Substance Abuse 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.
Treatments 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 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 Should Be Included in a Substance Abuse Treatment Program?
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.
The Best Practices in 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 Typically the First Step in the Substance Abuse Treatment Process?
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.
Medications in Drug and Alcohol Abuse Treatment
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.
Therapeutic and Holistic Methods for Treating Addiction
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.
Frequently Asked Questions
- Any use of an illicit drug is classified as substance abuse. In addition to illegal drugs, prescription drugs are also misused when used without prescription. Prescription medications are diverted from licit channels through theft, fraudulent prescriptions, illicit sale, 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. Some patients may also continue to take a prescription after it is no longer medically necessary, or they may take it in a manner or amount other than as prescribed.8Substance abuse affects the levels of dopamine, serotonin, norepinephrine, glutamate, and GABA (gamma-aminobutyric acid). These neurotransmitters have a variety of functions, including emotional regulation, movement, feelings of happiness, sleep functions, learning and memory, energy, appetite, and more.9When 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.
- Drugs and alcohol can have mind-altering effects and may serve to increase some of the naturally occurring chemical processes 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. 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.10Other 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 also make a person more vulnerable to problems with substance abuse.11
Alcohol is the most regularly used addictive substance in the US, with 14.1 million people battling alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), almost 90% of adults in the United States have consumed alcohol at least once in their lives.12
Alcohol is legal, relatively inexpensive, easy to obtain, and often a 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.13
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 alcohol-related problems and potentially even to dependence and addiction that would require treatments for substance abuse.12
Made from the Cannabis sativa plant, marijuana is classified as 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.
Marijuana is the top-used illicit drug in the U.S.14 Additionally, marijuana users are the largest group among treatment seekers in substance abuse treatment programs.15
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.16
NIDA warns that about 30% 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 18.17
Initially derived from the opium poppy plant, opioid drugs include the illicit street drug heroin and prescription pain relievers. According to official substance abuse treatment statistics, the number of people who seek substance abuse treatment programs for heroin addiction in the U.S. is higher than for any other illicit drug, except marijuana.16
- Hydrocodone (Vicodin)
The most commonly abused prescription opioids are:1
- Oxycodone (OxyContin)
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 2017 NSDUH survey found that an estimated 2.1 million people had an opioid use disorder. Opioid overdoses are driving the rising rates of drug overdose fatalities, as the Centers for Disease Control and Prevention (CDC) warns that over 60% of all overdose deaths in the United States involve an opioid drug.18
An official estimate from 2017 is that 572,000 people in the U.S. had a stimulant use disorder in the past year.1
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. Drugs from this category are considered to be highly addictive and they include:19
- Illicit drugs, mainly cocaine and methamphetamine; 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 drugs such as those prescribed to treat ADHD (attention deficit hyperactivity disorder), which contain amphetamine/dextroamphetamine (Adderall) or methylphenidate (Ritalin and Concerta); prescription stimulants are classified under Schedule II of the Controlled Substances Act (CSA).20
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 do not have a legitimate prescription for them in order to help keep a 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: CNN reports that as many as 30% may be misusing prescription stimulants.21
Prescription and over-the-counter (OTC) medications
Aside from alcohol and marijuana, OTC and prescription drugs are the most regularly misused substances in the United States by those older than 14, according to NIDA reports.22
In addition to opioid painkillers and prescription stimulants, the most common medications that are misused are:23
- 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).
- Sleep aids, such as Ambien (zolpidem) and Lunesta (eszopiclone).
- Cough and cold medications containing dextromethorphan (DXM).
Any use of an OTC or prescription medication without a legitimate medical need or required prescription is considered abuse. The 2017 national survey found that 3.2 million people in the U.S. were current misusers of prescription pain relievers. Smaller numbers of people were current misusers of prescription tranquilizers, stimulants, or sedatives.1 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 such as MDMA, GHB, and Rohypnol, ketamine are commonly abused in a nightclub setting by adolescents and young adults.24
- MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy or Molly, is created in laboratories for recreational abuse. Ecstasy and Molly may be distributed 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. According to NIDA reports, almost 7% of people in the United States report using MDMA at some time in their lives.24
- 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, which means that they slow central nervous system activity and interfere 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.24
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,” which 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.”
Common hallucinogens are PCP, LSD, and mescaline. LSD is made from lysergic acid. PCP (phencyclidine), often called angel dust; it was first used 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).25
It is estimated that 1.4 million people aged 12 or older in the U.S. are current users of hallucinogens.1
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 are typically abused by younger people. According to the 2017 survey, approximately 0.6 million people aged 12 or older were current users of inhalants.1
These are generally found in common household or commercial products including 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.26
Inhalants are abused by “huffing” (inhaling toxins from chemical-soaked rags), “sniffing,” “bagging,” (spraying fumes into a bag and then inhaling), or spraying directly into the mouth or nose. These products all produce mind-altering effects and can be damaging to the brain.27
- Using drugs regularly (even licit ones with a prescription) may result in developing tolerance, which means that a person will need to take higher doses to keep feeling the desired impact. Escalating dosage can quickly lead to physical dependence when a person takes drugs on a long-term basis.28Drug 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, the user experiences withdrawal symptoms and drug cravings.28Withdrawal symptoms can range from mild to life-threatening. They can be:29
- Physical: flu-like side effects, irregular heart rate and blood pressure, tremors or seizures.
- Emotional: depression, anxiety, cognitive deficits, and insomnia.
Individuals may choose to keep taking drugs in order to avoid difficult withdrawal symptoms and may no longer be able to stop taking drugs on their own without drug and alcohol abuse treatment at a trusted and specialized facility for substance abuse treatment.
The American Society of Addiction Medicine (ASAM) classifies addiction as a brain disease which occurs when brain chemistry is altered by substance abuse and an individual no longer has control over use.28The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that a person may be diagnosed with a substance use disorder if they suffer from two or more of the following symptoms in a one-year period:30
- 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. The factors that commonly exacerbate and increase the severity of addiction are the following:30
- Co-occurring disorders
- Genetic or biological vulnerabilities
- Polydrug abuse
- Using substances at a young age
- Environmental stressors
- One of the biggest possible dangers of drug abuse is a life-threatening overdose. Only in 2018, as many as 67,367 people died from drug overdose in the US.18With 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:31
- Extreme drowsiness or loss of consciousness
- Nausea and vomiting
- Trouble breathing or stopping breathing altogether
- Irregular blood pressure and heart rate
- Significant mental confusion
- Changes in body temperature (either too hot or too cold)
- Loss of muscle control and coordination
- Tremors or seizures
In addition to a fatal overdose, there are several more possible dangers from drug abuse. Over three million people visit emergency departments for nonfatal drug-related poisonings in the U.S. in one year.32 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 would normally not.
Substance abuse impairs thinking and decision-making, and individuals are more likely to get into trouble while using them. Some of the common risks are:33
- Traffic accidents.
- Contracting an infectious disease, such as hepatitis or HIV/AIDS, or a sexually transmitted disease (STD) through sharing needles or having unprotected sex.
- Committing violence and being a victim of violence.
Long-term substance abuse may have the following harmful consequences:34
- 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
- Infections of the skin and blood
- Constipation and gastrointestinal issues
- Changes in appetite and potential malnutrition
- Irregular sleep patterns
- Sexual dysfunction
- Brain damage
- 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)
- Increased rate of suicidal ideations
- Changes in personality and difficulties regulating moods (mood swings)
- Hormone imbalance
- Memory and learning problems
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2. National Institute on Drug Abuse. (2018). How long does drug addiction treatment usually last?
3. National Institute on Drug Abuse. (2020). Treatment and Recovery.
4. Substance Abuse and Mental Health Service Administration. (2020). The National Survey on Drug Use and Health: 2019.
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6. Douaihy, A. B., Kelly, T. M. & Sullivan, C. (2013). Medications for substance use disorders. Social work in public health, 28(3-4), 264–278.
7. National Institute on Drug Abuse. (2020). Treatment Approaches for Drug Addiction.
8. National Institute on Drug Abuse. (2020). Prescription Drug Facts, Effects, Teen Use.
11. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction DrugFacts.
12. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Facts and Statistics.
13. National Institute on Alcohol Abuse and Alcoholism. (2020). What are the different drinking levels? – Rethinking Drinking.
14. National Institute on Drug Abuse. (2020). What is the scope of marijuana use in the United States?
15. United States Drug Enforcement Administration. (2015). National Heroin Threat Assessment Summary.
16. National Institute on Drug Abuse. (2020). What are marijuana’s effects?
17. National Institute on Drug Abuse. (2020). Is marijuana addictive?
18. Centers for Disease Control and Prevention. (2020). Drug Overdose Deaths.
19. Drug Enforcement Administration. Drug Fact Sheet: Stimulants.
20. Drug Enforcement Administration. The Controlled Substances Act.
21. Yanes, A., CNN (2014). Just say yes? The rise of ‘study drugs’ in college.
22. National Institute on Drug Abuse. Over-the-Counter Medicines.
23. National Institute on Drug Abuse. (2020). Summary of Misuse of Prescription Drugs.
24. National Institute on Drug Abuse. Club Drugs.
25. National Institute on Drug Abuse. Hallucinogens and Dissociative Drugs Research Report.
26. National Institute on Drug Abuse. What are inhalants?
27. National Institute on Drug Abuse. How are inhalants used?
28. American Society of Addiction Medicine. (2019).SAM Definition of Addiction.
29. National Institute on Drug Abuse. Commonly Abused Drugs and Withdrawal Symptoms.
30. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
31. WebMD. Drug Overdose.
32. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes.