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Addiction Treatment

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Substance addiction is a chronic condition involving compulsive drug and/or alcohol use. People who are addicted to a substance may continue to drink or use drugs despite the potentially serious problems such substance use may cause in their lives.1 Addiction can adversely impact every part of a person’s life, including physical and mental health, family and relationships, employment, and finances.2

Once addicted, it can be very challenging for a person to quit using a substance because of the way drugs affect the brain.12 In some cases, it can also be dangerous to suddenly stop or decrease the use of certain substances without medical supervision.13 Addiction treatment isn’t always easy, but in addressing these and other issues, it has helped many people recover from substance use disorders.

While addiction is a chronic and complex condition, it is treatable.3, 14 Studies have shown that treatment is most effective when it is individualized, meaning that it is tailored to address specific emotional, medical, psychosocial, employment-related, familial, and other aspects of a person.3

If you or a loved one are considering alcohol or drug addiction treatment, this article will help you understand what treatment is, types of addiction treatment, and common therapies used during treatment.

What is Addiction Treatment?

Addiction treatment is a series of interventions designed to help people stop using drugs and improve functioning within their family, work, and community lives.15 Types of addiction treatment can vary depending on the specific type of substance(s) being used, individual medical and mental health needs, as well as other social issues.14 Some people seek addiction treatment on their own when they feel they cannot stop using substances while others may be required to enter treatment as a result of legal issues; in either instance, positive treatment outcomes may result.16

Certain changes in areas of the brain that are involved in impulse control, judgment, and decision making may accompany the development of an addiction.1 Many types of compulsive drug use are thought to be associated with changes in brain chemistry involving increased dopamine activity in the brain’s reward system.1

Some of the brain changes to develop in association with addiction may not suddenly disappear when a person stops using substances. Such changes may contribute to persistent behavioral patterns that make it relatively difficult for someone to control their impulses to use again.3 The compulsion to continue drinking or using drugs may also be tied to environmental and psychological triggers, of which an addicted person is sometimes not even aware. The good news is that addiction treatment uses evidence-based methods to target and change some of these deeply rooted triggers and behavioral patterns.3

A comprehensive approach to addiction treatment commonly involves a combination of several therapeutic components, including:3

  • Medical detox.
  • Treatment medications.
  • Behavioral therapies.
  • Family therapy.
  • Group and individual counseling.
  • Support groups.
  • Social services, including housing, legal, and financial services.

The combination of these services and length of treatment depends on the person’s particular needs. As these needs change over time, so should the treatment approach to address their changing needs.3 Like many other chronic health conditions, addiction is known to be a relapsing condition. Substance relapses themselves, should they occur, should not be taken as treatment failure. But rather, they could indicate that treatment approaches may need to be adjusted over time to maintain recovery momentum.1

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What Happens During Addiction Treatment?

When a person enters addiction treatment, the intensity of care and time frame of such care will vary depending on individual needs. The American Society for Addiction Medicine (ASAM) outlines a continuum of several levels of addiction treatment care, including the following levels:5

  • Outpatient services
  • Intensive outpatient/partial hospitalization
  • Residential/Inpatient services
  • Medically managed intensive inpatient services

Keeping such levels of care in mind, treatment providers may recommend an appropriate plan for care based on a multifactorial assessment of individual risks, supports, and various other treatment needs.5 During treatment, a number of approaches may be taken including medication, individual and/or group therapies, or a combination of these approaches.3

Types of Addiction Treatment

Addiction treatment programs will often combine approaches depending upon the specific needs of the person. It’s common for treatment to start with medically supervised detox, to help the person safely and comfortably overcome withdrawal symptoms from certain substances.3 Additionally, treatment may include a combination of other services such as individual and/or group therapies, family therapy, evaluation for co-occurring mental health disorders, and long-term follow-up.8

The interventions that work for one person may not work for another. Addiction treatment can be effective but needs to be continuously monitored and adjusted to the needs of the person to enhance long-term management of addiction. The length of treatment may also be an important factor in determining the effectiveness of treatment with longer treatment being recommended for more positive outcomes.3

Inpatient Rehabs

Inpatient rehab, a category that includes residential treatment settings, is a type of addiction treatment where a person stays in the facility 24/7 to receive services, often with medical supervision on-site. Inpatient rehabs can range from hospital settings to structured residential facilities depending on a person’s needs when entering treatment. Experienced clinicians will assess a person’s needs to help guide them toward the appropriate level of care.5

A person taking substances that have the potential for more severe withdrawal symptoms, or who struggles with ongoing emotional, behavioral, or cognitive problems, may be recommended for a medically managed inpatient hospital setting.5

Choosing the appropriate level of care should be done with the guidance of a medical professional who can properly assess a person’s needs, risks, strengths, and resources.5 They may consider inpatient treatment if:5

  • Substance misuse has been a long-standing problem.
  • A person lives with people who are actively using substances.
  • A person has underlying medical conditions.
  • A person has co-occurring mental health disorders.

The length of stay for inpatient rehab varies depending on the person and the treatment program. In 2016, the median length of completed treatment stays in inpatient settings was 28 days for hospital residential treatment and 24 days for short-term residential treatment.6 Completed long-term residential treatment stays averaged 83 days that same year.6 It’s important to note that longer courses of any type of treatment (inpatient and/or outpatient) are associated with better treatment outcomes, and that many people need long-term or repeated care to completely stop using substances.8

Outpatient Rehabs

Outpatient treatment settings are home to rehab programs in which a person attends regularly scheduled sessions or receives services at a treatment facility while still living at home. With a range of treatment offerings that is often similar to their inpatient or residential counterparts, outpatient treatment is often focused on education, counseling, and helping people cope without using substances. Outpatient treatment may be most appropriate for people who:3

  • Maintain stable employment.
  • Have strong social/family support.
  • Recently completed an inpatient or residential program.

Outpatient treatment services vary from one program to another, but in general, the hours may be more accommodating for people still working or going to school while undergoing treatment. The range of treatment programming, including drug education, behavioral therapy, and support group participation, may resemble that found in inpatient rehab. Yet, outpatient programs often have relatively less structure and round-the-clock supervision, which is common to more intensive inpatient or residential treatment settings.

Outpatient treatment itself encompasses various levels of care. These may include:5

  • Standard outpatient services that may consist of up to 9 hours per week of treatment for adults with a substance use disorder.
  • Intensive outpatient programs (IOPs), which provide at least 9 hours a week of treatment for people with more complex needs related to addiction and/or co-occurring conditions.
  • Partial hospitalization programs (PHPs), which offer at least 20 hours a week of treatment, but don’t require 24-hour care.

It’s important to keep in mind that within the spectrum of treatment settings, both inpatient and outpatient, people may move in either direction through the continuum as they journey through recovery. For example, someone may step down to a less intensive level of care if their recovery progress allows it. Others may find they would benefit from moving from an outpatient to an inpatient program, due to previously unforeseen challenges

Alcohol and Drug Detox

Drug and alcohol detox involves a supervised withdrawal management period, which allows the treatment team to stabilize a person in early recovery—keeping them as comfortable and safe as possible as their body rids itself of substances. An important facet of many detox programs is that they help to facilitate a person’s transition into ongoing treatment. 7 Detox is often just the first stage of treatment and not a substitute for more comprehensive treatment or rehabilitation, the latter allowing for greater focus on therapeutic services to support recovery.7

The withdrawal and detoxification process may vary somewhat depending on the substances used as well as the magnitude of physiological dependence associated with such use. Some detox treatments may involve medication management to help a person in early recovery by alleviating cravings, minimizing withdrawal symptoms, and decreasing the risk of withdrawal complications. Because of their association with significantly unpleasant and/or risky acute withdrawal syndromes, medical detox management may be particularly important if a person was using opioids, alcohol, or benzodiazepines.7

Medical withdrawal management may be especially critical for those with a history of regular use of certain substances such as benzodiazepines and alcohol, because suddenly stopping use could potentially result in dangerous health effects like seizures and other complications. Some potential withdrawal symptoms associated with both alcohol and benzodiazepines include:7

  • Anxiety.
  • Agitation.
  • Tremor.
  • Restlessness.
  • Insomnia.
  • Increased body temperature.
  • Increased pulse and blood pressure.
  • Hallucination.
  • Delirium.
  • Seizures.

Alcohol withdrawal is particularly dangerous as it sometimes associated with a condition called delirium tremens. This can occur when someone stops drinking after a period of heavy drinking. It can potentially lead to the symptoms outlined above in addition to seizures, changes in mental function, and other life-threatening complications.7

While not usually life-threatening, opioid withdrawal can result in many unpleasant symptoms, including:7

  • Anxiety.
  • Body aches.
  • Excessively runny nose.
  • Sweating.
  • Stomach cramps.
  • Nausea and/or vomiting.
  • Diarrhea.
  • Goose bumps.
  • Fast pulse.
  • Raised blood pressure.
  • Involuntary muscle contractions.

For safety and humanitarian reasons, withdrawal for certain substances is often recommended to be done under the supervision of qualified medical professionals.7 Proper withdrawal management can help reduce discomfort and minimize potential risks of withdrawal symptoms or other complications.

Types of Therapy Used in Alcohol and Drug Addiction Treatment

There are many different approaches to treating alcohol and drug addiction. Behavioral therapies and medication may be used in combination and tailored to a person’s specific needs. No one treatment is ideal for everyone, but there are common approaches that are used to treat substance use disorder, which are discussed in detail below.8

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy, or CBT, is a commonly used treatment approach for substance use disorders, as well as anxiety and depression.10 CBT focuses on changing a person’s way of thinking and adjusting previously maladaptive behavioral patterns, with an emphasis on problem-solving and correcting faulty patterns of thinking. The basic foundation of CBT is that thoughts and behaviors are learned and can also be unlearned.

In terms of substance use, CBT teaches people to cope with triggers that result in the use of substances and helps them learn different ways to cope and avoid using substances.10 CBT can be used in both outpatient and inpatient settings.

Contingency Management (CM)

Contingency management is a treatment intervention that aims to increase abstinence. It is based on the idea that the use of drugs and alcohol can be rewarding for people, which could make it more difficult to stop using.10

Contingency management seeks to replace the rewards people get from using drugs or alcohol with other things. For example, if a person submits a certain number of negative drug screens, they are given prizes, such as movie tickets. Or, a person may receive points that can be redeemed for items like baby diapers.3 This method has shown to be effective for encouraging drug abstinence.3

Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET)

Motivational interviewing (MI) is a therapeutic technique that can help a person uncover how their substance use is at odds with their goals and values. With this understanding, they can better navigate how to change their habits and may feel less resistant to treatment.10

Motivational interviewing involves meeting the person where they are at on their journey and trying an approach called “rolling with resistance.” Rolling with resistance means that the counselor guides a person towards his or her own definition of both the substance use problems and the solution to the problem. This approach can help minimize power struggles and resistance, as the person isn’t being told what to do.

Several other techniques may also enhance the motivation to change, including empathetic listening and working with ambivalence.11, 10

Motivational enhancement therapy (MET) is a structured approach that works to quickly motivate a person to engage in treatment through a series of therapy sessions.3 Research into this method shows it’s been effective with alcohol and marijuana use, and is useful in motivating treatment versus leading someone to change their drug use with this method alone.3

12-Step Facilitation Therapy

12-step facilitation therapy introduces people to the concept and practices of 12-step groups as part of their substance abuse treatment program. The principles of 12-step groups are sometimes incorporated into the foundation of a program, which includes cognitive, spiritual, and health focuses.

In addition, the encouragement and promotion of attendance in 12-step meetings, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is a core feature of these models. 12-step attendance is strongly encouraged as a means of aftercare.10 In fact, there is some research evidence that suggests that treatment programs which incorporate 12-step programs into their treatment model are associated with better treatment outcomes than those that do not.10

Matrix Model

The Matrix Model is an intensive approach to addiction treatment that uses various methods to treat the whole person, including relationships, emotions, and behavior. The Matrix Model puts a strong emphasis on the counselor-client relationship and encourages people to practice creating structure in their lives. This may help manage their daily schedule and free time and has shown promising results.10

This model was developed to help those using stimulants, such as cocaine, but is now used in addiction treatment for other substances as well. The Matrix Model includes: 3

  • Relapse prevention treatment.
  • Family therapy.
  • Drug screening.
  • Support groups.
  • Skill building.
  • Other techniques.

It can feel overwhelming when seeking treatment for an addiction, either for yourself or a loved one. If you or a loved one need help, contact American Addiction Centers at 1-888-744-0069 to speak with a caring admissions navigator who will take time to understand you, and guide you towards appropriate additional treatment.

You can also begin by verifying your insurance coverage at an American Addiction Centers facility using the free, confidential form below.

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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