You Are Not Alone
Whether you are someone struggling with drugs and alcohol yourself, or a family member of someone struggling, you are not alone. Addiction (now called “Substance Use Disorder”) is a problem affecting 23 million Americans, their families, friends, and co-workers - and nearly 200 million people worldwide. Substance Abuse costs the U.S. economy $346 billion every year, in direct medical costs, and in related legal, social, and lost productivity costs. Despite all this, only 11% of people who struggle with drugs and alcohol get the help they need.
But there is hope. 24 million Americans are currently in recovery, living their lives without dependence on drugs or alcohol after struggling with addiction. There are many paths to recovery - one size does not fit all - and recovery from substance use disorders happens every day.
You are not alone, even if it feels like it. Reach out for help, there are people waiting to support your recovery.
What is Substance Abuse?
The American Society of Addiction Medicine (ASAM) defines addiction as follows:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Two out of three people who struggle with addiction also have co-occurring mental health illnesses which can include PTSD, depressive disorders, anxiety, and/or obsessive-compulsive disorders. Over 50% of alcoholics and addicts can trace a genetic connection in their families to addiction. In addition to mood disorders which can be inherited, adverse environmental factors such as trauma are common.
The existence of co-occurring psychological disorders helps explain how many people who struggle with substance abuse get to the point of developing a chemical dependency or addiction. In addition to this psychological disorder, once a person’s brain is addicted to alcohol or other drugs, it also has a physical disease that must heal.
Generally (though not always), substance abuse doesn’t progress immediately to addiction. There are five stages of substance abuse that lead to addiction:
Five Stages of Substance Abuse
Just as it sounds, experimentation is the early occasional use of substances (including alcohol) to understand the experience.
Situational Misuse/ Regular Use
When a person discovers that use of a substance can serve as a coping mechanism for a psychological deficit, for example, social anxiety or difficulty confronting problems, real substance abuse begins. Once a “drug of choice” has been identified, this drug’s benefit as a coping mechanism promotes its regular use.
As a person’s regular use of a substance continues, often as a coping mechanism for emotional distress, tolerance to the drug or alcohol begins to build in the brain and body. As a result, the user must use more of the substance to get the euphoria or “high” that brings the stress relief he or she seeks. As users increase both the amount and frequency of their use, the lines begin to blur between when it’s safer to use and when it’s more dangerous. Binge drinking and drunk driving are two examples.
Dangerous use can build into dependence if the user continues to rely on the drug to cope with the anxiety that he or she may feel from a range of sources. Even if physical addiction hasn’t occurred, emotional dependence can be a strong motivator.
Eventually, the brain adapts to the constant presence of one’s drug of choice, modifying how it operates to include the substance. Once this has occurred, a person feels sick without the substance in his or her body, and full addiction has taken hold.
What is Drug Abuse Treatment?
Addiction treatment is highly-structured counseling that draws from several disciplines to help a person struggling with addiction begin healing. Treatment is a combination of education - understanding what addiction is and how recovery works - and the development and practice of new ways of coping and living life that support long term recovery.
Here’s What The Treatment & Counseling Process Looks Like
Before everything is the question of physical health.
- Does the client need help with detoxing from substance use?
- Is the client medically stable?
- Does the client need other health care services?
Next, through an assessment process, the counselor will uncover deficits that have developed in the client’s life as a result of substance use disorder. To start, the counselor will ask questions about physical health factors like exercise, proper nutrition, and sleep habits which are important factors to consider in the recovery process. As the assessment goes deeper, the counselor looks to uncover aspects of a client’s social life and spiritual connections which may need strengthening in order to support a sustainable recovery.
The assessment process will also uncover the possibility that co-occurring disorders are contributing to the addiction. If so, and when appropriate, the substance abuse counselor will bring in a professional who specializes in the type of co-occurring disorder that is burdening the client.
Once the assessment process is complete, the counselor and client collaborate on the creation of a substance abuse treatment plan that breaks down the areas of improvement into achievable goals, and puts them on a timeline. Using this plan, both the client and counselor can plan and measure the client’s work toward building a life in recovery.
With assessment and treatment plan complete, the client is ready to join a substance abuse therapy group. At most levels of inpatient and outpatient care, therapy is a mix of group and individual sessions. Group sessions form the backbone of drug addiction counseling because through the interaction with others in early recovery, clients gain perspective on their own recovery, and benefit from helping their peers gain similar perspective. Individual sessions provide time to discuss topics better explored in private as well as time for family therapy and case management.
Depending on the level of care, a client can expect to participate in a few or all of the following treatment modules explained here.
Types of Treatment
The “continuum of care” in drug addiction treatment spans the most intense levels of care through post-treatment recovery support. Ideally, clients progress from higher levels of care to lower levels, however, depending on a client’s success at a particular level, the counselor might recommend a higher level of care.
Medical Stabilization (Detox)
A person who drinks heavily every day may need supervised medical stabilization, also known as “detox”, for a period of 5-7 days. Withdrawal from any addictive substance can be unpleasant, but alcohol withdrawal in severe cases can result in delirium tremens (the DTs), which in the worst cases, if not medically supervised, can result in severe complications and even death.
Residential (Inpatient) Treatment
Just like it sounds, a “residential” drug and alcohol rehab center requires that you live at the center during your treatment. The terms “inpatient” and “residential” are often used to mean the same thing, but an inpatient facility might be more likely to be located in a hospital, rather than a separate treatment center. Hospital-based inpatient programs offer around-the-clock medical care, compared to inpatient/residential facilities located outside of a hospital, which may not.
A residential program can provide more of the continuum of care, beginning with medial stabilization and then stepping down through lower levels of care. A residential program is more likely to offer physical services, like nutrition and exercise, as well as alternative therapies, like equine and art therapies.
An extended care program is a residential program that offers a multi-month program, often 90 days.
Outpatient care refers to any level of care which does not include a medically/professionally supervised residential component. Partial Hospitalization (often called “PHP” or “Day Treatment”), Intensive Outpatient, and Outpatient are the three most common levels of Outpatient Treatment.
Partial Hospitalization is generally a 6-8 hour program five days weekly. Clients attend during daytime hours. PHP consists of the same kind of structured care provided in residential programs, but at the end of the day, clients go home. It’s common for clients in early sobriety to reside in a Sober Living Home (also know as a Sober Living Environment or Recovery Residence) while enrolled in Day Treatment.
Intensive Outpatient (IOP)
Intensive Outpatient Programs, often called IOP, are the next step down from Partial Hospitalization. Typically, IOP meets three times weekly for three-hour sessions, although clients may start with four or five sessions weekly and step down to three. IOP is approximately 80% group therapy, with the remaining 20% consisting of individual sessions.
Outpatient Treatment is the lowest level of professional substance abuse treatment. The frequency and mix of group and individual sessions depends on the counselor’s assessment of the client’s treatment needs. An Outpatient program can be an equal mix of weekly group sessions, usually 60-90 minutes, and hour-long individual sessions, or a different mix, that also can change flexibly as a client’s needs evolve.
Mutual Support Groups
Mutual support groups, like Alcoholics Anonymous (AA), play a critical role in recovery, but they themselves are not substance abuse treatment as it is currently defined. Treatment is provided by healthcare professionals, is “evidence-based” psychological therapy (like Cognitive Behavioral Therapy - CBT), and focuses on the individual with in-depth assessments and treatment plans that are customized each individual client. Treatment is “inside-out”, focused first on changing thinking patterns, so that changed behavior can follow.
Mutual support groups are led by peers - people in recovery from all walks of life. They are typically (but not always) spiritually-based, and they focus on the group, the community. AA calls it a “design for living”, and it is a philosophy of how to live in recovery. In sum, it is “outside-in”, implicitly putting behavioral change first, with the idea that understanding will flow from these changes, in turn changing thinking patterns generally.
How are Medications used in addiction treatment?
Medications are used in treatment as part of a holistic approach to finding a life in recovery. Early in drug addiction treatment, during a medical stabilization program or detox, medications may be used to ease the pain of withdrawal. In some cases, clients begin medication maintenance program designed to suppress cravings for drugs and alcohol. In alcohol abuse treatment, a different mix of medications can be used to effect the same outcome.
Once a client is medically stable, and begins to focus on behavioral therapy, the use of medication moves to support of a client’s mental stability. A majority of addiction clients struggle with some sort of co-occurring disorder, typically a psychological disorder that creates anxiety. Medications that counter depression, anxiety, and obsessive compulsive disorders are the most common way in which medications are used in conjunction with substance abuse counseling.
Finding a Treatment Provider
How to Choose a Treatment Provider
“There are many paths to recovery” is a cliche in the substance abuse treatment field, but it is true. The right treatment provider is the one who best fits a particular client’s individual needs.
Because this is true, the most important thing to consider is whether your prospective provider agrees with the concept of individualized treatment. At minimum, the right provider will perform an in-depth assessment, and from this create a treatment plan that addresses the breadth of needs of each client. Although many of the structures of treatment (group therapy, individual sessions, education and homework assignments) may be similar from program to program, treatment is most effective when it addresses each person as an individual.
How Long Does Treatment Take?
Treatment itself, from detox through step-downs in level of care to outpatient, is generally a 90-120 day process, though this can vary widely, depending on an individual client’s needs.
Substance Use Disorder, as Drug Addiction is now called, is generally a chronic illness that can have one or more acute phases. While short term treatments, such as detox and residential care can be a good start - especially so when treating the more acute aspects of the disorder - clients who follow treatment with involvement in a sober community/mutual support group generally have more success building a life in recovery.
The brain disease caused by long term drug and alcohol abuse can take up to a year of sobriety to heal, and if co-occurring disorders are present, these must be addressed over time, often with both behavioral and medication-based treatments. So, while treatment itself may be relatively brief, success in recovery requires a long term commitment.
How Much Does Treatment Cost?
Treatment costs vary widely, and are often covered by health insurance. Many programs make allowance for hardship in their pricing when people who need help cannot afford their care, and health insurance coverage isn’t available. There are also community-based treatment programs that cost little or are free. Mid-level outpatient treatment programs costs range from under $1,000 per month up to $5,000 per month, depending on the level of care. At the high end, private treatment programs can cost as much as $60,000 to $90,000 per month of residential care.
Is Insurance Accepted?
Both private healthcare insurance and public programs like Medicaid often cover alcohol and drug abuse treatment programs, though it’s not unusual to have some limitations on coverage. Check with your insurance carrier or a prospective treatment provider to find out more.
Inpatient vs Outpatient Treatment?
Inpatient vs Outpatient are two broad levels of care within the continuum of care. The best way to choose level of care is through a professional assessment by a behavioral health professional. There are times when barriers to treatment, like access or cost, add a non-clinical aspect to the decision of what level of care to pursue, but this is not ideal. Medical stability, time abstinent from drug or alcohol use, and motivation to adhere to an outpatient treatment program are some of the criteria assessed in making the determination as to appropriate level of care.
How Private is Treatment?
The U.S. federal government’s HIPAA regulations govern the privacy requirements for Substance Use Disorder treatment, as they do any provision of health care in the U.S. Under HIPAA rules, all of your “personal health information” must be private, and there are strict rules concerning how your “PHI” may be disclosed. Every treatment provider explains these provisions in the agreement clients sign before beginning treatment.
Making Treatment Work for You
Used in combination, substance abuse treatment and mutual support groups/communities form the most reliable path to recovery. They support the needs of early recovery and those that arise over time. Treatment is an accelerator of recovery that helps a person struggling with addiction to understand what addiction is, from its biomedical aspects to its social aspects, and what is driving the addiction. Building this understanding and becoming equipped with a set of skills to cope with addiction, including potentially medication therapies, builds the resilience needed to make it through early recovery. Adding a long term relationship with a recovery community provides
How to Avoid Relapse
Despite how it may seem, relapse is a process. The final act of relapse, picking up a drink or using a drug, only comes after a preventable decline in the awareness and maintenance of a person’s recovery. That’s because recovery is a set of behaviors and habits that together ensure the stability and health of a person who struggles with addiction. Whether it’s physical health (nutrition, sleep, exercise), psychological health (treating one’s depression or anxiety), or social/spiritual health (finding a recovery community to provide peer support), relapse begins when a person in recovery overestimates the strength of his recovery, or underestimates the challenge that addiction poses to long-running health.
So, there is no magic bullet, and avoiding relapse is the focus of all good treatment and mutual support groups. The only way to avoid relapse is to understand and work hard at the art of recovery.