Seeking Treatment for Substance Abuse Disorders
While each individual in treatment will have specific long- and short-term goals, all specialized substance abuse treatment programs have three similar
generalized goals (Schuckit, 1994; American Psychiatric Association, 1995):
– Reducing substance abuse or achieving a substance-free life
– Maximizing multiple aspects of life functioning
– Preventing or reducing the frequency and severity of relapse
For most persons, the primary goal of treatment is attainment and maintenance of abstinence (with the exception of methadone-maintained patients), but this may take numerous attempts and failures at “controlled” use before sufficient motivation is mobilized. Until the person accepts that abstinence is necessary, the treatment program usually tries to minimize the effects of continuing use and abuse through education, counseling, and self-help groups that stress reducing risky behavior, building new relationships with drug-free friends, changing recreational activities and lifestyle patterns, substituting substances used with less risky ones, and reducing the amount and frequency of consumption, with a goal of convincing the person of his/her individual responsibility for becoming abstinent (American Psychiatric Association, 1995). Total abstinence is strongly associated with a positive long-term prognosis. Persons who have both substance abuse disorders and mental must have treatment for provided at the same time that addresses both the substance abuse disorder and the mental illness. Persons with both issues are said to have a co-occurring disorder.
The initial stage of treatment is often detoxification. This process involves an evaluation, stabilization and a fostering of readiness for the person to participate in a Substance Abuse Treatment Program. Detoxification in a medical setting with 24 hour supervision is recommended by the Substance Abuse and Mental Health Agency (SAMHSA) for persons addicted to alcohol, sedative-hypnotic and opiods. Often withdrawal from these substances can create medical complications for the individual requiring this type of monitoring.
Becoming alcohol- or drug-free, however, is only a beginning. Most persons in substance abuse treatment have multiple and complex problems in many aspects of living, including medical and mental illnesses, disrupted relationships, underdeveloped or deteriorated social and vocational skills, impaired performance at work or in school, and legal or financial troubles. These conditions may have contributed to the initial development of a substance use problem or resulted from the disorder. Substantial efforts must be made by treatment programs to assist patients in ameliorating these problems so that they can assume appropriate and responsible roles in society. This entails maximizing physical health, treating independent psychiatric disorders, improving psychological functioning, addressing marital or other family and relationship issues, resolving financial and legal problems, and improving or developing necessary educational and vocational skills. Many programs also help participants explore spiritual issues and find appropriate recreational activities.
Increasingly, treatment programs are also preparing persons for the possibility of relapse and helping them understand and avoid dangerous “triggers” of resumed drinking or drug use. Persons are taught how to recognize cues, how to handle craving, how to develop contingency plans for handling stressful situations, and what to do if there is a “slip.” (Substance Abuse and Mental Health Agency website 01/04/08)