Posted on January 21, 2024

 

More than 40 million people in the United States,16 percent of all Americans over age 12 suffer from nicotine, alcohol, or drug addiction. Only about 10 percent of those people receive treatment, according to a recent report by the National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). And far fewer receive effective, evidence-based treatment, according to the report, entitled “Addiction medicine: Closing the gap between science and practice.”¹

The previous three articles for Insights have focused on the brain and how drugs change it. The changes can be long-lasting and a brain on drugs is not normal. It wants more drugs. But just like drugs change the brain, abstinence and treatment can at least partially reverse the changes.^2,3,4 

It may take some time and it won’t be easy, but all is not lost. 

Another problem is addicts have poor health. They have neglected the care of their body and mind.

They may have:  

• Infections from needles. 
• Sexually transmitted diseases. 
• Stress-related illnesses such as anxiety, depression and more. 

Being an addict also reduces life expectancy.

Treatment is necessary to help recover their productive lives.

 

Thinking style of an addict

 

Denial

“I do not have a problem. I can stop any time I want. Do not call me an addict! Why should I stop? Drugs help me.” 

Drugs can help control emotional symptoms, at least in part, but at the cost of potential addiction. 

Denying drug use allows them to do nothing and that can be a comforting frame of mind. They play the blame game (parents, bosses, illnesses, doctors and unfair treatment). 

Self-loathing is common along with low self-esteem, guilt and shame. 

The addict may come to realize what they have done to themselves and others. They may have tried to reverse course, but may have failed. They may sink lower and lower but are unable to stop it.

 

All of these factors promote continuing drug use. 

Confusion and fear of treatment

They may think that they will be:  

• Handcuffed. 
• Arrested. 
• Locked up. 
• Given a prison record. 
• Forcibly withdrawn from drugs. 
• Thrown back on the streets. 
• Mothers worried their children will be taken from them. 

People’s lives have been saved by timely treatment. The effectiveness of treatment is well documented.1 

Why seek treatment 

• The addict hit bottom and became desperate for a program that would help. 
• They may have experienced a spiritual rebirth. 
• Forced into treatment by the criminal justice system, employers or family. 
• Realize they have a lousy life, and it really does not have to be this way. 

Does it always work for each and every person? A person in treatment for their addiction may require multiple rounds of treatments and may experience relapses before finding success. There may be those that drop out of treatment or never get adequate treatment.

 

Factors that predict success in treatment: 

• Lower level of dependence or drug use. 
• Good support system. 
• Job or career. 

These factors seem to help, but people without these factors or characteristics have achieved success in their recovery.

 

The cost of treatment 

Treatment may be free, low cost or on a sliding scale, but this depends upon insurance, treatment availability and patient resources. 

Addicts cannot afford to not go into treatment.

 

Overall, it is cheaper to treat than not to treat.⁵ 

Why treat them? They are only addicts! 

This is a critical issue and has to do with society’s views and attitudes about addicts6:  

• Addicts and addiction carry a stigma. 
• People consider drug use a moral or character failure requiring something like an awakening or a spiritual rebirth for a cure. 
• Society feels that addiction is something that individuals do to themselves so therefore they should undo it by themselves. 

There is a tendency for self-righteousness and moralizing in some groups!

Addiction research has shown that addiction is a brain-based disorder because of biological vulnerabilities and environmental factors. 

From this perspective, drug abuse is similar to other diseases. 

Addiction is like other chronic diseases. The literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma.⁷ 

Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. 

Drug dependence produces significant and lasting changes in brain chemistry and function. 

We should insure, treat and evaluate drug dependence, like other chronic illnesses.⁷ 

Principles of treatment

The National Institute on Drug Abuse identified these principles of treatment ⁸:  

1. No single treatment is appropriate for everyone. Treatment varies depending on the type of drugs used and the characteristics of the patients. Matching treatment setting, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success. Treatment should be compatible with the individual’s age, gender, ethnicity, and culture. 
2. Treatment needs to be readily available. Drug-addicted individuals may have difficulty in finding or staying in treatment programs. 
3. Use qualified caregivers. These include psychiatrists, family physicians, psychologists, counselors and therapists, and sometimes even recovered addicts who have much experience with drug use and treatment. 
4. Remaining in treatment for an adequate period is critical. Research suggests that most addicted individuals need at least three months or more in treatment to significantly reduce or stop their drug use. The best outcomes occur with longer duration of treatment. Recovery may require multiple rounds of treatment. If individuals experience relapses to drug abuse, it is important to reinstate or adjust their treatment. 
5. Behavioral therapies, including individual, family, or group counseling, are the most used forms of drug abuse treatment. 
6. Medications are important for specific patients, especially when combined with counseling and other behavioral therapies. 
7. Continual assessment and modifications of an individual’s treatment plan is necessary to ensure that it meets their changing needs. Besides counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and/or social and legal services. 
8. Drug-addicted individuals may also have other mental health disorders. Healthcare professionals should evaluate patients presenting with one condition for other mental illnesses, as addiction often co-occurs with them. 
9. Medically assisted detoxification (getting drugs out of your system and getting through dependence and withdrawal) is only a first stage of treatment and by itself does little to change long-term drug abuse. 
10. Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.The healthcare professional should monitor for drug use during treatment, as relapses during treatment occur. To reduce potential harm and improve overall health, treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases. The programs should be able to direct patients to treatment for these problems. 

How do we define successful treatment?

When we say that treatment was a success, does it mean that the patient never takes the drug again? Is it total and permanent abstinence? That is certainly ideal and would be best. Historically, total abstinence has been the standard goal of treatment for substance use disorders involving methamphetamine and cocaine. 

On January 10, 2024, NIH National Institute on Drug Abuse published a news release⁹: Reduced drug use is a meaningful treatment outcome for people with stimulant use disorder. 

This study, published in Addiction, was led by scientists at the Johns Hopkins Bloomberg School of Public Health, Baltimore, in collaboration with researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. 

This finding is according to an analysis of data from thirteen randomized clinical trials of treatments for stimulant use disorders involving methamphetamine and cocaine. 

Researchers found that transitioning from high use (five or more days a month) to lower use (one to four days a month) was associated with lower levels of drug craving, depression, and other drug-related challenges compared to no change in use. These results suggest that reduction in use of methamphetamine or cocaine, in addition to abstinence, is a meaningful surrogate or intermediate clinical outcome in medication development for stimulant addiction. Unlike other substance use disorders, such as opioid use disorder or alcohol use disorder, there are currently no U.S. Food and Drug Administration-approved pharmacological treatments for stimulant use disorders. 

“These findings align with an evolving understanding in addiction, affirming that abstinence should be neither the sole aim nor only valid outcome of treatment,” said NIDA Director Nora Volkow, M.D. “Embracing measures of success in addiction treatment beyond abstinence supports more individualized approaches to recovery, and may lead to the approval of a wider range of medications that can improve the lives of people with substance use disorders.”⁹

Time for reflection 

1. While there are people who can walk away from drugs, others do not or cannot. 
2. Treatment can be a life saver. Drug-induced brain changes need reversal and personality factors need addressing. 
3. Identify coexisting medical problems. 
4. Identify resources to permit treatment. Treatment must match the circumstances of the patient. 
5. There are different caregivers, treatments, and treatment settings. 
6. Treatments can be behavioral or medical or both. 
7. Attitudes can make helping drug users difficult. 
8. The feeling that addicts are trash does not help anyone. An effective way of thinking about it is that addiction is like other chronic diseases such as cardiovascular or diabetes. They have similarities and treatments. 
9. A relapse is not a total failure, but rather a signal that treatment requires alteration or reinstatement. 
10. Prevention is the best treatment. 

References 

1. https://www.apa.org/monitor/2013/06/addiction 
2. https://pubmed.ncbi.nlm.nih.gov/35077955/ 
3. https://pubmed.ncbi.nlm.nih.gov/31507244/ 
4. NIDA. Treatment. National Institute on Drug Abuse website. https://nida.nih.gov/research-topics/treatment. January 10, 2023. Accessed January 16, 2024. 
5. https://www.samhsa.gov/sites/default/files/cost-benefits-prevention.pdf. 
6. Words Matter: Preferred Language for Talking About Addiction | National Institute on Drug Abuse (NIDA) (nih.gov) 
7. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-1695. doi:10.1001/jama.284.13.1689 
8. Principles of Drug Addiction Treatment: A Research Based Guide (1999) Rockville MD, NIDA (NIH Publication No. 99-4180.) podat_1.pdf (nih.gov) 
9. NIDA. Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders. National Institute on Drug Abuse website. https://nida.nih.gov/news-events/news-releases/2024/01/reduced-drug-use-is-a-meaningful-treatment-outcome-for-people-with-stimulant-use-disorders. January 10, 2024. Accessed January 16, 2024. 

Written by Cynthia Blair RN MA–January 2024 

Original Publication: https://www.soulsharbordallas.org/2024/01/seeking-treatment-2/