Basic Addiction Treatment: An Overview

Addiction is a progressive and chronic disease often characterized by periods of relapse and periods of recovery. It affects the individual and society, both necessary partners in its treatment.

The tasks of the person recovering from addiction is to become substance-free, to maintain abstinence, and to deal with relapse as quickly as possible. The responsibility of society is to financially support the development and implementation of effective prevention and treatment programs for all citizens.

Beginning the Process

In order to become “clean,” “sober,” or “abstinent,” a person must stop ingesting the substance, tolerate immediate withdrawal symptoms, and accept that periodic cravings may be lifelong.

When chemical use is stopped, a predictable group of symptoms will occur in virtually everyone who has become physically dependent. These may range from flu-like discomfort to acute anxiety to elevated blood pressure to seizures, depending on the substance abused as well as the duration and degree of the abuse.

With alcohol addiction, symptoms generally occur from six to 48 hours after the last drink. Withdrawal from short-acting drugs, such as heroin, begins in 12 hours, peaks at 48-72 hours, and is usually resolved within five to seven days.

Withdrawal may be undertaken at home or may require hospitalization, depending on the anticipated severity of response. Whatever option is chosen, however, this process should be supervised by a medical professional.

During the pain of withdrawal it is easy for an individual to believe he is “sick” and to bargain with life for one more chance to live addiction-free. When discomfort passes, however, and life issues recur that trigger a need to self-medicate, the path to recovery becomes harder and both therapeutic and social support is necessary.

Freeing the body from the presence of a particular chemical — becoming clean or sober — allows both mind and spirit to begin the lifelong work of staying substance-free. The first step in this process is to move from denial that one has a problem to acceptance that there is no cure for addiction; just a day-to-day respite from its active form.

There is help available in taking this important step.

Staying Clean and Sober

A variety of treatments and treatment programs are available to the newly withdrawn individual, depending on existing social supports and on the skills needed to be learned. Some addicts are able to return to their homes and jobs after going through a detoxification process and to utilize existing community and medical resources while recovering. Others require a specialized living arrangement, one less likely to trigger relapse.

Residential treatment facilities (including hospitals), therapeutic communities, and halfway houses exist to provide medical supervision, education, and 24-hour support.

Traditional residential services used to provide a 28-day to six-month stay in which addicts examine old behaviors and learn new ones that do not require the use of addictive substances. Unfortunately, today most insurance plans are governed by managed care guidelines and do not offer this inpatient time luxury. Residential treatment stays may be as little as three to 10 days.

The therapeutic community (TC) is a form of intensive, long-term (one to two years) residential treatment in which the client (resident) lives and is supervised in a facility 24 hours a day. It is less bound by insurance (many accept indigent clients) and helps the addict learn progressive responsibility within a community setting. Sometimes these groups are economically self-supporting. Such programs have been around since the 1950s, and include well-known organizations such as Daytop Village and Phoenix House.

The purpose of a halfway house is to provide successful transition from supported living to independent, drug-free living. After a residential program or a stay in a TC, an individual may move to a semi-supervised facility, such as a shared apartment. During the day he or she may seek employment, attend classes, or work at a job. Group therapy is still available, as is the support of fellow recovering addicts.

After experiencing detoxification most individuals remain at home and meet their treatment needs through outpatient arrangements at community mental health centers or with specially trained substance abuse counselors, psychologists, and psychiatrists.

Whatever the choice of post-detoxification living arrangement, treatment will likely include behavioral therapies (counseling, psychotherapy, family therapy, behavior modification, and support groups) and medical monitoring for medications that can reduce anxiety, cravings, or other psychological triggers to relapse.

Self-help groups, such as 12-Step programs, provide peer support for continued chemical abstinence as well as developing a supportive network or fellowship. They are free and available 24 hours a day within the addict’s community or via the computer on the Internet.

Relapse is a Reality

Relapse is as much a part of the disease of addiction as is recovery. The addict must learn to recognize the signs of impending relapse and develop a path back to recovery once it occurs.

Life pressures may trigger relapse. There may be one big stressor (death of a mate, divorce or loss of a job) or a series of little ones (flat tire, fight with spouse, a sick child). Twelve-Step programs warn their members to be aware when they are in a state of “H.A.L.T.” — hungry, angry, lonely, tired — and to gain extra support at such times.

When relapse strikes and the person has resumed use of his addictive substance, he must conquer his denial, find a way to withdraw, and then examine (with professional and support group assistance) the issues that brought him down.

For most people, relapse is an opportunity to learn more about themselves and to strengthen their program of recovery. As one 12-Step person said: “I better learn to stay clean and sober, I don’t know if I have another recovery in me.”

The Bigger Picture

Every addict must struggle with his or her own demons to choose recovery. It is the responsibility of society to make sure that when this decision is made, adequate and effective treatment facilities exist in both inpatient and outpatient settings.

That means funding not only buildings and beds but also the training of skilled addictions specialists including both professionals and recovering lay people. Society must also support the research of scientists working on the biochemical and genetic origins of addiction.

Finally, equal attention and funding must go to prevention research and supporting effective prevention programs. For every minute the initial use of a mind-altering substance by a youth is delayed, his or her chances of becoming addicted decrease. This is particularly true with regard to children from an addictive lineage.