What are treatment methods for addictions? What does research tell us?
Medical professionals and other experts have been studying the effectiveness of abstinence-based treatment programs for decades. These treatment programs require patients who are addicted to or are abusing drugs and alcohol to stop using them entirely.
In programs in which abstinence is not the focus, counselors attempt to teach patients how to drink alcohol or smoke cigarettes, for example, in moderation. Counselors and doctors in abstinence-based programs are not looking to help patients simply cut back on their drug or alcohol use. The goal of these programs is to help patients develop the strength to avoid drugs and alcohol for the rest of their lives. According to the World Health Organization, drop-out rates for abstinence-based treatment programs are quite high in the first three months of treatment. Once patients have cleared that hurdle, however, most complete the programs.
Addicts will have the most difficult time at the beginning stage of abstinence-based treatment: detoxification, which often involves withdrawal symptoms of nausea, headaches, muscle aches, and excessive sweating. Depending on the patients’ health, addicts at this stage also may experience life-threatening symptoms such as heart attacks, strokes, or organ failure. Because of the risks associated with withdrawal, this stage of the treatment program is often completed under the supervision of medical professionals in a medical facility. Doctors will sometimes administer prescription medications, such as methadone, clonidine, subutex, and suboxone, to ease withdrawal symptoms.
Once patients have successfully completed detoxification, they can begin their treatment programs. Programs may be outpatient or residential; residential programs are highly recommended for abstinence-based treatment, as they eliminate the risk of patients relapsing. Although the urge to use drugs remains, the chance is small that a patient in a rehabilitation facility will find and use the drugs he or she desires. In residential programs, patients meet in groups and with individual counselors to talk about their cravings, their experiences while using substances, and their goals for the future. Participants commit to the idea of abstaining from drugs and alcohol, and they learn life skills to keep them from relapsing upon release from treatment.
Outpatient abstinence-based programs are not as successful as residential programs because patients are permitted to come and go. The risk of patients being in areas where drugs are present is high. To encourage patients to abstain from drug and alcohol use, many programs offer abstinence-based vouchers as incentives. Patients can earn vouchers after undergoing a round of tests (often blood or urine) that reveal whether they have remained clean (drug and alcohol free). Patients collect vouchers and then trade them for particular items.
Researcher Alan J. Budney and colleagues at the University of Vermont spoke of the success of abstinence-based vouchers in their 2006 article “Clinical Trial of Abstinence-Based Vouchers and Cognitive-Behavioral Therapy for Cannabis Dependence” (Journal of Consulting and Clinical Psychology). They found that distributing vouchers alone produced the same success rate as behavioral therapy alone. Combining the vouchers with behavioral therapy produced even better outcomes than either individual approach.
One of the most common approaches to recovering from a drug or alcohol addiction is group therapy . Highly recommended by drug and alcohol counselors, group therapy is helpful both in residential and in outpatient treatment programs. Group therapy brings like-minded people together under the supervision of a trained counselor or medical professional. Group therapy is often required by physicians or psychologists overseeing the treatment of their patients. Some insurance companies cover the cost of this treatment.
People who cannot afford to go to group therapy or who do not wish to participate in such a formal type of treatment may choose to attend support group meetings. Support group meetings are similar to group therapy in their setup: A group of persons struggling to overcome drug abuse or addiction meet to share their stories and to encourage others to quit using. Unlike group therapy, however, attendance is not required and is free of charge. Also unlike group therapy, support groups are typically sponsored by drug-free organizations and can be led by former drug addicts, by representatives of the sponsoring organizations, or by the family members of an addict. Sometimes support group leaders invite doctors, psychologists, or drug and alcohol counselors to their meetings to speak about formal treatment options and new research about treatments and addiction. Support group meetings may also be held on the phone or online.
Regardless of whether the group is led by a medical professional or a former addict, the goals of group therapy sessions and support group meetings are similar. Including people who can relate to each other’s circumstances is a way to offer comfort to newcomers. People struggling to overcome drug abuse and addiction should not feel as though they are alone; group therapy and support groups offer addicts a chance to tell their stories, to confess their fears and trepidations, and to receive practical advice and information about challenges they will eventually face. During these meetings, members should not feel as though they are being judged or isolated. Instead, their relation to and encouragement from other members in the group should make them feel empowered and in control of their lives.
A successful meeting is marked by a reduction in stress or depression and anxiety and by an increase in confidence and self-knowledge. These methods of treatment should provide members with the skills and information they need to cope with their cravings and to adjust to their new drug-free lives.
Traditionally in the United States, people seeking help for more than one condition would attend more than one meeting for treatment. For example, a person with a drinking problem who also is a domestic violence offender would need to attend one session with a drug and alcohol counselor and another with a domestic violence counselor. The same is true for people living with comorbidity, or the presence of a mental illness with a drug addiction. A cocaine addict who also has bipolar disorder would need to be treated for the two conditions separately. Medical professionals are also trying to develop more efficient treatment programs that do not require patients to compartmentalize their struggles.
In 2008, psychiatrist Alan S. Bellack and colleagues at the University of Maryland School of Medicine designed a program named Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS) to bring treatments together. This group treatment program included motivational interviews, goal setting, social skills training, and informational meetings on drug abuse and addiction. It also featured an incentive program that involved urine tests. Every clean urine test led to a monetary award that could later be exchanged for desirable products.
In the study, after two months of treatment, BTSAS was producing impressive results compared with traditional group therapy (known in this study as STAR, or Supportive Treatment for Addiction Recovery). About 59 percent of participants in the BTSAS study produced drug-free urine tests on a regular basis, while only 25 percent of participants in STAR did the same. About 33 percent of participants in BTSAS maintained their abstinence past the eighth week of treatment; only 8 percent of STAR patients did the same. Bellack’s research may lead medical professionals to combine treatment for drug abuse and treatment for mental illnesses into a single group effort.
Many types of behavioral therapies exist. Some occur in a group setting similar to group therapy, others work best using a one-on-one approach. Some psychologists or counselors find it best to invite spouses to behavioral therapy sessions; others ask the entire family and those closest to the patient to come to meetings.
The point of behavioral therapies, regardless of the location and participants, is to teach the patient new methods of dealing with his or her addiction. Although addiction can be treated, it cannot be cured, and the risk of relapse is always present. In behavioral therapy, patients learn new skills that will help them to beat the cravings when they reappear.
One of the most common types of behavioral therapy is cognitive-behavioral counseling. This type of treatment follows the theory that all behavior, whether healthy or destructive, is learned behavior. In therapy, patients learn skills that will help them take care of themselves in drug-free environments. The main focus of cognitive-behavioral therapy (CBT) is to teach patients how to conduct themselves in situations in which drugs may be present or at times when the craving for a drug becomes overwhelming. Much of this training is done through role playing; the counselor takes on the role of a friend offering drugs and the patient must decline the offer. According to the National Institute on Drug Abuse (NIDA), many studies have shown that the behavior and lessons learned in CBT remain with patients long after therapy has ended.
Another effective type of behavioral therapy is motivational enhancement therapy (MET). Patients in MET are those who have yet to be convinced that they have a problem; many do not wish to alter the way they live their lives.
MET has two parts: an initial assessment and motivational interviews. During the initial assessment, counselors gather information about the patient’s physical health and history of drug use. They then use this information in motivational interviews that occur in two or three counseling sessions with the patient. The information is used to try to persuade, or motivate, the patient to take control of his or her life and to commit to a treatment program. The counselors help the patient realize that he or she wants to get better and that life could be better without drugs or alcohol. In subsequent sessions, counselors monitor their patient’s drug use and encourage the patient to keep working toward positive change. This type of therapy works well for alcoholics, people who are marijuana dependent, and adolescents who use a variety of drugs. Research has shown inconsistent results for people addicted to cocaine, heroin, and prescription drugs.
Abstinence-based incentives work well when combined with behavioral therapy. These incentives are sometimes called motivational incentives and can be used both in rehabilitation facilities and in outpatient therapies. These incentives can be cash-based or can be in the form of printed coupons.
Medical professionals have been using medicines to treat addiction since the late nineteenth century. At this time, Sigmund Freud suggested alcoholics could be treated through the distribution of cocaine. By the early twentieth century, home remedies to treat alcohol addiction included combinations of alcohol, morphine, opium, cocaine, and cannabis. Doctors even used heroin as a treatment for alcoholism. While occasionally such treatments were successful, they came with a high risk of developing an addiction to the treatment substance itself.
Opioid addiction became a serious concern in the mid-twentieth century. Scientists worked to develop medications that would counteract the effects of drugs such as opioids and alcohol. These medications would ideally help addicts avoid drugs of abuse and addiction as they started drug-free lives. In the mid-1950s, methadone became the first drug to show promise in helping a person overcome opioid addiction.
Scientists have since developed a handful of drugs approved by the US Food and Drug Administration for treating various addictions, including addictions to alcohol, opioids, and nicotine. Although many medications are effective, they are often only a part of the treatment programs patients must complete. Addiction medicines were designed to help dull the cravings, to balance chemicals in the brain, and to make certain substances less desirable to the user. Addiction medicines do not contain any elements that can help a patient relearn how to behave in social situations or to develop impulse control. This explains why medication is typically paired with group therapy, behavioral therapy, or individual counseling.
The most common medications administered for alcohol addiction today are naltrexone, acamprosate, and disulfiram. Naltrexone is a favorite among patients because it facilitates quitting alcohol. If a patient drinks while taking naltrexone, he or she cannot feel the effects of the alcohol. The drug blocks the brain receptors that react to alcohol and therefore the patient cannot get drunk. This decreases alcohol’s desirability.
Acamprosate, which is recommended for patients with severe alcohol dependency, calms the side effects that may accompany withdrawal, such as irritability, depression, and anxiety. Disulfiram also is effective in treating alcoholism, but only if the patient regularly uses the drug. Most patients request alternative medications after they have started taking disulfiram, as disulfiram causes patients to become nauseous if they consume alcohol with the medication in their systems. Patients who remain on disulfiram throughout treatment are more likely to be successful in staying alcohol-free.
Naltrexone is also used to treat persons with opioid addictions. Also effective are methadone and buprenorphine, but these drugs must be administered at different times. Methadone treatment can start before the patient begins withdrawal. This medication helps with withdrawal symptoms and helps the patient feel normal. The patient does not feel euphoric or depressed while using methadone. Medical professionals with a license to distribute buprenorphine are the only doctors allowed to do so. Taken at the incorrect time during the withdrawal process, buprenorphine can be deadly. Once the medication is safely in the patient’s system, it reacts similarly to methadone.
Medications designed to help treat nicotine addictions are divided into two groups: first-line therapies and second-line therapies. Bupropion and varenicline are grouped among the patches, nasal sprays, lozenges, and chewing gums recommended for nicotine addiction. These first-line therapies are not as strong as second-line therapies and simply work to soothe withdrawal symptoms and calm cravings. Second-line therapies include nortriptyline and clonidine.
Many people do not believe in traditional approaches to addiction treatment; they do not wish to speak to a counselor, they do not want to be part of a support group, and they may not want to take any medications. Instead, they may try alternative therapies such as herbal therapy, hypnosis, acupuncture therapy, chiropractic therapy, or prayer.
Patients in withdrawal may not request the supervision of a medical professional and may not check themselves into a rehabilitation center. Instead, they may prefer to make home remedies containing vitamins and herbs, for example. To make up for the nutrients the body has lost because of the addiction, people may prepare foods and drinks packed with beta-carotene; zinc; vitamins A, B, C, and E; and selenium. They may begin diets that are low in sugars and refined carbohydrates, but high in complex carbohydrates. They also may cleanse their bodies with burdock root and echinacea.
Another alternative approach to traditional addiction therapy is avoiding a life of abstinence. Some programs exist in which the addict attempts to learn how to drink alcohol or smoke cigarettes in moderation. They learn how to avoid drinking to become drunk. They may learn to cut back to two cigarettes a day rather than two packs a day. These programs are typically disregarded by those in the medical community, but many psychologists and counselors in the field offer these opportunities to those patients not seeking or unable to follow an abstinence plan.
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