Addiction Treatments
There are many options that have been successful in treating drug addiction and patients can receive treatment in many different settings with various approaches.
Behavioral therapies which help patients modify their attitudes and behaviors related to drug use, increase healthy life skills, persist with other forms of treatment, such as medication.
Outpatient behavioral treatment includes a wide variety of programs for patients who regularly visit a behavioral health counselor. These programs involve a combination of individual or group drug counseling and additional forms of behavioral therapy such as:
- cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs
- multidimensional family therapy, developed for adolescents with drug abuse problems as well as their families and addresses a range of influences on their drug abuse patterns and improve overall family functioning.
- motivational interviewing, which makes the most of people’s readiness to change their behavior and enter treatment.
- motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
Treatment is sometimes intensive at first and patients may attend multiple outpatient sessions each week. After completing intensive treatment, patients transition to regular outpatient treatment, which meets less often and for fewer hours to help sustain their recovery.
Inpatient or residential treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches aimed at helping the patient live a healthy lifestyle after treatment. Examples of residential treatment settings include:
- Therapeutic communities, highly structured programs for patients who remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use. Read more about therapeutic communities in the Therapeutic Communities Research Report.
- Shorter-term residential treatment, typically focuses on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.
- Recovery housing, provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.
(Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.)
How are medications & devices used in drug addiction treatment?
Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.
Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself “treatment,” but the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Also, in May 2018, the FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.
Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.
- Opioids: Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine® , Sublocade™), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. Learn more about medications for opioid overdose, withdrawal and addiction.
- Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.
- Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:
- Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.
- Acamprosate (Campral®) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.
- Disulfiram (Antabuse®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.
- Co-occuring conditions: Other medications are available to treat possible mental health conditions, such as depression or anxiety, that may be contributing to the person’s addiction.
(Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.)
Additional Treatment
- Mutual Aid Support Groups – Groups of people who come together to support each other in dealing with the hardships of addiction. Can offer support from everything to drug and alcohol addiction (Alcoholics/Narcotics Anonymous) to gambling and addiction to sex.
- Adjunct Recovery Programs – Additional recovery service programs that can be used to supplement those who are already receiving medical treatment or who are receiving help from mutual aid support groups. Examples in NYS include: Yoga of 12-Step Recovery Program and ROCovery Fitness, Inc.
- Certified Recovery Peer Advocates (CRPA’s) – Individuals who have “lived experiences,” meaning that they are currently in recovery from addiction, are allies of the recovery community, or have friends/family who are living with addiction. These professionals help bridge the gap between recovery services and the road to recovery. Be sure to check whether any potential CRPA is certified with the state by checking the New York Certification Board website.
- Peer Engagement Specialists – Trained specialists whose job is to integrate themselves within environments where individuals and families commonly deal with addiction (such as emergency departments or clinics) and act as a resource to help individuals enter and navigate recovery successfully.
