most Helpful?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970823/

[5]Soyka, M., et al. Six-year Outcome of Opioid Maintenance Treatment in Heroin-dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample
https://www.ncbi.nlm.nih.gov/pubmed/28376505

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