Navigating Treatment Options
A Common Myth About Treatment:
Many people are led to believe that treatment for addiction is as simple as sending the person to rehab and them coming home cured. This is very rarely the case. Addiction is a chronic, relapsing brain disease that frequently requires more than one round of treatment. This is difficult for someone facing this illness for the first time to stomach, but it must be accepted early on. People can and do recover from even the most severe addictions to go on and lead productive and fulfilling lives. However, this takes consistent, life-long attention to their recovery. Refusal to come to terms with this fact causes many relapses.
The Step Down Method:
Some of these treatment modalities may not be necessary depending on the unique circumstances of each individual. This can only be determined by you and your doctor or treatment professional. However, where applicable, combining as many of these options as possible increases the chances of entering long term recovery. If you or your loved one had cancer, your doctor would likely recommend multiple approaches such as surgery, chemotherapy, radiation, hormone therapy, dietary supplements, etc. Addiction is also a very lethal disease that we must tackle from every possible angle. For this reason experts recommend using a step down method of treatment beginning with detox and medication assisted treatment if necessary, followed by residential treatment, intensive outpatient treatment in combination with residence in a therapeutic community and regular counseling. Counseling, self-help meetings, exercise, healthy eating, and numerous other support strategies may be continued for life. If a relapse of symptoms occurs, all or some of these steps should be repeated.
Treating the family:
Addiction is a family disease, and everyone, not just the person with addiction, must make changes to increase odds of maintaining recovery. Family therapy is highly recommended to root out any past or present issues that may aggravate addiction as well as to teach positive ways to support your family member. It is also essential for parents and other close loved ones to get individual counseling and support of their own.
A Guide to Finding Quality Addiction Treatment:
The National Center on Addiction has a wonderful PDF guide to finding addiction treatment. Be sure to read it all and use the questionaire towards the bottom when you are interviewing treatment facilities.
Types of Treatment
MEDICATION-ASSISTED TREATMENT (for opioid addiction)
Medication-assisted treatment: In this treatment approach, patients receive medication to block the effects of opiates by attaching to the same nerve receptors involved in opioid use. Methadone maintenance treatment is the most common medication-assisted treatment program. Buprenorphine and naltrexone are also used in this approach. These medications, as well as Antibuse, are also sometimes used to treat persistent alcoholism. These medications require regular monitoring by physicians, who are regulated by the federal government. Not all physicians provide buprenorphine or naltrexone. A medication-assisted approach is considered by the Substance Abuse and Mental Health Services Administration as the most effective and safest approach for opioid rehabilitation when combined with counseling and other behavioral interventions.
Important Note: Some treatment centers advocate for an abstinence-only philosophy and prohibit the use of MAT or will require a patient detox from their medication rapidly. These facilities are not recommended for those with an opioid addiction, or who are currently on medication assisted treatment. MAT is not the only way to overcome opioid addiction, but it is a valid option for every patient to discuss with their treatment provider.
“Detox” programs wean drug users from their immediate physical dependence on drugs or alcohol in a supervised and controlled setting. There are two main reasons for this. Withdrawal symptoms from some substances like benzodiazepines and alcohol can be life threatening and require professional care. Withdrawal, especially from opioids, can be so uncomfortable that when attempted without help, some people give up and go back to using. Medical assistance can be provided to lessen the physical impacts of withdrawal. Detox is not a treatment program per se, but rather is an essential first step to treatment. Detox without long-term treatment often leads to relapse and return to use.
Residential drug and alcohol services are provided at a residential facility where individuals learn, eat and bunk together. Treatment in a residential facility can include medically supervised detoxification, drug education, individual and group counseling, mental health evaluations, medication management and more. Residential stays generally range from 5 to 90 days. Many people have heard of programs lasting 28 days, and are led to believe that is the magic number when it comes to getting treatment for addiction. This short-term length of treatment was actually set in place by insurance companies seeking to limit the amount of treatment days they cover. The amount of time required to thoroughly treat a complex disease like addiction actually varies drastically from person to person. However, studies show that treatment lasting at least 90 days or more significantly reduces the risk of relapse post-treatment. Many opioid addicted patients require much longer than that. The longer the treatment the better chances are of avoiding relapse.
Extended drug rehab programs are available for those with serious drug or alcohol addictions. These programs are especially recommended for those with opioid addiction. Extended addiction treatment programs may include rehabilitation aftercare, or it may simply extend the time in the facility beyond the usual long-term program of 90 days. Extended care is designed to last from three months to a year. This depends on the needs of the individual. Extended care programs can even be extended beyond a year, and some patients stay for more than one extended program.
For some, inpatient treatment is not a viable option due to insurance limitations, work/financial commitments or family issues. The alternative is outpatient care, which enables people to attend a less intensive level of treatment with a more convenient schedule. Outpatient treatment can range from a daily visit like in some Intensive Outpatient Programs (IOPs), to a couple visits a week in less intensive programs. Outpatient programs are also frequently used to transition or “step down” from a highly structured inpatient program into a moderate amount of structure provided by outpatient care. This is highly recommended. Abrupt transitions from intense structure to total freedom are a recipe for relapse.
People generally spend 6-18 months in these highly structured, peer-based residential programs. They are designed to help people alter, modify, and re-learn behaviors through intensive educational, medical, legal, social, and psychological counseling services. TCs have been successfully adapted to meet the needs of adolescents, women, people with severe mental health problems, and prisoners in the criminal justice system. Sometimes called “sober living” environments, this form of treatment may require regular drug testing and strict adherence to residential living rules and conditions.
SUPPORT GROUPS / SELF-HELP
The most common support / self-help group is Alcoholics Anonymous (AA). Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.
For drug use there is Narcotics Anonymous (NA.) NA is a nonprofit fellowship or society of men and women for whom drugs had become a major problem. We are recovering addicts who meet regularly to help each other stay clean. This is a program of complete abstinence from all drugs.
NOTE: The above fellowships are abstinence-based models. If you are on medication assisted treatment like Suboxone, Subutex, Methadone, Antabuse, etc. you may find that this is discouraged at those meetings. AA and NA meetings, and the community of like-minded individuals found there, can be so important to recovery, and you need not avoid them if you are on medication. However, know that medication assisted therapy is a dividing issue among many in the recovery and addiction communities. Please do not let anyone pressure you into getting off of medication, or going on it. That is for you to decide based on your personal needs. Those on medication seeking to get off it must follow a medically supervised taper over months or sometimes years in order to achieve the best chance of avoiding relapse. Some are never able to successfully do this and require medication indefinitely. Again – this is a decision made with careful thought and planning between you and your doctor. *see medication assisted treatment section below.
Counseling is an essential part of substance use disorder treatment for many people. Addiction is more than just a physical dependence on a substance. It involves complex processes in the brain that can be triggered by stress, mental illness, environmental and social factors long after the detox phase. Cognitive behavioral therapy, family counseling, motivational interviewing, group and family therapy, and other therapy approaches can help people recovering from addiction stay clean and learn to cope with triggers. Individual psychotherapy can also treat the other mental health conditions that often contribute to addiction.
MENTAL HEALTH / DUAL-DIAGNOSIS
Substance Use Disorder and mental health disorders often go hand-in-hand. Because of this, many treatment facilities offer co-occurring services that address both issues using individual and group counseling, mental health assessments, psychiatric care and medication management. Addressing both disorders simultaneously is vital to successful recovery. The majority of people who are addicted to drugs, approximately 53%, also have a mental health disorder. Unfortunately, only 7% of them will receive treatment for both disorders. Due to overlapping symptoms between the disorders, many people simply don’t realize that they have both and treatment providers don’t always address both issues. It’s important to explore the possibility of co-occurring disorders early on in treatment and find a treatment provider or counselor knowledgeable about both.