Although all addictions are treated similarly, initial treatment differs depending on the addictive substance (or behavior) and the “depth” of the addiction.
Depth of addiction is based on;
(a) How long the addict has been addicted.
Generally, the longer the addiction the harder initial recovery attempts are going to be. Even if the drug-of-choice is relatively “soft“, chronic long-term use may indicate the same approach as for “hard” drugs.
(b) How many “unsuccessful” attempts at recovery have previously been attempted.
Because of personality or character problems, there is a class of addicts who are unable to recover in the “open” community. In these cases, a closed “therapeutic” community may be needed.
(c) The addicts “ecosystem” during recovery.
The addict-in-recovery needs to be in a safe environment during initial recovery. If there are “using” family members or partners in the home or using friends and neighbors in the area, the addict may have to consider a “closed” community (in-patient program)for the first three months of recovery and a “safe” place living environment for the next three to six months.
There are several programs available depending on the above factors.
1. Detox Facility
Addictive substances fall in to two categories.
Psychologically addictive only (eg. Marijuana, cocaine, ecstasy, PCP etc,)
Physically addictive (eg. Heroin, Crack-cocaine, alcohol etc.)
Detox generally refers to physically addictive substances which, when withdrawn, are extremely unpleasant and painful. Addicts experience a wide range of symptoms from flu-like symptoms to nausea and cramps to seizures and extremely powerful muscle contractions. The symptoms are, in some cases, so severe as to be life-threatening. Detox facilities provide the neccessary medical supervision required as the addict’s body detoxifies.
A Detox Center is a facility which only treats the effects of chemical withdrawal, thereafter the addict moves on to one of the other options available. These in-patient programs are from 14 to 21 days in length.
Detox Centers may be a separate facility or incorporated within a general hospital, sometimes in a Psychiatric facility.
2. Rehabilitation Center
Usually, an in-patient rehabilitation (rehab) program is followed after a stay in a Detox facility. (However, there are some Rehabs that offer a Detox program as well.)
A Rehabilitation Center is suited for the following cases;
(a) Addicts who are psychologically addicted and are unable to stay off their drug-of-choice in the open community.
(b) Addicts who need to be removed from their home “ecosystem” because it is not conducive to quitting. This may be because there are other “users” in the environment, or, because the family or members of the family are interfering with the addict’s recovery either through “enabling” behaviors or an inability to trust.
(c) Addicts who are young and lack the self-discipline needed to follow a recovery program.
3. Methadone Program
Methadone programs are usually offered by local hospitals who have an out-patient program for addicts. Methadone is a synthetic chemical which is mainly used to replace heroin, however, there are some centers who will also use it for benzodyazapine(tranquilizer) and some other highly addictive substances.
Methadone in itself is highly addictive and withdrawal from it is difficult. The only justification, in my mind, for using methadone instead of quitting “cold turkey” is if the addict’s addiction now requires high amounts of the drug, or if the addict has a long history of relapse and does not have the “strength” to quit through Detox and rehab.
The methadone is administered orally on a daily basis and is, at first, dispensed from a participating pharmacy or clinic. As the addict proves to be more and more reliable, and tests “clean” when drug-tested, enough methadone for a week will be given to the addict.
Abuse usually occurs when the addict self-administers more than the daily dose, runs out before the week is up, and uses heroin to make it through the rest of the week.
An addict on methadone will most probably have to take it for a period of about two years. The initial dose may be high and then reduced over this period to nil.
The problem is that, after each reduction, the addict becomes ill and suffers from withdrawal systems.
Over a two year period, the chances of the addict relapsing are high whereas an in-patient, well-managed Detox program gets the addict “clean” within two weeks, in fact, withdrawal symptoms, although severe, rarely last more than five days when going cold-turkey.
I believe that methadone should only be considered if the addict has tried at least three times to Detox cold turkey and failed (and even then, the problem may be due to environment, using friends or not joining a 12 step program!)
Methadone is about detoxing, it’s not a recovery program. Methadone without a program will not work.
4. Out-patients Program
A growing trend in addiction recovery is the establishment of out-patient programs. These are facilities where the addict can see a counsellor or therapist, on a daily basis, for about an hour. As the addict gains “clean-time” the visits are reduced. The length of such programs are about two years.
Out-patient programs work best if addicts also attend a 12-step group. Although each center’s program is different, they usually have similarities in structure. The counsellor’s goal is the give the addicts coping skills and recovery goals – some short-term, some long-term.
Out-patient programs suit addicts that are highly motivated, have jobs, are in a “clean” and supportive home environment and possibly have children that need to be cared for by the addict.
Often, an out-patient program is seen as a continuation of a rehab program, and many of these programs are, in fact, offered by the rehab center.
5. Day-Care Center
A new phenomenon now appearing are Day-Care Centers. These are similar to rehab centers except that the addict sleeps at home. Day-care requires the addict to report before breakfast and to participate in a number of structured activities on a daily basis.
The average length of these programs is 12 weeks and addicts who drop-out or relapse have to start over from the beginning of the program.
This program is suited to addicts who are in a healthy, supervised, home environment and who have spouses or children. As these are mainly 5-day non-weekend programs, family supervision is necessary when the addict is at home.
Day-care centers will not accept addicts unless they commit to being supervised at all times (while at home) by a family member.
6. Support Group
It is a fairly established principle that addiction is a life-long disease and requires ongoing and regular “maintenance” because of the insanity factor which all addicts have. Support groups are ideal for this purpose.
The basic components of 12-step groups are as follows;
(a) On joining, attending 90 meetings in 90 days
(b) Finding a “sponsor” to guide you through the program.
(c) Doing each of the 12 steps in the program with the sponsor.
(d) Doing “service” (making coffee, laying out chairs etc.)
(e) Spreading the message to the addict/alcoholic who is still suffering.
There are a number of different 12-step support groups available;
AA (Alcoholics Anonymous) is mainly for alcoholics but many drug-addicts prefer this group as well.
NA (Narcotics Anonymous) welcome addicts and alcoholics no matter their drug-of-choice.
CA (Cocaine Anonymous) deals with cocaine and crack-cocaine addiction but welcomes others.
SA (Sex Anonymous) is specifically for people with addictions to sex and/or pornography.
CMA (Crystal-Meth Anonymous) focuses on addicts recovering from crystal meth addiction.
There are also non-spiritual groups and gender specific groups. A search of the Internet will provide a long list of options.
Support groups also exist for the families of addicts (see 5. Addiction is a Family Disease)
Adult Children of Alcoholics - A support group for adult children of alcoholics.
Al-Anon - Although primarily for parents and spouses of alcoholics, many parents and spouses of drug addicts also attend Al-Anon meetings.
Al-Ateen - Although primarily for the teenage children of alcoholics, many children of drug addicts also attend Al-ATeen meetings.
Nar-Anon Family Groups - a support group for families and spouses of drug addicts.
Choosing a suitable program can be confusing but in many cases it is really a trial-and-error process until the addict “takes” to one.
