Treating a patient for substance use disorder is a highly complex undertaking. Even compared to other mental health issues, treating substance use disorders can be quite challenging due to the patient’s compulsion to act against their self-interest. By taking the time to understand substance abuse and the available treatment options, both patients and those that care for them can make more informed choices, leading to better outcomes.
What Are Substance Use Disorders?
To understand why structured treatment and rehabilitation is often necessary, first we have to understand what substance use disorders are. Substance use disorders, also called “substance” misuse, refers to any use of substances in a manner that isn’t medically recommended. In the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) updated in 2013, the term “substance use disorder” has largely superseded both “substance abuse” and “substance dependence” as described in the older DSM-IV.
Substance use disorders are ranked by their severity, with “addiction” being typically used to describe the most severe forms. The National Institute on Drug Abuse officially defines addiction, the most severe form of substance abuse disorder, as “a chronic, relapsing disorder characterized by compulsive drug-seeking, continued use despite harmful consequences, and long-lasting changes in the brain”.
Even in less severe cases, substance use disorders typically have a strong psychological component and may involve a physical dependence on the substance as well. The strong compulsion of patients with these disorders as well as the poor health many patients have due to their illness makes them extremely difficult to treat outside of a highly controlled environment.
Thankfully, decades of research and the resulting better understanding of the science behind substance use disorders has, in turn, led to better treatment outcomes.
When Is Treatment at a Rehab Center Necessary?
It can be difficult for patients with substance abuse disorder to admit that they need help. Contrary to depictions in popular culture, most drug users do not hit “rock bottom” shortly after developing a substance use disorder. Most are able to lead lives that appear normal on the surface for years. Because many people that abuse harmful substances remain productive or develop strategies to hide their condition, it can be difficult for both the patient and casual observers to spot a substance use disorder unless they know what to look out for.
If the following apply to you or a loved one, you may want to strongly consider seeking medical help and checking in to a rehabilitation center:
1.) Your physical health is beginning to suffer
2.) Finding and using your drug of choice is your number one priority
3.) You have an underlying mental illness
4.) You recognize you have a problem
5.) Your drug tolerance is far beyond a normal person’s
How Is a Substance Use Disorder Diagnosed?
As with any mental illness, only qualified medical professionals can tell for sure if a patient has a substance abuse disorder or some other related condition. Typically, a physician will try to rule out physical causes and administer a thorough psychological evaluation.
As substance use disorders often have physical as well as mental effects on a patient, the attending physician will try to take these into account. Occasionally, lab tests may be administered to check for hormone and drug levels or signs of brain damage.
Types of Addiction Treatment Programs
Treatment programs are diverse and the types of programs continue to expand our knowledge of the mechanisms behind substance use disorders. However, most of these programs do have some features in common that it is possible to classify them according to different types. The National Institute on Drug Abuse groups treatment programs into the categories below:
Long-term Residential Treatment
These programs provide patient care 24/7, usually in a specialized treatment center or a “therapeutic community” rather than a hospital. Patients may be undergoing treatment for anywhere from 6 to 12 months. Aside from withdrawal management and other forms of physical therapy, substance use disorder treatment centers that provide long-term residential treatment also focus on helping patients address the root causes of their condition, including underlying personal issues.
To this end, the staff and patients will work together to help change self-destructive behavior. Because serious substance abuse can also take a toll on a patient’s eating habits, social life, and job prospects, these programs will often include education on better nutrition, socialization, and job training as part of the recovery process.
Short-term Residential Treatment
These programs are relatively short compared to long-term treatments, but they could be quite intensive as well. Short-term residential treatment programs often incorporate a modified form of the popular “12-step” approach popularized by the founders of Alcoholics Anonymous. They typically involve inpatient treatment at a hospital lasting up to 6 weeks, followed by outpatient therapy. This outpatient therapy may be in the form of individual or group sessions. These outpatient sessions are necessary to prevent patient relapse, given the short duration in which patients are directly supervised.
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Patients with substantial social support may want to opt for outpatient treatment. The types and intensity of outpatient treatment vary widely, ranging from short intensive treatments done in a hospital setting to regular education and therapy sessions in a classroom. These may not be appropriate for patients with more serious substance use disorders given the lack of direct supervision during much of the treatment period. However, for patients with less severe substance use disorders and an intact support network, outpatient treatment can be an economical alternative.
In these types of treatments, patients regularly visit a psychiatrist or qualified counselor to not only address the disorder itself, but to also treat other underlying conditions that contribute to it. As these sessions are typically one-on-one, they are a good way for patients to develop highly individualized strategies for overcoming their substance use problems as well as other related issues. Counselors may also provide other types of support needed for a patient to better reintegrate into society.
Social reinforcement can be a useful way to help curb a recovering patient’s residual drug cravings. Sessions with other patients that have had similar experiences are a proven way to stave off the isolation that many people with substance dependency issues often face. Group sessions are now an extremely common part of substance use disorder therapy and nearly all inpatient and outpatient treatments will include it in some form.
Patients that have run-ins with the law may be legally compelled to attend treatment or drug counseling sessions in prison, as part of a deal to avoid jail time or as part of some other condition set by the court. While it’s ideal for patients to seek treatment out of their own free will, there is some evidence that the threat of legal repercussions can help improve outcomes for substance use disorder patients, likely due to the additional monitoring and the possibility of better isolating the patient from associates involved in drugs.
What Is Detox and Withdrawal Management?
Today, “withdrawal management” has become the preferred term to describe the process popularly known as “detox” or “medical detox.” The reason for the change among treatment specialists is that detox or detoxification more accurately refers to the natural process by which our bodies expel toxins, such as the case when a patient’s body naturally excretes drugs through their urine, stool, and sweat.
“Withdrawal management” is a more accurate term used by treatment specialists to refer to the types of intervention used so that a patient’s body can detoxify more safely.
While extensive withdrawal management is not necessary in all cases, there are many classes of drugs where suddenly stopping one’s intake is not recommended. Serious dependence on alcohol, opiates, and benzodiazepines, for example, will have to be managed more carefully as quitting “cold turkey” on these types of drugs can potentially be fatal. Attending physicians will normally administer some kind of “substitute drug” that will help safely wean the patient off of their drug of choice.
What Are Patient Alumni Programs?
Substance use disorders can have lifelong effects on a patient’s brain that causes them to continually crave for their drug of choice. Also, even if their preferred drug is no longer present within their system, the circumstances that led them to abuse drugs may still be present. They may also retain cravings for the drug due to a feeling of comfort and a strong psychological dependence.
Another issue is that patients that undergo treatment often find themselves unable to relate to other people, including those who they may have taken drugs with. This can lead to feelings of isolation which can trigger a relapse. Oftentimes, the only people a patient can truly relate with are those that have undergone experiences similar to theirs.
To help retain and improve positive patient outcomes, many treatment centers offer alumni programs so patients can continue to keep in touch and help with each other’s recovery over the long term, possibly years after they leave the initial treatment program.
The strong compulsive behaviors caused by serious substance use disorders make them challenging to treat outside of a controlled environment. A patient with a severe case may experience better outcomes if their ability to procure drugs or harm themselves is heavily restricted.
Effective treatments are not just about weaning off patients of their drug of choice either, but rather, are intended to help address the root causes of substance abuse, including underlying mental disorders as well as social, familial, and professional issues. By adopting a more holistic approach, patients have a much better chance at becoming happier, more empowered, and better integrated with their families and communities.