Therapies and Treatment for Addiction
When considering what to do when it becomes apparent that addiction is a problem for oneself or a loved one, it is important to become knowledgeable about the various levels of treatment available and the types of intervention that best meet the needs of the person and family needing treatment. For example, some people prefer a Christ-centered approach to treatment whenever possible. Another factor that is also important is cost. Does the person have an insurance plan that covers addiction treatment? If so, what types of treatment are covered? As a general rule, treatment begins with the least restrictive method first. If that does not work, then more intense levels of treatment are used. Typically, an assessment is done to determine whether or not a diagnosis of addiction can be made and then to recommend to the person/family the most appropriate level of care for the person/family.
Before discussing the levels of care, it might be helpful to discuss differing philosophies of treatment that are used in the field today. The vast majority of treatment programs are abstinence-based. That is, the goal of treatment is to abstain completely from the addictive element. In most of these programs, addiction is seen as a chronic disease that is treatable much like diabetes or arthritis. When the addiction is to alcohol, one drink is seen as too many and many are not enough. The disease of addiction is seen as progressive so that, if they relapse, addicts will pick up in the disease process where they would have been if they had not participated in a recovery process. Denial is a cardinal feature of the disease where we think we are in control, but are not. Relapse begins with the thinking process (stinking thinking) before the addict actually begins to drink or use drugs. Sobriety is seen as more than not using. Sobriety is demonstrated through an internal change of letting go and turning one’s life over to the power of God through the practice of the twelve steps.
There are other models of treatment that are not sobriety-based. The goals of some treatment programs is a return to the possibility of social drinking. Some of these programs use cognitive behavior therapy (CBT) as the primary therapeutic intervention. The belief is that if the person becomes aware of their self-defeating thoughts and feelings and is able to change them, it will lead to healthy functioning including social drinking. Another model of treatment is called harm reduction. This model is most often used when an addict is involved with street drugs such as heroin or other opioids. These drugs lead to much crime and the philosophy is that there will be less crime if the addict is given maintenance doses of substitute drugs such as methadone. Addicts in these programs may stay on these substitutes for the rest of their lives. Some methadone maintenance programs offer counseling in addition to the drug.
Prior to treatment, it is not uncommon for a need for an intervention to nudge the addict toward treatment. Often, the addict’s manipulation leads to a family member not having all of the information that other family members do. Interventions are most often facilitated by a person trained in how to conduct successful interventions. Prior to the intervention, one or more sessions are held with the family to plan the intervention. Information is shared, a rehearsal is conducted with participants strategically placed with the objective that the addict will enter a treatment program after the intervention is completed. Prior arrangements have been made for the addict to be accepted into a residential treatment program. Most addicts agree to enter treatment and they are immediately transported to treatment when they agree to go.
Many addicts need an initial period of detoxification. The methods of detoxification and time required for detoxification vary by the type of drug used, the individual’s personal profile (e.g., male or female), and the length and severity of drug use. The primary goal of detoxification is to withdraw the person safely from the substance they have been using. My own research for my doctoral dissertation found that nonmedical (social support) detoxification, when done well, is just as safe as the traditional medical detoxification that is normally used. It is important to understand that detoxification is not the same as treatment. It is simply getting the substance out of the person’s system. It is important to note there is an important psychological aspect to detoxification as well. When a person is addicted to a non-chemical behavior, mood, or thought process, a very real withdrawal occurs as well when the person stops using it. The person often goes through a very real period of grieving even for the loss of something or someone who has been hurting them.
A period of primary treatment ideally follows a detoxification regimen. In today’s world of addiction, there are several levels of primary treatment. The most intensive is residential treatment usually at an inpatient hospital or specific addiction treatment center. The stays last from 7 – 28 days typically. A more recent development, but one being used with increasing frequency, is intensive outpatient treatment (IOP). Here the client goes to treatment every day for several weeks but returns home in the evening. This modality can be very effective if there is reasonable assurance that the addict will not relapse. In both of these types of intensive treatment, the clients work through the steps, attend meetings, and work on the wounds that may have contributed to the addiction. It is important to understand that, for addicts, the thing that they are addicted to is meant to be a solution to relieve them of their pain, but their solution has turned out to be a larger problem than the one they sought to medicate.
Another frequently used modality is long term treatment (LTT). This treatment is used for individuals who are particularly at-risk for relapse. Some long term treatment is used after inpatient treatment for those who are judged to need a supportive environment with other recovering people. The requirements for treatment meetings and twelve step meetings is not as rigorous as for intensive treatment programs, but the person is in a setting where they can practice recovery skills in a safe environment. Most long term treatment programs require a commitment of six months to a year of residence and clients normally work to help support themselves and pay the fee for the treatment. Such programs are often called halfway houses or extended treatment.
Normally, after a period of intensive treatment, aftercare is recommended. Aftercare meetings usually occur weekly for several months and up to a year. The aftercare group is a place where addicts can check-in with their aftercare counselor and their group members to see how their recovery is progressing. The relapse prevention plan that was developed in intensive treatment is reviewed and updated in aftercare.
A final word on addiction treatment: addiction is a condition that affects the entire family system. Therefore, good treatment programs will invite, and sometimes require, that the family also be involved in the treatment process. Often there is a family week or a family weekend planned for families. Some programs for sex addiction require the same length of treatment for the spouse as for the sex addict. It makes sense that returning an addict to an environment that is unhealthy will make recovery much more difficult.
David Sedlacek, Phd. Andrews University Theological Seminary, Discipleship and Religious Education Department
[Editor’s note: David has previously served as Director of a detoxification center, a 32-bed inpatient treatment program, a private practice and an aftercare program for the treatment of addiction.]