Substance Abuse & Treatment

Substance abuse happens when some people use psychoactive substances in a hazardous or harmful way. These substances include illicit drugs, prescription drugs, over the counter drugs, tobacco, and alcohol. Those who use them tend to develop a dependency on them. While this often appears as a physiological condition, it actually affects behavior and cognitive function as well. Once people become dependent, which can happen after any length of time of usage, they develop an increasingly strong desire to use that particular substance. They tend to lose control over their behavior, even though they often realize that it has harmful effects. In fact, using their chosen substance becomes more important than any other obligation or activity. At this point, they are trapped in a downward spiral where tolerance increases, causing them to increase their dosage, until full addiction is reached.

Global Statistics on Substance Abuse

The global statistics on substance abuse paints a grim picture:

  • Around 3.3 million people a year die as a result of alcohol abuse alone.
  • On average, every individual on the planet with ages 15 or over drinks a yearly 6.2 liters of pure alcohol. However, only 38.8% of the global population drinks alcohol, which means that those who do drink consume an average of 17 liters per person each year.
  • Some 15.3 million people have a drug abuse problem.
  • 148 countries around the world have an issue with intravenous drug use. 120 of them report that the population of users have HIV.

National Statistics

National statistics on substance is not much better than the worldwide statistics. According to the National Survey on Drug Use and Health, released by the Substance Abuse and Mental Health Services Administration (SAMHSA), some 23.5 million people over the age of 12 needed substance abuse treatment in 2009 alone. This equates to 9.3% of that particular segment of the population. Unfortunately, just 2.6 million, or 11.2%, actually received treatment.

The National Survey on Drug Use and Health also listed the characteristics of people who are admitted and discharged from a treatment facility. Some of those statistics include:

  • 1.8 million people were admitted in 2008.
  • 41.4% of admissions were in relation to alcohol abuse.
  • 20% of admissions were in relation to heroin and opiates.
  • 17% of admissions were in relation to marijuana.
  • In terms of ethnic origin, 60% were white, 21% were African American, 14% were Latino or Hispanic, 2.3% were Alaska Native or American Indian, and 1% were Pacific Islander or Asian.
  • In terms of age, 14.8% of those admitted were aged between 25 and 29, 14.4% were aged between 20 and 24, and 12.6% were aged between 40 and 44.

Substance Abuse Treatment

There are many different types of treatment options and services available for those who have a substance abuse problem. These have been designed following a number of principles of effective care and can really work if used properly. Broadly speaking, the services that are offered through these centers include:

  • Residential and inpatient treatment
  • Individual and group counseling
  • Partial hospitalization programs
  • Intensive outpatient treatment
  • Medication
  • Care or case management
  • 12 Step programs
  • Recovery support services
  • Peer support

Those who undergo treatment usually do not require support from all of the elements above, but none is more important than the others. The systems should be properly integrated into the community, ensuring that support is available at every level. In so doing, people with substance use disorders are more likely to be able to recover.

Residential and Inpatient Treatment

Treatment is often offered in inpatient or residential facilities. These facilities specialize in treating substance abuse disorders. The services can be offered by focusing on a broad behavioral issue, but they can also be hospital units. Inpatient treatment facilities can offer their services for varying lengths of time. While 30 days is common, treatment can be as long as one year. Regardless of how the services are offered, the goal is for patients to learn how to modify their behavior while being supported by a structured environment. Most inpatient treatment centers offer care for a shorter period of time, whereby the focus is strongly on detox. Detox, or medically managed withdrawal, helps patients to rid their body of the chemical residues of their chosen substance. After the period of detox, some intensive treatment is also offered, after which patients usually start to attend outpatient or community-based treatment.

There is an alternative as well, which is partial hospitalization, also known as intensive outpatient treatment. Here, patients attend treatment for around eight hours a day, seven days a week. This is incredibly intensive, and means that while people return home at the end of the day, they receive the same treatment as in an inpatient facility. Usually, this lasts for a few weeks, after which they start to attend less intensive outpatient treatment sessions.

Individual and Group Counseling

At the heart of treatment generally lies counseling, which is offered individually provided or in groups (including families). In individual counseling, the focus tends to be on stopping substance use, developing and sticking to a recovery plan, skill building, and personal, educational, and professional outcomes. During group counseling, however, people are provided with a form of social reinforcement that helps them achieve recovery.

People undergoing treatment have access to variety of services offered by specialized counselors. These include full assessment of the issue, treatment planing and monitoring, and direct counseling. They also offer a wealth of different therapies, with the most common ones being:

  • Cognitive behavioral therapy (CBT), whereby individuals learn to recognize a negative thought pattern or behavior and challenge it within themselves. As an example, through CBT, recovering patients learn to recognize the stressors that would usually lead to them using their chosen substance. By recognizing these stressors, people can also learn to avoid them altogether or to respond to them in a different way when they cannot be avoided.
  • Contingency management, which is a treatment form whereby patients are provided with incentives to change their behavior. This has been particularly beneficial for those with a cocaine addiction.
  • Motivational enhancement therapy, whereby patients find motivation within themselves and this is then used to create and commit to a certain recovery plan. This is often best used at the start of treatment, ensuring that patients are committed to the long road ahead.
  • 12 step facilitation, whereby patients are guided and supported through engagement in a 12 step program. Some of the best known programs are the AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and CA (Cocaine Anonymous).

It is also possible to receive counseling specific to a population group. Young people, for example, often require different services in order to achieve lasting recovery. Usually, there is a strong focus on the family when a young person is treated. The SAMHSA also offers grants for two specific treatment options for young people:

    1. Assertive Continuing Care (ACC), which includes home based services and intensive followup to avoid future relapse.
    2. Adolescent Community Reinforcement Approach (ACRA), which follows specific procedures to support engagement and build skills by taking part in positive activities.

Medication

It is quite common for medication to be offered as part of a substance use disorder treatment plan. In fact, the principles for effective addiction treatment include medication assisted treatment (MAT). Here, medication is used alongside behavioral therapy and counseling. It helps to reduce the symptoms associated with withdrawal, as well as cravings. The drugs are agonists or partial agonists, which means that the brain’s reward system will start to function differently. When people use drugs, antagonists are released, which make them feel rewarded, and this is stopped through MAT. In fact, some MAT even induces negative feelings when administered. It is very commonly used in heroin addiction and in alcohol addiction.

Drugs commonly used in the treatment of alcohol addiction include:

    1. Acamprosate is often used. This helps to reduce the feelings of withdrawal in alcoholics, as well as help them remain abstinent for longer periods of time.
    2. Naltrexone has also been used, although it is more common in the treatment of opioid addiction. This particular drug helps to reduce cravings.
    3. Disulfiram, which changes how alcohol is metabolized by the body, leading to feelings of nausea, vomiting, and flushing if the patient consumes alcohol.

Drugs commonly used in the treatment of tobacco addiction include:

    1. Nicotine replacement therapy (NRT), which helps to reduce the feelings of withdrawal. These include irritability, anger, decreased concentration, anxiety, and depression. Common NRTs that have been approved by the U.S. Food and Drug Administration (FDA) are gum, patches, inhalers, nasal sprays, and more.
    2. Bupropion, which was first marketed and approved as an antidepressant, can help people quit smoking as well. It can also be used in the treatment of both.
    3. Vaernicline, which is a partial agonist for nicotine, helping to reduce craving.

Drugs commonly used in the treatment of opioid addiction are methadone, naltrexone (extended release injectable), and buprenorphine. These medications are so successful that they are now seen as critical. In the latest opioid treatment surveys, it was found that some 300,000 people received one of these medications for the treatment of an opioid disorder in 2011. Specifically:

  • Methadone and buprenorphine make opioid withdrawal more manageable, while at the same time reducing cravings. Surveys have shown that people who use this MAT are more likely to complete treatment and avoid risky behaviors that are more likely to lead to infections such as hepatitis and HIV, which are common in people who use opioids intravenously.
  • Extended-release injectable naltrexone has been shown to lower relapse rates, as well as control cravings. It is a very good type of MAT for those who are leaving an intensive inpatient setting or who have been incarcerated, and where using a different type of opioid agonist may not be suitable.

It is important to understand that MAT for opioid addictions is not just suitable for people who use heroin, but also for those who abuse prescription opioid drugs.

The FDA has not approved any other medication for the treatment of any kind of substance use disorders. That said, significant research is currently taking place in medication that could be suitable for cocaine addiction and similar substances. The Addiction Technology Transfer Center Network at SAMHSA maintains a record of currently approved MAT options, as well as experimental drugs.

Recovery Support Services

These types of services are not clinical, but they are vital to the long term success of addiction treatment. They are designed to help people who have set recovery goals, ensuring that they are able to reach them. Usually, these services are provided by peers, meaning they are also in recovery and understand the journey the individual has gone through. Some of the most common forms of support include:

  • Employment and educational support
  • Help with transportation to recovery activities and treatment
  • Coaching, mentoring, and peer to peer activities
  • Sober living facilities
  • Support groups and self-help
  • Faith based and spiritual support
  • Outreach and engagement
  • Parenting education
  • Education on recovery and wellness
  • Warmlines, crisis services, respite, clubhouses, and more

Peer Support

Peer support is incredibly important in the recovery of people with substance abuse disorders as their personal experiences can serve as an inspiration to others. In fact, peer support is now seen as critical in the overall journey to recovery. Very often, people who work as case managers or counselors within treatment centers are themselves recovering patients, and they understand like no one else how important such an understanding is.

Peers are also found in mutual support groups, where they play an equally vital role. Most of these groups are 12-Step programs like Alcoholics Anonymous, Narcotic Anonymous, and Cocaine Anonymous. Here, recovering patients are able to receive support at any point, including when they feel that they are starting to relapse. These networks are international and operate in various convenient locations, including over the telephone. Essentially, they create a support network around the recovering person.

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