How does Substance Abuse Treatment Work?

Substance Abuse Treatment

In 2014, the National Survey on Drug Use and Health (NSDUH) found that nearly 30 million American adults used an illicit drug in the month prior to their survey and almost 140 million adults in the United States drank alcohol during that time. Close to 22 million Americans, ages 12 and older, suffered from a substance use disorder in 2014.

There a several different types of drugs that may be abused, including illegal drugs and prescription medications. Drugs and alcohol can have mind-altering effects and may serve to increase some of the naturally occurring chemicals in the brain that induce pleasure, creating a desirable “high.” Drugs may be abused in order to escape reality, to relieve stress or increase sociability, as a form of self-medicating medical or mental health problems, or just as a method of feeling good. People may start out with legitimate prescriptions for medications that can be habit-forming and have a high potential for misuse, and then begin abusing them.

Being the victim of trauma and having high levels of stress can increase the risk for drug and alcohol abuse, as the National Child Traumatic Stress Network (NCTSN) reports that almost three-quarters of studied adolescents in a substance abuse treatment program had a previous history of exposure to trauma. Other environmental factors, such as a lack of a good support system or elevated levels of stress at home, can also lead to experimentation with drugs and alcohol. Genetics, biology, and family history of substance abuse and addiction can make a person more vulnerable to problems with substance abuse as well.

Common Substances and Rates of Abuse in the United States


Alcohol is the most regularly used addictive substance in America, as one out of every 12 adults battles alcohol addiction, the National Council on Alcoholism and Drug Dependence (NCADD) publishes. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that as of 2015, almost 90 percent of adults in the United States have consumed alcohol at least once in their lives.

Alcohol is legal, relatively inexpensive, easy to obtain, and regularly part of social interactions among adults. Alcohol can be consumed responsibly by adults who are of legal age. When women drink fewer than three drinks in a sitting (and fewer than seven total in a week), or men drink fewer than four in a sitting (and fewer than 14 in a week), NIAAA says that this is considered to be low-risk drinking. Binge drinking (bringing the blood alcohol concentration [BAC] above 0.08 g/dL) and heavy drinking (binge drinking five or more days in a month) on a regular basis may lead to issues with alcohol abuse and potentially even to dependence and addiction.


Made from the Cannabis sativa plant, marijuana is considered an illicit drug on the federal level; however, many states have legalized the medicinal and even recreational use of this plant-based mind-altering substance. While marijuana is generally smoked, it can also be infused into beverages and edibles to be ingested.

The National Institute on Drug Abuse (NIDA) reports that within the United States, marijuana is the top-used illicit drug, as more than 22 million Americans used it in the month leading up to the 2015 NSDUH. Marijuana has both hallucinogenic and depressant properties as it alters perceptions of time, the senses, and the surrounding environment while also slowing down blood pressure, respiration, and heart rate, and lowering stress and anxiety levels. A marijuana “high” is generally considered to be relaxing, although heavy use may induce psychosis.

Marijuana use can lead to addiction. NIDA warns that about 30 percent of those who use marijuana are estimated to suffer from a marijuana use disorder. This risk is increased between four and seven times if marijuana is used prior to age 18.

Opioids, including heroin and prescription painkillers

Initially derived from the opium poppy plant, opioid drugs include the illicit street drug heroin and prescription pain relievers, such as fentanyl, morphine, oxycodone (OxyContin), hydrocodone (Vicodin), and codeine. Most of these prescription opioids are classified as Schedule II controlled substances, the highest designation for drugs with accepted medicinal use.

Opioid drugs are effective for pain relief; however, prolonged use can be habit-forming. When misused, opioid drugs can create a mellowing feeling as well as a surge of euphoria. These drugs are central nervous system depressants, which slow breathing, heart rate, and blood pressure, and lower body temperature.

The 2014 NSDUH found that close to 5 million American adults were considered current opioid drug abusers (counting both licit and illicit opioids), and the American Society of Addiction Medicine (ASAM) reports that over 2.5 million people in the United States battled addiction to these potentially dangerous drugs in 2015. Opioid overdoses are driving the rising rates of drug overdose fatalities, as the Centers for Disease Control and Prevention (CDC) warns that over 60 percent of all overdose deaths in the United States involved an opioid drug in 2014.

Stimulants (cocaine, methamphetamine, and prescription stimulants)

Around 3 million American adults abused a stimulant drug in the 30 days before the 2014 NSDUH, including illegal drugs like cocaine and methamphetamine, and prescription stimulant drugs like those that are prescribed to treat ADHD (attention deficit hyperactivity disorder), which contain amphetamine/dextroamphetamine (Adderall) or methylphenidate (Ritalin and Concerta). Cocaine comes from the coca plant, mostly found in South America, while meth (short for methamphetamine) is typically manufactured in illicit laboratories for street distribution. Prescription stimulants are classified under Schedule II of the Controlled Substances Act (CSA).

Cocaine and meth may be marketed in either powder to be snorted, smoked, ingested, or injected, or in rock (“crack cocaine”) or crystal (“crystal meth”) formulations that are typically smoked. Prescription stimulants may be taken as “study drugs” by those who don’t have a legitimate prescription for them in order to help a person focus or stay awake longer, although this kind of misuse can be highly risky. College students are a high-risk population for misusing these medications, and CNN reports that as many as 30 percent may be misusing prescription stimulants.

Stimulant drugs increase energy and alertness levels while creating an intense high. Heart rate, body temperature, and blood pressure are all increased by stimulant use. These drugs are considered to be highly addictive.

Prescription and over-the-counter (OTC) medications (depressants and cold medications)

Aside from alcohol and marijuana, OTC and prescription drugs are the most regularly misused substances in the United States by those over the age of 14, NIDA reports. Aside from opioid painkillers and prescription stimulants, benzodiazepines (tranquilizers and sedatives), including anti-anxiety medications like Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam); antidepressant drugs, such as Prozac (fluoxetine), Effexor (venlafaxine), and Zoloft (sertraline); and sleep aids like Ambien (zolpidem) and Lunesta (eszopiclone) are common prescription medications that are misused. Cough and cold medications containing dextromethorphan (DXM) are often abused as well.

Any use of an OTC or prescription medication without a legitimate medical need or required prescription is considered abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that 15 million Americans (ages 12 and older) abused a prescription drug in 2013. There is a common misconception that since these drugs are available over the counter, or can be prescribed by a doctor, they are “safer” to use; however, misuse can cause multiple problems, not the least of which are overdose and addiction.

Club drugs (ketamine, MDMA, GHB, Rohypnol)

Club drugs are commonly abused in a nightclub setting by adolescents and young adults. Drugs like MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy or Molly, are created in laboratories for recreational abuse. Ecstasy and Molly may be distributed in on blotter paper, or in tablet, liquid, or powder form. They are usually ingested to induce a lasting high that promotes emotional warmth, heightened senses, and sexual feelings while distorting time perception, and increasing energy and pleasure.

Almost 7 percent of people, ages 12 and older, in the United States (as of 2015) report using MDMA at some time in their lives, NIDA publishes.

GHB (gamma-hydroxybutyrate) and Rohypnol (flunitrazepam) are often called “date rape drugs” as they can cause memory loss, sedation, and lowered inhibitions. Coming in clear, odorless, and tasteless liquids, these drugs may be added to drinks unknowingly and act as sedative hypnotics.

Ketamine is typically used in veterinary practices as an animal tranquilizer. It is a dissociative anesthetic that may be abused for its hallucinogenic and sedative properties. Along with ketamine, GHB and Rohypnol are depressants, slowing central nervous system activity and interfering with cognitive abilities and decision-making processes. They may also produce a euphoric feeling.

These drugs are largely illegal and have many hazards associated with their use.

Hallucinogens (PCP, LSD, mescaline, etc.)

Drugs that are considered in the class of hallucinogens are generally illegal drugs that distort the senses and alter a person’s mental state. A high from one of these drugs is often called a “trip,” and these trips can be long-lasting and unpredictable. Sometimes, people claim to experience a spiritual awakening while “tripping” but others may suffer from panic attacks, paranoia, delirium, and violent or aggressive behaviors during a “bad trip.”

LSD is made from lysergic acid. PCP (phencyclidine), often called angel dust, began as a general anesthetic but now has no accepted medical uses. Many other hallucinogenic drugs come from plants or their extracts (e.g., peyote, salvia, psilocybin, DMT, and ayahuasca).

Over 1 million Americans abused a hallucinogenic drug in the month before the 2014 NSDUH. These drugs change the way people see the world and themselves, and cause users to see, hear, or feel things that are not actually there. They may be swallowed, brewed in tea, injected, smoked, or inhaled, and they come in many different forms.

While not typically considered to be addictive, the abuse of hallucinogenic drugs can cause a person to experience “flashbacks” many months or even years after taking them. Trips can also be unpredictable and have unintended or undesirable side effects.

Inhalants (solvents, nitrates, aerosol sprays, gases)

Inhalants are typically abused by younger people. These items are generally found in common household or commercial products. NIDA publishes that close to 10 percent of people in the United States report abusing an inhalant at least once in their lifetime as of 2015.

Inhalants include things like gasoline, nail polish remover, paint thinner, glue, spray paints, aerosol whip cream dispensers (“whippets”), or anesthetic gases like chloroform, nitrous oxide (“laughing gas”), or ether. Nitrates are sold under the guise of “video head cleaner” or “room odorizers” for sexual enhancement.

Inhalants are abused by “huffing” (inhaling toxins from chemical-soaked rags), “sniffing,” “bagging,” (spraying fumes into a bag and then inhaling), or spraying them directly into the mouth or nose. These products all produce mind-altering effects and can be damaging to the brain.

Drug Use to Abuse

Any use of an illicit drug is classified as drug abuse. Prescription drugs are also misused when someone who doesn’t have a prescription uses them. Essentially, drug diversion occurs when a prescription drug is diverted from licit channels and taken without a prescription. Prescription medications are diverted through theft, fraudulent prescriptions, illicit sale, and by borrowing, receiving, or taking them from a relative or friend for free. People may make up or exaggerate symptoms of illness in order to receive prescription medications, or “shop” different doctors to get them. Individuals may also continue to take a prescription after it is no longer medically necessary to do so, or they may take it in a manner or amount other than as prescribed.

Misuse of prescription drugs is a huge public health concern. Any nonmedical or recreational use of a prescription medication should be addressed.

Abusing drugs can cause a multitude of issues, from physical and emotional to social and behavioral concerns. Drugs change the way a person thinks, feels, and acts by altering brain chemistry. Many drugs impact some of the brain’s natural messengers, called neurotransmitters.

Levels of dopamine, serotonin, norepinephrine, glutamate, and GABA (gamma-aminobutyric acid) can be impacted by drug abuse. These neurotransmitters have a variety of functions, including emotional regulation, movement, feelings of happiness, sleep functions, learning and memory, energy, appetite, and more. When brain chemistry is changed due to substance abuse, individuals may feel more happy, energetic, and sociable. They may take bigger risks, engage in potentially hazardous behaviors, and make bad decisions. Drugs can also alter moods and may cause a person to suffer psychotic symptoms or become aggressive or violent.

When Drug Use Becomes Addiction

Using drugs regularly (even licit ones with a prescription) can cause a tolerance to build, and a person will need to take higher doses to keep feeling the desired impact. Escalating dosage can speed up the rate of physical dependence a person can develop when they take drugs on a long-term basis.

Drug dependence occurs when brain chemistry is so altered by drug use that it is out of balance without the drug’s interaction. This means that when the drug wears off, withdrawal symptoms and drug cravings can occur.

Withdrawal symptoms can range from mild to life-threatening. They may include both physical (flulike side effects, irregular heart rate and blood pressure, tremors or seizures, etc.) and emotional symptoms (depression, anxiety, cognitive deficits, insomnia, etc.). Individuals may choose to keep taking drugs in order to avoid difficult withdrawal symptoms. A person may then no longer be able to stop taking drugs on their own.

Compulsive and out-of-control drug-seeking and using behaviors are earmarks of addiction. Addiction is classified as a brain disease by ASAM, which occurs when brain chemistry is altered by substance abuse and an individual no longer has control over use.

The most current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as published by NIDA, reports that if a person suffers from two or more of these symptoms in a one-year period, they may be diagnosed with a substance use disorder:

  • Desire to stop using drugs but inability to do so
  • Using drugs more often and in larger amounts than intended
  • Continuing to use drugs in situations that may be deemed hazardous
  • Spending an inordinate amount of time getting drugs, using them, and recovering from them
  • Cravings for drugs
  • Using drugs despite interpersonal and social issues that drug use creates
  • Giving up social or other activities that were important in order to use drugs instead
  • Drugs interfering with a person’s ability to fulfill regular life obligations
  • Continuing to use drugs even though doing so will bring a person physical and/or emotional harm
  • Drug tolerance
  • Withdrawal symptoms

The severity of addiction is defined by how many of these symptoms are present. Things like co-occurring disorders, genetic or biological vulnerabilities, polydrug abuse, using substances at a young age, and environmental stressors can exacerbate and increase the severity of addiction.

Hazards of Substance Abuse

One of the biggest possible dangers of drug abuse in the short-term is a life-threatening overdose. The CDC reports that over 50,000 Americans died from a fatal drug overdose in 2015, the highest amount ever recorded in one year.

With even just one use, drugs can become toxic in the brain and body as the system is unable to metabolize them properly. Brain damage, coma, and death may all be the result of a drug overdose. Signs of an overdose include:

  • Extreme drowsiness or loss of consciousness
  • Nausea and vomiting
  • Trouble breathing or stopping breathing altogether
  • Irregular blood pressure and heart rate
  • Significant mental confusion
  • Psychosis
  • Changes in body temperature (either too hot or too cold)
  • Loss of muscle control and coordination
  • Tremors or seizures

In addition to fatal overdose, there are several more possible dangers from drug abuse. The Drug Abuse Warning Network (DAWN) publishes that in 2011, approximately 2.5 million Americans were treated in an emergency department (ED) for misuse or abuse of drugs. Individuals under the influence of drugs or alcohol may be more likely to become the victim of a crime, get into an accident, be injured, or do things they wouldn’t normally do.

Close to one-third of fatal motor vehicle accidents in the United States involve a driver or pedestrian who is intoxicated, NCADD publishes. Substance abuse impairs thinking and decision-making, and individuals are more likely to get into trouble while using them. The risk for contracting an infectious disease, such as hepatitis or HIV/AIDS, or a sexually transmitted disease (STD) increases with substance abuse. People may be more prone to engage in unsafe sexual practices while intoxicated or share dirty needles when injecting drugs.

Long-term substance abuse can lead to dependence and addiction. It may also cause the following issues:

  • Cardiovascular concerns and increased rate of heart disease, failure, and cardiac arrest
  • Liver problems, including cancer, cirrhosis, and disease
  • Weakened immune system
  • High blood pressure and raised risk for stroke
  • Increased risk for many types of cancers
  • Pancreatitis
  • Infections of the skin and blood
  • Constipation and gastrointestinal issues
  • Changes in appetite and potential malnutrition
  • Irregular sleep patterns
  • Sexual dysfunction
  • Brain damage
  • Psychosis
  • Respiratory issues, including lung infections, asthma, pneumonia, bronchitis, and lung disease
  • Hearing loss
  • Kidney damage
  • Damage to bone marrow levels
  • Risk for developing tuberculosis (TB)
  • Anxiety
  • Depression
  • Increased rate of suicidal ideations
  • Changes in personality and difficulties regulating moods (mood swings)
  • Hormone imbalance
  • Memory and learning problems

Help for Substance Abuse and Addiction

When substance abuse interferes with a person’s ability to function normally in their daily life, it is time to seek help. There are many different forms of treatment to choose from, which range from flexible outpatient programs that can work around a person’s existing schedule to more structured and comprehensive residential programs where a person stays on site for a length of time in order to fully address all aspects of drug abuse and addiction. In general, the more heavily dependent on drugs or alcohol a person is, the higher the level of care may need to be. Medical, mental health, and substance use assessments and evaluations are helpful tools used by trained providers in order to determine the type and level of care that will be best.

A treatment plan may include various components, such as:

  • Detox: Medical detox can manage the side effects of drug and alcohol withdrawal while toxins process out of the body. In the case of alcohol, benzodiazepines, and opioid drugs, medical detox is often required, as these substances should not be stopped suddenly without professional care. Medical detox will often use pharmaceutical tools to manage withdrawal and help a person become physically stable.
  • Counseling and therapy: Group, family, and individual sessions help people to work through personal concerns, engage in life skills trainings, and modify negative thought and behavior patterns to improve communication skills and learn how to manage stressors.
  • Medication management: Medications are often beneficial during addiction treatment and recovery, and professionals can help individuals learn to manage them.
  • Education: Learning about the disease of addiction and what to expect in recovery can be helpful in sustaining long-term abstinence.
  • Relapse prevention: Tools for spotting potential triggers and learning how to manage them going forward are important, as NIDA reports that drug addiction relapse rates are 40-60 percent. Relapse prevention programs as part of a complete treatment plan can help to minimize relapse.
  • Support groups: Twelve-Step programs and other peer-based support groups can provide lasting encouragement and help with sustaining abstinence long-term, as groups are made up of similar individuals who can empathize and offer advice for recovery.
  • Transitional services: Sober living homes and other transitional programs can be helpful when a person leaves a treatment program and is not quite ready to re-enter society fully. These living environments provide stability and security in a drug-free setting so people have time for healthy habits to become ingrained.
  • Co-occurring disorders treatment: SAMHSA publishes that close to 8 million people in the United States battle both a substance use disorder and a mental illness. When both of these disorders are diagnosed in the same person at the same time, they are said to be co-occurring. During addiction treatment co-occurring disorders are managed in an integrated and simultaneous fashion by highly trained professionals.
  • Alumni and aftercare programs: There are many types of aftercare and alumni services that are provided to help people maintain recovery and long-term sobriety.

An important aspect of addiction recovery is remaining in a treatment program for long enough to allow the brain time to heal and for new habits to be formed. NIDA recommends at least 90 days in a treatment program. Staying in a treatment program for an extended amount of time may help to lessen and minimize instances of relapse as new coping mechanisms and tools are learned and solidified.

Medications for Addiction Treatment

Medications are often necessary during medical detox in order to lessen or eliminate withdrawal symptoms. These medications may include supplements, vitamins, and pharmaceutical tools designed to manage specific symptoms, such as antidepressants, sleep aids, gastrointestinal medications, and more. Clonidine, a blood pressure medication, is often used off label to treat withdrawal from central nervous system depressants, such as opioids, alcohol, and benzodiazepines, as it can calm the sympathetic nervous system. Medications are often necessary to treat co-occurring medical or mental health disorders as well, which is why it is important for treatment providers to work together in an integrated manner to ensure that all potential complications are minimized or avoided.

Since alcohol withdrawal can be life-threatening (in its most severe form: delirium tremens), it is often slowly tapered off during detox instead of stopped “cold turkey.” There are four main drugs used to treat alcohol addiction and prevent relapse, NIDA publishes. Topiramate (Topamax) is an anticonvulsant drug that may be beneficial in treating alcohol withdrawal and addiction. Acamprosate (Campral) may help with lasting withdrawal symptoms, and both naltrexone (Vivitrol, ReVia) and disulfiram (Antabuse) work as deterrent medications to keep individuals from returning to alcohol use after completing detox and a treatment program.

Benzodiazepine and opioid drugs may also be tapered off, and short-acting drugs are commonly replaced with longer-acting ones to be weaned off during a taper. Methadone (Methadose, Diskets, Dolophine) and buprenorphine (Subutex, Probuphine) are long-acting opioid drugs that are approved for the treatment of opioid addiction. Methadone is a full opioid agonist with an extremely long half-life, which means that it can be dispensed as little as once per day and still keep withdrawal symptoms and cravings at bay. As a full agonist, it may also be abused, however.

Buprenorphine is only a partial opioid agonist, and it even has a “plateau” effect after a set amount builds up in the system, meaning that it does not induce the same kind of euphoric high that other opioids do. It is also commonly combined with the antagonist drug naloxone to further discourage abuse. Combination buprenorphine/naloxone medications (Suboxone, Bunavail, Zubsolv) are often used later on during opioid addiction treatment to maintain compliance. The naloxone component does not become active unless the medication is altered and abused via injection. If this happens, it can precipitate a more significant withdrawal syndrome.

Therapeutic and Holistic Methods for Treating Addiction

Behavioral therapies are typically considered the gold standard in addiction treatment. Therapies like Cognitive Behavioral Therapy (CBT) help individuals to recognize that what they think affects how they act. CBT works with people to identify why they may have abused drugs and/or alcohol in the first place and what they can do in the future instead. Self-destructive life habits and patterns can be reversed and self-esteem can be raised through CBT. Group and individual therapy sessions are both important, as during group CBT sessions, people are often taught new overall life skills and coping mechanisms, and during individual sessions, people can delve into personal thoughts and stressors that need to be addressed and managed. Homework is often assigned between sessions for individuals to practice newly learned skills.

Another form of behavioral therapy is Dialectical Behavior Therapy, or DBT, which was initially designed to treat bipolar disorder. DBT is a research-based method that helps individuals find the motivation to grow, change, and become more self-reliant.

Motivational Interviewing (MI) is another form of therapy, which helps people to find their own motivation to change. It is a non-confrontational method where the therapist and individual work together to accomplish positive change. Contingency Management (CM) programs use small rewards or incentives for positive drug tests in order to maintain sobriety. Family Systemic Therapy works with entire families to improve the functioning of the overall unit and is generally performed in intensive and short-term workshops.

Holistic therapies, such as art therapy or music therapy, can be beneficial as adjunctive methods to traditional treatments. Art therapy can be relaxing and uses artistic mediums to help people express themselves and communicate in a new way. It also helps to occupy the mind, which can serve to dispel cravings. Equine-assisted therapy uses horses and the care of these animals as therapeutic tools to build up confidence and communication skills. Other holistic measures, such as exercise programs, nutritional planning, chiropractic care, yoga, mindfulness meditation, neurofeedback, spa treatments, massage therapy, acupuncture, and more, can all supplement traditional treatment methods as well.

There are many different options available when it comes to substance abuse and addiction treatment. No matter which type of treatment is chosen, care should always be tailored to each individual, and the plan should be reassessed continually as progress is made.

Angie’s story:

Angie, a recovering addict living in Alabama, told her story to the Mobile Register. Once a healthy cheerleader in school, Angie’s years of cocaine addiction took a severe physical toll. “My stomach perforated, it just blew up. And I wound up in the hospital for a month on a morphine pump, ” she said. “And when I got out, I was addicted to pain medication.”

For ten years, Angie was in and out of doctors’ office, trying to get prescriptions. When doctors finally turned her away, Angie began using Dilaudid, a synthetic form of heroin. She contracted a serious staph infection in her arms that almost forced doctors to amputate. “I was living in my car, and then finally chose to go live in the streets,” she said. “I didn’t know there was a way out.”

Angie’s family refused to give up hope, and one Christmas they offered Angie the present of a drug rehab stay. She accepted, and experienced a remarkable turnaround. Angie returned to school and resumed her education, and found a new career. She now works as an addiction counselor, helping others find victory over the same battles she faced. “My life has never been the same,” she said.

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