What is the most effective treatment for addiction?
Whilst many treatment programs and approaches are available to treat individuals who are addicted, effective treatment programs involve not one but a combination of many approaches, tailored to meet the specific needs of the individual. Addiction treatment broadly involves treating withdrawal symptoms, getting the individual to restrain from using the substance and preventing relapse.
Many times addiction may not be the only problem and other physical or psychological disorders might develop alongside, such as depression. These need to be addressed as well. This is known as dual diagnosis. Addiction treatment can thus be complex, as it needs to address a number of different aspects in each individual. Typically, however, addiction treatment involves a combination of the approaches explained below.
Detoxification: This is usually the first step in addiction treatment and involves removing the addictive substance from the addicted person’s body, under proper medical supervision and stabilizing the person physically. Suddenly stopping alcohol or drugs after prolonged use can cause painful withdrawal symptoms ranging from mild tremors to confusion and hallucinations.
To reduce withdrawal symptoms and physical discomfort, patients are usually given medication which makes them feel similar to being on the addictive substance, gradually, over time, the dose is reduced and the individual is weaned off the addictive substance. Detoxification aims at removing physical or chemical dependency on the substance. After detoxification the dependency on the substance is more psychological and it is here that the actual treatment begins.
Detoxification is really preparation for addiction treatment rather than treatment in itself, as it has no effect if not followed by rehabilitation. It is in rehab that people suffering from addiction learn how to control the urge to use the addictive substance, remain sober and take back control of their lives.
Rehabilitation: Depending on the severity of the problem and the patients’ ability to remain sober in their living situation, a person could be admitted into a rehabilitation center that offers residential living as an inpatient. Alternatively, the person could seek outpatient rehabilitation.
Rehabilitation usually involves many components – Pharmaceutical Treatment, Cognitive Behavior Therapy, Biofeedback, Cognitive Remediation, Individual Counseling, Group Therapies and Family Therapy. Rehabilitation aims at getting individuals with addictions to maintain sobriety, addressing issues that caused the problem in the first place and finding alternative ways of coping with similar issues. It facilitates lifestyle changes which lead to better physical and psychological health, along with improved social and occupational functioning.
Pharmaceutical Treatment: This is used during different stages of addiction treatment. Its use during detox has already been discussed above. It is also used to help people who have stopped consuming the addictive substance to restrain from using them during the treatment process. The changes in the brain that are characteristic of addiction can persist long after stoppage of the addictive substance, resulting in relapse.
Thus, drugs like Antabuse (disulfiram), which works as a deterrent, making the person sick if they consume any alcohol are used. Pharmaceutical Treatment is combined with counseling, individual and group therapies to treat craving and prevent relapse until these therapies start having an effect on the individual and modify thinking and behavior.
Counseling, Individual and or Group Therapies: Counseling, Cognitive Behavior Therapy, Biofeedback and Neurofeedback, Cognitive Remediation, support groups and other forms of Individual and group therapies play a crucial role in addiction treatment. They aim at teaching individuals who are addicted new ways of thinking, behaving and coping with life situations, thereby preventing relapse. Some of the therapies used are discussed below.
Cognitive Behavior Therapy (CBT): The underlying principle of this therapy is that by identifying and controlling your thoughts, you can modify your behavior. In practice it involves two distinct stages: Functional Analysis and Skills Training. Functional analysis involves identifying thoughts, feelings and circumstances that might have led to use of the substance and determining what, in the future, could lead to relapse.
In Skills Training, the individual is made to unlearn old habits associated with substance use and learn new skills to cope with situations that might trigger relapse. Scientific research has shown CBT to be an effective addiction treatment for addiction disorders and to be compatible with the other approaches, including support or self groups – even though very different from them.
Biofeedback and Neurofeedback: Biofeedback involves training your mind to heal your body. In Biofeedback, sophisticated equipment monitors and gives you moment to moment information about your bodily processes such as heart rate, blood pressure, muscle tension, and skin temperature. Initially, you use the equipment to monitor your bodily processes and correlate them with your thoughts and feelings and slowly, with training, you learn to identify and control your mental state to bring about the desired physical and physiological changes in your body amplifying in the addiction treatment process.
Both Biofeedback and Neurofeedback has shown increased success rates and relapse prevention when used with conventional treatments for addiction. Additionally, an improvement in the overall functioning – cognitive and psychological – can be seen in patients who undergo Neurofeedback Training. It helps replace self defeating patterns of thinking and behavior in patients, with healthier patterns and choices, thereby making it an addiction treatment of choice.
Cognitive Testing and Remediation: There is evidence that substance abuse causes deficits in brain functioning. These deficits can impair the success of addiction treatments. Brain functioning can be improved with cogntive testing and remediation, but not many treatment programs incorporate this. It involves a 6 week program, comprising of exercises for the mind that have been proven to generate new dendrites and increased blood flow to brain.
The testing processes are simple and occur at the beginning to set a baseline and again after 6 weeks to measure and show progress. The tests indicate the strengths and weakness, allowing a custom remediation program for each patient aimed at teaching them to utilize their strengths and improve on the weak areas. The end result – improved ability to make choices, think clearly, and recall what they have learned – assists in the successful recovery process.
Social Support Groups: Social support groups are those where individuals with a common problem like alcohol or drug addiction meet on a regular basis to share their experiences and help each other overcome the problem. Alcoholics Anonymous is probably one of the biggest and the best known support groups. Research has shown that participation in support groups, in conjunction with other addiction treatments, are more effective in helping individuals suffering from addiction remain sober as compared to participating in addiction treatment by itself.
Family Therapy: Families can play an important role in recovery. The main aim of this therapy is identifying and removing factors within the family which are blocking the patient from recovering, identifying and addressing issues that could lead to relapse in future, increasing family support in the individual’s recovery and improving the overall functioning of the family.
Aftercare plans and continuing care: The key to long term success is providing patients with a structured aftercare plan, making the transition from an intense staff supported recovery to outpatient care smooth. The components of aftercare plans and continuing care remain more or less the same as treatment, but occur less frequently – for example, the patient might be required see his counselor only once a month or engage in group therapy once a week, instead of, everyday, continuing addiction treatment.
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