By: Mariah Stein
There is no single treatment approach in the US to helping people with AOD (alcohol or other drug dependence or abuse) problems, but there are over 13,000 specialized substance abuse treatment facilities in the US that provide a variety of treatments. These are some of the treatments that are used with substance Abuse. (Straussner, 2012, pg. 128)
Pharmacotherapy: (Straussner, 2012, pg. 128-129)
- There are medications that can help diminish the cravings for drugs and assist clients in re-establishing normal brain functioning for opiate addictions, as well as other medications to treat alcohol addiction.
- Methadone is highly controversial because it is a drug replacement and not abstinence, but it is currently the most widely applied and researched medication for opiate dependence
– Methadone significantly decreases opiate use, reduces drug related crimes, illnesses and death, and enhances social productivity
- Buprenorphine is the newest medication for opiate addiction. In 2000, Congress passed the Drug Addiction Treatment Act (DATA) allowing qualified physicians in private practice to prescribe this to a limited number of patients.
- These medications are not enough for the majority of patients, but need to go along additional psychosocial and medical services
- Disulfiram has been used to treat alcohol dependence for over 40 years. It produces extremely unpleasant side effects (nausea, flushing headaches, and heart palpitations) if the patient drinks alcohol.
- Naltrexone (typically used with counseling) blocks opioid receptors that are involved in the rewarding effects drinking and the craving for alcohol.
- Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness and dysphoria.
Behavioral Therapies: (Straussner, 2012, pg. 129-130)
- There are a few different behavioral therapies that help people engage in the treatment and recovery process, provide incentives to remain abstinent, modify their attitudes and behaviors related to substance abuse, and increase skills to handle stress and environmental cues that may trigger craving for AOD
- Contingency Management (CM):this involves giving patients incentives (food vouchers, travel/movie tickets) for meeting previously agreed upon behavioral goals. This is highly effective (because of operant conditioning) for people diagnosed as being dependent or abusing alcohol, stimulants, narcotics, and marijuana.
- Cognitive Behavioral Therapy (CBT): attempts to reduce self-defeating behavior by modifying cognitive distortions and maladaptive beliefs, as well as teaching techniques of thought control. CBT is based on trying to enhance self- control by teaching the patient to explore the costs and benefits of continued substance use, to pay attention to their thinking, to cravings and substance-seeking behaviors, to identify high risk situations that con compromise one’s recovery, and to develop effective relapse prevention strategies.
- Motivational Enhancement Therapy (MET): this draws upon combining (precontemplation, contemplation, preparation, action, and maintenance) with the clinical techniques of Motivational Interviewing. This emphasizes expressing empathy, developing discrepancies, avoiding argumentation, and rolling with the resistance. This approach is very successful, especially with engaging substance abusers to enter treatment.
-the MET led to the development of the SBIRT (Screening Brief Intervention, and Referral to Treatment) which is becoming a widely adopted model for early identification of alcohol problems in primary health facilities.
- Twelve Step Facilitation Therapy (TSF): a brief structured approach to facilitating early recovery from alcohol and drug abuse. It is implemented in 12-15 individual client sessions, and is grounded in the behavioral, spiritual, and cognitive principles of the fellowships of AA and NA. Central principles include: accepting that AOD addiction is a chronic, progressive disease that one is powerless over and that life has become unmanageable, surrendering to a higher power, and active involvement in 12 step fellowships.
- Harm Reduction: designed to reduce the harmful consequences associated with drug use. This includes needle exchange programs and opioid substitution therapy. This is also used by engaging clients in a therapeutic relationship without getting into a power struggle over preordained set goals by the therapist.
Straussner, S. (2012). Clinical Treatment of Substance Abusers: Past, Present and Future. Clinical Social Work Journal Clin Soc Work J, 40, 127-133.