Millions of people in the United States struggle with a substance use disorder every year. Very few of them, however, get the treatment they need.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 22.5 million people over age 12 needed treatment in 2014 for an illegal drug use problem. Of those people, only 4.2 million received any treatment at all. Less than 3 million people received treatment through specialty treatment programs. Out of all of the people in the country who struggle with a substance use disorder — be it to legally obtained prescription medications, alcohol, or illicit drugs — only about 10 percent receive addiction treatment.
While many people face barriers to receiving addiction treatment, such as poor access to care, lack of motivation for change, and high costs of treatment programs, addiction treatment is effective when people engage in it. The structure of treatment programs ranges from inpatient to outpatient, short-term to long-term, and intensive to less formal.
Selecting the right treatment program for you depends on your unique history of substance use and what your goals in recovery are. No single type of treatment is the best fit for everyone, but there are options available to meet every person’s needs.
The National Institute on Drug Abuse (NIDA) explains that addiction is a very complex but treatable disease. The three primary goals of all treatment programs are to help individuals:
Many different approaches to treatment are successful in addressing substance use disorders. Behavioral counseling, medication, treatment of co-occurring mental health issues, and aftercare planning are included in comprehensive treatment programs. These programs can be administered through any of the following settings:
This setting provides the highest level of structure and support throughout the detox and recovery process. Participants are provided accommodation at the treatment facility where they are expected to stay and engage in many different forms of therapy and education around substance misuse.
This option is available for people who may not need quite as much structure and support as an inpatient setting but could still benefit from many hours a day spent dedicated to recovery. Detox and therapy services are provided.
These programs provide the lowest level of structure and can vary in how many services they offer. This is a good option for people whose substance use is not incredibly severe and who have a strong social support network. Individuals participate in multiple therapy sessions throughout the week, live at home, and may even be able to continue working while participating in treatment.
Each type of treatment program can be highly effective for the right person. It is important to be honest about the level of treatment you need and select a treatment program accordingly. When individuals engage in treatment programs that can meet their needs and they complete the programs successfully, many positive treatment outcomes can be observed.
What makes addiction treatment most effective depends on the substance use disorders that are being treated. What is most successful for treating alcoholism is not the same as what is the most successful for treating stimulant use disorders, such as cocaine addiction. Comprehensive and effective treatment programs typically begin with an assisted detoxification period, followed by a range of behavioral therapies.
Below is a list of behavioral therapies commonly used in addiction treatment and the substance use disorders they are most commonly used for.
Researchers have identified the above therapies as being very effective in the treatment of the disorders listed with them. As you can see, there is overlap between some substance use disorders and the forms of therapy that can be used to treat them.
What is an effective form of therapy for one person may not be as effective for someone else. For this reason, it is important that treatment programs take the individual’s needs and preferences into consideration when establishing a treatment plan. In general, however, the above therapies have been found to be widely effective for their associated populations of substance users.
NIDA has outlined the principles of effective treatment that have been gathered from more than four decades of evidence-based research on addiction treatment. There are many different approaches and models of treatment, but they must all incorporate the following principles to be effective.
When the above considerations are incorporated into treatment planning, individuals stand to gain a lot from participating in therapy. An underlying theme of these principles is that the client is at the center of the treatment program. The client’s needs, preferences, and responses to therapy must be addressed and accounted for.
Needs will likely change throughout the treatment period as well. Medications that were useful in the beginning of the detox phase may no longer be necessary a few weeks into treatment. Because therapy is such an organic process, new information and issues are likely to arise during therapy. As those issues come up, new approaches might need to be taken to address them in the most effective ways possible.
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Most types of addiction treatment were not developed with a specific demographic in mind. Rather, they were developed to treat a specific substance use disorder. Skilled therapists, however, can adapt their treatment methods to fit whomever they are working with by using culturally sensitive therapy.
Culturally sensitive therapy encourages the therapist to gain an understanding of the client’s background, ethnicity, and personal belief system. Factors such as age, gender, race, sexual orientation, socioeconomic status, and gender are all incorporated into cultural sensitivity. By approaching therapy with this mindset, therapists can gain a better understanding of their client’s world and how their addictions came out of it. Cultural sensitivity can also inform how the therapist proceeds with therapy.
Cultural sensitivity can be applied to any mode of therapy, and it makes the therapist available to work with a wide range of clients. It can be used to build the therapeutic relationship and trust between the therapist and client. The client is likely to feel better understood and more comfortable with being their genuine self in therapy. As a result, the client is more likely to achieve positive treatment outcomes as a result of participating in therapy.
The effectiveness of addiction treatment depends greatly on the individual. Their motivation to change and the commitment to establish a radically different lifestyle free from substance use determine the likelihood of maintaining sobriety or not. While many different approaches to addiction treatment have been developed for specific substance use disorders, and some approaches certainly work better than others for specific addictions, the individual has the true power to make a lasting change.
Despite decades of scientific research gathered on thousands of people participating in rehab programs each year, relapse rates are still high. According to NIDA, about 40 percent to 60 percent of people who complete drug rehab programs will relapse at least once.
Relapse, despite popular belief, is not a failure. Through relapse, people learn more about themselves and their relationship with substance abuse. Treatment and recovery are ongoing processes that must be constantly reevaluated and updated. Relapse simply indicates a need for treatment or aftercare planning to be adjusted to be more effective.
The effectiveness of addiction treatment is in the eye of the beholder. Ideally, everyone who participates in treatment will get sober and remain sober forever. Realistically, this is not the case. People can relapse after treatment for a number of reasons, but success depends on how they deal with it. On average, half of the people who participate in rehab will relapse at some point, but success is determined by the severity of the relapse and how quickly the person can get back on the right track.
A large part of therapy is learning skills to identify triggers for substance use, recognizing when you are starting to slip, and knowing how to engage the best supports to keep you moving in the right direction. The majority of people who graduate from rehab programs report improved quality-of-life standards, such as employment capabilities and personal relationships. Effective treatment programs instill habits to maintain long-term sobriety and empower clients to lead their best lives.
Culturally Sensitive Therapy. Psychology Today. from https://www.psychologytoday.com/intl/therapy-types/culturally-sensitive-therapy
(March 2017). National Survey of Substance Abuse Treatment Services. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/2015_National_Survey_of_Substance_Abuse_Treatment_Services.pdf
(January 2018). Principles of Drug Addiction Treatment: A Research-Based Guide. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies
(October 2011). Therapeutic Alliance and Outcome of Psychotherapy. US National Library of Medicine: National Institutes of Health. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/
(January 2018). Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction