Drug addiction, also known as a substance use disorder (SUD), is a national crisis in the United States. According to the National Institute on Drug Abuse (NIDA):1,2,3
- Approximately 53 million people aged 12 and older (nearly 1 in 5 Americans) used an illicit substance (marijuana, cocaine, heroine, LSD, PCP, ecstasy, inhalants, and methamphetamine) in 2018. (Over 23 million people aged 12 and older used an illicit substance other than marijuana).
- Almost 17 million people aged 12 and older misused prescription drugs (including pain relievers such as prescription opioids, stimulants, and tranquilizers or sedatives.
- Rates of overdose deaths from prescription opioids in 2017 have gone up more than five times what they were in 1999.
- Approximately 66 million people aged 18 and older reported binge use of alcohol in the past month. Bing use is defined as drinking four or more drinks for females and five or more drinks for males at the same time or within a couple of hours of each other on at least 1 day in the past 30 days.
- Addiction to and abuse of illicit drugs and prescription opioids costs the country nearly $272 billion each year. Alcohol abuse costs the country about $249 billion.
With these staggering numbers of people struggling with—and drying from—from substance abuse and addiction, many may wonder whether there’s a viable cure for this chronic, relapsing condition.
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The American Society of Addiction Medicine defines addiction as a primary, chronic disease of brain reward, motivation, memory, and related circuitry.13
Addiction to drugs (including alcohol) is characterized by the intense, compulsive desire to obtain and use a drug(s), regardless of the negative effects on themselves and others.4-6 Over time, it causes noticeable and predictable changes in the user’s brain that create overwhelming cravings to use and make it extremely difficult to quit using, even when the negative effects of using become unbearable.4-7
Signs of Addiction
People who are addicted may spend more time and energy focused on using substances rather than caring for themselves or tending to other responsibilities. This pattern can lead to a decline in physical and mental health, social relationships, employment, finances, and legal standing:7,8
During the decline, addicted people may not realize or show concern for the changes. Instead, they may deny there’s a problem and blame others for negative consequences in their lives.
Can Addiction Be Cured?
This is a tricky question and depends on how you define “cure.” Very few people achieve sobriety and never look back. Most people have enduring periods of relapse and recovery. In either case, even if the person stops using completely, there is often an enduring struggle to ward off cravings and remain sober. The individual, because of their biological/psychological makeup, environment, development, and personal history, must take greater care and caution to avoid relapsing.4,5,14 One might say that they will never be “cured,” but rather in the ongoing process of “healing.”
With this in mind, be wary of any individual or institution claiming they can undo a drug abuse problem. By following treatment guidelines, seeking the best addiction treatment support, and using proven strategies, the patient can experience fewer relapses and extend periods of recovery, and hopefully find lasting sobriety along the way.
NIDA provides more than a dozen principles that are meant to guide effective treatment. These include (but are not limited to) the following:4
- The condition of addiction is multifaceted but treatable.
- The best treatments are readily available and treat the entire person (including any mental health issues).
- Counseling and medications are useful, especially when used in collaboration.
- Success in treatment relies on staying in a program for an appropriate amount of time.
- Even involuntary treatment can be successful.
- Treatment should be monitored and tweaked continually to provide optimal care.
- Supervised detox is only the first step in treatment—not the only step.
Based on information from NIDA, it is clear that no one approach is appropriate for all people interested in treating addiction. Many people will benefit from several different modes of treatment depending on their abused substance and severity of addiction. These treatment strategies may be used in stages and/or concurrently. Treatment strategies include:4,9
- Withdrawal management (or detox). The first step for many people who’ve become dependent on a substance is safely managing the physical and mental effects associated with withdrawal. The detoxification process allows the body to process and remove the substance while under the care of a medical staff to ensure safety. At times, medications may be offered to maintain comfort or minimize potentially life-threatening symptoms during the withdrawal process.[/
- Inpatient/residential programs. Inpatient treatment offers a structured and supervised program with 24-hour care. Programs typically last between 28 and 90 days, although residential programs may last longer for extended support. These programs are designed to achieve symptom stability.[/
- Sober living/halfway houses. These settings are a midpoint between a residential setting and returning home. Though they differ in certain ways, both involve living in a less structured environment with others in recovery from substance use. Generally, these options will require participants be employed as well as staying engaged outpatient treatment.
- Outpatient. Depending on a person’s needs, treatment will range from an hour per month or 30 hours per week. Outpatient treatment is an umbrella term for many levels of care including individual, group, and family therapy; intensive outpatient programs; and partial hospitalization programs.
- 12-step programs and group support or therapy. Support groups are an informal style of treatment with other people in recovery leading the meetings. They tend to focus on ideas of fellowship and mentoring to treat addiction. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) promote a 12-step methodology to treating addiction and maintaining a sober lifestyle while Self-Management And Recovery Training (SMART) promotes a science-based 4-point program.
Medication can be a helpful tool throughout the recovery process and may be critical for safe and effective withdrawal management of opioids or alcohol. These medications have been approved by the FDA as safe and effective without adding the risk of continued or new addictions. Medications can be used as:4,6
- A means to decrease the physiological effects of withdrawal during detox.
- A method to help manage possible mental health symptoms such as depression, anxiety, and psychosis that may have led to or been triggered by addiction.
- A way to prevent relapse, especially in the cases of addiction to substances like opioids and alcohol.
There are a variety of therapy styles that are used when treating SUDs, and they are based on the theoretical perspective of the therapist or the program. Styles that have been tested and shown success in the treatment of addiction are called evidenced-based treatments. They include:4,10-12
- Cognitive-behavioral therapy (CBT): This therapy type focuses on identifying links between thoughts, feelings, beliefs, and behaviors. It helps to identify triggers for using and teaches ways to deal with negative thoughts and behaviors.
- Contingency Management (CM): This therapeutic style aims to directly reinforce wanted behaviors like completing negative drug screens and attending treatment. Money and prizes are provided as rewards.
- Motivational Interviewing (MI) – This approach works to help the person in recovery build their own motivation and desire for wellness. The therapist works with the client to collaboratively discover internal motivation and reasons for changing.
- Dialectical Behavior Therapy (DBT)): Addiction is often related to difficulties regulating stress and emotions. DBT teaches clients strategies to better tolerate distress, effectively deal with their emotions, and make wiser choices.
- Community Reinforcement and Family Training (CRAFT): This set of therapeutic techniques works with the patient’s loved ones, rather than the patient directly, so that the loved ones can help the patient.
- Substance Abuse and Mental Health Services Administration. (2018). Table of Contents for the 2018 NSDUH Detailed Tables.
- National Institute on Drug Abuse. (2019). Overdose Death Rates.
- National Institute on Drug Abuse. (2017). Trends & Statistics.
- National Institute on Drug Abuse. (2019). DrugFacts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2018). DrugFacts: Understanding Drug Abuse and Addiction.
- National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
- Mayo Clinic. (2017). Drug addiction (substance use disorder).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2013). Seeking Drug Abuse Treatment: Know What To Ask: 5. How do 12-step or similar recovery programs fit into drug addiction treatment?
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
- Psychology Today. (n.d.). Dialectical Behavior Therapy.
- Scruggs, S.M., Meyer, R., Kayo, R. (2014). Community Reinforcement and Family Training Support and Prevention (CRAFT-SP).
- American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction.
- American Society of Addiction Medicine. (2013). Terminology Related to Addiction, Treatment, and Recovery.