Addiction is an increasingly severe problem in the United States. During the pandemic, more people have turned to drugs and alcohol to deal with the effects of stress and isolation. As a result, there is a greater demand for addiction treatment services than ever before.
Understanding how the beginning stages of addiction treatment works is essential in helping a friend or loved one decide to look after themselves. Chambless Johnston, an addiction specialist from Tennessee, explains the early steps of addiction treatment and how they can help people regain control of their lives.
The first step toward successful addiction treatment is always the client’s willingness to work on themselves. Chambless Johnston believes that no one can enter addiction treatment successfully if they are not committed to making a change. Likewise, no one can force a person with a substance abuse problem to get help, though they can make a case for prioritizing their health and safety.
Treatment initiation happens next. Patients and their families should choose a program based on its accessibility, organization’s services, and treatment types.
Many people who begin their treatment are ambivalent or in denial about the severity of their problem. Many people believe that others have it much worse and that their situation will be easier to treat than others. It is best to abandon this attitude at the beginning of treatment and to make an early commitment to sobriety.
Leaving the Drug Behind
Giving up the client’s drug of choice can be a difficult decision. Patients realize that they will miss the emotional outlet and the detachment that the drug brings them, and they may be challenging to convince.
The initial goal of drug or alcohol treatment is to help clients decide that they should actively participate in their treatment and keep abstinence as their ongoing goal.
The next stage of treatment is early abstinence. If clients follow early abstinence protocols, they are likely to have a successful recovery. This recovery stage can be challenging because many clients experience worrisome withdrawal symptoms that may make them want to use again. They may experience physical cravings and the pull of psychological dependence. Finally, they may be vulnerable to triggers that tempt them into relapse.
Understanding Social Pressures
One of the worst pressures felt by early-stage addiction recovery clients is the social pressure to drink or use drugs. In the case of alcohol, modern-day society has normalized the daily use of alcohol. Many addicts may not realize they have a problem until it significantly interferes with school, work, or family life. People addicted to drugs also experience this problem, mainly if most of their friends also use drugs.
Addiction counselors have many coping techniques that they can use to help clients get through these difficult weeks and months. Some of these strategies could help include participation in healthy activities, alternative behaviors, self-help groups, and recognizing environmental triggers.
Types of Addiction Treatment
Dr. Chambless Johnston recommends several different substance abuse treatment types to help clients get through the difficult stages of their recovery and reenter everyday life.
Long-Term Residential Treatment
Long-term residential treatment offers 24/7 care, generally outside a hospital in a dedicated treatment center. The most popular model is called the “therapeutic community.” People typically stay in a therapeutic community for 6 to 12 months.
These programs focus on helping people “re-socialize” within the community. Addiction is viewed as a component of the client’s psychological and medical problems. Clients are encouraged to develop a sense of accountability to their families, friends, and the community to keep them away from using drugs or alcohol.
In a therapeutic community, treatment can sometimes be contentious. Clients are encouraged to get familiar with beliefs and self-concepts that can be damaging.
Short-Term Residential Treatment
Short-term residential treatment often involves a three to six-week hospital stay and subsequent participation in an outpatient program. Support groups like AA or Narcotics Anonymous are also encouraged. 12-step programs are often followed.
Outpatient treatment could be more appropriate for people who have jobs and who also have good social support. A low-intensity program may not have as many services as an inpatient or intensive outpatient program. Group counseling is one of the primary focuses of this type of treatment.
When clients take part in individual counseling, they are offered some of the same services listed above. The program tends to focus on behavioral goals and the tools that clients need to proceed with abstinence.
Medications Used for Addiction Recovery
There are several medications on the market that can help people break the cycle of alcohol or drug dependence. One of the most popular medications used for opioid addiction is buprenorphine. Marketed for depression as Wellbutrin, the medication can reduce or eliminate withdrawal symptoms. These medications are combined with another drug called naloxone to produce a withdrawal reaction if drugs are ingested. Let’s take a look at the Buprenorphine treatment first and its process.
This medication is one of the critical components of opioid addiction recovery. Scientific studies have found that the medication is as beneficial as methadone in terms of decreased opioid use and treatment retention.
The medication is a derivative of the opioid alkaloid thebaine. The drug is not as useful for pain control as other opioid medications, but its usefulness in opioid addiction treatment has not been equaled.
The drug works by blunting the high of heroin and other opioid drugs. Scientifically speaking, it displaces full opioid agonists like morphine, methadone, and heroin from the body’s opioid receptors. This keeps users from experiencing the euphoria associated with taking drugs. The medication has a long half-life, mainly when prescribed as a sublingual tablet. This allows clients to feel stable during the day and permits them to enjoy regular daily activities.
Selecting Clients for Success
Chambless Johnston emphasizes that client selection is one of the critical aspects of deciding who will be a good candidate for medication-assisted treatment. Clients who are the best candidates for this type of therapy are stable or controlled in terms of the psychiatric problems that often coexist with substance abuse disorders.
Clients who are also addicted to benzodiazepines or other sedatives may have an increased risk of problems. Clients who are living in unstable situations may have a difficult time safeguarding their medications. They may be unable to prioritize engagement with their medication-assisted treatment. These clients may have an easier time if they receive treatment in an inpatient setting.
Initial Screening Process
To screen clients for the optimal use of the treatment, baseline urine testing should be performed in advance. Clients will need to review the treatment contract and provide informed consent.
Induction of Treatment
At the induction appointment, clients will be instructed to arrive in a mild to moderate state of withdrawal. This means that they should not have consumed any opioids for the past eight to 12 hours. Patients who do not have withdrawal symptoms should be rescheduled.
After the first dose of the medication, Chambless Johnston recommends that clients be monitored every 60 minutes, titrating the dose until the withdrawal symptoms have disappeared. Follow-up is necessary within the next week, preferably the next day.
When added to this treatment, clonidine helps increase abstinence rates and assist with cravings.
Clients who have reached a stable dose of the medication and are no longer using opioids can have longer follow-up intervals. If clients experience breakthrough drug use, they should have more frequent follow-ups and increase their complementary therapies. Cognitive-behavioral therapy is often a practical option for clients who are in treatment.
Suppose patients cannot abstain from opioid use even after their medication has reached 24 mg per day. In that case, it is often best to transition them to treatment using a full opioid agonist medication like methadone.
Medication-assisted treatment using buprenorphine can be a long-term solution. With continued medication-assisted therapy, clients can achieve long-term success in their treatment. If treatment is discontinued, it is preferred to wean clients from the medication gradually.
Other Medications Used For Addiction Recovery
Chambless Johnston understands that not all medications are one-size-fits-all. Here are some of the other medicines that are also used for addiction recovery.
Methadone is another useful drug that is appropriate for people suffering from opioid addiction. It reduces cravings and enables people to step down from their drug use without withdrawal symptoms.
Naltrexone is used to prevent relapse to the use of opioids. It blocks the high that a person experiences when taking opioids.
Acamprosate and Others
For alcohol use disorders, acamprosate is used to normalize systems in the brain that are disrupted by excessive alcohol consumption.
Disulfiram or Antabuse causes an extremely unpleasant reaction if a person consumes alcohol while taking it.
Finally, naltrexone blocks the euphoria associated with alcohol use.
Opioid and Alcohol Abuse Treatment Using Vivitrol
This medication is an intramuscular injection of the drug naltrexone. It helps to keep people from relapsing in alcohol abuse and opioid drug use. Naltrexone works by stopping the sedation and euphoria caused by central nervous system depressants like opioids and alcohol. When a client is taking naltrexone in any form relapses, the illicit drugs fail to bind to the opioid receptor sites. This means that no “high” is produced.
The first step in opioid treatment using naltrexone is that a client must complete a full detox program. If full detox is not achieved, this medication can cause withdrawal symptoms. This contrasts with buprenorphine treatment, where patients do not need to complete a full detox before starting treatment.
Next, clients must be screened with a thorough physical exam. They must be prepared to take drug screening tests, and females must take a pregnancy test. Their liver function must be tested. Finally, they must exhibit no signs or symptoms of opioid withdrawal.
Clients will receive their Vivitrol injections once per month. Since they have gone through opioid detox, they should be advised to have a lower tolerance for drugs and that they may experience accidental overdose at lower levels than before.
The treatment will effectively block the pleasurable sensations associated with opioid or alcohol use. Clients should be told that taking large doses of drugs to “bypass the blockade” will result in severe illness or death.
A scientific study published by the National Institute on Drug Abuse found that the monthly Vivitrol injection is just as effective as Suboxone treatment in preventing relapse.
Hope for People With Addiction
Using these treatment methods and medications, clients can find drug recovery more accessible and more permanent. Dr. Johnston encourages people who are experiencing drug and alcohol use disorders to talk with their primary care physicians and discuss whether a drug treatment program is right for them.