Treatment generally begins with an assessment (see the Professional Assessment section) which allows the A&D practioner to develop a treatment plan. The assessment should establish both the severity of the problem and the underlying issues that need to be addressed.
INDIVIDUAL COUNSELLING
Once an assessment has been done, the course of action required to deal with the problem should become clearer. For many people, individual counselling with a competent alcohol and drug counsellor will be sufficient. Clients who are functioning well in most areas of their life and have good communication skills often do well with individual counselling. Where there is less functionality, individual counselling combined with attending a support group can often work well. Whatever the person's background, if the problem is severe the client may need to attend a residential treatment programme (see Will I Need to Go To a Treatment Centre? below).
The benefit of seeing a professional A&D counsellor is that they are trained to assess the severity of substance use problems and should be able to give good advice on what level of support the client will need - and make the appropriate referrals to obtain that support. Most people still believe that seeking professional help is more rewarding than just going online with your broadband connection and getting solutions from the net.
SHOULD I CUT BACK OR STOP?
A question that arises for many users is whether or not they can just cut back or will have to stop drinking or taking drugs completely.
If you are an 'alcoholic', then in terms of treatment, it is valid to suggest that you need to stop drinking completely. The abstinence approach is common in the United States where the AA movement originated, and is based on the medical model of addiction - which states that alcoholism is a disease (see below).
New Zealand and many other countries tend to take more of a harm reduction approach to treatment. The harm reduction approach includes abstinence, especially for people with severe dependence. However, it also allows for the possibility that some people may not be ready to stop drinking or taking drugs completely, but may be willing to cut back or change certain behaviours thereby minimising the harm done.
Harm reduction is based on the understanding that complete abstinence is actually not achievable for some people. There are many opioid users in this category. For such clients, harm reduction strategies which reduce the health risks associated with their drug use are generally better than no treatment at all. For instance providing clean needles to IV drug users is a harm reduction approach. Although it doesn't help the user stop taking drugs, it substantially helps in reducing the risk of contracting a virus such as hepatitis C or HIV.
Controlled drinking programmes (which involve cutting back on the amount the person drinks) are another example of harm reduction. Such programmes are generally suitable only for those people with alcohol abuse problems. If someone is genuinely dependent, they will probably need to stop drinking completely. (For information on the difference between substance abuse and substance dependence, go to the section: What is Addiction?), or view the questionnaires under Self-Assessment.
BEHAVIOURAL APPROACHES
The behavioural approach to substance abuse problems is based on the assumption that drug use is learned and reinforced (or conditioned) by various stimuli (such as stress or peer pressure). What this means for treatment is that if a behaviour has been learnt, it can also be 'unlearnt' and new behaviours put in place.
This approach is very different from the medical perspective that alcohol dependence is a disease from which there is no recovery. The behavioral approach encourages the individual to take responsibility for his or her behaviour, and learn to restructure their environment and lifestyle to provide reinforcing stimuli from sources other than alcohol or drugs.
There are a number of different behavioural approaches and some of these are discussed briefly below.
CBT AND DBT
CBT or cognitive behavioural therapy is one of the most common forms of behavioural therapy. In essence, this approach addresses faulty or distorted thinking patterns (cognitions) which sometimes lead to dysfunctional behaviours such as substance abuse.
DBT or dialectical behavioural therapy evolved from CBT and is used specifically to treat people with borderline personality disorder who lack skills of emotional self-regulation and tend to be emotionally unstable. In the last few years, DBT has evolved even further and is now also used to treat individuals with borderline personality disorder combined with a substance use disorder.
SYSTEMS THEORY
Systems theory is another counselling model which is part of the behavioural approach. When applied to family systems, it requires a shift in focus from the symptoms or problems of the individual - to the overall system of which the individual is a part.
This approach recognizes that the individuals (or parts in the system) have a consistent relationship to each other, and that in a given family, these 'parts' interact in particular ways which sometimes produce 'symptoms'. When the dominant sub-system (usually the parents) attempts to confront the symptomatic member of the family, often the result is that the problem becomes intensified by the family's attempt to control it - and the proposed solution then becomes part of the problem.
An understanding of systems theory is essential when dealing with someone who comes from a family where almost everyone is either drinking or taking drugs. In such circumstances, it is difficult to treat one member of the family and expect them to take control of their substance use, while they continue to exist within a family (system) where almost everyone is 'using'.
Systems theory is also helpful in treating someone in a relationship (also a system), where the non-drinking or non-drug using partner is reacting strongly to (and perhaps trying to control) their partner's substance problem. In such situations, outcomes are likely to be better if the non-using partner also engages in counselling or perhaps attends a support group such as Alanon.
WILL I NEED TO GO TO A TREATMENT CENTRE (REHAB)?
People and their problems vary enormously in their complexity and severity; and obviously the more serious the problems are, the more support and treatment the individual will need to address them. For those with relatively mild alcohol or drug issues, a few sessions of individual counselling may be sufficient to assist them get on top of the problem.
If you meet criteria for substance abuse (rather than substance dependence), it would also be unlikely that you would be referred to a residential programme. However if you meet criteria for substance dependence, and lack the resources to deal with it in the community, the counsellor might suggest that you need to go to a residential treatment centre.
Counsellors usually spend a few sessions with a client assessing and preparing him/her to attend a residential programme. Most treatment centres (but not all) prefer the client to stop using before starting treatment. The intention behind this is that if the client has completed the withdrawal process from their drugs before they actually start the programme, they are then in the best frame of mind physically and psychologically to get the most out of the programme. To achieve this, sometimes it may be necessary to go to hospital to be medically detoxed before starting "treatment" at the appropriate centre.
DRUGS USED IN THE TREATMENT OF ADDICTION
For many years there was only one drug available (Antabuse) which was helpful in treating alcohol dependence. Antabuse is an antagonist medication which, when taken with alcohol, usually makes people very sick. Drinking on top of Antabuse is generally a very unpleasant experience, and so for some people, taking Antabuse on a daily basis may be enough to encourage them not to drink.
Naltrexone is a newer drug used in the treatment of addiction, but only on prescription from an addiction specialist. Naltrexone binds to particular receptors in the brain which have an attraction for opiates. If someone who is taking naltrexone then takes opiates, the naltrexone does not make the user sick, but by taking up most of the available receptors, has the effect of reducing the 'rush' or the pleasure generally derived from the opiates.
Naltrexone has also been found to be useful in the treatment of severe alcohol dependence, and is sometimes prescribed for this purpose.
Drugs such as Antabuse or Naltrexone increase the range of options available to addiction specialists. However the best outcomes are achieved when these drugs are used in conjunction with counselling and other forms of support. In one sense, they are very similar to nicotine patches which can assist someone give up smoking - but which work best when combined with other forms of therapy.
METHADONE PROGRAMMES
Methadone is also a prescription medication; and methadone treatment is another example of a harm reduction approach. In such programmes, opiate users are placed on a daily dose of oral methadone so that they no longer need to access illicit heroin or morphine derivatives.
There are two immediate advantages that come from this. The first is that the user no longer has to inject him or herself, so there is a substantial health gain involved. The second is that by getting methadone from a legal source, the user now has the option of living life without the massive financial problems usually associated with drug addiction and the need to commit crime to sustain the habit. In this way, methadone provides opiate addicts with the opportunity to move away from a criminal lifestyle and 'normalise' their lives.
The reality is that this does not work for everyone on the programme; many people on methadone continue to abuse other drugs and still get involved in legal offending. However, many opiate users do manage to live more productive lives once they get on to a methadone programme. The point is that harm reduction strategies such as methadone programmes are one of many effective tools available in combating alcohol and drug problems. You can learn more about the safety of methadone by doing some research online before deciding which treatment option is best suited for your recovery.
ALCOHOLICS ANONYMOUS & NARCOTICS ANONYMOUS
Alcoholics Anonymous (AA) provides support for people with alcohol problems and Narcotics Anonymous (NA) provides support for people with drug problems other than alcohol. AA provides regular meetings in most western countries, and research indicates that regular attendance at AA helps many people stop drinking.
However AA is fundamentally for those people who identify themselves as "alcoholic". If you choose to speak at such a meeting, you will probably be expected introduce yourself by saying: "Hi, I'm so-and-so and I'm an alcoholic". If you attend an NA meeting you will probably be expected to identify yourself as an "addict". So if you have a problem with alcohol but do not see yourself as an alcoholic; or if you have a problem with drugs, but don't see yourself as addicted, this approach may not be appropriate for you.
Success at AA also tends to require a high commitment to attend meetings for long periods of time (possibly the rest of you life if you truly are "alcoholic"). Commitment will always be required to deal with alcohol and drug problems, but when someone is beginning to explore their options, the notion that they might need to attend AA meetings for the rest of their life can be very daunting.
SELECTING THE BEST TREATMENT OPTION
Which treatment option is appropriate depends entirely on your individual circumstances. A professional alcohol & drug counsellor can provide an assessment of which criteria you meet, explore the strength (or fragility) of your personal resources, the level of support you have (or don't have) in the community, and develop a treatment plan based on your particular needs.
A good counsellor can also assess your level of motivation. There is little point sending someone to residential treatment, especially at the taxpayers' expense, if they have not reached the point where they actually want to do something about their problem. So part of the alcohol & drug practitioner's role may be to motivate the client and raise their level of awareness regarding the impact of their drug use until they are ready for residential treatment.
The Self-Assessment section of this website may help you decide whether you need to take further action.
