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A person who is looking into getting help for alcohol or drug addiction – or others who may be concerned about a loved one’s use of alcohol or drugs – may be intimidated by conflicting or confusing information about substance abuse treatment programs and how they work. There are many different kinds of groups and individuals online and otherwise who advertise quick fixes, or offer strange or untested treatments to help people recover from addiction. Sometimes, it can be hard to figure out what treatments can really help compared to those that are less effective.
Research-based treatment for substance abuse and addiction does exist, and knowing what it looks like and where to find it can help people who are troubled with a drug or alcohol problem make sense of what’s out there. Through knowledge, it can be easier to find treatment that is right for the person who needs help.
Treatment for alcoholism requires particular care in certain areas. Starting with medical detox, there are some symptoms of alcoholism that differ from those of other substance withdrawal and treatment requirements. In addition, because alcohol is a legal, easily attainable substance, risk of relapse can be very high for people who have developed an alcohol dependence. For this reason, a full-spectrum treatment program is recommended to offer the best chance at recovery without relapse.
Detox from any substance can be an uncomfortable process. With alcohol detox, there is also the risk of severe withdrawal symptoms, particularly for those who have been heavy users for a long period of time.
Some of the withdrawal symptoms include:
The last two symptoms listed above, in particular, are dangerous and can lead to death if not treated by a professional. For this reason, medical detox is always recommended for alcohol withdrawal.
Through medically assisted detox, a doctor can administer medications that help reduce the severity of these symptoms. In addition, professional support can assist in managing the longer-term symptoms of alcohol withdrawal and alcoholism, such as fatigue and mood changes, which can last for weeks or months after ceasing alcohol use. This support can help reduce cravings.
Inpatient care is most beneficial for those who are dealing with addiction to alcohol, or alcoholism. This includes people who have perhaps tried outpatient programs without success and people who are at high risk for returning to alcohol use during or after rehab. However, inpatient care can help anyone who is dealing with an alcohol use disorder, including regular binge drinking or heavy use without addiction.
Inpatient facilities help by offering care that is available 24 hours per day, seven days per week. Because of this, managing the addiction and achieving recovery are the main focus of the person’s day, without distraction or temptation. This frees the person who is being treated from having to deal with work or school, family problems, and other stresses of daily life that may only make it harder for the person to focus on recovery and may serve as triggers for the person to return to alcohol use before treatment is over. In addition, being in residential care eliminates the possibility of relapse for the time that the person is in treatment, because alcohol is not available.
As part of a comprehensive program like the one described above, AA or other 12-Step programs can be a good source of support and motivation to stay in treatment and maintain recovery after treatment. Beginning participation in a 12-Step group during treatment is part of the continuum of care that can continue well after the official treatment program has ended.
One of the stronger signs that a person will achieve long-term recovery from alcoholism is the ability to avoid relapse in the short-term after treatment. Research has shown that participating in 12-Step programs like AA on a continuing basis after treatment increases the rates of sobriety in the short-term, which leads to a greater likelihood that the person will still be sober more than two years after treatment is over.
Just about everyone has heard of Alcoholics Anonymous – or AA – which is based on the 12-Step model. These types of programs follow a series of guidelines that encourage personal and spiritual growth and change as the basis of recovery from addiction. The 12 Steps are the guidelines that encourage an ongoing progress that starts with the person admitting to and accepting the presence of alcoholism and continues through creating self-awareness of the triggers and temptations that result in the person’s alcohol use. The program’s core is usually based on drawing on a higher power to sustain abstinence from alcohol.
Other treatment programs that do not follow the 12-Step model include a variety of medical, psychological, practical, and social therapies undertaken to reduce the risk of relapse during and after treatment. These therapies help the person:
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These types of treatment are generally supported by research. When combined under a continuum of care, all these elements, including 12-Step involvement, can provide a comprehensive program demonstrated to result in more positive recovery outcomes than a single element alone.
Sobriety coins are tokens offered by Alcoholics Anonymous to commemorate the amount of time a person has remained sober. The purpose of these coins is to give the person who is in recovery from alcoholism a physical reminder of success that can serve as both a reward for the person’s achievements and a motivation to continue on the path of sobriety.
Studies have consistently shown that an important element leading to long-term recovery is the commitment of the individual to complete treatment and stay sober. This motivation makes it more likely that the person will spend enough time in treatment for it to have a positive effect on reducing alcohol-seeking behaviors.
After treatment, this motivation can sometimes be a challenge to maintain. Sobriety coins and other motivational techniques can help to keep the commitment to sobriety strong so the person will continue to avoid relapse.
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Much like treatment for alcoholism, drug addiction treatment is most likely to result in positive outcomes when provided under a full-spectrum program involving multiple areas of treatment. The main goal of drug addiction treatment is to help the person avoid returning to drug use after the treatment program is over.
The principles of drug addiction treatment are basically the same across all types of substance abuse and addiction. One of those principles considers the idea that each individual’s addiction history is different, which means that each person’s treatment should be customized to the greatest degree possible in order to offer the best chance of recovery.
Nevertheless, some of the differences between alcoholism and some drug addictions can mean that treatment is approached differently. Depending on the substance being used and the level of abuse or addiction, there may be slightly different priorities for detox, therapy, practical education, and post-treatment care in order to achieve the most positive recovery outcome.
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Aside from alcohol, there is only one class of drugs for which withdrawal is potentially fatal and requires intensive medical supervision; these drugs are benzodiazepines (benzos), which are prescription anti-anxiety drugs. Benzos are often also used illicitly as club drugs. Familiar names of these drugs include Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam), among others.
Opiate withdrawal – whether for illicit drugs like heroin or prescription painkillers like OxyContin – does not generally carry the risk of death; however, it can be extremely uncomfortable. Relapse is likely if a person attempts opiate detox alone, so medical detox is also recommended. It can also be complicated if the person who is withdrawing from the opiate is also withdrawing from benzos; this is a common combination and can lead to dangerously low respiration.
There are methods of opiate detox that are sometimes advertised that do come with serious risks. Rapid opiate detox using anesthesia has been shown to result in death and other adverse events. To be on the safe side with opiates, and to help make withdrawal easier to manage, opiate withdrawal should also be managed by a medical professional.
While withdrawal from other drugs might not be life-threatening, medical detox is often recommended to keep individuals safe and comfortable throughout the withdrawal process. By making the withdrawal process a bit easier, medical detox lowers the chance that the person will relapse simply to stop withdrawal symptoms.
Detox programs enable a person to safely withdraw from drugs by providing forms of medical support for withdrawal. Certain medicines are provided for several reasons, including:
While it may only take a few days or a couple of weeks for the drug to completely clear the system, some withdrawal symptoms may extend beyond that period. For this reason, people should remain in detox for the full period recommended by their treatment specialists.
Some people believe that detox is all that is needed to recover from addiction, but this is not the case. In fact, people who simply go through detox without any other type of treatment are likely to relapse into drug use after detox is completed.Related: Treating Co-Occurring Disorders
For people who present a high risk of relapsing to drug use after detox, residential care can be an important next step. Residential care provides isolation from sources of the substance in case the temptation to use becomes uncontrollable, along with 24-hour supervision and support to help control cravings. Sometimes, medications can be provided to ease those cravings, and in residential treatment, this medication can be managed at any time to fine-tune the dosage for the maximum benefit. Medical supervision also ensures that these medications are not abused during treatment, if abuse potential is likely.
People who are at high risk of relapse include those who:
Similar to residential care for alcoholism treatment, another benefit of residential care for drug use disorders is fulltime focus on recovery without distraction.
Therapy can treat a psychological addiction in several different ways. These include:
As with alcoholism treatment, the goal of drug addiction treatment is to help the person manage recovery from drug abuse for the long-term. For this reason, a comprehensive treatment program will generally involve aftercare in the form of an alumni program or other post-treatment program.
Because the length of time that a person stays in treatment is often an indicator of whether or not the person will remain clean from the substance for the long-term, the simple answer to this question is to stay in aftercare for as long as possible. However, because this is not always practical, a period of no less than 90 days is generally considered to be the minimum time needed to produce positive, lasting results.
For some people, participating in aftercare for a year or more is helpful. Positive effects can be maintained by keeping up with a 12-Step or other peer self-help group to maintain support and motivation indefinitely after treatment.
One of the best ways to approach a loved one about a drinking or drug problem is to plan and perform an intervention – a gathering where the person’s family and friends come together to discuss the person’s suspected substance abuse and encourage the person to get help by going to rehab.
This sort of gathering can sometimes seem confrontational to the loved one. Because of this possibility, it is a good idea to plan out ahead of time how the intervention will be handled, with a planned response for each potential reaction that the person may have. Consulting with a selected rehab center beforehand or with a drug addiction or intervention expert can help in planning the intervention.
It’s important to remember that the person may resist going to rehab and may even become resentful of those who are involved in the intervention. This is often a natural, though frustrating, part of the process. Ultimately, those who stage the intervention need to set limits on the behavior that will be acceptable and be ready to follow through on any conditions that are set during the intervention, such as limitations on interaction with the person if help is not sought.
Different insurance plans cover different levels of treatment, depending on the plan limitations. While some plans may pay for little or no substance abuse treatment, others may pay for up to 60 days in a rehab center. For example, Medicare parts A and B will pay for some elements of treatment, and it may be possible to get a good portion of care covered. Similarly, insurance coverage under the Affordable Care Act is required to offer substance abuse treatment coverage at the same level as care for any other physical or mental health condition.
Private insurance plans or those obtained through an employer may be a different story. It is important for people to check with their insurers to see what coverage is provided. Often, personnel at the selected rehab center can work with the person and the insurance company to verify coverage.
As mentioned above, the length of time spent in rehab is often one of the strongest predictors of whether or not the person can achieve and maintain recovery from substance use disorders. For this reason, a person who is committed to managing drug or alcohol addiction should be prepared to follow through on a full course of treatment. In certain circumstances, this could look like the following basic timeline:
Because of a person’s individual needs, such as a high relapse risk or co-occurring conditions, this timeline can vary greatly. Each person responds to treatment differently and has different treatment requirements, so it is prudent to work with rehab facility staff or other medical professional to outline the best course of action for the specific individual.
Insurance can cover a good deal of the cost of treatment in a rehab program. However, there are often still costs beyond what the insurance will cover, such as:
On the other hand, some companies have an out-of-pocket maximum limit, which means that the client only has to pay for services up to a certain amount, and the company will then cover the rest. These plans may have higher premiums to begin with, but in the long-term, they can save money for those with chronic conditions, such as substance use disorders or mental health issues.
In order for rehab to have positive results, it is important for the person attending rehab to have a level of engagement in and commitment to the treatment program. For that reason, there are relatively strict rules for conduct at the facility. These include:
These rules, and others, are established for many reasons, which include protecting clients from potential triggers, making sure clients and staff are protected from any type of abuse, and ensuring that the person’s full focus is on treatment and recovery. Some of the rules may seem overly restrictive, but they are established to protect everyone involved in treatment.
During treatment, visits from friends and family are often restricted. However, many programs include family therapy as part of the treatment plan when appropriate.
Sometimes, family relationships can unwittingly serve as triggers for drug or alcohol abuse. If this is the case, the family may have a need to change behavioral patterns as much as the individual being treated does. To help with this issue, family members may be asked to attend therapy sessions during rehab, both with the person and, if needed, alone, to build a stronger understanding of the person’s needs, improve communication, and strengthen the support system for the person to improve the chances of lasting recovery once the person has completed treatment.
A number of medications are helpful for treatment, at various points in treatment. Medications can be prescribed for several reasons, including:
The preferred medications are those with an established lack of or minimized addiction potential, so they do not encourage further addiction or abuse issues. These can include substances such as methadone and buprenorphine, which are used to reduce cravings for opiate substances, or naltrexone, which is used to block the effects of opiate substances.
Using drugs to manage addiction is a viable part of treatment. However, even with low addiction potential, use of these drugs is closely monitored for any sign of further substance abuse.
Co-occurring mental health disorders can make substance use disorders more challenging to treat. This is because these co-occurring disorders can often contribute to or be worsened by the substance abuse.
As an example, mood disorders, such as depression and anxiety, tend to co-occur with substance abuse problems. In some cases, the mood disorder may be present before the substance abuse begins, and it may even contribute to the disorder or serve as a trigger. However, the substance of abuse may also result in further symptoms of the disorder, which then causes the person to use the substance even more. This can result in a cycle where the symptoms of the mental health disorder are difficult to separate from the symptoms of the substance abuse.
Because of this, it is important that the treatment facility or professional has experience treating co-occurring disorders, and that the treatment plan provides therapies for all involved disorders in order to have the best chances for recovery.
Substance abuse counselors are specifically trained in and qualified to provide substance abuse treatment. Many years of dedicated schooling and training are spent in preparation for this work, and national certification bodies exist to provide testing and verification that substance abuse counselors are qualified to provide the services they offer.
It is important when researching substance abuse treatment programs to make sure that the staff includes medically trained and certified substance abuse counselors. In addition, if the treatment facility provides detox, the person providing that treatment should be a medical professional with training and experience in managing detox from addictive substances. This is especially true in the case of detox from alcohol and benzos, as withdrawal from these substances can potentially result in deadly symptoms like seizures and delirium tremens.
Halfway houses – often referred to as sober living homes or recovery houses – have been shown to result in positive outcomes as part of the continuum of care for individuals transitioning out of residential care.
For some people, it is a challenge to return to their typical lives after completing inpatient treatment, particularly since substances of abuse may be easily available again after being restricted during treatment. It’s obviously much easier to be abstinent when there’s no access to drugs or alcohol.
Recovery housing provides a chance for people who have completed treatment to live with others who are going through the same recovery process, in a place where support for abstinence is stronger than it might be at home. For this reason, this type of program can be a helpful part of a post-treatment program.