- Jul 31, 2019
- 6 min read

Drug and Alcohol

Principles of Effective Treatment

Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program:

• Addiction is a complex but treatable disease that affects brain function and behaviour.

• No single treatment is right for everyone.

• People need to have quick access to treatment.

• Effective treatment addresses all of the patient’s needs, not just his or her drug use.

• Staying in treatment long enough is critical.

• Counselling and other behavioural therapies are the most commonly used forms of treatment.

• Medications are often an important part of treatment, especially when combined with behavioural therapies.

• Treatment plans must be reviewed often and modified to fit the patient’s changing needs.

• Treatment should address other possible mental disorders.

• Medically assisted detoxification is only the first stage of treatment.

• Treatment doesn't need to be voluntary to be effective.

• Drug use during treatment must be monitored continuously.

• Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.

Completing treatment for substance abuse or alcohol addiction is a major accomplishment. But the real work starts when you walk out the door. You are now making a commitment to abstinence from drugs and alcohol every single day.

You will encounter cravings for your drug of choice, and for any escape, an opportunity to numb out, and perhaps, sometimes, an overall desire to not feel what you are feeling.

You will encounter triggers in the form of events, people, and subsequent emotions that will make you want to drink or get high again. What can you do in these situations?

Here are 5 tips for managing triggers during recovery from addiction:

Identify your personal triggers.

Everyone is different, so every recovering addict’s set of triggers will be different as well. Some common triggers are walking by a bar, seeing someone who is drunk or high, getting paid, the end of a gruelling workday or -week, getting into an argument with someone, and being bored.

Know what you are working with.

Triggers and cravings are a very real part of recovery. Do not try to fool yourself into thinking that they will not happen to you. Instead, know your triggers, stay open to anything that may surprise you, and have a plan for when you feel yourself being triggered.

Practice your trigger plan.

Role play, even just with yourself in the mirror, what you will do when you feel like using again. You may save yourself from a rough day, a temporary lapse, or a full relapse back to substance abuse.

Take care of yourself.

You can handle triggers more easily when you are eating and sleeping well, exercising, and remaining aware of your emotions. You are probably familiar with H.A.L.T.: Hungry, Angry, Lonely, Tired. These four things are said to cause more lapses and relapses.

When you are taking care of yourself you can identify when you feel any of the four, and that is when you can take action. Taking action, but not reacting, puts you back into the driver’s seat. The trigger may be emotionally affecting you, but you will not act on it. If you are hungry, you will eat. Tired? Take a nap or at least rest your eyes or meditate. Lonely and angry can be a little harder to manage, but phone a friend (or your sponsor) and talk it out.

Do not test yourself.

If you know that walking by a bar is a definite trigger for you, for example, then do not knowingly walk by a bar to see if your recovery is as strong as you believe it to be. Maybe that time you are able to avoid going into the bar. But the seed of a trigger is planted. Something else you have not identified yet as a trigger can occur, and the combination can lead you right to a drink.

There is no need to test yourself. When you identify your current triggers, are aware of what you are working with, practice a plan, and employ good self-care, you are managing your triggers during recovery from addiction.

What are treatments for drug addiction?

There are many options that have been successful in treating drug addiction, including:

• behavioural counselling

• medication

• medical devices and applications used to treat withdrawal symptoms or deliver skills training

• evaluation and treatment for co-occurring mental health issues such as depression and anxiety

• long-term follow-up to prevent relapse

A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.

How are behavioural therapies used to treat drug addiction?

Behavioural therapies help patients:

• modify their attitudes and behaviours related to drug use

• increase healthy life skills

• persist with other forms of treatment, such as medication

• Patients can receive treatment in many different settings with various approaches.

How are medications and devices used in drug addiction treatment?

Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.

Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself "treatment," but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Also, in May 2018, the FDA approved lafutidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.

Opioids: Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine® , Sublocade™), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behaviour and help them become more open to behavioural treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness

Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioural treatments, such as group and individual therapy as well as telephone quitlines.

Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:

Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.

Acamprosate (Campral®) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.

Disulfiram (Antabuse®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.

Co-occurring conditions: Other medications are available to treat possible mental health conditions, such as depression or anxiety, that may be contributing to the person’s addiction.

Drug and Alcohol

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