Treatment of Addiction. Description

In this section, we review some of the techniques that have been developed to treat drug-addicted people. Regardless of which treatment modality is used, the first step in assisting the addicted person must sometimes be detoxification—a medical procedure for helping addicts withstand the trauma and associated health risks that accompany abrupt withdrawal from the intoxicating drug. In fact, inpatient drug rehabilitation programs, which treat the more seriously addicted persons, often begin treatment with a period of detoxification.

Nevertheless, detoxification, to some extent, must be tailored to the individual patient; i.e., the attending physician must take into account the particular psychoactive drug or combination of drugs that the person has abused, the length of the addiction, and the medical complications that may have resulted from the addiction. As indicated earlier, withdrawal from high doses of alcohol can be most severe. To prevent seizures and delirium tremens (i.e., visible tremors of the body along with hallucinations and delusions), the physician sometimes administers tranquilizing medications such as Valium.

Persons withdrawing from cocaine often are depressed, lethargic, and irritable. These symptoms are sometimes treated with antidepressant drugs or lithium, a medication that is ordinarily used to treat mood disorders. Individuals who have been addicted to drugs for many years, or who have used them in high dosages, sometimes have severe damage of the central nervous system and other internal organs. These conditions might require extensive rehabilitation and often are not completely reversible.

Following detoxification, the major aims of drug rehabilitation programs are (1) to teach addicts the skills that they need in order not to resume using drugs and (2) to address the underlying problems that led to their drug use in the first place. Different treatment programs deal with these two goals in very different ways; however, Alcoholics Anonymous (AA)—and adaptations of it, such as Narcotics Anonymous—is the intervention program that is most widely followed. In fact, many hospital programs, although using multiple treatment strategies, depend heavily on the AA model and encourage patients to affiliate with AA when they leave the hospital.

AA is a self-help program, consisting of alcoholics helping other alcoholics. Established in 1934 by two recovering alcoholics, it has grown into a worldwide organization with millions of members. The members attend numerous meetings, sometimes as often as several times per day, the frequency depending on an individual member’s needs and the stage of their recovery.

The philosophy of AA consists of 12 guiding principles (the “12 steps”); they are discussed at the meetings, along with their application to an individual member’s current needs. The overriding goal of the AA program is for its members to remain completely abstinent from alcohol. Adherents admit that they have lost control over both alcohol and their lives, but they attempt to regain control by surrendering to a “higher power” and “working” the AA program. By doing so, they hope to develop a new, satisfying life-style that is free of alcohol.

Without doubt, many alcoholics have been helped by AA. At the same time, no scientific data exist on its effectiveness as a self-help organization, because AA does not allow itself to be subjected to scientific scrutiny. What is clear, however, is that hospital programs that subscribe to the AA philosophy and whose effectiveness has been formally evaluated have been largely unsuccessful. Relapses (i.e., returning to problem drinking) are quite common among patients who complete these programs, with numerous alcoholics relapsing within a few months after completing treatment. These discouraging results have prompted many professionals who work with alcoholics and other drug addicts to develop alternative treatment strategies.

Some of the newer techniques are aimed at reducing the attractiveness of the abused drug. For instance, aversive conditioning procedures have been used in which the abused substance is paired with an unpleasant, noxious stimulus, such as electric shock or nausea-inducing drugs. The goal is for the drug itself to acquire aversive qualities, so that the addict will want to avoid it. Other techniques have been aimed at overcoming addicts’ tensions and anxieties that may have propelled their drug use. For example, relaxation and stress-management techniques have become an integral component of many treatment programs.

Still other techniques have been employed to help addicts acquire skills (e.g., social or job-finding skills) to improve the quality of their lives and to help them reduce their need to use drugs. Teaching alcoholics to drink moderately, another new technique, has been surrounded by controversy because it challenges the most basic tenet of the AA philosophy—that alcoholics must maintain life-long abstention from alcohol. Among professionals, the consensual opinion seems to be that controlled drinking is by no means advisable for the vast majority of chronic alcoholics, although it may be an appropriate strategy for a selected few.

At the same time, controlled drinking has been used effectively with early-stage problem drinkers—those individuals who drink too much, but who would be unwilling to enter a traditional treatment program where they would be diagnosed as “alcoholic” and told that they could never drink again.

The effectiveness of the newer interventions remains to be established, particularly when long-term abstinence is the criterion for successful treatment. Accordingly, professionals have begun to focus their efforts on “relapse prevention” techniques to use during “aftercare”; i.e., once addicts have stopped using drugs with the aid of formal treatment and have returned to the environment of their everyday lives, they are given assistance in preventing relapses to abusive drug use.

Relapse prevention techniques attack the behaviors and cognitive processes (maladaptive thought patterns) that are so characteristic of drug abusers and that set the stage for their eventual relapse. Specifically, they are taught to deal with “high-risk” situations in which they are likely to resume their drug use and are helped to achieve a balanced, drug-free lifestyle.

Helping patients to achieve a balanced life-style is also an aim of Systematic Motivational Counseling, which is based on the Motivational Model. As we said earlier, the model views people’s motivation to use drugs as depending on the balance between the emotional satisfaction that they expect to achieve by using drugs and by striving for nonchemical goals. In turn, people’s motivational patterns determine whether they will succeed or fail in their goal-striving.

For example, people are likely to reach their goals insofar as these goals are realistic (i.e., the chances of goal attainment are reasonably high), appropriate (i.e., reaching the goal will, in fact, produce the emotional satisfaction that was anticipated), and the various goals to which a person is committed do not significantly conflict with each other (i.e., pursuit of one goal does not interfere with attainment of another goal).

Systematic Motivational Counseling helps drug addicts to identify appropriate and realistic goals and to make satisfactory progress toward achieving them, thereby maximizing their healthy, nonchemical sources of emotional satisfaction and minimizing their motivation to seek emotional satisfaction by using drugs. This counseling approach is intended to complement rather than replace other treatment interventions, and although clinical impressions indicate that the technique is promising, formal evaluation of its effectiveness remains to be completed.