Substance Abuse Treatment: Effective Program Design - Prosperity Haven

Principles of Effective Substance Abuse Treatment

Early recovery is no picnic. Those first shaky steps can make you feel as if you’re about to walk the plank and dive into the abyss – even if the real story is much different. The right substance abuse treatment program can help you move forward, heal, and find a life you love without turning back to substances and maladaptive behaviors.

But what exactly is “the right treatment,” anyway?

Here’s a little secret many addictions specialists won’t tell you: every addict is different. There’s no one magic fix for addiction that works for every person all the time – but the same core principles are present in nearly every effective substance abuse treatment program.

No matter what route you choose for your treatment, these 13 principles can help you succeed.

1. Addiction Is a Complex, Treatable Brain Disease

Substance abuse treatment programs must accept that addiction is a complex disease originating in the brain that affects every area of a person’s life, function, and behavior.

Nearly all drugs of abuse alter brain structure and/or brain chemicals, producing marked changes in personality and how the reward center of the brain functions.

Programs that ignore this basic mindset, or don’t see addiction as a disease, may put the addict at risk for continuous relapse.

2. Treatment Must Be Tailored to Individual Needs

Cookie cutter treatment programs almost never work, often because the person doesn’t feel understood, respected, or acknowledged.

Thus, there is no one treatment, program, or approach that works for every person or even every type of addiction. All aspects of treatment should be tailored to the needs of the individual patient, including the patient’s unique history and environmental influences, past trauma, family influences, friends, spirituality, mental health, and physical health.

3. Treatment Should Be Available, Flexible and Adaptable

People who are addicted often resist treatment, especially during active use. If a patient cannot access treatment when they feel driven to do so, they may lose motivation and spiral into deeper disease.

Programs must be available, flexible, and adaptable enough to accept the patient the moment they show a desire for help or a willingness to attend. The earlier patients get help, the better the chance for positive outcomes. This is true for both initial treatment attempts and each time the patient relapses.

4. Treatment Must Address the Whole Person, Not Just the Addiction

Addiction is influenced by a person’s complex medical, psychological, social, vocational, financial, and familial needs. Variables like gender, age, culture, religion, and socioeconomic standing also play a role.

Problems in one or more of these areas can, and often will, cause patients to remain addicted and/or relapse, especially if they go unaddressed. The only effective way to achieve long-term sobriety is to address and treat the whole person, not just the addiction itself.

5. Longer Length of Treatment Stay Is Associated With Successful Outcomes

Short-term substance abuse treatment programs are rarely effective for a variety of reasons. The addict who leaves treatment after just a few days or weeks doesn’t have enough time to truly examine the driving forces behind their addiction (much less address them).

It is critical that patients remain in treatment for a minimum of three months – longer if the severity of addiction is higher or where the drug of choice is also physically addictive.

Patients who leave early almost always relapse, even if they feel comfortable with staying sober in treatment. The outside world lacks the environmental influences associated with inpatient or residential care.

Regardless of when the patient leaves, relapses should be viewed as proof treatment needs to be adjusted, not as a personal failing of individual who chose to leave.

6. Behavioral Therapies Show the Best Potential for Long-Term Sobriety

Psychotherapy, including Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are remarkably effective in treating addiction, especially when combined with other therapies.

Group, solo, and family therapy sessions help addicts address their motivation to change, help them identify ways to stay sober, and give them newer, healthier coping skills to use in place of drugs.

Therapy also teaches people how to replace substance use with constructive activities, how to set and meet goals, how to solve problems, and how to cope with negative emotions without turning to self-medication with drugs or alcohol.

In group therapy, addicts also forge new and healthy connections with people who share their sober living goals. With every conversation and session, they re-learn how to socialize, interact, and communicate – or even how to navigate uncomfortable interpersonal conflicts – without running away or turning to substances for comfort. This allows the addict to develop meaningful, lasting relationships.

7. Medication Is Integral to Effective Substance Abuse Treatment

Substance abuse treatment programs should not demonize or disallow medication use, including replacement therapies like methadone, buprenorphine, and naltrexone, if they provide benefit to the patient and help them stay clean. These drugs are remarkably effective in helping patients stabilize their lives, especially where the drug of choice has physical addiction properties (e.g., heroin or nicotine).

Some patients may benefit from treatment with mental health medications, whether or not they suffer from a specific diagnosed conditions, because they reduce cravings or eliminate withdrawal symptoms. These drugs should also be respected for the important role they play in helping patients become or remain sober.

However, they should always be given in tandem with a comprehensive addiction treatment program – not as a “quick fix.”

8. Treatment Must Be Assessed and Modified as Necessary

Patients often require treatment adaptation as their needs, or situation, changes; this is referred to as a continuing care approach. Effective programs achieve continuing care by remaining connected with the patient, their loved ones, and their extended care team. Treatment intensity in this realm should adapt and change according to the patient’s needs over time, becoming more intense when addicts struggle.

Programs must be mindful that “continuing care,” in the sphere of addiction treatment, also includes addressing the patient’s needs in other areas that may not necessarily be directly related to the addiction. This includes:

      • Vocational struggles
      • Academic goals
      • Medication
      • Parenting guidance
      • Family therapy
      • Social and legal services
      • Helping the patient to find a safe “community” of friends

9. Treatment Should Consider Both Mental Health and Substance Use

Not all patients with mental illness struggle with substance use, but nearly all addicts have concomitant (meaning “at the same time) mental illnesses disorders. An initial psychological assessment can provide surprising insight into why the patient became addicted in the first place.

In fact, many addicts are relieved to receive a diagnosis because it helps them to understand  their addiction and need to self-medicate.

Failing to treat both the addiction and the mental health disorder significantly raises the risk for relapses and future self-medication episodes. Treatment, including therapy and medication, should address both needs at all times.

10. Medically-Assisted Detox Alone Is Never Enough

Medically-assisted detoxification has distinct benefits, the least of which is safely managing potentially dangerous or deadly withdrawal symptoms, such as seizures.

In early treatment, it may also increase an addict’s willingness to participate in the program, reducing fears about unpleasant withdrawal symptoms. It should not, however, be considered a standalone treatment for addiction.

Patients who are released a short time after detox are at a very high risk for relapse, and in some cases, may even be at risk for overdoses due to lowered tolerance.

Programs should incentivize long-term treatment from the moment patients walk through the door, motivating them to continue treatment long-term.

11. Treatment Does Not Need to Be Voluntary to Be Effective

The idea that addicts must be ready and willing to change isn’t necessarily always true.

Sometimes, court orders and/or demands from loved ones are the only way to get the addict to agree to attend or remain in treatment long-term.

Effective programs recognize that even patients who attend “because they have to” can start to engage, or even become motivated to stay sober, with time and the right approach.

12. Relapse Is a Probability and Must Be Taken into Account

Relapse, and even occasional recreational drug use, is a very normal part of addiction treatment. In fact, between 40 and 60 percent of all addicts relapse at least once after initially getting sober.

Relapse should be viewed as proof that the patient’s treatment plan needs to be adjusted, not as a failure.

Whether this means increasing maintenance medications or helping the patient identify relapse triggers, what matters most is that the treatment program constantly monitors and responds to relapses, adjusting it to better suit the patient’s needs.

13. Testing for Sexually Transmitted and Infectious Diseases Is Critical

Patients who abuse drugs and/or alcohol frequently engage in other risky behaviors, such as sharing needles, having unsafe sex, or even sharing snorting straws. These behaviors may raise a patient’s risk for HIV/AIDS, Hepatitis B, Hepatitis C, tuberculosis, and most other infectious diseases. This is especially important for IV drug users due to the risk of blood-to-blood transmission between users.

Substance abuse treatment programs should test all addicts for the presence of these and other diseases.

When tests are positive, medical treatment and counseling for the disease should be provided immediately.

Antivirals like sofosbuvir, ribavirin, and interferon cure a high majority of all Hepatitis C cases, especially when given promptly after infection. Treatment with HAART (Highly Active Antiretroviral Therapy) drugs can completely suppress the HIV/AIDS virus, leading to long-term remission.

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