Drug and Alcohol Treatment

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Not unlike other diseases and illnesses, drug and alcohol addiction can be overcome with prevention, professional treatment, and increased research efforts.  As serious as drug and alcohol addiction are, fortunately they can be treated.  Drug and alcohol treatment programs usually use a combination of doctor prescribed medications and counseling to help addicts stop their abusive behavior.  In the vast majority of cases, the first step utilized in the drug and alcohol treatment process is detoxification, a process which lets the body rid itself of drugs and alcohol while controlling the withdrawal symptoms in a harm-free environment.

What is Alcoholism?

Alcoholism, also known as alcohol dependence and alcohol addiction, is an increasingly degenerative disease that includes the following four symptoms.

• Loss of control: an inability to stop drinking after the first drink.
• Physical dependence: withdrawal symptoms such as anxiety, nausea, headaches, the "shakes", and perspiration when abstaining from alcohol.
• Tolerance: the need to drink greater amounts of alcohol in order to feel a “buzz” or to get “high.”
• Craving: a strong urge or need to drink.

What is Drug Abuse?

Drug abuse, also known as substance abuse, can be defined as the excessive and repeated use of a drug in order to feel pleasure or avoid problems or reality, despite negative and damaging consequences.

The substance that is abused can be an illegal drug such as heroin or cocaine, inhalants such as airplane glue, or prescription drugs used inappropriately such as abusing oxycontin or vicodin.

Drug abuse is characterized by the dysfunctional way in which it takes over the addict's life, disrupting his or her relationships and daily functioning at work, home, or school, leading to recurring drug-related legal problems, or adversely affecting his or her peace of mind.

Drug addiction can be physical, psychological, or both.  Physical addiction refers to the physiological effects of drug use and is typified by tolerance, defined as the need to take increasing amounts of the drug in order to experience the initial "buzz" or "high" and withdrawal symptoms when the addict stops taking the drug.  

Psychological addiction, on the other hand, refers to the subjective feelings and cravings the addict has in order to experience feelings of pleasure and well-being.  For instance, taking a drug in order to "chill" or to overcome the discomfort of a painful circumstance are examples of psychological dependence.

The more that drug abuse starts to affect and control an individual's life, the more likely it is that this individual has a drug problem.

Regrettably, the people who are actively involved in substance abuse are frequently the last individuals to gain an awareness of their damaging drug-related behavior and their own symptoms of abuse. 

Drug and Alcohol Treatment:  An Overview

Similar to other diseases and medical conditions, drug and alcohol addiction can be overcome with quality treatment, prevention, and increased research.  

By providing more people with access to professional treatment, the costly drain on society and the psychological, physical, and financial, burdens these diseases place on families can be substantially reduced.

Indeed, research has shown strong evidence that effective prevention and competent drug and alcohol treatment programs result in significant reductions in unwanted pregnancy, child abuse, strokes, HIV, crime, heart disease, cancer, and traffic fatalities.  Moreover, quality drug and alcohol treatment improves one's quality of life, job performance, and health while at the same time reducing drug and alcohol abuse, family dysfunction, and involvement with the criminal justice system.

Drug and alcohol treatment programs typically employ a combination of counseling and doctor-prescribed medications to help a person refrain from drug or alcohol abuse.  Although most addicts need professional help in order to recover from their disease, research has shown that with support and competent treatment, many addicts are able to abstain from drug and alcohol abuse and reclaim their lives.

Drug and Alcohol Treatment:  Withdrawal Symptoms

When a drug or alcohol addict abruptly discontinues their drug of choice, he or she commonly suffers from withdrawal symptoms.  Drug and alcohol withdrawal symptoms are basically responses by the body and by the brain to the lack of the drugs or alcohol to which they had become adapted.

Depending on the drug in question, some of the typical withdrawal symptoms are as follows:  depression, anxiety, insomnia, headaches, nausea, rapid heart rate, vomiting, and irritability.  Even with professional treatment, these symptoms can take days or weeks before the body returns to "normal."

A number of various techniques exist for treating drug and alcohol withdrawal symptoms.  While many, if not most of these treatment approaches use medications, a number of alcohol therapies, conversely, do not.

Indeed, according to current substance abuse research findings, the safest way to treat mild withdrawal symptoms is without meds.

Such non-drug detoxification approaches use extensive social support and screening all through the withdrawal process. 

Traditional Forms of Drug and Alcohol Treatment

There are numerous traditional drug and alcohol treatment methodologies that are relatively well established and considered "mainstream" therapies.  The following drug and alcohol treatments and programs, all of which are considered "traditional" approaches, will be discussed:  Detoxification, Behavioral Treatment, Therapeutic Medications, Outpatient Treatment and Counseling, Residential Treatment Programs, and Family and Marital Counseling.

Detoxification

Detoxification is the process of letting the body rid itself of drugs and/or alcohol while managing the withdrawal symptoms in a harm-free environment.  Drug and alcohol detox treatment is typically done under the supervision of a medical practitioner and is commonly the first step employed in a drug and alcohol treatment program.  Most detox procedures include closely monitoring the person’s vital signs, doctor-prescribed medications, and therapeutic support and counseling.

Detox is typically the first step in drug and alcohol treatment because of the following:  until there are no drugs and/or alcohol in an individual's body, withdrawal can cause craving for more drugs or alcohol. Moreover, and equally as important, while an individual is in an alcohol or drug induced state, he or she is not totally ready to involve himself or herself in the therapeutic and educational aspects of the rehab and treatment process.  Stated differently, until an individual completes the detox process, he or she is simply not ready for drug and alcohol treatment. 

Whereas various drugs necessitate medical detox, others do not.  Opiates, such as methadone and heroin and methadone, alcohol, and prescription medications such as Oxycontin, Lortab, Codeine, Xanax, Vicodin, Hydrocodone, Darvocet, and Percocet all require medically supervised detox.  Other illegal drugs, such as crystal meth, cocaine, marijuana, and crack, on the other hand, do not usually require medical detox.  Frequently, however, there is a strong sense of psychological dependence associated with these latter mentioned illegal drugs that necessitate a period of medical stabilization.

There are numerous ways to perform drug and alcohol detox. These different detox approaches depend on the drug that has been abused, the treatment methodology, and the philosophy that underlies the treatment that is employed.  The more successful and effective detox facilities feature counseling and therapy during and after detox.  This usually helps the person address and work through his or her psychological and social problems that he or she may be experiencing.

Due to the relatively long time frame and the required medical monitoring involved in this process, detoxification programs are usually part of an inpatient, residential drug and alcohol rehab program.

Withdrawal Symptoms

Withdrawal symptoms are the result of stopping or drastically reducing drug or alcohol use after excessive and long-term use.  Common drug and alcohol withdrawal symptoms include the following:

• drug craving
• nausea
• sweating
• diarrhea
• anxiety
• vomiting
• agitation
• shaking or the shakes
• abdominal cramping
• headaches
• insomnia
• depression
• confusion
• irritability

Behavioral Treatments

Behavioral treatments include such methodologies as 12-step programs, Cognitive Behavioral Therapy, and Motivation Enhancement Therapy. 

12-Step Drug and Alcohol Programs

1. Al-Anon is a 12-step support program for family members and friends of problem drinkers.
2. Alateen is a 12-step program for youth whose parents are problem drinkers.
3. Narcotics Anonymous is a 12-step program for people who have a major drug problem.  Membership is open to all drug addicts, regardless of the specific drug or drugs that have been abuse.
4. Alcoholics Anonymous is a mutual support program for recovering alcoholics that is based on the 12-steps of recovery that are used to stay sober.
5. Nar-Anon is a 12-step support program for family members, relatives, and friends of addicts.
6. Co-Dependents Anonymous (CODA) is a 12-step support program for people who manifest an inability to involve themselves in and maintain meaningful, functional relationships.

Motivation Enhancement Therapy (MET)

Motivation Enhancement Therapy (MET) is a systematic therapeutic approach that is almost 180 degrees different from the various 12-step drug and alcohol programs in that it uses motivational strategies to activate the client's own change mechanisms.  Some of important characteristics of MET are the following:

• Helping the client achieve self-efficacy or a sense of optimism.
• Therapist empathy
• Receiving clear advice to make healthy changes
• Emphasis on taking personal responsibility for positive change
• Providing feedback regarding the personal risks or damage associated with the abuse
• Providing the client with a number of alternative change options  

Cognitive Behavioral Therapy (CBT)

There are several forms of cognitive behavior therapy.  Most of them, however, have the following commonalties:

• CBT usually has therapeutic sessions that are briefer and fewer in number than most other forms of therapy.
• CBT is based on stoic philosophy.  CBT does not tell clients how they should feel.  Rather, this form of therapy focuses on helping clients learn how to think more logically and effectively.
• CBT is a mutually shared effort between the therapist and the client.
• CBT is structured and directive.
• In CBT, a solid therapeutic relationship is necessary but not the primary focal point for effective therapy.
• CBT is based on an educational model that views most emotions and behavioral reactions as learned responses.  Thus, the therapeutic goal in to help the client unlearn undesirable reactions and emotions and replace them with new and more positive ways of feeling and reacting.
• CBT uses the Socratic Method that is based on the asking of questions for insight.
• Homework is a central feature of CBT.
• CBT theory and techniques rely on the Inductive Method.  This method has clients look at their thoughts as hypotheses (or suggested explanations) that can be tested and questioned.  If clients discover that their hypotheses are incorrect, they can then change their thoughts and feelings to be more in line with reality.
• CBT is based on stoic philosophy.  CBT does not tell clients how they should feel.  Rather, this form of therapy focuses on helping clients learn how to think more logically and effectively.
• CBT approaches are based on the cognitive model of emotional response.  That is, if we change the way we think, we can act and feel better, even if the situation doesn't change.  

Therapeutic Medications

In this therapeutic methodology, medical doctors prescribe medications to treat drug and alcohol dependency.  Many drug and alcohol abuse researchers and practitioners maintain that chronic addicts who cannot maintain abstinence should receive doctor-prescribed medications to treat and manage their withdrawal symptoms.  Another significant benefit of medications-focused treatment is that individuals who are drug and alcohol dependent are less likely to experience seizures and/or possible brain damage when they receive therapeutic medications for their addiction.

Medications Used to Treat Drug Withdrawal Symptoms

The most commonly used therapeutic medication to treat the withdrawal symptoms associated with many drugs is Klonepin which helps reduce physical symptoms.  Buprenophex, an anticonvulsant, is also widely used when treating drug withdrawals.  Importantly, both of these medications have been shown to provide relief for drug addicts who suffer from withdrawal symptoms.  Under most conditions, the time period for drug detox is three to seven days under the supervision of medically monitored staff.

Regarding heroin withdrawal, clonidine which blocks some of the physical withdrawal symptoms as well as opiate agonist drugs such as methadone are used.  In a similar manner, clonidine is the most commonly used medication to reduce the physical withdrawal symptoms associated with prescription drugs.  A progressively decreased dose of methadone can also be used to reduce the intensity of the withdrawals that generally take place when prescription drugs are discontinued.  This treatment methodology, however, is usually more effective when undertaken in residential, inpatient, as opposed to outpatient programs.

And finally, it should be mentioned that methadone is also employed as a replacement therapy for opiate addiction.

Medications Used to Treat Alcohol Withdrawal Symptoms 

According to the research literature, substance abuse researchers have recently discovered that the benzodiazepines are the medications most likely to produce beneficial results when treating alcohol withdrawal symptoms.  Examples include the longer-acting benzodiazepines such as Valium and Librium and the shorter-acting benzodiazepines such as Ativan and Serax.

Historically, when medical practitioners used benzodiazepines to treat alcohol withdrawals, they used a progressive decrease in doses over the duration of the withdrawal procedure.

Intermediate To Short Half-Life Benzodiazepines

Numerous alcoholism researchers and practitioners have discovered that intermediate to short half-life benzodiazepines should be utilized when treating withdrawal symptoms.  These healthcare professionals made their decision based on the following two points.  First, the shorter-acting benzodiazepines can be administered by way of measurable and observable dose reductions.  And second, the shorter-acting benzodiazepines do not stay in the individual's blood for an extreme period of time.

Medications To Prevent Alcohol Relapse

Another aspect of alcoholism treatment with therapeutic medications centers on different drugs such as disulfiram (Antabuse) or naltrexone (ReViaT that are prescribed by a medical doctor to help prevent the alcoholic from returning to drinking after he or she has experienced a relapse.  In short, this treatment approach features doctor-prescribed drugs to treat an individual's alcohol dependency.

For example, antabuse produces negative effects such as vomiting, flushing, nausea, or dizziness if the person drinks alcohol.  It almost goes without saying that antabuse is effective primarily because it is such a powerful deterrent.  Naltrexone (ReViaT), to the contrary, is effective because it targets the brain's reward circuits and diminishes the craving the alcohol dependent person has for alcohol.

Outpatient Drug and Alcohol Treatment and Counseling

There are various approaches to counseling that teach drug and alcohol addicts how to become aware of the situational and psychological triggers" of their substance abuse.  Equipped with this information, drug and alcohol abusers can then learn about different ways in which they can manage and deal with circumstances that do not include the use of drugs or alcohol. These types of drug and alcohol treatment methodologies, unlike detox therapies, can be offered on an outpatient (or on an inpatient basis). 

Residential Drug and Alcohol Treatment Programs

If there's a need for alcohol AND drug abuse treatment, if the person's withdrawal symptoms are excessive, if a person needs drug or alcohol overdose treatment, of if outpatient and support-oriented programs such as the various 12-step drug and alcohol programs are ineffective, the individual typically needs to enroll into a hospital or a residential drug and alcohol treatment facility and receive inpatient rehabilitation.  Such programs are usually geared for drug and alcohol inpatients and usually include doctor-prescribed medications to help the addict get through detox and through drug and alcohol withdrawal in a safe manner.

Family and Marital Counseling

Due to the fact that the recovery process is so intrinsically associated to the support the addict receives from his or her family, a number of drug and alcohol treatment programs include marital and family counseling as key components in the treatment protocol.  Such therapeutic programs, moreover, may also provide addicts with basic community resources, such as legal assistance, financial management classes, childcare courses, parenting classes, and job training.

Alternative Drug and Alcohol Treatment Methods

Even though the research findings are not conclusive, there are some alternative treatment approaches for drug and alcohol abuse that are becoming more widely used and available.

There are various therapeutic methods that are seen as "natural" forms of drug and alcohol treatment and include the following:  the naturalistic and holistic approaches used by Traditional Chinese Medicine, "Drumming out Drugs" (a type of therapy that employs the use of drumming by addicts), and various vitamin, mineral, and supplement therapies.  A more "revolutionary" approach, moreover, regarding alternative drug addiction treatment involves the giving of substitute drugs to addicts such as crystal-meth and cocaine dependent individuals.

As promising as these alternative therapies are, more research is required in order to establish their effectiveness and to determine if they provide long-term drug and alcohol treatment success. 

Drug and Alcohol Treatment:  Conclusion

In spite of the fact that a cure for drug and alcohol addiction has not been discovered, various drug and alcohol treatment approaches however, have been developed that help addicts recover from addiction.  Not surprisingly, there is a host of drug and alcohol treatment information that is available, both offline and online.

Some individuals ask the following question regarding treating drug and alcohol addiction:  "What is the most effective type of drug and alcohol treatment?"  Not unlike most chronic diseases, there are different levels and degrees of success related to drug and alcohol treatment.  For example, some addicts, after treatment, refrain from abusing drugs or alcohol.  Other addicts, conversely, experience fairly long periods of abstinence after receiving treatment, and then experience a drug or alcohol relapse. And still other addicts cannot abstain from drugs or alcohol for any sustainable period of time, regardless of the type of treatment they have received.

Not surprisingly, all of these treatment outcomes occur with every known type of drug and alcohol treatment.  In any event, one thing is certain regarding drug and alcohol treatment: the longer an addict refrains from abusing drugs or alcohol, the more likely he or she will be able to remain sober and possibly avoid further drug and alcohol treatment. 

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