Addiction is a complex, chronic disease of the brain, particularly the reward system. This condition manifests in compulsive behaviors, most often around consuming drugs or alcohol; however, addiction is also associated with behaviors that trigger the reward system, such as sex or gambling. Therapy is very effective in treating drug addiction. Generally, behavioral therapy works best, but many different types of therapy can effectively address addiction.
Defining a Substance Use Disorder
People who struggle with substance use disorder, the term associated with addiction to intoxicating substances, exhibit several symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). There are 11 criteria listed in the DSM-5. They are:
- Taking more of a substance than intended, and/or taking it for longer than intended
- Wanting to quit but being unable to stop using the drug
- Spending a lot of time acquiring and consuming a substance, and then recovering from the comedown or hangover
- Continual urges to use the substance
- Inability to perform regular tasks at work or school due to substance use
- Continuing to abuse drugs or alcohol even when there is a negative impact on relationships
- Giving up hobbies, activities, social events, or other aspects of life to abuse more of a substance
- Abusing drugs or alcohol repeatedly despite legal, financial, and/or physical danger
- Experiencing negative physical and/or psychological effects associated with the substance, but continuing to abuse it anyway
- Needing to take more of a substance to feel the original level of intoxication (tolerance)
- Experiencing withdrawal symptoms when trying to quit or when unable to take the substance
According to these updated criteria in the DSM-5, having two or three of these symptoms indicate a mild substance use disorder; four to six symptoms indicate a moderate substance use disorder; and more than six symptoms indicate a severe substance use disorder. You must struggle with at least two of these listed symptoms for a year to be diagnosed with any substance use disorder.
Understanding the definition of addiction is one of the first steps in treatment. Getting a diagnosis from a clinician can help you begin the journey to overcoming this chronic illness and managing symptoms.
Once you have a medical diagnosis, you can find evidence-based treatment that fits your needs. Working with professionals during this process is important. Using scientific evidence and the current medical understanding of addiction will help you manage this condition for a long time. There are several steps to the long-term process of managing addictive behaviors, with different approaches depending on the substance and what you, as an individual, need.
The Evidence-Based Approach to Alcohol and Drug Addiction
In general, evidence-based addiction treatment starts with ending the body’s dependence on drugs (detox), changing behaviors around substances (rehabilitation), and creating a plan to manage long-term challenges like cravings, triggers, and life stress (aftercare). This is a long-term process whether you have a mild or a severe addiction. Since addiction is a chronic illness that changes structures in the brain, learning to identify and manage signs of relapse and returning to get help are two of the most important aspects of treating this condition.
According to the National Institute on Drug Abuse (NIDA), the overall outline of evidence-based treatment focuses on this three-step process. It is important that each step in the process has several options because everyone needs different forms of help. Here is an overview of how each step in the process can be tailored to your needs:
This is the first step in treating addiction, and it involves quitting drug or alcohol consumption with medical supervision. When your body becomes dependent on the presence of a substance to feel normal, this indicates that drug or alcohol has changed the chemical balance in your brain.
Withdrawal symptoms typically occur when your brain does not regulate neurotransmitters, especially dopamine, serotonin, and norepinephrine, without help. During the detox process, you give your brain and body time to stop relying on drugs or alcohol to reach equilibrium, so your brain relearns to manage its own chemistry.
Detox starts with the type of drug you struggled with: depressants, stimulants, or hallucinogens. For some drugs, like alcohol, tobacco, and opioids, you can receive medication-assisted treatment (MAT) during withdrawal. This is an approach that uses prescription drugs to ease withdrawal symptoms over a longer tapering process.
It helps to stabilize brain chemistry to reduce or prevent cravings along with uncomfortable withdrawal symptoms, like body aches and nausea, and uncomfortable psychological symptoms, like anxiety, depression, or insomnia. While drug tapering eases these symptoms, most programs encourage you to enter some form of behavioral therapy, which can transition you into a rehabilitation program once the detox process is complete.
Several drugs are not associated with MAT. Methamphetamines, cocaine, cannabis, and some prescription substances of abuse have no specific medications that ease withdrawal symptoms. Still, when you work with a detox program, a physician can offer either over-the-counter medicines or small doses of prescription drugs, like anti-anxiety or anti-nausea medication, to ease specific symptoms.
Typically, it takes three days to two weeks for acute withdrawal symptoms to end. However, psychological symptoms — especially mood swings and cravings — may persist for weeks or months, especially if you have tried to quit cold turkey a few times in the past and relapsed.
This is called post-acute withdrawal syndrome (PAWS). If you do not have medical supervision during this time, your risk of relapse is high.
Whether you need MAT or you can safely detox without specific medical intervention, supervision through a detox program is important.
You may need inpatient monitoring, or you can safely be an outpatient, but having a doctor specifically diagnose your body’s needs during detox and work with you on a plan to manage withdrawal symptoms improves your chances of success.
Detox helps you end your physical dependence on a substance, but it is important to follow that with rehabilitation.
As with detox, you may need inpatient or residential rehabilitation, outpatient rehabilitation, or a combination of both. Regardless, the National Institute on Drug Abuse (NIDA) recommends that everyone attend some form of behavior-focused rehabilitation for at least 90 days, or three months, after detox.
If you are safe living at home, or you cannot leave work or move away from your family, you may be compatible with outpatient treatment. If you don’t have a safe home environment or supportive family and friends, inpatient treatment is the best option.
There is a range of possible rehabilitation options within these two points, however. The American Society of Addiction Medicine (ASAM) describes a Continuum of Care to understand these points.
Standard outpatient services
You can attend treatment for 10 hours a week or less and otherwise go to work, live at home, and attend social events. Most rehabilitation in this option focuses on group therapy, although some individual therapy may be available.
Intensive outpatient treatment
In this form of treatment, adults are expected to attend programs for nine or more hours per week. Although you can live at home, you may not be able to go to work because of the hours of treatment required. There is a heavy focus on changing behaviors, mostly in group therapy, but individual therapy may also play a large role.
This option may apply more often to people with serious health issues or a co-occurring mental illness along with their addiction. They may spend a few days in the hospital but then return home and attend several hours of behavioral therapy.
The standard model of residential treatment is designed to keep you away from drugs and alcohol for one to three months while providing nutritional support, group therapy, individual therapy, and other forms of treatment. It is not designed for those with additional serious health needs, however.
Medically managed inpatient treatment
For people who have severe, chronic health issues including mental or physical disabilities, along with substance abuse, working with 24/7 nursing care and consistent access to doctors is an important component of their long-term care, along with behavioral therapy.
While detox programs may be combined with the above approaches to treatment, these models more often apply to long-term programs associated with rehabilitation. Most evidence-based programs provide cognitive behavioral therapy (CBT) as the main psychological approach to changing behaviors since it has been found to be the most effective for most people.
Other approaches to therapy include contingency management, motivational incentives, family behavioral therapy, the 12-step model, and the Matrix Model. These may be used as the primary psychological focus or alongside CBT to help you understand addiction, the behaviors associated with addiction, and what triggers those behaviors, so you can successfully avoid intoxicating substances.
This is the final step in addiction treatment, although it has not always been listed as an equally important component compared to detox and rehabilitation. It is now believed that an aftercare plan is a critical part of treatment. Working with a therapist, counselor, social worker, or other clinician to create an aftercare plan can help you securely transition back into working, going to school, caring for family, and other aspects of life that are potentially stressful.
This is a plan that may contain daily actions like exercise, healthy eating, mindfulness, and medications. It may involve weekly or monthly check-ins at therapy, mutual support groups, and doctors’ appointments. It can involve emergency information like a sponsor, therapist, or close friend to contact in the event of high stress or a relapse.
Ideally, aftercare is the primary plan after detox and rehabilitation. Creating this plan can also help you identify when this chronic condition changes and you might need a higher level of care, such as in the event of a relapse.
Treatment to Overcome Addiction is a Long-Term Process
Between 40 percent and 60 percent of people who enter detox and rehabilitation will eventually relapse and return to substance abuse. While this statistic may seem startling, and some may say it suggests that perhaps addiction treatment does not work, this is far from the truth.
As a chronic illness, addiction has symptom relapse rates similar to other chronic illnesses. NIDA compares symptom relapse rates.
- Type 2 diabetes symptom relapse rates are between 30 percent and 50 percent.
- Hypertension symptom relapse rates are between 50 percent and 70 percent.
- Asthma symptom relapse rates are also between 50 percent and 70 percent.
People with diabetes, asthma, or hypertension are not moral failures if they experience a return of symptoms or new symptoms. They are people with a medical condition who must go back to their doctor and discuss treatment options. It is important to treat addiction in this manner as well. Evidence-based treatment does work; addiction simply needs to be continually managed.