The National Institute on Drug Abuse (NIDA) estimates that abuse of drugs and alcohol costs the United States over $600 billion annually in lost work productivity, crime, and healthcare. According to a 2009 government survey, 23.5 million Americans 12 years of age or older needed treatment for a substance abuse problem, but only 2.6 million of these people received treatment at a rehab facility.
Not only does addiction put a financial burden on the average American in the form of taxes, not enough people are receiving addiction treatment. On top of this, the national average for relapse after treatment is 40-60%. This means that around half of the people receiving “traditional” addiction treatment will return to drugs.
Even with this rate of individuals returning to drugs, the return on investment for treatment programs is considered a good risk. NIDA estimates that every dollar invested in addiction treatment programs yields a return of anywhere between $4-$7 in reduced costs when it comes to crime. There are also unquantifiable returns to successful rehab like: saved lives, improved interpersonal relationships, stronger families, and greater productivity.
With lives hanging in the balance and huge quantities of money being spent, it’s important to understand what the different types of addiction treatment programs are, and why they may (or may not) work.
The First Step: Detoxification
Detoxification is a process whereby an individual who is using and/or addicted to drugs or alcohol is helped through a period of abstinence, withdrawal or wean-down so that he or she is no longer using or experiencing withdrawal symptoms.
This is not considered “rehabilitation” because the individual is moving through withdrawal symptoms – not working to rebuild his or her life. Detox may be a part of one’s rehab program, or a person may go to an inpatient or outpatient facility to get medical help during the withdrawal process.
While detoxification is an important step to rehabilitation, it is certainly not the only step. One must stop using drugs before moving forward with any rehabilitation program, but then one must actually move forward and continue to get help in order to conquer his or her addiction.
What is the Difference between Inpatient and Outpatient Rehab?
Inpatient rehabilitation occurs when one stays in a facility during the duration of their initial rehabilitation. Outpatient rehab is when one works with a facility or program to move through rehabilitation, but they are not living at a facility and are only coming in for appointments, checkups, or treatment. In some cases it is done in the home.
Research shows that positive outcomes to rehab are greatly increased when one stays in rehab for as long as needed – with 90 days being the minimum amount of time necessary for effective rehabilitation.
Is Court Ordered Rehab Different?
One of the larger societal problems caused by drug addiction is criminal behavior. Some courts counteract this problem by sending drug addicted individuals to rehab instead of to jail. This type of legal pressure has been controversial, but according to NIDA, when an individual undertakes court ordered rehab, it tends to be as effective, or sometimes even more effective, than rehab undertaken without legal pressure.
Many court ordered and voluntary rehab programs are the same or similar. A court may simply order someone to a Twelve Step program for example. The main difference is the individual who is legally bound to attend rehab must also check in with the court and get regularly tested for drugs.
Twelve Step Programs
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are probably the two most famous rehabilitation programs out there. They use the Twelve Steps (or a version of them) as originated by Bill Wilson and Dr. Bob Smith in the 1930’s. These programs are often community-based and work with the idea that, with a support group and a person called a “sponsor”, an individual can move through the Twelve Steps and control his or her alcoholism or addiction.
While the effectiveness of AA and NA has been disputed, a government study found its efficacy increased as long as one attended regular meetings. Motivation to attend and get better was a big factor in a person’s success or lack of it. One advantage of AA and NA is that a person travelling can find meetings in cities and communities across the country and attend them free of charge. One need only show up and may remain anonymous or simply give their first name. They can also make a small donation if they wish.
Methadone and Buprenorphine Treatment
Methadone is a Schedule 2 synthetic opioid used to treat addiction to heroin and other opiates. Buprenorphine is another opioid used to treat opiate addiction. Buprenorphine is a Schedule 3 controlled substance and has less addictive qualities compared to methadone. The brand Subutex is buprenorphine whereas Suboxone is a combination of buprenorphine and naloxone, another drug used to treat opiate dependency.
According to a 2011 report, 306,000 Americans were taking methadone and 7,020 were on buprenorphine as part of a long-term maintenance program.
The pros of long-term maintenance programs are that individuals addicted to opioids do not have to go through the painful withdrawal process. They can instead take methadone or buprenorphine and replace the drug to which they are addicted with these two opioids. This allows many individuals to continue with their lives without using illegal narcotics.
However, the cons of such a program are glaring.
Methadone and buprenorphine are addictive opioids which can cause a high and are, themselves, abused and sold on the street.
Additionally, individuals attempting to withdraw from opiates have built a physical tolerance against them. This means that one may need to start out on a very high dose of methadone or buprenorphine to begin treatment. The idea is that over time the dosage of methadone or buprenorphine will be gradually reduced until one day the former addict can just stop completely.
Different doctors have varying philosophies on how long methadone maintenance needs to last. Some doctors feel that methadone maintenance may take anywhere from 6 months to two years. Others feel that once an individual has begun maintenance and some counseling, they can stay on methadone or buprenorphine indefinitely. Staying on these drugs indefinitely means one will never be drug-free and he or she will need constant dose increases to avoid withdrawal symptoms.
No matter how long one takes to taper down methadone or buprenorphine, each lowered dose will cause withdrawal symptoms. This is because physical tolerance to opiates is increasing at the same time.
While drug replacement therapy has been touted as effective treatment for opiate addiction, the process is very flawed. It might be more accurately stated that long-term maintenance is the most effective way to transfer illegal addiction to legalized addiction.
Methadone has proven to be more addictive in the long run than heroin. Buprenorphine has some limited use in the initial stages of detox in order to take the edge of withdrawal. Combined with holistic methods that include nutrition, fluids, vitamins and minerals, an opiate addict can safely detoxify without being put on a replacement drug.
The most effective rehabilitation techniques are those which have been studied and found to work in real situations. Certain types of behavioral and cognitive therapy have proven effective within a rehabilitation structure. These therapies often have these characteristics:
- There is a structure and agenda for each session.
- Education is used to explore ways to change behavior.
- Therapists do not tell the participant how to feel.
- Participants work on their therapy both in the session and outside of it, often taking homework away from the session.
- There are measurable treatment goals; when therapy is begun, there is an end goal in sight.
Workable behavioral and cognitive therapy helps the individual with internal and external influences that affect decision-making, how one interacts with others, and the methods one uses to solve problems and deal with situations. Statistics and government studies support this method of substance abuse treatment.
There are different methods of drug rehabilitation and recovery. Some vital points to consider when looking for the right program for you or a loved one:
1. Will they offer a way to become completely drug-free? This is an important one as many programs put people on anti-anxiety medications, antidepressants, or antipsychotic drugs as treatment. Adding more drugs to the mix may relieve withdrawal symptoms, but the end goal of detox is a drug-free person.
2. Do they provide evidence-based treatment methods like behavioral and cognitive therapy?
3. Do they take a holistic approach and offer therapies such as massage, fitness, sauna, and faith-based and spiritual counseling?
4. Will they help for only a month or is the program 90 days or open-ended?
5. Do they have an aftercare program or can they connect to aftercare activity like AA or NA in my area?
It’s extremely important to your health, your relationships, and your continued life to seek help when you recognize you have a substance abuse or addiction problem. The same goes for your loved ones and friends you care about.
To get further information, read Part 2 of this series or call one of our addiction specialists right away.