Drug Abuse and Addiction

Does drug treatment work?

Addiction is a challenging disorder. Relapses often will happen, which can be frustrating and disheartening for the person using drugs and their family. But does treatment for addiction really work? It can- and does- for many people. Treatment varies from attending peer support meetings to staying in a residential treatment facility. Some people might use medications to help them reduce cravings for the drug.

Treatment is more than getting sober

While getting sober from drugs is an important first step, it is only the beginning of the recovery process. Once sober, the brain needs time to recover and rebuild connections that have changed while addicted. In this period, depression and cravings to use can be intense and very hard to fight. Without support, relapse is very likely. Good treatment helps you develop new coping skills to deal with stressful situations and triggers for relapse. Without these skills, stressful situations frequently trigger relapse.

Getting started

Realizing that you have a problem and that you need help is a tremendous first step. The following resources are a good place to start:

• Peer support (AA, NA). A good place to reach out for support is a peer support group like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). These peer support groups provide a place to share struggles with addiction and what others have done to stay sober. More information about these groups is below.
• Therapy. If you are seeing a therapist, share your intentions with him or her. A therapist can be a good resource and support for addiction treatment.
• Medical professional.  Some drugs create withdrawal symptoms that require medical intervention. There are also medications that may help make withdrawal symptoms more comfortable. Your primary care doctor can be a good starting reference, and you may want to consider working with an addiction medicine specialist.

Drug Detox and Withdrawal

Most abused drugs are not only mentally addictive but physically addictive as well. More and more of the drug is needed to achieve the same effect. Trying to cut down or stop once the body is used to the drug is unpleasant or even painful. These withdrawal symptoms can include shakes, chills, severe aches and pains, difficulty sleeping, agitation, depression, and even hallucinations or psychosis.

Withdrawal symptoms
Cocaine	Agitation, insomnia, anxiety, depression, anger, cravings, fatigue, nausea, vomiting, shakes, irritability, muscle pain.
Methamphetamine	Extreme fatigue, disturbed sleeping patterns, irritability, restlessness, intense hunger, moderate to severe depression, anxiety, angry outbursts, lack of motivation, mental confusion, psychotic reactions, depression, intense cravings for the drug.
Opiates (e.g. heroin, oxycontin, vicodin)	Watery eyes, runny nose, yawning, sweating, chills,  stomach cramps, shakes, feeling jittery, irritability, panic, tremors, anxiety, restlessness, insomnia, dilated pupils, goose bumps, rapid heart beat, high blood pressure, nausea/vomiting, diarrhea, muscle aches and pains.
Benzodiazepine (Anti-anxiety medications)	Sleeplessness, irritability, anxiety, feeling shaky, headache, dizziness, loss of appetite, rapid heartbeat, sweating, agitation, and in extreme cases seizures.

Drug detox

The initial period where drugs are being cleansed from your system is often called drug detox. The time it takes for drug detox varies with the drug, but normally takes between about 3 and 14 days. In some cases, detox is done in a hospital or residential setting under medical supervision. Other times, it is done on an outpatient basis. The level of medical care you need depends on your age, drug usage history and any other medical or psychiatric conditions.

Drug treatment programs

There are many types of drug treatment programs. When considering a program, remember that everyone’s needs are different.  In general, the longer and more intense the drug use, the longer and more intense the treatment you may need.  Regardless of a program’s length in weeks or months, follow-through and long-term follow-up are crucial to recovery. A quality treatment program should start to address that substance abuse often is masking emotional pain, and it needs to be addressed as treatment progresses.

An overview of drug addiction treatment programs
Residential treatment	Residential treatment involves living at a treatment facility while undergoing intensive treatment during the day. Residential treatment normally varies from 30-90 days.
Medical detoxification	Admission to this level of treatment requires an assessment, and is only the first step in drug treatment. Sometimes medical detox is started from a trip to the emergency room due to overdose or drug related issues.
Partial hospitalization	This relapse prevention treatment program usually meets 3-5 days a week, 4-6 hours/day and is for people who require medical monitoring on an outpatient basis
Intensive Outpatient Program (IOP)	Usually meets 3 days a week, 2-4 hours/day. These relapse prevention treatment programs are often scheduled around work or school
Counseling (Individual, Group, Couple or Family Therapy)	Works best in conjunction with other types of treatment or as follow up support. Looking at your issues from a different perspective can help to identify the root causes of your drug usage  and can be beneficial in helping you  learn how to make more constructive choices in your life.
Sober living	Normally done after an intensive treatment like residential treatment. Sober living facilities are useful if returning home too soon is a strong trigger for relapse or the recovering addict has no home. Sober living homes are comprised of recovering addicts who support each other, and provide an alcohol and drug free environment.

Choosing a drug treatment program

How do I find a program?

The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services offers an extensive listing of licensed, certified drug treatment facilities by location through its Substance Abuse Treatment Facility Locator. SAMHSA also operates a helpline: (800) 662-HELP (4357) with help in English and Spanish, or TDD at (800) 487-4889.

Another place to look is your local state substance abuse agency. States often have their own listings, toll-free hotlines, and information about accreditation.

If you are working with a doctor or therapist, you can also ask them about programs in your area; they might be a good starting resource.

What should I look for in a drug treatment program?

When you start looking for drug treatment, you may see advertisements for programs in tranquil settings with gorgeous views. While amenities like that are nice to have, they also will probably come with a big price tag.  Focus on what is truly important; appropriate licensing, quality of care during the program and follow up, and staff credentials. Things to check include:

• Program accreditation and licensing.  Several national accreditation agencies evaluate detox and aftercare facilities, checking whether they offer effective elements of treatment and a well-documented patient complaint process.
• Studies measuring the effectiveness of the program's treatment methods. Treatment effectiveness is a new field of study, but treatment centers should at least have some statistics on their success rates, preferably from an objective external agency.
• Type of aftercare program to prevent relapse. Intensive treatment requires follow-up. Programs should offer a well-run aftercare program, with referrals to appropriate self-help groups. It’s important that a staff member collaborate with you to create a discharge plan before you leave the program.

How much does drug treatment cost? How will I afford it?

Drug treatment costs can vary widely because each individual has different treatment needs and insurance coverage. Is there a hospital or medical facility stay, and for how long?  Will there be 30, 60, 90 day residential treatment? Outpatient treatment can vary from almost a full day daily to a few hours weekly. Long term drug therapy, like methadone maintenance, can affect costs too. For an idea of costs involved, visit SAMSHA’s Alcohol and Drug Services Study (ADSS) Cost Study.

Check your insurance. If you have insurance, call the number on the back of your medical I.D. card to access your mental health and substance abuse benefits, obtain pre-authorization for services, and learn what out-of-pocket costs will be, including deductible and co-payment amounts.

Check for programs that offer sliding scale or reduced payment options. SAMSHA recommends to check with your local state substance abuse agency for any leads on affordable programs.

Group support programs for drug abuse  

12–Step Programs

12-step programs, such as Alcoholics Anonymous or Narcotics Anonymous, are the most common type of group support programs for drug abuse. These free programs, facilitated by peers, use group support and a set of guided principles, the 12 steps, to obtain and maintain sobriety. The treatment recovery steps include admitting powerlessness over the addiction and surrendering to a “higher power,” which you can interpret according to your own beliefs.

A key part of a 12-step program is choosing a sponsor. A sponsor is a former addict who has time and experience remaining sober, and can provide guidance and assistance to you. A good sponsor helps you understand and work the 12 steps and is available to provide support if you are craving drugs.

Maintaining sobriety

Life without drugs

The road to recovery is not easy and it can sometimes feel overwhelming. Drug use affects your brain chemistry, and once the drugs have been cleansed from your system, it takes time for your body to readjust. Relapse prevention includes identifying triggers to using drugs, learning more adaptive coping skills, and making better decisions when dealing with life’s challenges.

• Stay involved in a support group. Your chances of staying sober improve if you are participating in a social support group like Alcoholics Anonymous or Narcotics Anonymous, have a sponsor, or are involved in an Intensive Outpatient Program or individual therapy.
• Start or maintain healthy lifestyle practices. Basic self care practices are essential to good mental and physical health. Eating right gives you plenty of energy and helps prevent mood swings. Make sure you are getting enough sleep- 7½ to 8 hours a night for most. Exercise releases endorphins and improves your mood.
• Identify people, places or things that are triggers for you. While it is good to practice what you may do if pressured to do drugs just once more, building healthier associations is critical in the long run. Surround yourself with positive influences and people who make you feel good about yourself.  A good support network can help you in this as well.
• Continue to work on healthy coping skills. When life stresses occur, having healthy coping skills helps prevent turning to alcohol. Stress management skills go a long way towards preventing relapse. Skills to build healthier emotional awareness help keep you in balance and cope with adversity.
• Get adequate treatment for medical or psychological issues. If you have underlying chronic pain or were self medicating to avoid the pain of anxiety, depression or other mental health issues, make sure that you get the treatment you need. If the underlying issue is not treated, you may turn to drugs again to get relief.
• Be up front about your history of drug use when seeking medical treatment. If you need a medical or dental procedure done, be up front about your history and find a provider who will work with you in either prescribing alternatives or the absolute minimum medication necessary. You should never feel shamed or humiliated about previous drug use or denied medication for pain; if this is the case, find another provider.

Managing intense feelings and emotional pain

Feelings that may have been masked by the drugs will resurface, and when they do, you will need to do something different because you won’t have the drugs to fall back on. Building stress management and emotional awareness skills will help you manage these intense times. Although peer groups can provide emotional support, therapy can also provide a solid base to build on if you find the feelings overwhelming.

Helping a family member or friend

You might be heaving a sigh of relief if a family member or friend has agreed to drug treatment. However, drug treatment is just the first part to staying sober. You and your family might still be coping with the financial and legal ramifications of the drug abuse. Your loved one might feel overwhelmed with dealing with the day to day aspects of life that were overshadowed with all the energy it took to obtain and do drugs. Feelings of depression and hopelessness are not uncommon as the brain readjusts itself. The best way to help is to educate yourself on the process of recovery, and make sure you get the support you need for yourself as well.

Get support for yourself

Free family peer groups can provide support through all parts of the recovery process, including if there is a painful relapse. Al-Anon may be a place to begin as these groups are the most numerous, and frequently alcohol is abused with other drugs as well. Similar to Al-Anon, there are many support groups for families coping with specific drug abuse as well. These include Nar-anon, for families coping with narcotic abuse, and Co-anon, for families coping with cocaine abuse. Listening to others with the same challenges can be a tremendous source of comfort and support.

Encourage your family member or friend to build outside support

You might be used to being the sounding board for your loved one’s problems. However, the stronger the network of support your loved one has, the greater the chance for recovery. Some treatment programs even severely limit contact with family for the first part of the program, so that the person can focus on what recovery means to them and what they will have to do.  Even after the initial period of obtaining sobriety, encourage your family member to continue attending meetings and working with a sponsor if they have one.

Expect change to be a little unsettling

As your loved one adjusts to sobriety, you are also adjusting as well. Change can be unsettling, even if it is a positive change. You might end up taking a look at patterns in your life and what you want to change. Don’t be surprised if feelings of resentment or anger bubble up if you have been suppressing them while dealing with your loved one’s drug abuse. Reach out for support in working through this process.

Related links for group support and treatment programs

Treatment for drug abuse & addictions

Substance Abuse Treatment Facility Locator – An online resource for finding private and public drug and alcohol treatment facilities by location. (U.S. Department of Health and Human Services)

Principles of Drug Addiction Treatment: A Research Based Guide – Index page to a 56-page booklet issued by the National Institute on Drug Abuse (NIDA) describing what makes a treatment for drug addiction effective, answering questions about drug abuse treatment, and detailing different types of treatment programs.

Does Drug Treatment Work? – Provides a summary of recent studies evaluating drug treatment by state, federal and nonprofit policy centers. (Frontline, PBS.org)

Some Questions to Ask When Choosing an Addiction Treatment Program – Succinct but detailed list of points to consider when choosing a treatment program. (pbs.org)

12-step self-help programs for drug abuse & addiction:

The following organizations all sponsor websites based on the Alcoholics Anonymous 12-step model, that allow people to find meetings in the United States and foreign countries:

• Narcotics Anonymous
• Cocaine Anonymous World Services
• Crystal Meth Anonymous
• Marijuana Anonymous World Services

For families:

• Al-Anon: For families coping with alcohol abuse, a good place to begin for drugs as well since meetings often more numerous
• Nar-anon: For families coping with narcotic abuse
• Co-anon: For families coping with cocaine abuse

Coping With Urges – A psychologist proposes three mental strategies that can help someone reduce the urgency of cravings for addictive substances. (Selfhelp Magazine)

Joanna Saisan, MSW, Deborah Cutter, Psy.D.,  and Jeanne Segal, Ph.D. , contributed to this article. Last modified in January 09.