Drug Abuse and Addiction:

Rehab, Self-Help and Treatment Options

Drug addiction is a treatable disorder. Like people with diabetes or heart disease, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen.
Source: National Institute on Drug Abuse
In This Article:

Types of drug treatment programs
Help for families
Finding a drug treatment program
Preventing drug abuse and addiction
Choosing a drug treatment program
Self-help programs for drug addiction
If you or anyone you love suffers from drug addiction, know there is hope. Real help is available. According to several studies, drug treatment reduces drug use by 40 to 60 percent— but typically only for those who stay in treatment for three months or longer. People recovering from drug addiction can learn new behaviors and take medications to help them overcome the physiological, psychological and social dynamics of their condition. Through engaging in a program tailored to meet the individual needs of participants, patients can return to leading healthy, productive lives.

What are the general types of treatment and rehab programs for drug addiction?
Treatment programs for drug addiction could be classified into two broad categories: short-term and long-term treatment methods. Short-term methods are usually six months or less in duration. These include residential therapy, medication therapy, and drug-free outpatient therapy. Longer term treatment may include methadone maintenance treatment for opiate-addicted individuals and residential therapeutic community treatment. Here is a closer look at the main treatment options:
Short-term residential programs
Short-term residential programs were originally developed to treat alcoholism, but expanded to include drug addiction with the rise of cocaine use in the mid-1980s. Since then, they have been applied to a variety of drug addictions. They are set up to be intense, but relatively brief programs of between 3 and 6 months. Most are based on the Minnesota Model, a method of drug addiction treatment that grew out of the success of the Alcoholics Anonymous, or 12-step model, of recovery. The elements of the Minnesota Model typically include:
Thorough assessment of all aspects of a client: physical, emotional, mental, behavioral
A personalized treatment plan for each participant
Attendance of 12-step meetings and application of the 12-step philosophy
Self-reflection with an emphasis on greater acceptance of personal responsibility, changing negative beliefs about self and others, and learning new coping skills
Group and individual therapy (80-90% done in groups)
Family support, education, and involvement
Extensive outpatient follow up and support
The Minnesota Model is conducted by a multidisciplinary team of professionals—chemical dependency counselors, psychologists, psychiatrists, nurses, etc. The purpose of the model is to enable addicted individuals to achieve a significant transformation in their basic thinking, feeling and acting in relation to themselves and others. The resulting life change is identified as basically spiritual, though non-religious, in nature and is associated with the positive influence of group affiliation.
Medical detoxification
Medical detoxification, more accurately considered a precursor to treatment, is the process of physiological withdrawal from chemical dependency under the supervision of a physician. It can be in an inpatient or outpatient setting. It is often thought of as a distinct treatment in itself, as withdrawal from certain classes of drugs such as alcohol, barbiturates and sedatives can be extremely dangerous or even lethal. Detoxification alone does not lead to lasting abstinence, since it does not address the psychological and behavioral facets of addiction.
Long-term residential programs provide 24-hour a day care, usually in settings other than a hospital. The most common of the long-term programs are the therapeutic communities (TCs), which involve stays of between 6 and 12 months. TCs typically serve drug-addicted individuals with more severe problems, who are often also dealing with mental illness and criminal behaviors. The emphasis of TCs is on resocializing the individual through the social context of the community, which includes other residents, staff, and the day-to-day activities that form the basis of the treatment.
The program is highly structured and often confrontational, as it is designed to make the participants aware of the social and psychological deficits that led to their addiction. As such, the treatment focuses on examining damaging beliefs and self-concepts, developing personal accountability and social responsibility, and adopting new, more harmonious and constructive ways of relating with others. Many include employment training and other on-site support services.
Methadone maintenance treatment
Methadone maintenance treatment is designed to help individuals addicted to opiates (such as heroin) wean themselves off their dependency and resume a productive lifestyle. These programs administer an oral synthetic opiate medication, usually methadone or LAAM, for a period of time long enough to help stabilize patients so they can find employment, keep away from the crime and violence of the street culture, and protect themselves against the risk of HIV from sharing dirty needles or engaging in high-risk sexual behavior. The medication administered has three effects:
To prevent opiate withdrawal
To block the effects of illicit opiate use
To decrease opiate craving
With the effects of the addiction neutralized, patients are more able to engage in counseling, which is provided in the best methadone maintenance programs in the form of individual and group therapy, or referrals to community-based medical, psychological, and social services.
Outpatient drug-free treatment
Outpatient drug-free treatment is an appropriate alternative for people who are employed, are abusers of drugs other than opiates, and have an established network of social support. Programs run the gamut from minimal, education-only treatment to the more common intensive day treatment programs which offer group counseling. Outpatient treatment is less expensive than residential or inpatient programs. Some outpatient programs are designed to treat patients who have medical or mental health problems as well as a drug addiction.
While the effectiveness of outpatient programs does not rival that of its residential counterparts, the drop in drug use after treatment is still significant. One study sponsored by the National Institute on Drug Abuse tracked over 10,000 drug users in treatment from 1991-1993. For patients reporting weekly or more frequent cocaine use, the percentage of use dropped from 41.7% in the year before outpatient drug-free treatment to 18.3% in the year after treatment.
Criminal Justice Treatment Programs
Research has shown that individuals under legal mandate to engage in drug treatment programs do as well or better as those participating voluntarily. Treatment programs administered by the criminal justice system are twofold:
Prison-based treatment programs employ drug education classes, self-help programs, and the Therapeutic Community model. During treatment, participants are segregated so that their progress is not impeded by exposure to the prison culture. Relapse rates are lower when prisoners continue treatment after rejoining the general prison population. A study of one such prison-based treatment program, called “The Delaware Model,” showed that treatment including a work release therapeutic community and community-based aftercare reduced the probability of rearrest by 57 percent and reduced the likelihood of returning to drug use by 37 percent.
Community-based treatment programs exist as alternatives to incarceration. These include pre-trial release contingent on entry into a treatment program and sanctioned probation. The Treatment Accountability and Safer Communities Program (TASC), for example, offers counseling, medical care, parenting instruction, family counseling, school and job training, and legal and employment services. Some of its features are early identification and assessment of drug-involved offenders and monitoring offenders through drug testing.
How do I find an appropriate drug rehab treatment program?
The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services offers an extensive listing of drug treatment facilities by location through their Substance Abuse Treatment Facility Locator. Simply click your state on the map and then type in your city and/or zip code for treatment locations and descriptions of services.

What are some questions to ask in choosing a drug treatment program?
Obviously, the quality of care and the credentials of the caregivers who assist in recovery from drug addiction are of utmost importance. The following list of questions to ask of prospective treatment facilities is taken from the online companion to the PBS television series Moyers on Addiction: Close to Home:
What type of accreditation or licensing does the program have? National accreditation programs (such as the Joint Commission on Accreditation of Health Organizations, the Rehabilitation Accreditation Commission, the National Committee for Quality Assurance, and All-States) look for elements of treatment that research has shown to be effective. Accreditors also require a well-documented patient complaint process. Remember that " state licensing" is not the same as accreditation, since states vary widely in their licensing requirements. Failure to obtain accreditation may mean nothing—but it could indicate fringe status or, in the worst case, a quasi-cult or abusive form of "care."
Have there been studies to measure the effectiveness of the program's treatment methods? Treatment effectiveness is a new field of study, so it is still too early to expect all providers to have full research-based evaluations of their methods. Still, it is not too early for them to be planning these studies. The most objective evaluations usually come from external agencies rather than " in-house" evaluators.
What medication does the program support or prescribe to treat an addicted patient' s other possible medical problems? Is its staff knowledgeable about and willing to consider the use of medication that may help treat addiction? Many of addicted patients' medical symptoms may be complications of addiction, and clear up after a period of sobriety, but this is not always the case. Clinical depression, anxiety, or other conditions can undermine chances for recovery. The best treatment programs evaluate patients for such problems shortly after admission and offer appropriate medical care, including medication if indicated. Also, medications such as methadone, naltrexone, and disulfiram (Antabuse) can be effective in helping some addicts. Treatment centers should discuss them with patients.
What sort of "aftercare" does the program offer? Short-term treatment by itself is not enough to sustain recovery in most patients. Aftercare is crucial, preferably at least a year of weekly or biweekly outpatient counseling, plus participation in 12-Step programs (such as Alcoholics Anonymous) or other addiction self-help groups (such as Rational Recovery or Women for Sobriety). A good treatment program will actively help the patient integrate into a self-help group, although patients sometimes have to " shop around" to find the one in which they feel most comfortable.
What does the program do about relapse? Unfortunately, relapse is a common occurrence in substance abuse treatment—just as it is in treatment for other chronic illnesses. A good program includes relapse prevention classes that teach patients to recognize and avoid or deal with situations and emotional states that could trigger relapse. It should also have a plan for the patient's re-entering treatment and/or support groups to prevent a one-time lapse from becoming a full-blown return to active addiction. Relapse—though demoralizing—can be an important learning experience, but the individual may need further help.
What kinds of “self help” programs are available for overcoming drug addiction?
The National Institute on Drug Abuse states that “self-help groups can complement and extend the effects of professional treatment.” Many people with drug problems kick their addiction or maintain through their participation in non-professional, peer-directed groups. Among these are:
12–Step Programs
The most prominent self-help group for addiction is the 12-step program, a spiritually-based set of principles for living first conceived by the founders of Alcoholics Anonymous (AA). Since the formation of Alcoholics Anonymous in 1935, this self-help model has been adopted by other groups struggling with addiction, leading to the formation of Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, Crystal Meth Anonymous and others. The movement is still growing. In 1978, there were fewer than 200 registered Narcotics Anonymous groups in three countries. In 2005, those numbers rose to 21,500 registered groups, holding over 33,500 weekly meetings in 116 countries.
The 12-Step meetings are facilitated by fellow addicts who share their strength and experience in applying the program principles to stay drug-free. Attendance is voluntary, membership is free, and participation is entirely devoid of professional guidance. The program is structured around admitting powerlessness over the addiction, surrendering to a higher power of one’s own understanding, and drawing on group strength and support to find acceptance of oneself regardless of past actions or the tendency towards addictive behavior. The program includes a fearless inventory of one’s personal history and taking responsibility for reshaping life into a meaningful experience of service to self and others.
Research bears out the program’s effectiveness. In a study conducted by Dr. Robert Fiorentine of the UCLA Drug Abuse Research Center, 262 patients were interviewed 6 months after completing treatment at different facilities in the Los Angeles area. 86.4% of those who attended at least one 12-Step meeting per week after treatment maintained their abstinence, whereas only 48.4% remained drug free who did not attend weekly meetings. These results held up regardless of motivation; simple participation made the difference.
Smart Recovery
Smart Recovery is based on the principles of Cognitive-Behavioral Therapy (CBT). It differs from the 12-Step program in philosophy, in that it views addiction more as a complex maladaptive behavior than as a disease. The program offers specific tools and scientific techniques to help individuals gain independence from any addiction—be it to a substance or activity support participants. Smart Recovery utilizes the following 4-point method of recovery:
Enhancing and Maintaining Motivation to Abstain
Coping with Urges
Problem Solving (Managing thoughts, feelings and behaviors)
Lifestyle Balance (Balancing momentary and enduring satisfactions)
Smart Recovery is practiced in over 300 meetings around the world, and in16 meetings online. The method is purported to work even for those individuals whose ultimate goal is not abstinence, but managed use of their addictive substance. Smart Recovery recognizes that there are many paths to healing, and does not discredit any other means that help with the problem of addiction.
Secular Organizations for Sobriety (SOS)
Secular Organizations for Sobriety (SOS) is a network of independent meetings that promotes abstinence from alcohol and drugs, and provides peer support for others struggling with the same issues. SOS credits the individual for achieving and maintaining his or her own sobriety, as opposed to the 12-Step model of reliance on a higher power. It emphasizes honest, clear, and direct communication of feelings, thoughts, and knowledge to aid people in choosing rational approaches to living without drugs. Some of the tools used in SOS meetings are:
Sobriety—this is priority one, no matter what!
Seriousness—the addiction is nothing less than life or death
Determination—there is no turning back, especially if it gets rough
Easily obtainable goals—success breeds success. Reach for the moon later.
Listening—especially to people with long-term sobriety
Do it now—procrastination is an anti-tool, feeding the negative and working against self-esteem.
Credit yourself—for your attainment and maintenance of sobriety.
Women for Sobriety
Women for Sobriety was founded in 1976 to meet the unique needs of women alcoholics, whose recovery in AA was found to be less successful than that of men. It since been adapted to women addicted to drugs. The method is based on the premise that the psychological needs of women in recovery are different than for men. Participants hold weekly meetings in small groups of 6-10 women, with a structured format for confidential discussion.
The core of the approach is the “New Life” Program of Positivity, based on Thirteen Statements to encourage emotional and spiritual growth as a means of recovery. Women are encouraged to arise each morning fifteen minutes earlier than usual and go over the Thirteen Affirmations. They then take one statement and use it consciously all day. At the end of the day, they review what effects use of the affirmation had on their state and their actions.
What help is available for the families of individuals with a drug abuse problem?
Nar-Anon is a 12-Step program formed for families of individuals addicted to drugs. Nar-Anon groups are patterned after Al-Anon groups and help family members learn to recognize and avoid enabling behaviors, take better self-care (regardless of the behavior of the addicted person), and improve the interpersonal dynamics within the family that contribute to and/or are impacted by the problem of drug abuse.
What are the most effective methods for preventing drug abuse and addiction?
The research-based evidence suggests that prevention efforts be aimed towards reducing risk factors among children and adolescents. The National Institute on Drug Abuse published a booklet called Preventing Drug Use: A Research-Based Guide, which outlined 16 prevention principles to help parents, educators, and community leaders develop and implement effective drug prevention programs. Some of the key findings were:
Risk factors change with age. Risk factors within the family have greater impact on a younger child, while association with drug-abusing peers may be a more significant risk factor for an adolescent.
Early intervention with risk factors (e.g., aggressive behavior and poor self-control) often has a greater impact than later intervention by changing a child’s life path (trajectory) away from problems and toward positive behaviors.
Family bonding is the bedrock of the relationship between parents and children. Bonding can be strengthened through skills training on parent supportiveness of children, parent-child communication, and parental involvement.
Parental monitoring and supervision are critical for drug abuse prevention. These skills can be enhanced with training on rule-setting; techniques for monitoring activities; praise for appropriate behavior; and moderate, consistent discipline that enforces defined family rules.
Some of the most promising trends in prevention aim at school-based programs that integrate social and life skills training to teach kids how to resist drugs. This is a practical training program based on real-life examples that teaches adolescents coping skills, rather than merely giving them facts about drug abuse and the consequent health risks.
The Life Skills Training program, developed at Cornell University and used in middle schools, teaches students to develop skills in resisting social pressures to use drugs and encourages anti-drug attitudes in them. The program has shown it can reduce use of tobacco, alcohol, and marijuana among teenagers by as much as 75 percent. Likewise, the message that parents send to their kids about drug use, either overtly or through example, greatly increases the probability of their children using. Karol Kumpfer, Ph.D., president of the Society for Prevention Research, says it is important for parents to set rules and stay connected to their children. "Teens actually listen to their parents. Setting rules about substance abuse has a major effect."