Outpatient treatment for addiction

DEFINITION: Medical and scientific professionals have come to regard addiction as a complicated disease caused by a combination of genetic, environmental, behavioral, and emotional factors. Although there is no one methodology that successfully treats addiction, most professionals agree that therapeutic behavioral care is an important facet of whatever treatment methods are utilized. Two therapeutic treatment options are inpatient treatment and outpatient treatment, the main difference being that individuals reside at inpatient programs twenty-four hours a day; they attend outpatient programs during the day and return to their homes afterward.

Causes of Addiction

The reasons people abuse drugs and alcohol are innumerable and often complex. Some become addicted to a drug after the first recreational use. Others find comfort in the escape that the effects of drugs and alcohol provide them: Any physical or emotional pain or memories of past trauma are numbed, as are any thoughts or emotions that may be causing anxiety or stress. Still others abuse medications that doctors prescribe for particular ailments or illnesses.

Research has shown that a high percentage of individuals who use drugs are survivors of past emotional or physical trauma, which has resulted in post-traumatic stress disorder (PTSD). Many have experienced physical, emotional, verbal, or sexual abuse as children or adolescents. Others survived being raised in violent households with quarreling parents who were not able to meet the emotional needs of their children. Women in physically or sexually abusive marriages are more likely to seek comfort in drugs and alcohol than women in healthy relationships.

Men who are domestic violence offenders also are more likely to abuse drugs and alcohol—and act violently toward others while intoxicated—than men who are not violent. It is important to note, however, that drug and alcohol abuse is not a proven cause of domestic violence, and domestic violence is not a proven cause of drug and alcohol abuse. These situations are known as correlated rather than causal.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are more likely to use drugs—and continue to use them throughout their lifetime—than are heterosexual individuals. The drug use is often in response to the frequent and perceived discrimination and abuse that LGBTQ individuals face because of their sexual orientation or gender expression. Additionally, some psychological or emotional disorders occur at an increased rate in the LGBTQ community—major depressive disorder and generalized anxiety disorder—which may lead to substance use disorder.

When a person uses a drug too frequently, they can become addicted to that substance. Another cause of drug addiction is genetics. It is true that some people are predisposed to addiction because of family history and genetics. Abuse also may lead to addiction if the person has a mental illness, such as antisocial personality disorder, bipolar disorder, or schizophrenia. Drugs may ease the symptoms of these conditions or can make living with them more bearable. Thus, people may become addicted to drugs or alcohol as they attempt to self-medicate their disorders.

People also are more likely to abuse drugs if they enjoy the effects the substances have on their brains. Opioids, for example, block the nerve receptors in the brain that help the body to sense pain. Opioids also engage the receptors in the brain that detect pleasure. The drug causes users to enter a euphoric state in which they experience stress relief and a carefree emotional state. People who enjoy this sensation may come to think they need the drug to be happy. Users report feeling an intense desire to use the drug again after their first encounter with it, even though their body is not physically addicted to it at that point. Repeated and ongoing use of opioids causes significant and detectable changes in the brain and the brain's chemistry. Chronic use requires a period of one to three years of abstinence for the brain to heal.

Research has found that people living with mood disorders have a greater likelihood of becoming addicted to drugs than individuals without such mental health conditions. In addition, patients with drug disorders are two times as likely to be diagnosed with a mood or anxiety disorder. Men seeking help for drug abuse are often diagnosed with antisocial personality disorders, while women are likely to exhibit behavior indicative of depression, anxiety, or post-traumatic stress disorder.

Screening and Diagnosis

The first step in treating individuals with substance use disorder typically involves their loved ones—people who take notice of their behavioral changes, physical appearance, and drug use. These persons may convince or force the substance abuser to seek treatment, which is usually first in the form of calling their primary physician or family doctor. After an initial screening in which the doctor runs a series of tests and asks the patient questions about their drug use, the doctor may refer the patient to a specialist for an accurate diagnosis. If the individual requires detoxification from the substance, they are referred to a medical facility or specialized detox and recovery program.

Another important part of the screening and diagnosis process is the discovery of other physical ailments, coexisting drug addictions, or mental health issues, which is referred to as comorbidity. Specific medications and methods used in addiction treatment may counteract other drugs the patient is using or may interfere with other conditions the patient may have; it is crucial to discover all illnesses, diseases, and dependencies before treatment begins. Often, mental health issues cannot be addressed unless and until the individual is free from drugs and alcohol for a period.

Diagnosing comorbidity is a critical step in addiction treatment; treating a patient addicted to cocaine requires a different approach than the one taken to treat a patient addicted to prescription painkillers who is simultaneously struggling to overcome depression, anxiety, or a personality disorder. According to the National Institute on Drug Abuse, 50 to 60 percent of substance abusers also have a mental illness. A mental illness may be present before a person starts using drugs, or a person might start using drugs before becoming mentally ill. Both conditions also may be the result of similar risk factors, such as genetic predisposition and environmental triggers (such as high stress or trauma).

Through laboratory screenings, medical professionals may discover that vital organs such as the lungs, liver, or heart have been damaged by repetitive drug abuse. They also may discover conditions such as Hepatitis C or HIV, which are common among individuals who share needles used for intravenous drug use.

Outpatient Treatment for Addiction and Substance Abuse

Ideally, a person who is abusing or is addicted to one or more substances and who is also dealing with an emotional disorder should be treated in the same facility, often referred to as a dual diagnosis facility. This does not often occur in the United States, however, and dual diagnosis facilities are often difficult to find. Too often, a patient's substance use disorder is viewed as separate and unrelated to the patient's mental health disorder, and patients are sent to multiple facilities to speak to a variety of medical and mental health professionals, psychotherapists, and drug and alcohol counselors. Holistic approaches to addressing addiction, whereby one team of professionals with a variety of specialties cares for all of an individual's medical and mental health needs, are becoming more commonplace in the United States as the stigma of addiction is reduced and acceptance of substance use disorder as a brain disease becomes more accepted.

A common course of outpatient treatment for addiction is an Intensive Outpatient Program (IOP), where individuals attend daily group therapy sessions and one-on-one counseling. IOP attendees also meet weekly with a psychiatrist to discuss medication needs, such as medications to help calm cravings, fight depression, or reduce anxiety. Naltrexone, Antabuse (Disulfiram), and Campral (Acamprosate) are common drugs administered to individuals with an addiction to alcohol. Naltrexone also can be distributed to opioid addicts. Those addicted to nicotine may be prescribed bupropion or Varenicline (Chantix) in addition to nicotine gum, patches, nose sprays, or other nicotine replacement products. IOPs typically meet every day for an average of six hours a day, five days a week for anywhere from three to six weeks, depending on the participant's need and desire, as well as what the individual's insurance will approve.

In group therapy sessions, members speak about their drug use in front of other persons who understand what they are going through. If they are uncomfortable with—or are in need of supplementing—group therapy, a drug and alcohol counselor or psychologist may counsel them independently. Therapy helps patients learn to deal with their cravings, the issues that led them to drugs in the first place, and to learn to begin to live a drug-free life. It enables them to set goals for the future and to repair strained or broken relationships with friends and family members.

To prevent relapse, people recovering from substance abuse and addiction are reminded to pay attention to their bodies and minds and to ask for help when they need it. The relapse process includes three stages: emotional, mental, and physical. If a patient feels anxious, defensive, or angry and misses group meetings or doctor’s visits, they could be in the first stage of relapse. Combined with poor sleeping and eating habits and mood swings, this first stage may lead a patient to post-acute withdrawal. Patients are instructed to reach out to medical professionals, friends, or family members if they feel they are in danger of relapse.

Persons suffering from a drug or alcohol addiction may require rehabilitation to overcome their physical and emotional dependencies and resume a normal life. Rehabilitation for addiction often involves a series of steps.

If an individual is addicted to alcohol or benzodiazepines, medical detoxification is required because detoxification from these substances can result in death if not monitored by health officials. Opioid detoxification, while not usually fatal, is extremely painful, and patients find the process much more bearable in a supervised medical setting. Detox is a process that removes the toxic substances from the body. Even if the ultimate goal is to attend an outpatient program, patients are required to be drug- and alcohol-free, and detox is often the first step.

Many individuals with substance use disorder also have a mental illness. Therefore, many types of therapy are used to help the individual deal with whatever situation has most likely contributed to the addiction. Cognitive behavior therapy, family therapy, and group therapy are often used to help individuals understand their patterns of maladaptive behavior and to teach them better strategies for identifying, thinking about, and coping with situations or people that may trigger addictive behaviors and cravings. Medications such as Campral may be used to help people with alcohol addictions. Suboxone may be used to assist individuals addicted to opioids by reducing withdrawal symptoms and cravings. Therapists also may introduce a twelve-step program like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), which involves group therapy and support to keep individuals in recovery clean and sober.

Research has found that the majority of those seeking help for addiction are men, as women are less likely to admit that they have substance abuse problems and are traditionally responsible for childcare, thus making it difficult to attend inpatient programs or even IOPs unless their children are older and in school during the day. Most rehabilitation facilities or drug and alcohol centers are not equipped to care for children and do not offer babysitting or daycare services.

Outpatient treatment is most appropriate for individuals who live in a stable environment and home life. For example, someone married and with a steady job would benefit from outpatient treatment. However, a celebrity traveling between cities or living in a volatile, chaotic environment would most benefit from an inpatient program because their environment likely contributes to their condition. Additionally, someone with a severe psychiatric illness or those with suicidal ideations benefit from an inpatient program. Notably, the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA) provide some assurance to employees who are hesitant to seek treatment for a substance use disorder because they fear they will lose their jobs.

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