Guide to Substance Abuse Rehab & Treatment Programs
Substance abuse is a major public health concern. The National Survey on Drug Use and Health (NSDUH) survey from 2017 established that among the US population aged 12 or older:1
- 30.5 million people used an illicit drug in the month prior to the survey.
- 140.6 million people were current alcohol users.
- 19.7 million people suffered from a substance use disorder (SUD).
- An estimated 20.7 million people needed substance use treatment, out of whom 4 million received some substance abuse treatments in the past year.
How Effective is Substance Abuse Treatment Program?
When substance abuse interferes with a person’s ability to function normally in their daily life, it is time to look into treatment options for substance abuse. There are many different forms of treatment available at specialized facilities for addiction treatment and recovery. The programs may include outpatient treatment that can work around a person’s existing schedule. Some options also entail more structured and comprehensive inpatient programs where a person stays on site for a length of time 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 they may need within a substance abuse treatment program.
An important aspect of addiction recovery is remaining in a substance abuse treatment program long enough to allow the brain time to heal and for new habits to be formed. NIDA recommends that treatment for substance abuse should be at least 90 days long. Staying in treatment for an extended amount of time helps to lessen and minimize the instances of relapse as new coping mechanisms and tools are learned and solidified.2
What Does a Substance Abuse Treatment Plan Look Like?
Substance abuse treatment plans typically include the following components:3
- 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 training, and modify negative thought and behavior patterns. The focus is often placed on improving communication skills and learning 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 drug addiction relapse rates are 40-60%.3 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 an inpatient treatment program for substance abuse 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: There are 9.5 million people in the U.S. who are struggling with an SUD and a mental health disorder at the same time.4 When both of these disorders are diagnosed in the same person at the same time, they are said to be co-occurring. In substance abuse treatment programs they are managed by trained professionals in an integrated and simultaneous fashion.
- 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.
What Are The Best Practices In a Substance Abuse Treatment?
According to Substance Abuse and Mental Health Service Administration (SAMHSA), the best practices in substance abuse treatment are the following:5
- Screening for hazardous substance use/misuse/abuse/use disorders and where there are indications of substance abuse referring the patient for specialty treatment.
- Screening for mental health problems, including depression and suicidal thinking.
- Assessing physical health.
- Developing a treatment plan that addresses all substance use and mental disorders by involving all necessary providers into the plan development: primary clinician, case manager, counselor, psychiatrist, medical provider.
- Determining if medications are needed and monitoring for effectiveness/side effects.
- Determining psychosocial treatments, which may involve counseling, psychoeducation, MI, CBT, CM, family therapy.
- Ensuring recovery support, which may involve vocational/educational assistance, child care assistance, transportation, or housing.
What Is the First Step of a Substance Abuse Treatment Plan?
When deciding which of the options for substance abuse treatment is the most appropriate for a particular patient, the first step is always a comprehensive medical, mental health, and substance use assessment and evaluation.
The treatment plan should be tailored to meet the individual needs of patients and it should be reassessed continually as progress is made.
Unsure where to start? Take Our Substance Abuse Self-Assessment
Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. This evaluation consists of 11 yes or no questions that are designed to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result. Please be aware that this evaluation is not a substitute for advice from a medical doctor.
What Medications Are Used In Drug and Alcohol Inpatient Rehab?
Medications are often necessary during 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.6
Medications are also often necessary in treating co-occurring medical or mental health disorders. This 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:6
- Topiramate (Topamax) is an anticonvulsant drug that may be beneficial in treating alcohol withdrawal and addiction.
- Acamprosate (Campral) may help with lasting withdrawal symptoms.
- Naltrexone (Vivitrol, ReVia) is used after completing detox and a treatment program to prevent relapse.
- Disulfiram (Antabuse) also works as deterrent medications to keep individuals from returning to alcohol use.
Benzodiazepine and opioid drugs may also be tapered off, whereby short-acting drugs are commonly replaced with the following longer-acting ones to be weaned off during a taper:6
- Methadone (Methadose, Diskets, Dolophine) 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. However, as a full agonist, it may also be abused.
- Buprenorphine (Subutex, Probuphine) 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.
- Naloxone is often used in combination with buprenorphine 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.
What Is a Holistic and Therapeutic Approach For Treating Substance Abuse?
Behavioral therapies are typically considered the gold standard in substance abuse treatment.7
- Cognitive behavioral therapy (CBT) helps 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. During group CBT sessions, people are often taught new overall life skills and coping mechanisms. In 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.
- Dialectical behavior therapy (DBT) 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 by using artistic mediums helps people express themselves and communicate in a new way. It also helps to occupy the mind, the purpose of which is to dispel cravings.
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 substance abuse treatments.