Substance dependency changes the brain; in many ways it becomes more important for the person to take the drug than to breathe. To address that “siren’s song,” it is vital to get help from professionals and address the underlying issues. Treatment works,[1] if the person is present and puts in the effort.  In treatment a person learns how to respond to things differently and ultimately, the person has to change everything: people, places and routines. But it is important to remember that change is not easy for anyone; it takes hard work and it takes time.  [2]

There is no quick fix in treatment and in fact, the length of time a patient spends in treatment is a reliable predictor of his or her post treatment performance.  Beyond a ninety day threshold, treatment outcomes improved in a direct relationship to the length of time spent in treatment, with one year generally found to be the minimum effective duration of treatment. [3]  Remember that a person’s dependency didn’t happen overnight, and finding a way to overcome that addiction also won’t happen overnight. Sadly, on a regular basis we hear about famous people who go into rehab, but aren’t successful.  Different types of rehab work for different people, it depends on the extent of the problem and the type of drug the person is dependent on.

When we talk about treatment, it can be inpatient or outpatient or a combination of the two.  Initially treatment may be very intensive, requiring multiple times a week and then over time changing to less frequent sessions but continuing the work of changing their behavior. Typically dependency is treated through a number of steps:

• Detoxification – getting the drug out of the body
• Behavioral counseling
• Medication
• Evaluation and treatment for co-occurring mental health issues such as depression and anxiety
• Long-term follow-up to prevent relapse

Just getting clean, or clearing the body of the substance is never enough.  Detoxification is the first step of a long process.  Then the person has to understand what drives him or her to use the drugs and find alternatives to using. Behavioral treatment helps the person recognize and modify their attitudes and behaviors, increase healthy life skills and continue with other forms of treatment. One type of therapy is cognitive-behavioral therapy which helps a person identify and address situations where he or she is likely to use drugs. That is just one aspect of therapy.  Other forms may include group therapy or motivational interviewing.  But no matter what, treatment must evolve as the person evolves to address that individual person’s needs at that moment.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) is the use of medications in combination with other therapies to provide a whole-patient approach to treat a substance-use dependency.  It is recognized as one more effective and important tool to use in combination with treatment to support someone who has a substance-use dependency.  Unfortunately, for some individuals, MAT leaves a sour taste.  They ask why it is necessary to give a person another drug to get them off of drugs.  The answer is because it is more successful in the appropriate situation.  There are a variety of medications that can be used.  Such as:

• Medicines that can help them feel less bad when they first quit.
• One medicine in particular makes people throw up and feel sick if they drink alcohol. It helps them choose not to drink, since they know it will make them feel sick.
• Another medicine makes people want the drug less.
• And even other medicines block the “high” that people get when taking the drug. It can make it easier to quit.[4]

Unfortunately, there is no medication that “cures” a substance use disorder.  When appropriate, it takes a combination of MAT and treatment initially, and for some people, because of the nature of their dependency, they may have to use some type of medication for the long term.

After treatment, being involved in support groups such as NA or for alcoholism, AA can be an important component of a lifelong effort to remain substance free.  Support groups are NOT replacements for treatment, but they are helpful in continuing the work that was done during treatment.  Remember, a substance-use dependency is a chronic, lifelong disease.  It doesn’t go away like a cold; it requires continuous attention and effort.

Relapse

Relapse, unfortunately, happens. (See sidebar) We are all human, and we make human mistakes.  Some people no matter how hard they try, they return to drug use.  This does not make them an evil person, it means they are human and they have to continue working to remain clean.

What is very dangerous is when a person who relapses goes back to using the same amount of drug(s) used before when the person quit.  In that situation, a person can easily overdose because the body may have started to heal and can’t handle the same amount as before.

However, the bottom line is that a person who relapses can get back to recovery.  If a relapse happens, the person should get back into treatment as quickly as possible.

“Stopping drug use is like trying to diet and lose weight. It's hard to learn to do things differently, like eat less, exercise more, and avoid some favorite foods. It's easy to slip up, eat too much, and gain back the weight. But then you have to try again.

It's the same with quitting drugs. People with addictions might get treatment, slip up, and then go back to treatment many times before it works. It's important to get treatment for as long as you need it.”[5]

For more information on Treatment go to:  https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

Footnotes:

[1] Drug Abuse Reporting Project (DARP), Treatment Outcome Prospective Study (TOPS), Drug Abuse Treatment Outcome Study (DATOS), and the National Treatment Improvement Evaluation Study are the most compelling research evaluations to date on treatment.  These four studies, starting in 1968 at Texas Christian University and ending in 1995 at the Center for Substance Abuse Treatment span nearly three decades and followed 70,000 patients through all levels of substance abuse treatment and care.

[2] How many times has an individual tried to lose weight or exercise more or stop some other habit that does not involve a chemical substance?  New Year’s resolutions are the norm every January 1^st, unfortunately, within 30 days half the people that have set a goal are no longer working towards it and within 3 months, 75% had quit.  Change is hard for everyone and when you add a chemical substance into the mix, it becomes even harder.

[3] Also see Drug Abuse Reporting Project (DARP), Treatment Outcome Prospective Study (TOPS), Drug Abuse Treatment Outcome Study (DATOS), and the National Treatment Improvement Evaluation Study for the length of time.

[4] Easy-to-Read Drug Facts, Types of Drug Treatment, National Institute on Drug Abuse.  Obtained from: https://easyread.drugabuse.gov/content/types-drug-treatment

[5] East-to-Read Drug Facts, Does Drug Treatment Work? National Institute on Drug Abuse.  Obtained from: https://easyread.drugabuse.gov/content/does-drug-treatment-work