What Happens in Treatment Programs?

by National Institute of Health

(Page 4 of 6)

Treatment for Mental Disorders

Many people with a substance use disorder also have emotional problems such as depression, anxiety, or post-traumatic stress disorder. Adolescents in treatment also may have behavior problems, conduct disorder, or attention deficit/hyperactivity disorder. Treating both the substance use and mental disorders increases the chances that the person will recover. Some counselors think people should be alcohol and drug free for at least 3 to 4 weeks before a treatment professional can identify emotional illness correctly. The program may provide mental health care, or it may refer a person to other sites for this care. Mental health care often includes the use of medications, such as antidepressants.

Family Education and Counseling Services

This education can help you understand the disease and its causes, effects, and treatment. Programs provide this education in many ways: lectures, discussions, activities, and group meetings. Some programs provide counseling for families or couples.

Family counseling is especially critical in treatment for adolescents. Parents need to be involved in treatment planning and followup care decisions for the adolescent. Family members also need to participate as fully as possible in the family counseling the program offers.

Medication

Many programs use medications to help in the treatment process. Although no medications cure dependence on drugs or alcohol, some do help people stay abstinent and can be lifesaving.

Medication is the primary focus of some programs, such as the medication-assisted OTPs discussed earlier. Methadone is a medication that prevents opioid withdrawal symptoms for about 24 hours, so the person must take it daily. Taken as directed, it does not make a person high but allows him or her to function normally. In fact, methadone blocks the "high" a person gets from an opioid drug.

Some people stay on methadone for only 6 months to 1 year and then gradually stop taking it; most of these people relapse and begin to use opioids again. However, others stay on methadone for long periods of time or for life, which is called methadone maintenance treatment. People receiving this treatment often have good jobs and lead happy, productive lives.

If your family member is taking medications for HIV infection or AIDS or for any other medical condition, it is important that OTP staff members know exactly what he or she is taking. Mixing some medications with methadone or LAAM may mean that your family member will need special medical supervision.

Buprenorphine is another medication that may be used to treat opioid dependence and is sometimes used by OTPs. Buprenorphine recently was approved for treatment by primary care doctors in their offices. A doctor treating a patient with buprenorphine generally will provide or refer the patient for counseling, also.

Disulfiram (Antabuse®) is a medication that causes a bad reaction if people drink alcohol while taking it. The reaction is flushing, nausea, vomiting, and anxiety. Because people know the medication will make them very ill if they drink alcohol, it helps them not to drink it. Antabuse is taken daily.

Q: If substance use disorder is a disease, why aren't there medicines that will help? A: There are medicines that will help, though only for some addictions. No "magic pill" exists to cure substance use disorders, but medicines can often be an important part of the treatment. Medications are used to detoxify a person, to prevent him or her from feeling high from taking drugs, to reduce cravings, or to treat a person's mental disorder.

Another medication, naltrex-one (ReVia®), reduces the craving for alcohol. This medication can help keep people who drink a small amount of alcohol from drinking more of it. Programs also sometimes use naltrexone to treat heroin or other opioid dependence because it blocks the drug's effects. It is important for people who use heroin to go through detox first, so they are heroin free before starting to take naltrexone.

Because it is very difficult for a person to detoxify from opioid drugs, many people don't make it that far; buprenor-phine is sometimes used to help people make that transition. If a person does detoxify from opioids and begins to take naltrexone, it still will not work well for this purpose unless a person has a strong social support system, including someone who will make sure that he or she continues to take the medication regularly. When an adolescent is taking naltrexone to treat opioid dependence, it is particularly important that parents provide strong support and supervision.

Followup Care (Also Called Continuing Care)

Even when a person has successfully completed a treatment program, the danger of returning to alcohol or drug use (called a "slip" or relapse) remains. The longer a person stays in treatment, including followup, the more likely he or she is to stay in recovery. Once a person has completed basic treatment, a program will offer a followup care program at the treatment facility or will refer him or her to another site. Most programs recommend that a person stay in followup care for at least 1 year. Adolescents often need followup care for a longer period.

Followup care is very important to successful treatment. Once a person is back in his or her community, back in school, or back at work, he or she will experience many temptations and cravings for alcohol or drugs. In followup care, your family member will meet periodically with a counselor or a group to determine how he or she is coping and to help him or her deal with the challenges of recovery.

For some people, particularly those who have been in residential treatment or prison-based programs, more intensive forms of followup care may be helpful. Halfway houses or sober houses are alcohol- and drug-free places to live for people coming from a prison-based or residential program. People usually stay from 3 months to 1 year, and counseling is provided at the site or at an outpatient facility.

Supportive living or transitional apartments provide small group living arrangements for those who need a sober and drug-free living environment. The residents support one another, and involvement in outpatient counseling and self-help groups is expected.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.