Addiction is a serious disease in the United States where it is currently spreading like wildfire across all demographics and state lines without distinction. No one seems to be immune to addiction. Addiction is considered very similar to other chronic diseases like type 2 diabetes as both are the result of habits that lead to a chronic problem. In one, the victim uses addictive drugs and in the other, they eat too many sugary foods. Both seem to be correlated to genetic factors and both have relapse rates around 50 percent.
However, addiction comes with a few more complications. There is a wide range of underlying factors that can contribute, worsen, or cause addiction. Plus, addiction can come with a host of co-occurring disorders that can be difficult to diagnose such as depression, anxiety disorders, and Post-traumatic stress disorder. There are also a variety of barriers to treatment that may not be present with other diseases in the United States.
Because of these challenges and several other factors, there is an alarming growth in addiction and overdose consuming huge portions of the American population. Opioids are, in particular, a growing problem in the U.S., leading to thousands of overdose deaths every year. According to the U.S. Centers for Disease Control and Prevention, more than 63,600 drug overdose deaths in 2016 involved opioids. In recent years, the number of overdose deaths has increased dramatically, and the numbers correlate with a spike in the use of synthetic opioids like fentanyl and carfentanil.
The illegal trafficking of drugs like fentanyl and its analogs have increased the drug’s presence in black market drug supplies. Fentanyl is much stronger than your average hit of heroin, 50 times stronger, in fact. It’s so strong that a dose smaller than a grain of sand is enough to kill the average person. With a potency like that, relatively large amounts of the drug can be transported in small containers which makes it difficult to detect. It’s also cheaper and easier to produce than other opioids. The availability and price of this powerful drug make it lucrative for dealers to mix it into heroin supplies to stretch profits. The problem is that a lethal dose is too small for most people to mix in safe amounts on the street. People will often use heroin without knowing that it contains fentanyl until it’s too late. Fentanyl-laced drugs can cause extreme overdose, causing slowed breathing, coma, and death.
The increase in opioid addiction may be partly related to the significant increase in opioid prescription. As a powerful pain reliever, doctors use opioids to manage pain symptoms for post-surgery pain, chronic pain, and pain from injuries. However, opioid prescribing has increased three-fold in the last 16 years, which amounts to millions of opioid prescriptions written annually. While only a small percent of people who are prescribed opioids actually become addicted, even a small percentage of such a large number means significant risk.
As addiction and overdose increases, addiction treatment methods and their availability continue to grow. Learn more about how addiction treatment works and how it is able to help people who are struggling with substance use disorders.
Addiction has come to be understood as a chronic disease that primarily affects the brain’s reward center. Though dependence on a chemical can affect functions all over your body, the long-lasting cravings and draw toward relapse is largely centered on the part of your brain called the limbic system. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines addiction as a mental disorder called substance abuse disorders. It also outlines several subcategories based on the specific substance uses like alcohol use disorders or opioid use disorders.
Addiction involves chemical dependence, which is when your brain gets used to an addictive substance and relies on it to manage brain chemistry. As tolerance grows, the more your brain is relying on the drug. If you stop using the drug or cut back on the dose, the resulting chemical imbalance can leave you feeling withdrawal symptoms. These symptoms can vary in severity based on the drug used, the length of time you use it, and the dosage you were accustomed to.
Psychological dependence can also occur when you become emotionally attached to a drug. For instance, a person may feel that they “need” to smoke marijuana when stressed, even though marijuana isn’t physically addictive.
Unlike its depiction in television and movies, drug and alcohol addiction doesn’t go away after the drug is purged from your system. Though some portray addiction as a long-lasting chronic disease, characters with addiction often go through one uncomfortable night of withdrawal before leaving the problem behind forever. In reality, the long-lasting effects of addiction can cause cravings that last well after your last dose has left your body.
Addictive drugs typically affect the brain by altering natural neurochemical processes. Your brain controls your whole body via the central nervous system. It does this by passing messages through spaces between the nerve cells called synapses. To pass messages across the synapse, the cell that’s sending the signal will release a chemical called a neurotransmitter. The neurotransmitter then attaches to a receptor on the receiving nerve cell and can agonize (activate), partially-agonize, or antagonize (suppress) the receptor’s function. Different drugs disrupt this process differently. Here’s how a few of the most common addictive drugs work in the brain:
Opioids bind to your body’s natural opioid receptors. In normal circumstances, your body’s natural opioids, called endorphins, would be released in moderate amounts and bind to the opioid receptors to manage pain. However, medicinal and illicit opioids do this on a more intense level.
Opioids like morphine, oxycodone, and Percocet are useful in stopping pain dead in its tracks. Opioids work at the pain site, in the spine where pain signals are relayed, and in the brain. They also soften your psychological response to pain, helping you to avoid a traumatic experience. However, the powerful effects can also cause addiction
This is a category of drugs that includes cocaine, meth, and amphetamines. Stimulants typically work by increasing the activity of dopamine in your brain. Dopamine causes you to feel excited and increases desire and motivation. Cocaine blocks the reuptake of dopamine.
This means that instead of being reabsorbed into the cell that sent it and recycled, it is left in the synapse to attach to more receptors. Meth does this and increases the production of dopamine. Flooding the receptors with that much dopamine can actually damage them, making it more difficult for you to feel pleasure without meth.
Central nervous system depressants include alcohol, benzodiazepines, barbiturates, and other sedatives. Depressants work by increasing the activity and efficiency of gamma-Aminobutyric acid, a neurotransmitter that suppresses the activity of neurons. Depressants can become chemically dependent. Withdrawal symptoms can be deadly without medical treatment.
The long-term disease of addiction occurs when your reward center perceives the euphoric or otherwise positive effects of the drug as necessary for survival. The limbic system is designed to identify activities that are good for you and encourages you to repeat them through cravings and impulses. It typically identifies activities that trigger the release of feel-good chemicals like serotonin, dopamine, and endorphins. When these chemicals trigger a limbic system response, the brain’s learning center records the activity for later use.
Certain drugs cause an intense release of these limbic system stimulating chemicals. Your brain can’t tell the difference between natural healthy activities like eating and sleeping and something like cocaine, at least in regards to the release of dopamine. So, the effects of the drug cause a powerful response to remember and encourage using again.
Addiction is an extremely complex disease that can have a variety of underlying causes and risk factors. It’s impossible to identify one definitive cause for addiction. Each person is unique and people who are suffering from substance use disorders often have a myriad of different risk factors that could be underlying issues that can contribute to substance abuse or addiction. Typically, addiction is caused by a combination of factors, some of which that have to be addressed in order to lead to lasting recovery.
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Some people have co-occurring mental disorders that can worsen or lead to a substance use disorder. To treat addiction, these causes need to be explored in treatment to get to the root of addiction or alcoholism.
There are a variety of addiction treatment options through rehab. As we continue to learn more about addiction, the debate as to the best treatment options continues. However, treatment works on an individual basis. In fact, it’s should be a rare occurrence for two treatment plans to be identical. Because addiction and the causes for addiction are so vastly varied from one person to another, so too should addiction treatment be. That being said, there are several tried and true treatment options and many of them are backed up by evidence that show they are effective.
Though the necessities for each individual can be unique, there is a set of fairly definitive principles that you should look for in addiction treatment. The principles of effective treatment are outlined by the National Institute on Drug Abuse. Here are some of the principles that you should look for if you pursue treatment or investigate treatment options for a loved one:
There is no one method of addiction treatment that is guaranteed to work for everyone. Instead of trying to fit the person to the treatment plan, the plan should be built around the person. More than that, you should be instrumental in the formation of your own treatment plan. Your input is a valuable resource in determining what you need to work on during addiction treatment. Services, settings, and interventions should be matched to your individual needs.
Addiction treatment often involves more than just treating addiction itself. Going to the source of addiction can mean treating underlying issues. For instance, someone with the dual diagnosis of alcohol use disorder and depression will require their mental health issues specifically treated. If the alcohol use is treated but depression isn’t, it would most likely lead to a relapse. Addiction permeates multiple aspects of a person’s life which may mean they will present with multiple issues. Effective addiction treatment should address social, medical, psychological, legal, and vocational problems that a person might have.
The length of time you spend in treatment depends on several factors, not the least of which is your personal needs. However, studies show that the most effective treatment duration is 90 days or more. Your progress will ultimately determine the length of your stay in treatment but 90 days is the gold standard.
There are a variety of therapy options in addiction treatment but behavioral therapies have proven to be among the most effective options. Behavioral therapies include individual, family, and group therapy and often employs the cognitive- behavioral model of treatment, which focuses on correcting the thinking that leads to negative behavior.
A person’s needs may change from week to week while in treatment, as such, treatment plans need to respond to people with flexibility. Quality addiction treatment centers typically re-assess and modify treatment plans on a weekly basis.
Co-occurring disorders are extremely common in people with substance use disorders. According to the Substance Abuse and Mental Health Services Administration’s 2014 National Survey, 7.9 million people had co-occurring disorders that year. Depressive disorders and anxiety are common among mental issues that present with substance use disorders. Treating these disorders alongside addiction helps avoid complications in relapse preventions and treats the whole person.
Addiction treatment uses these principles to treat a person and address every need. Effective treatment can make the difference between a life time of struggling with addiction and lasting recovery. Access to this type of service is essential in potentially turning the tide in the opioid epidemic.
In addiction treatment, a person’s needs are met based on Maslow’s hierarchy. The needs for safety, security, and health are generally addressed before addiction therapy begins. Many people who first enter treatment need to have medical needs addressed first. Addiction can have a significant impact on health. Chemical dependence means that your body may have to go through uncomfortable or painful withdrawal symptoms.
Withdrawal can take on many forms and with varying symptoms. Opioids produce flu-like withdrawal symptoms, stimulants often produce psychological symptoms like depression and anxiety, and depressants can produce potentially deadly symptoms like seizures and Delirium tremens.
Medical detox is often the first step in recovery. It involves 24 hours of medically managed service every day for up to two weeks (typically just one). The services provided can include medical treatment to alleviate symptoms of withdrawal and avoid potentially dangerous complications.
Addiction can come with a variety of secondary medical issues as well. For instance, drugs used intravenously increase your risk of contracting infectious diseases. People who enter treatment that have or may have such diseases as HIV or hepatitis need to be screened and treated.
Other medical disorders that create pressing needs in clients are also addressed in medical detox. Injuries, chronic diseases, and even the flu can create distractions for people who are in treatment. Someone in pain may find it difficult to focus on therapy objectives and interventions, so they often address those medical needs in detox.
The levels of care in addiction treatment are on a continuum based on a person’s specific needs. During a person’s initial intake, their needs are assessed based on a list of criteria outlined by the American Society of Addiction Medicine (ASAM). ASAM also defines the levels of care in addiction recovery. Detox is the highest level of care, involving 24-7 addiction treatment and medically managed service. However, detox alone isn’t enough to create a lasting change in a person seeking long-term abstinence from drugs and alcohol. At Arete Recovery, we have on-staff clinicians who are dedicated to finding your ideal next step in treatment after detox. Long-term addiction treatment provides the greatest chance for success and it typically follows ASAM’s continuum of care. Here are the next levels of care after detox:
If there is still a medical need or concern after detox then inpatient services can provide continued medical monitoring to ensure your safety. Certain drugs like benzodiazepines and alcohol can cause potentially dangerous symptoms for several weeks after acute withdrawal symptoms pass. 24-7 medical monitoring as you begin your addiction treatment therapies can help avoid dangerous medical complications. Inpatient services include medically monitored inpatient services, clinically managed high-intensity residential service, and clinically managed low-intensity residential service.
This level of care allows the client to have more independence but still provides 9 hours of clinical services or more every week. In this level, you will be able to dive into therapies and interventions and address any complex or co-occurring disorders you may have. This level also includes partial hospitalization services.
Outpatient treatment involves fewer than nine hours of clinical services every week. It serves as additional structure and stability while the intensiveness of your treatment decreases. You will have more independence and flexibility in your treatment schedule, but you will still have the support of continued treatment services.
Evidence-based addiction therapies are treatment methodologies that have been studied and proven to be effective in clinical trials. While it’s true that no one treatment option will work for everyone, evidence-based therapies have the greatest likelihood of efficacy. If you are considering a treatment program or center, it’s important for your treatment plan to have a solid foundation based on therapeutic methods that are backed up by evidence. Evidence-based treatment strategies include:
CBT is the most commonly recommended treatment option for people with substance use disorders. It involves increasing awareness of high-risk situations for triggers and learning to either avoid them or cope with them in a healthy way.
This is the process of setting up a system of tangible rewards to increase motivation. Studies have shown their effectiveness alongside psychosocial counseling.
The 12-step model is among the oldest and longest-standing modern addiction treatment modalities. Alcoholics Anonymous started the first 12-step program in 1935 and the model has spread to other types of addiction and adapted to treatment centers all around the world. Active involvement in 12-step support groups has shown to decrease the likelihood of relapse.
There are a variety of addiction treatment methodologies that are used in modern addiction treatment centers. With the opioid epidemic growing, clinicians are trying new techniques to meet the needs of a variety of clients. Alternative treatments and therapies are used with some anecdotal success. Examples include yoga, art therapy, and equine therapy. While there may be opportunities where such therapies can help, treatment plans should be rooted in an evidence-based approach and supplemented by alternative therapies when necessary.
American Society of Addiction Medicine. (n.d.). Retrieved April 16, 2018, from https://www.asam.org/resources/the-asam-criteria/about
National Institute on Drug Abuse. (n.d.). Treatment and Recovery. Retrieved April 16, 2018, from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
National Institute on Drug Abuse. (n.d.). Drugs and the Brain. Retrieved April 16, 2018, from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
National Institute on Drug Abuse. (n.d.). Principles of Effective Treatment. Retrieved April 16, 2018, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
Opioid Overdose. (2017, August 30). Retrieved April 16, 2018, from https://www.cdc.gov/drugoverdose/epidemic/index.html
Relapse Prevention – National Institutes of Health. (n.d.). Retrieved April 16, 2018, from https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf
Vital Signs. (2017, September 26). Retrieved April 16, 2018, from https://www.cdc.gov/vitalsigns/opioids/index.html
Walsh, L. (2015, October 23). Co-occurring Disorders. Retrieved April 16, 2018, from from https://www.samhsa.gov/disorders/co-occurring