If you or a loved one is facing the challenge of handling the devastating effects of substance abuse, you are not alone. More than 1 in 7 people (40 million) in the United States abuse or are addicted to drugs, alcohol, or nicotine, and a common perspective of drug and alcohol addiction is that it is a chronic, relapsing disease that can’t be cured, but can be successfully managed.1
The goal of treatment is long-term recovery, defined as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”2 Unfortunately, only a very small percentage of people with addictive disorders receive the treatment they need to be able to return to a fulfilling, productive, and healthy life.3 This is, in part, due to trying to navigate an often-confusing addiction treatment system. To make clearer your options, we break down the various types of addiction treatment here.
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Types of Treatment
We have all heard about famous people going into luxurious treatment programs to help overcome addictions, but addiction treatment is not just for the wealthy. The range of treatment centers that provide medical oversight and specific addiction treatment expertise covers the spectrum from public and low-cost to private, high-end facilities. While treatment plans are typically tailored to your needs and specific recovery goals, the severity of your addiction, and the overall treatment approach of the rehab center, the steps involved in helping you transition to sobriety using addiction therapy are essentially the same.
First, addiction clinicians evaluate the level of care needed by reviewing your medical history, the severity of your addiction, any concurrent mental health issues, and your readiness to change. Once the necessary level of care is determined, you will likely enter the withdrawal process and need detoxification. Depending on your drug of abuse, withdrawal produces unpleasant physical and psychological effects, many of which require qualified medical supervision.
Detoxification is your body’s way of getting rid of your substance of abuse. Since quitting a substance that has been abused heavily for an extended period can cause dramatic physical and psychological effects, going through this process under medical management is frequently encouraged. In some cases of acute withdrawal, such as those seen with alcohol and some sedative drugs, medical management is a must. Detox programs provide a setting in which addiction clinicians monitor your detox process and may prescribe medications to help relieve negative symptoms and ensure your physical and mental safety.
Detox is a necessary first step in getting clean and sober, but it’s not sufficient to completely recover.
Detox is a necessary first step in getting clean and sober, but it’s not sufficient to completely recover. Detox is widely considered the starting point of a comprehensive treatment plan to ensure sustained recovery.4
Inpatient and Residential
Attending inpatient treatment means making the choice to stay in a residential rehabilitation facility that provides medical supervision and specialized addiction and psychosocial clinical care for a typical length of 30, 60, or 90 days (and in some cases, longer). Inpatient addiction treatment is often referred to as the gold standard of care because:
- A team of addiction experts provides medical and psychological services in a supportive environment 24/7.
- It completely removes you from the people, places, and things that may have triggered your addiction in the first place.
- It provides evidence-based information and psychosocial strategies for you to learn more about your addiction and how to rebuild new behaviors and healthy habits.
Components of outpatient recovery support often become part of your sustained recovery.Outpatient treatment provides much that inpatient care does, but with a less time- and treatment-intense approach. It is a great option if your substance abuse doesn’t require acute care.
Outpatient services are generally much less disruptive and less expensive than inpatient or residential rehab since you continue to live at home and attend specialized addiction, medical, and psychosocial care on a daily or weekly basis. Since it doesn’t necessitate relocating and taking a leave of absence from work and family obligations, outpatient care can be integrated into your life more easily. Components of outpatient recovery support often become part of your sustained recovery. Outpatient treatment is usually recommended for at least 90 days, although many addiction experts recommend that you continue to participate in aftercare recovery support services (e.g., individual therapy and group support such as Alcoholics Anonymous or Narcotics Anonymous) to increase your chances of staying healthy and sober long-term.
Once your acute physical dependence is under control through detox and you begin to understand the causes of your addiction through inpatient or outpatient treatment, treating the psychological dependence that comes along with addiction is critical. Addiction therapy modalities you may encounter in treatment include:
- Cognitive behavioral therapy (CBT) seeks to replace your negative thoughts and behaviors with healthy beliefs and help you identify healthy coping mechanisms (wellness practices such as yoga, mindfulness, and self-compassion training) instead of using substances.
- Dialectical behavioral therapy (DBT) is a type of CBT that works on expanding your ability to manage your emotions without using substances as a coping mechanism.
- Motivational Interviewing (MI) is a type of counseling that identifies your personal motivation to stay sober and uses that to help you overcome any ambivalence you may have toward choosing recovery.
- The Matrix Model combines CBT and MI in a group therapy setting that is structured, lasts for 16 weeks, and provides intensive skills-building for the challenges of early recovery and relapse prevention.
- Psychodynamic psychotherapy focuses on processing the unconscious emotional issues that led to your addiction to create more emotional bandwidth for positive life experiences.
Length of Treatment
Participation in an addiction treatment program in early recovery is important because it helps you avoid triggers and learn how to live without substances. The longer you stay in treatment, whether inpatient or outpatient, the higher the chances you have of being successful in recovery.5
The average length of inpatient and outpatient treatment is 30 and 90 days, respectively. These are the minimum amounts of time usually recommended, but you may be advised to extend treatment if your addiction is severe. The Affordable Care Act (ACA) mandates that addiction treatment services are covered by insurance in the same way as other physical health problems. However, states interpret this legislation differently, so depending on where you access care and whether you have insurance, addiction treatment coverage varies widely.
Medically Managed Treatment
Medically managed treatment involves trained addiction clinicians prescribing medications designed to manage withdrawal and decrease cravings.6 The medications most commonly used to treat drug and alcohol addiction in a treatment setting currently fall into 2 major categories—those for opioid and alcohol abuse—and some, like naltrexone, are used for both. There currently aren’t any medications approved for specifically managing cocaine, methamphetamine, or marijuana addictions.
Heroin and Prescription Pain Relievers (Opioids)
Methadone, buprenorphine, Suboxone, and naltrexone are the front-line clinical options to treat opioid abuse. Methadone, which has been used for more than 50 years to treat opioid addiction, and buprenorphine are themselves synthetic opioid substances. Methadone is taken orally, either in pill or liquid solution form, and is dispensed only at specialized Outpatient Treatment Programs (OTP) where you take a daily dose.
While methadone is effective, having to go to an outpatient clinic every day can be inconvenient, particularly if there is not an OTP nearby. Different formulations of buprenorphine became available as an alternative medication 15 years ago and are prescribed by physicians with specialized certification in their offices and treatment centers.
These medications work by affecting the brain in the same place as opioids.
In combination with the opioid antagonist naloxone, Suboxone is taken orally in pill and filmstrip forms, and a newer-formulation buprenorphine, known as Probuphine, is implanted into your arm. These medications work by affecting the brain in the same place as opioids (opioid receptors), but in a slightly different way so that withdrawal symptoms are alleviated and cravings are reduced.
Naltrexone is another treatment option that can be administered orally or as a long-acting formulation that is injected monthly. While it also works via interaction with opioid receptors, naltrexone completely halts their activation and, in doing so, diminishes the dopamine release that would otherwise occur in conjunction with opioid drug use. Naltrexone may be used after detoxification is completed so as not to further precipitate acute withdrawal, but its effectiveness in reducing cravings is inconclusive.8
Acamprosate (Campral), naltrexone, and disulfiram (Antabuse) are three FDA-approved medications used to treat alcohol dependence. Addiction clinicians consider variables such as addiction severity, motivation to be abstinent, and the need for symptom reduction over an extended period when selecting the best medication for your alcohol dependence.
Acamprosate is often used if you have severe alcohol addiction. Data shows it is particularly effective at treating withdrawal symptoms such as anxiety, insomnia, and dysphoria (the opposite of euphoria). This is a key factor because a primary cause of relapse in early recovery is starting to drink as a type of self-medication to relieve the psychological distress that occurs in detox and extended withdrawal.
According to the National Institute on Drug Abuse (NIDA), depending on genetic differences, naltrexone is also very effective at reducing the potential for relapse.6 Surprisingly, the way in which naltrexone blocks opioid receptors has been shown to be more effective for treating alcohol dependence than opioid dependence because it reduces the high that drinking produces, as well as the cravings for more alcohol.9 In contrast, disulfiram works well for people who respond well to negative incentives to stay sober because it interrupts the alcohol breakdown process, makes you feel nauseated, causes hot flashes, and increases heartbeat if you drink alcohol while taking it.
Even though cigarette smoking is the number-one preventable killer in the U.S. and an estimated 40 million Americans are tobacco-dependent, you don’t normally go into treatment to quit smoking. There are two effective medications your doctor can prescribe, however: varenicline (Chantix) and bupropion (Zyban). Varenicline works by affecting certain brain receptors to reduce the positive effects of nicotine if you start smoking again. Bupropion is an anti-depressant (a re-branded Wellbutrin) that has also been shown to be effective in reducing your chance of relapsing.10
- Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.
- Substance Abuse and Mental Health Services Administration. (2012). SAMHSA’s Working Definition of Recovery Updated.
- Ries, R., Fiellin, D., Miller, S., & Saitz, R. (2014) ASAM Principles of Addiction Medicine. New York: Lippincott Williams & Wilkins.
- Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2014). Heroin.
- Dijkstra, B. A., De Jong, C. A., Bluschke, S.M., Krabbe, P.F., & van der Staak, C.P. (2007). Does naltrexone affect craving in abstinent opioid-dependent patients? Addiction Biology, 12(2), 176–82.
- Srisurapanont, M. & Jarusuraisin, N. (2000). Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews, (3).
- U.S. National Library of Medicine National Institutes of Health. (2014). The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General.