DRUG REHAB

Even though recovering from drug addiction can be challenging, it is possible. The right treatment can make a real difference in people’s lives. It is the most effective way to address substance use disorder and help people to move on from being active drug addicts to living lives of sobriety.

According to the National Institute on Drug Abuse (NIDA), there are several principles of effective substance addiction treatment, based on mid-1970s scientific research, which all treatment programs should reflect. These are:

• Addiction is a chronic and complex disease, primarily affecting brain function and an individual’s behavior, but it is TREATABLE
• No single treatment is the correct treatment for everyone
• People require quick and obstacle-free access to treatment – otherwise, they may reconsider their decision to go to drug rehab
• Effective treatment addresses 100% of the patient’s health needs, eg. their mental health – not just their drug use
• Staying in treatment long enough is critical to recovery
• Counseling and other behavioral therapies are the most commonly used forms of treatment
• Medications are an important part of treatment (known as medically-assisted therapy or MAT), especially when used in conjunction with behavioral therapies
• Treatment plans must be reviewed, and modified, on a regular basis, to address the patient’s changing needs
• Treatment should address other possible mental disorders if diagnosed or present (known as dual diagnosis or co-occurring disorder)
• Medically-assisted detoxification is only the first stage of treatment
• Treatment doesn’t have to be on a voluntary basis to prove effective
• Any drug use during treatment must be monitored rigorously and continuously, because of the risk of addiction relapse
• Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, as standard clinical practice, as well as to teach patients about steps they can take to reduce the high risk of these illnesses

There is no single “right” way to treat substance addiction; therefore, there are many different options available, as well as many possible combinations of these individual options. This is because people all have very different needs when it comes to recovery. It is critical for those needs to be properly addressed during their treatment.

It is always best for people to discuss their needs for treatment with an addiction professional. They can then provide a recommendation for the proper level of care based on the information they are given.

Inpatient drug rehab programs offer drug addiction treatment in a residential center or facility, so the patient can focus 100% on their therapy and the beginning of their recovery. Drug rehab removes the triggers or temptations of relapse that exist in the patient’s normal environment, and the patient can receive 24/7 constant care, if required.

Inpatient drug rehabs can vary widely in the environment they offer – from a 5-star hotel-type setting, with all the luxury facilities and amenities, to the rather sterile surroundings of a typical hospital ward. However, the vast majority of drug rehabs are positioned halfway between these extremes, providing a warm and friendly environment so patients feel comfortable and relaxed while receiving their treatment.

Research studies have shown that inpatient drug rehab programs offer the best chance of success for a long-term recovery, as it allows the patient to fully engage with their treatment and improving health. Furthermore, patients can learn how to enjoy their free time in a way that does not involve the use of drugs.

Lastly, many inpatient rehabs offer a professional, medically-assisted detox as a part of their programs. Those that do not do this normally provide their patients with a referral.

Outpatient drug rehab programs offer the same drug addiction treatment as an inpatient program, but without the residential element. Instead, patients access their treatment by attending an outpatient drug rehab center or facility at certain times during the day – this can range from a full day to specific appointment times.

Outpatient programs for drug addiction treatment are also offered at differing levels of care, ranging from partial hospitalization programs (PHPs), to intensive outpatient programs (IOPs), and down to traditional outpatient programs.

These different levels of care are determined by a combination of clinical patient assessment, and the number of hours per week someone can commit to their drug addiction treatment. Depending on the treatment center, outpatient treatment timetables can be highly flexible, enabling people to either meet family obligations, continue working or attend school while still receiving treatment.

However, with an outpatient program, the individual is still living in the environment that allowed or enabled their substance use. In that respect, they are slightly less successful in attaining a long-term recovery than inpatient programs.

In fact, outpatient programs are at their most effective when they form part of an overall drug addiction treatment plan that provides a continuum of care for a recovering individual that begins with inpatient drug rehab.

Partial hospitalization programs (PHP) offer the highest level of care that is available on an outpatient basis. Clients live at home and during the day, they come to the treatment facility. PHPs offer many services that people in recovery need, such as:

• Medication management services
• Treatment for mental health conditions
• Individual therapy sessions
• Group therapy sessions
• Family therapy sessions
• Therapeutic activities

Partial hospitalization programs typically require people to remain at the facility for the entire day. This time requirement might be lessened as time goes on.

Intensive outpatient programs (IOP) also offer a high level of care. Many experts believe that an IOP is very similar to what people experience when they go to inpatient rehab. IOPs are typically about 12 weeks in length, and they require people to attend regular appointments, usually between 3-5 times per week.

During IOPs, clients participate in various types of therapy. They can receive treatment for co-occurring disorders as well as for their SUD. The program provides people with a well-rounded treatment plan, including Individual and group counseling sessions, that is fully personalized to meet their individual needs.

Many people gravitate toward IOPs, because they have so many benefits. They work well for people who work or go to school, and for parents to care for their children during the day, because of the flexibility of appointments.

A more traditional outpatient alcohol treatment program may not be best suited for people who are new to recovery. This level of care tends to offer less professional support, and there may not be any peer support available at all. It is usually reserved for those who have gone through an IOP, PHP or inpatient program in the recent past.

But traditional outpatient rehab does have its place in addiction recovery. It typically involves regular individual therapy sessions with an addiction treatment specialist. Some may also have group therapy sessions available, but most do not. This type of treatment can work well for people as a form of follow-up, but it can also work for those who milder addictions.

Sober living homes are often essential for people who are in addiction recovery. While they do not provide any in-house alcohol treatment, they do offer safe places to live for those who need them. Many people are not able to return home after going to rehab because of the risk of relapsing, domestic violence, or for any number of reasons. Having access to sober living homes gives people the added security they need during this critical time in their lives.

For many people, sober living homes provide them with opportunities they would not have had otherwise. They can serve as a helpful way to transition back into ordinary life. They can also help people who want to relocate to a new city or state once they are in recovery.

Residents are required to pay rent every month, and there may be other rules that need to be followed as well. It is not uncommon for many sober living homes to have curfews and require chores. Every resident may need to submit to drug and alcohol testing, and secure their own outpatient addiction treatment program.

The first step in drug addiction recovery is going through the detoxification (“detox”) process. Before any recovery can fully begin, it is imperative that the individual being treated is 100% free from the drugs they have abused, as well as any toxins in the body that have been produced by their drug use.

When people use addictive drugs, over time they will build up a “tolerance” to the substance, which invariably leads them to keep increasing the amount they use and how often they use it just to get a similar effect. When they stop using, the result is drug withdrawal.

Detox allows for a safe withdrawal from a drug, as some of the symptoms that can appear during the process can range from uncomfortable to severe, and even life-threatening, and it is virtually always the first step for anyone withdrawing from moderate to severe forms of drug addiction.

The type of detox a person requires depends on the substance(s) they are addicted to, the severity of their addiction, and how long they have been addicted.

Inpatient Detox

Also know as medical detox, the person stays in a facility where they are constantly supervised by medical staff to avoid deadly withdrawal symptoms

Outpatient Detox

The person detoxes at home. Best suited for those with strong social support and less severe addictions that won’t trigger fatal withdrawal symptoms.

Depending on the drug, detox can require the use of specific medications in order to reduce the intensity of the symptoms. A process of “tapering” can also be used where the medicating drug is itself addictive, meaning the medication is slowly reduced in dosage until the patient is no longer physically dependent.

Drug withdrawal occurs when a person stops using addictive drugs, and the severity and type of withdrawal symptoms that are experienced can vary with the type of drug used, the length of time the drug use continued, and the amount taken each time the drug was used.

Some of the most common signs of drug withdrawal include:

• Sweating
• Fatigue
• Irritability
• Headaches
• Loss of appetite
• Nausea and vomiting
• Tremors
• Anxiety
• Depression
• Mood swings
• Cognitive problems
• Sleep disruption
• Nightmares
• Rapid heart rate

During detox (and possibly during post-detox treatment), patients can be prescribed specific medications to assist with their recovery process. This is known as “medically-assisted treatment” (MAT), and these medications are used for:

• Managing withdrawal symptoms during detox
• Reducing drug cravings
• Treating a co-occurring mental health disorder

In no way does MAT (which is described in more detail later in this article) replace evidence-based drug addiction treatment; it is only effective when used as part of a comprehensive treatment program.

Drug addiction treatment programs, whether inpatient or outpatient, use prescription medications during detox and /or as part of the patient’s therapeutic treatment, if required, and this is known clinically as pharmacotherapeutics, as well as medically-assisted treatment or medication assisted treatment (either is abbreviated to MAT).

The clinical use of these medications is normally dependent upon the drug that the patient is addicted  to, and any other existing medical conditions affecting the patient – for example, a heroin addict with a co-occurring disorder, such as major depressive disorder, may require medication during the detox to help with withdrawal symptoms, and then medications to control cravings and to treat the depression throughout their treatment.

It has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services. This treatment approach has been shown to:

• Improve patient survival
• Increase patients’ ability to gain and maintain employment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders

MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a

“whole-patient” approach to the treatment of substance use disorders

To understand how the medications provided by MAT actually work, and why they can be essential to a patient’s recovery from drug addiction, we firstly need to work out how addictive substances affect the brain when an addict uses them.

>Addictive substances produce euphoria, and other side effects, by manipulating the brain’s pleasure and reward centers. Although different MAT medications work in different ways, the majority of these pharmacotherapeutics are designed to restore the brains’ natural balance in both of these centers, and to stabilize the patient’s neurochemical processes, previously disrupted by a patient’s substance abuse.

Pharmacotherapeutics are only used as part of the drug addiction treatment for specific addictions, and they can continue to be prescribed after treatment has finished. They are prescribed because they offer a particular benefit, such as:

• To diminish cravings and withdrawal symptoms
• To counter the intoxicating effects of a drug
• To provide “off-label” benefits that can support a patient’s recovery, or
• To replace the drug with a less powerful drug; this is known as "opioid replacement therapy," which uses medications, such as methadone, to replace the abused opioid

The most common medications prescribed for use within an addiction treatment program, offering one or more of these benefits, include include:

• Naltrexone (Vivitrol): Naltrexone, known as an opioid agonist, is highly effective when used in opioid addiction treatment, as it completely blocks other drugs from binding to and so activating the brain’s opioid receptors – necessary for achieving the euphoric effect. It is used in post-detox treatment. If it was used during the detox, when opioids are still present in the body, it will significantly increase the severity of withdrawal symptoms.
• Buprenorphine (Suboxone, Zubsolv): Buprenorphine, a partial opioid agonist, works in a similar way to naltrexone, but only partially blocks the opioid receptors – this means that the receptors are activated after the drug is administered, but not to the full extent that, say, heroin can activate them. It can be used to wean patients off their use of opioid substances.
• Methadone (Dolophine, Methadose): Methadone is a synthetic opioid agonist, and it is used in opioid replacement therapy.
• Naloxone (Narcan): Naloxone is a competitive antagonist, which means it blocks the effects of opioids, and even reverses them. It is commonly used to reverse opioid overdoses.
• Other medications include mirtazapine (Remeron) and bupropion (Wellbutrin, Zyban), which are antidepressants, and modafinil (Provigil), used to treat sleep disturbance.

It is important to remember that addiction is medically defined as "a chronic, relapsing brain disorder," and just like other chronic diseases, like type I diabetes, hypertension, and asthma, it requires ongoing treatment to control its symptoms.

Drug rehab works, and there is clear proof it does. However, it does not cure drug addiction. Regardless, drug rehab can help people recover to the point where their continued abstinence in the future can control the addiction. It does this by the providing the following treatment and care:

In-depth clinical patient assessment, where individuals are clinically assessed to determine the extent of their drug addiction; from this assessment, the level of care can be determined, eg. inpatient or outpatient, and other needs.

Personalized drug addiction treatment plan.

Safe, medical detox for the drug-addicted patient.

Medications, as and when or if required.

Secure, drug-free environment enabling the patient to focus fully on recovery (residential drug rehab).

Professionally delivered evidence-based therapies for the patient’s physical and mental health, including one-to-one counseling, specialized therapies, such as cognitive behavior therapy (CBT), and exercise and nutrition.

Proven strategies and tools to control cravings and relapse triggers.

Professional recommendation for the next stage of addiction recovery, eg. an outpatient program, if required.

Personalized relapse prevention plan on departure.

Just like the other chronic diseases mentioned previously, patients with addiction can and do relapse. Drug addiction relapse should actually be more likely. However, for those who attend and complete their drug rehab program, the success rate is on a par with other chronic diseases:

• Relapse rate for Type 1 Diabetes is between 30-50%
• Relapse rate for drug addiction is between 40-60%
• Relapse rate for hypertension or asthma is between 50-70%

When a patient leaves rehab from 7-14 days is when they’re most susceptible to overdosing and dying. The person’s tolerance to their usual substance of use tends to be much lower. heir bodies won’t be used to the same amount they used to take. This potentially can cause an overdose that could be fatal.

The proven behavioral therapies that are used in drug addiction treatment are based on the individual patient’s physical and mental health, as well as their substance use history. A wide range of effective therapy options are available, and these include:

Individual counseling sessions, held one-to-one with a professionally qualified counselor or therapist, are an integral part of drug rehab treatment. This counseling gives the individual the opportunity to express themselves fully, particularly about their own psychological and social concerns that could potentially trigger a relapse; for example, stress or their home environment.

Counseling helps individuals understand their addiction and its root causes, learn to manage cravings, and deal with the potential triggers that exist in daily living.

CBT is one of the most common and most effective therapies used in drug rehab, either in an inpatient or outpatient setting. As virtually all addicts engage in both destructive and negative thinking and behavior, and since cognition fundamentally affects our wellbeing, it is vital to change these harmful thought patterns into far more positive, constructive and forward-thinking ones. These changes can be accomplished through the use of CBT, which is highly goal-orientated and focused on problem resolution.

CBT works by:

• Exploring the patient’s patterns of behavior, and why they are resulting in self-destruction and negativity
• Identifying which thought and behavior patterns require changing, and actively working on an alternate way of thinking
• Helping a patient cope positively with everyday life with practical and helpful strategies developed through CBT
• Lastly, helping clients formulate their own coping strategies to handle potential triggers and stresses following their drug addiction treatment program

Initally introduced to help those with suicide thoughts, and now primarily used in the treatment of severe personality disorders, particularly borderline personality disorder, DBT has been again adapted for use within drug addiction treatment.

Its aim in drug rehab is to reduce cravings, to help patients avoid the situations, and even opportunities, to relapse, and to learn healthy coping skills. It is actually a form of CBT, as it addresses a person’s thinking (their cognitions) that form their belief systems, personal assumptions, and assumptions about the world they live in.

MET is used to assist recovering addicts change the negative thoughts and behaviors that are intrinsic to their addiction. It is particularly beneficial to those with dual diagnosis, who are also suffering with mental health issues such as bipolar disorder and post-traumatic stress disorder (PTSD).

Biofeedback is a therapy designed to help patients understand the normal, yet involuntary processes that our bodies go through. During the therapy, electronic sensors are positioned on the patient’s skin to monitor their brain activity. Once the resulting brain patterns have been reviewed by the qualified therapist, they can recommend a number of psychological techniques that the patient can use to help overcome aspects of their addiction.

Further to the standard therapies described above, there are a wide range of alternative therapies designed to complement the treatment program, and may be included in a drug rehab’s list of available modalities and services.

These complementary therapies improve the patient’s wellbeing, and can act as a way of decreasing stress levels. Examples of these types of therapy include:

• Art/Music Therapy
• Horticultural Therapy
• Experiential Therapy
• Equine-Assisted Therapy
• Exercise
• Meditation/Mindfulness
• Yoga

Although long-term recovery from substance addiction can be a difficult and life-changing process, it is certainly possible. However, to increase the chances of a successful recovery, it is absolutely vital that the addict is 100% committed to getting clean, sober and healthy.

SpringBoard Recovery, located in Scottsdale, Arizona (near Phoenix), provides effective and affordable outpatient treatment programs for individuals struggling with substance use disorders and mental health disorders. The goal at SpringBoard is to give clients a completely fresh start, along with the recovery skills needed to thrive in everyday life – substance-free.

• Individualized treatment plans based on patient needs and treatment goals
• One-to-one therapy with a qualified counselor or therapist
• Group therapy, allowing peer-to-peer discussion
• Full range of clinical therapies available
• Follow-up with a quality outpatient or intensive outpatient treatment plan for clients who complete their drug rehab programs

SpringBoard Recovery, located in Scottsdale, Arizona (near Phoenix), provides effective and affordable outpatient treatment programs for individuals struggling with substance use disorders and mental health disorders. The goal at SpringBoard is to give clients a completely fresh start, along with the recovery skills needed to thrive in everyday life – substance-free.

• National Institute of Drug Abuse (NIDA): Treatment Approaches for Drug Addiction. January, 2019. Available at DrugAbuse.gov.
• National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Evidence-Based Approaches to Drug Addiction Treatment.” January, 2018. Available at DrugAbuse.gov.
• Science Direct: Behavior Therapy. 2002. Available at ScienceDirect.com.
• U.S. National Library of Medicine: Definition of Partial Hospitalization. Spring, 1990. Available at NLM.NIH.gov.
• American Nurses Association: Nursing World – “Medication-Assisted Treatment (MAT) for Opiate Dependence” (downloadable PDF). 2021. Available at NursingWorld.org.