What are the Different Drug Treatment Options?

What are the Different Drug Abuse Treatments Options?

Drug abuse treatment options vary depending upon a variety of factors including the patient’s history, evidence of mental illness, existing health conditions, availability of government or insurance aid and in many cases, the family’s financial position. Generally speaking, drug addiction treatments generally include one or more of the following approaches:

• behavioral counseling
• medication
• medical devices and applications used to treat withdrawal symptoms or deliver skills training
• evaluation and treatment for co-occurring mental health issues such as depression and anxiety
• long-term follow-up to prevent relapse

A holistic approach, one that addresses detoxification, behavioral counseling, and transitional living has yielded the best results statistically speaking. In any case, drug addiction treatment should include both medical and mental health services at a minimum.

Drug Treatment Options: MAT

The Use of Medications and Devices as Drug Treatment Options

Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and to treat co-occurring conditions. The use of medication and devices often serve as viable drug treatment options at the early stages of detox and recovery. Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself “treatment,” but only the first step in the process. Patients who fail to receive any further treatment after detox usually relapse within a year. One study of drug abuse treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.

• Opioids: Methadone (Dolophine^®, Methadose^®), buprenorphine (Suboxone^®, Subutex^®, Probuphine^® , Sublocade^™), and naltrexone (Vivitrol^®) are often used to help treat opioid addiction. Acting on the same areas within the brain as heroin and morphine, methadone and buprenorphine, these drugs suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at within their receptor centers inside the brain and are best used only in patients who have already been detoxified. All these medications help patients reduce cravings and related criminal behavior. They also help addicts become more receptive to behavioral treatments. Studies have shown  that once treatment begins, both a buprenorphine/naloxone combination (along with an extended-release dosage of a naltrexone formulation) are similarly effective in treating opioid addiction. Because full detoxification is necessary prior to beginning treatment with naloxone, initiating treatment among active users would be difficult, without detoxification. Once complete, both medications had similar effectiveness.
• Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban^®) and varenicline (Chantix^®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.
• Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:

Naltrexone
blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.

Acamprosate (Campral^®)

may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.

Disulfiram (Antabuse^®)

interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.

Outpatient and Inpatient Treatment

Outpatient behavioral treatment includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. Most of the programs involve individual or group drug counseling, or both. Rehab is considered in-patient treatment while sober living housing is considered out-patient, as an example. Both of these programs typically offer forms of behavioral therapy such as:

• cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs
• multidimensional family therapy—developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning
• motivational interviewing, which makes the most of people’s readiness to change their behavior and enter treatment
• motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs

Treatment is sometimes intensive at first, where patients attend multiple outpatient sessions each week. After completing intensive treatment, patients transition to regular outpatient treatment such as sober living housing, which usually conducts meetings less often and for fewer hours per week to help sustain recovery efforts. In September 2017, the FDA permitted marketing of the first mobile application, reSET^®, to help treat substance use disorders. This application is intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and stimulant substance use disorders. In September 2017, the FDA permitted marketing of the first mobile application, reSET^®, to help treat substance use disorders. This application is intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and stimulant substance use disorders. Inpatient or residential treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Examples of residential treatment settings include:

• Therapeutic communities, which are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use.
• Shorter-term residential treatment, which typically focuses on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.
• Recovery housing, which provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.

Collectively, in-patient and out-patient treatment offer the most successful outcomes in the long term. The challenge is to first break the cycle of addiction and in this case, drug treatment options that use a holistic approach can only increase the chances of recovery.