Drug Abuse and Dependence

Treatment for drug abuse or dependence usually includes group therapy, one or more types of counseling, and drug education. A 12-step program is often part of treatment and continues after treatment as part of your recovery.

Treatment doesn't just deal with drugs. It will help you manage problems in your daily life. It helps you take control of your life so you don't have to depend on drugs. You'll learn good reasons to quit drugs.

Treatment helps you overcome dependence, but it doesn't happen all at once. Staying drug-free is a lifelong process that takes commitment and effort. You may be in group therapy or counseling for a year or more.

Recovery helps you stay drug-free and adjust to life without drugs. It is important that you plan for a relapse, which happens when you slip up and use drugs again. Your doctor, family, and friends can help you avoid this. See the Recovery section for more information.

Getting started

How treatment begins can vary. You might start with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend could bring you to a self-help group, such as Narcotics Anonymous, or you might walk into a clinic that deals with drug abuse.

No matter how you get into treatment, your main goal will be to stop using the drug. You can think clearer and make better decisions when you keep drugs out of your system. If you tell yourself that using a little bit of the drug is okay, it will be very hard to break the drug habits.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

You may be asked questions about your drug use, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your treatment team may write a treatment plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.

Detoxification

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox "flushes out" the drugs in your body. You may need detox when you are physically addicted to a drug. Being physically addicted means that when you stop using the drug, you have physical withdrawal symptoms, such as feeling very sick to your stomach or feeling intense anxiety.

People who are dependent on drugs often have to go to a hospital or treatment facility. Detox usually is done under the care of a doctor because detox without medical care can be dangerous. A doctor also may be able to prescribe medicines to help with detox and withdrawal symptoms. Detox can be done in an inpatient or outpatient setting, depending on the drug you are dependent on and other factors.

Detox helps get you ready for treatment. It does not help you with the mental, social, and behavior changes you have to make to get and stay clean.

Therapy

Treatment for a drug problem usually involves one or more types of therapy.

• In group therapy, you talk about your recovery with other people who are trying to quit. You can get support from others who have struggled with dependence.
• In cognitive-behavioral therapy (CBT), you learn to change thoughts and actions that make you more likely to use drugs. A counselor teaches you ways to deal with cravings and avoid going back to drugs.
• With motivational interviewing (MI), you resolve mixed feelings you have about quitting and getting treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET) uses motivational interviewing to help you find motivation to quit and get you started toward recovery. It usually lasts for 2 to 4 sessions.
• Couples or family counseling can help you to stop using drugs, stay drug-free, and improve your relationships with your partner and family.

Treatment usually includes support group attendance, such as going to Narcotics Anonymous (NA) meetings. Your family members might also want to attend a support group such as Nar-Anon.

Medicines

You may take medicines to help you quit or to help you overcome withdrawal symptoms. Medicines often are used for addiction to opiate drugs like heroin or certain painkillers. Medicines that can help you include:

• Buprenorphine, such as Subutex. Buprenorphine works by targeting the same places in the brain that opiates do. This relieves drug cravings without giving you the same high or side effects as opiates.
• Methadone, such as Dolophine. It works on parts of the brain and spinal cord to block the "high" caused by using opiates. It also helps reduce cravings and withdrawal symptoms caused by opiate use.
• Naltrexone, such as ReVia. It blocks the effects of opiate drugs and helps reduce your craving.

Treatment programs

Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies. Your treatment team can help you decide which type of program is best for you.

• In outpatient treatment, you regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• In inpatient treatment, you stay at a hospital and have therapies during the day or evening. This usually lasts around 6 weeks. You most likely will then go to outpatient therapy.
• Residential treatment provides a place for you to live for 6 months or more while you recover. You get therapy and 24-hour care. This may be a good option if you have a long history of drug abuse or crime or if you have an unstable work or home situation.

Most programs provide education about the causes and effects of drug abuse and dependence. Learning these things helps you and your family know how to overcome drug use. Some programs also offer job or career training.

Some treatment programs give rewards, called vouchers, when you stay off drugs. The rewards may get bigger when you go for a long time without drugs.

Many programs give regular drug tests while you go through treatment. Knowing that you will be tested can make you more likely to resist your cravings.

What to think about

People with drug problems often have other problems or are in unique situations. They may need other treatments, or other resources may be available to help them with the drug problem.

• If you have a drug problem and a mental health problem, you will need treatment for both problems. Doctors call this a dual diagnosis.
• Older adults also may have drug problems because of misuse of prescription medicines such as painkillers or sleeping pills. Learning more about the medicines might help the problem, but older adults also may need more extensive treatment.
• Drug abuse in the military is like drug abuse in the general population. But there may be other concerns, such as post-traumatic stress disorder or military sexual trauma.
• Some people are sent to drug treatment because of a court decision. This may happen if you have a drug problem and you commit a crime. A court may require treatment and then keep track of your progress. Treatment often is available in prison.