How Addiction Is Treated

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Addiction is a complex chronic brain condition that is characterized by substance abuse or repetitive engagement in preblematic behaviors, such as gambling, which then continues despite causing harm to yourself or others. It involves interactions between the brain, genes, and environmental factors. 

Young man talking to therapist about his problems, on therapy session

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Common treatment approaches include behavioral therapies and medications. Different treatment options are recommended depending on the specific addiction, and in many cases, a combination of approaches is advised.

As with most chronic conditions, the earlier treatment is started, the more likely recovery will be successful.

Treatment isn’t a cure and recovery is often a long-term process. Having a relapse during treatment is not uncommon, though newer treatments are being developed to try to prevent this from happening.

Prescription Medications

For many patients, prescription medications will be part of their treatment plan. These may be prescribed for various reasons and at different stages, including when someone first stops using a substance, to treat withdrawal, or later to prevent relapse.

Withdrawal happens when someone first stops substance abuse. It can cause various physical and emotional symptoms as well as mental health conditions.

Some addictions require detoxification through specific medications. However, this is not the same as treatment to prevent further use. Successful recovery requires following a treatment plan after detoxification has finished.

There are currently no FDA-approved medications to treat addictions to stimulants, such as cocaine and methamphetamine, or cannabis addiction. For addictions to these substances, treatment is focused on behavioral counseling interventions.

For Opioid Addiction

Opioids are one of the most frequently reported prescription medicines in substance abuse-related cases in the United States.

In 2017, the U.S. Department of Health and Human Services declared a public health emergency regarding the opioid crisis after a significant rise in deaths through an overdose of synthetic opioids.

For those with addictions to opioids, including prescription painkillers or drugs such as heroin, medication is recommended both during detox and as medication-assisted treatment to sustain recovery. This treatment is alongside some form of behavioral therapy. 

The most common medications used to treat opioid addiction are:

  • Methadone: This binds to the opiate receptors in the brain in a similar way to heroin and other opiates.
  • Buprenorphine: This is a medication that both blocks and stimulates opiate receptors. As such, it is considered to be less likely to be abused.
  • Extended-release naltrexone: This is not an opiate replacement treatment like methadone and buprenorphine. Instead, naltrexone acts to block the euphoria and sedative effects of opioids.
  • Lofexidine: The first medication to reduce opioid withdrawal symptoms by the FDA, lofexidine has been used widely in the United Kingdom since the early 1990s. It has been shown to significantly reduce symptoms of withdrawal compared to placebo and may cause less drop in blood pressure than similar agents that have been used in this way for some time.

For Nicotine Addiction

For those with addiction to nicotine, the most common medications are:

  • Nicotine replacement therapies (NRTs): Going "cold turkey" (stopping smoking completely) has a low success rate. Available as a patch, inhaler, or gum, NRTs replace nicotine that would otherwise have been obtained through smoking.
  • Wellbutrin (bupropion): This antidepressant has been shown to improve the chances of quitting smoking over the long- and short-term.
  • Chantix (varenicline): This drug decreases cravings by stimulating the nicotine receptors in the brain, though not as fully as nicotine does.

You may have heard about electronic cigarettes, also called e-cigarettes, being used to quit smoking. However, it is a subject of debate as to whether they should be recommended for this use.

While there is evidence that electronic cigarettes are effective to a limited degree at helping someone to stop smoking, it is also argued that they simply act to prolong nicotine addiction. The long-term health effects of e-cigarettes are also currently unknown.

For Alcohol Addiction

The most common medications used for treating alcohol use disorder (AUD)—commonly called alcoholism—are:

  • Benzodiazepines: Used for the treatment of withdrawal, benzodiazepines target certain neurotransmitters, particularly GABA, in the brain.
  • Campral (acamprosate): This is used to decrease alcohol cravings when given in the period initially after acute withdrawal.
  • Naltrexone: This is an anti-craving medication for the long-term treatment of alcohol dependence. 
  • Antabuse (disulfiram): By taking this medication daily, patients know they will have an unpleasant and potentially dangerous reaction if they drink alcohol.
  • Antidepressants: It is thought that antidepressants, specifically SSRIs, may be of some use for treating alcohol use disorders and certain other psychiatric disorders.

Therapies

Behavioral therapies are the most commonly used treatment for addictions. These treatments help those with addiction to change their attitudes and behaviors relating to the addiction. They are recommended alongside medications in almost all instances.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a psychotherapy approach that is commonly used to treat depression, anxiety disorders, and other mental disorders. However, it has also been shown to be effective in treating addiction.

CBT helps patients identify and change maladaptive thoughts and behaviors that might be contributing to the addiction. A central part of this therapy is identifying experiences that may trigger relapses, and helping patients develop self-control and effective coping strategies.

Cognitive behavioral therapy has been shown to be an effective treatment for substance use disorders on its own and in combination with other types of treatment.

It has also been shown to be effective over the long-term. In one study, 60% of patients with cocaine dependence who underwent CBT alongside prescription medication provided clean toxicology screens a year after their treatment.

Family Therapy

Family-based interventions have been shown to be an important part of the treatment of addictions, especially for young adults and adolescents. Family therapy is a specific and focused treatment that addresses family roles, relationships, boundaries, and functioning.

The goal is to improve relationships within the family, leading to a reduction in problematic behavior. It can help family members become aware of their own needs and help prevent addictions from moving from one generation to another. 

Contingency Management

Contingency management (CM) involves using positive reinforcement, such as rewards or privileges, to support abstinence or continuing with treatment. Incentives include things such as vouchers that can be exchanged for retail items or money. It is typically used in combination with other types of treatment. 

A review of studies of CM interventions for substance-use disorders between 2009 and 2014 found that 86% reported significant during-treatment effects. However, there is mixed evidence regarding how long CM is effective for post-treatment.

For example, a systematic review noted that one study found no sustained benefit of CM at six months post-treatment. Other studies in the review found that CM may be effective over the long-term if used in combination with other treatments such as CBT.

Motivational Enhancement Therapy

Motivational enhancement therapy (MET) is a short-term treatment that leads to rapid and internally motivated changes in behavior. The aim is to help those with addiction become motivated to get help or make changes in their behavior.

Research has shown that the effects of MET depend on the type of addiction and the goal of the intervention. It is not thought to be as effective, for example, when treating those who use multiple drugs.

Alternative Treatments

The first line of treatment for most forms of addiction is medication combined with some form of behavioral therapy or counseling. However, there are also alternative treatments that have been shown to be effective. It is not advisable to solely rely on these treatments, but they may support you as you work through your recovery.

Ear Acupuncture

A common alternative treatment for substance abuse is ear acupuncture, also known as auricular acupuncture. Ear acupuncture involves stimulating specific points on the ear. It may be administered individually but is often performed in a group during substance abuse recovery programs.

The National Acupuncture Detoxification Association (NADA) developed a standardized ear acupuncture protocol in the 1970s. Since then, there has been some research and anecdotal evidence that supports the effectiveness of this treatment.

However, the theory has been difficult to validate with randomized controlled trials. One of the reasons for this is that it is difficult to blind the recipient—where they do not know what treatment they are getting.

Hypnotherapy

Hypnotherapy has been widely promoted as a method for helping with some addictions, such as to help someone quit smoking. A trained therapist will conduct the treatment, which involves the client being induced into an altered state of consciousness (hypnosis) where they are more open to suggestion.

While hypnotherapy is popular, research into its effectiveness has yielded mixed results.

A 2019 population study included 18,929 adults in England who had attempted to quit smoking during a 12-month period. It found that hypnotherapy was not significantly associated with abstinence and it was concluded that it was less effective for those with a higher level of nicotine addiction.

A 2019 review of 14 randomized controlled trials concluded that there was insufficient evidence to determine whether hypnotherapy was more effective than other therapeutic interventions or whether it was more effective than no treatment at all.

Lifestyle

There are things that you can do on your own to help with recovery and coping with addiction. Self-care strategies can support your treatment plan and can also help reduce stress and fatigue.

Strategies include:

Some forms of addiction may be connected to how you cope with certain stress. For example, if you live with chronic pain you may be at greater risk for addiction or relapse.

Developing new coping mechanisms can help prevent reliance on addictive substances or behaviors. Therapies, such as CBT, aim to help you with creating these new strategies.

Social support is essential. Joining a support group can help you connect with others who have similar experiences and be a crucial part of your treatment plan.

Other conditions may also impact your recovery. There is a high prevalence of mental health disorders among those with substance use disorders.

According to a nationwide survey published in 2018, 32% of those with substance abuse disorder in the United States also had major depressive disorder. It is important to get treatment for conditions such as depression as part of your addiction treatment plan. This will increase the chance of successful recovery.

If you, or a loved one, want information on support or treatment facilities in your area, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357.

A Word From Verywell

Remember that there is no one way to treat addiction, and recovery will look different for everyone. Do not feel like you have failed if you experience relapses during your treatment. This is something that can happen and is not uncommon. 

Seeking addiction treatment can be daunting, but it is important to get help as soon as possible. Long-term recovery will be an ongoing process. While it can be challenging, managing addiction is possible, and there are effective treatments available. 

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