The Best Evidence-Based Addiction Treatments
Medically reviewed byDr. Richard Foster, LICDC-CS
March 8, 2019
Treatment methodology is constantly evolving as new breakthroughs are made, increasing the overall success rate of rehabilitation. The positive outcomes of these, and existing, treatments can be credited to the diligent research and forward motion of these scientific initiatives. Numerous evidence-based addiction treatments continue to pave the way for lasting recovery.
What Are The Principles Of Effective Treatment?
To better inform, and shape, both current and future treatment protocols, the National Institute on Drug Abuse (NIDA), our government’s leading agency on science-based research, initiatives, and information on drug abuse, presents us with a thorough directive on evidence-based treatment. This publication outlines 13 key principles which aid in offering dynamic, effective care. These include:
- Addiction is a disease: Addiction can change the way a person functions and behaves due to the way drugs alter your brain’s composition and operations, effects which may remain even after abstinence. Despite this complexity, addiction is treatable.
- Treatment approaches vary: Individualized treatment is essential to ensuring a person’s best chance at a positive outcome and solid recovery, while also ensuring they are successful “in returning to productive functioning in the family, workplace, and society.”
- Treatment should be accessible: Positive outcomes are increased with earlier intervention. Treatment should be an option as soon as an individual needs it.
- Multifaceted treatment: Treatment should address additional needs, including those which are legal, medical, psychological, or vocational in nature. Additionally, NIDA urges that treatment should be specific “to the individual’s age, gender, ethnicity, and culture.”
- Treatment length is important: The optimal commitment of time within rehabilitation varies per client; however, NIDA asserts that the most favorable outcomes are linked to greater lengths of treatment, and that most situations warrant, at minimum, three months of care to produce favorable results. They urge programs to change or moderate treatment to counter concerns of relapse and to create action plans to increase retention rates.
- Behavioral therapies: Offered in an individual, group, and/or family format, these therapies are among the most frequently utilized modalities within treatment. Beneficial both within and following treatment, behavioral therapies “vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships.”
- Medications: Certain medicines can aid individuals by treating dependence, reducing drug use, and providing greater solidarity within their lives. A critical element within treatment, medications “can be an effective component of treatment when part of a comprehensive behavioral treatment program.”
- Need-based treatment: A person’s needs may grow or shift, requiring dynamic care that changes to accommodate these needs. To ensure this, all components of a person’s treatment plan should be consistently evaluated, and, if necessary, altered, increasing the odds of an optimal outcome.
- Treatment for co-occurring disorders: Substance abuse and addiction are mental disorders which often co-occur alongside of various mental disorders. Because of this, an individual who manifests one disorder should be screened for the other. In instances where there are co-occurring disorders, effective treatment should encompass care for each concern, including the utilization of situation-specific medications.
- Detox should only be the first step: While medically-supervised detoxification is a useful tool for addressing withdrawal, NIDA cautions that it “is rarely sufficient to help addicted individuals achieve long-term abstinence.” Continuing care which transitions into addiction treatment is highly recommended. Also, NIDA recommends certain approaches, such as motivational enhancement and incentive strategies be implemented at the start, to increase client engagement.
- “Treatment does not need to be voluntary to be effective.”: An individual may encounter higher odds of enrolling in treatment, better retention rates, and more favorable outcomes from an intervention, due to the actions of loved ones, employers, or as a result of court actions.
- Monitored treatment: Drug abuse and relapse may happen within treatment. To counter these risks, and increase client incentive and motivation, regular monitoring should be implemented. Monitoring may reveal the possibility of relapse, allowing providers to alter their approach to alleviate this risk.
- Infectious disease testing, awareness, and education: “Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.”
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In recovery, there are many facets to consider—medication, mental health, and motivation carry a great deal of weight in the outcome of a recovery program. Within their guide, NIDA continues by outlining certain evidenced-based approaches, including pharmacotherapies (the use of medications within treatment) and behavioral therapies.
The National Institute on Drug Abuse supports certain medications within the treatment of addiction for opioid and alcohol addictions. These medicines are widely used within a medication-assisted treatment or -therapies (MAT), a comprehensive program which blends their benefit alongside of behavioral therapies.
Opioid Addiction Treatment
The sale of opioid prescriptions has quadrupled in the past decade, causing a staggering rise in the number of opioid addictions. Opioids are highly addictive and produce intense and painful withdrawal. Medical intervention is necessary to aid in a safe recovery from opioid addiction. In the detoxification period, medical professionals administer the following medications to either help ease withdrawal or maintain sobriety.
- Methadone, a synthetic opioid agonist medication prevents withdrawal symptoms and blocks the effects of opioids when used correctly. Combined with behavioral therapy, studies reveal a higher success rate in patients seeking recovery. Psychiatric, employment, and social services are recommended to aid in rehabilitation, as methadone is often used as an outpatient sobriety maintenance program.
- Buprenorphine, a synthetic opioid acts as a partial agonist for opioid receptors, producing a weaker euphoric state compared to other opioids, while reducing the severity of withdrawal. Buprenorphine is most commonly combined with naloxone, an opioid blocker, in a medication called Suboxone.
- Naltrexone, a synthetic opioid antagonist blocks opioids from binding to receptors in the brain, lessening cravings by starving the individual of the desired euphoria. Naltrexone is best used when taken as directed, and takes additional restraint to comply with the necessary steps for full recovery.
These medications have been proven to provide significant relief from withdrawal symptoms and aid in a more successful rehabilitation process.
Alcohol Addiction Treatments
Withdrawal symptoms, including cravings, can create great discomfort during detoxification from alcohol. Because of this, some individuals are more inclined to submit to treatment if withdrawal can be managed through medication. In this time, and afterwards, medication-assisted therapies are used to ease the transition into sobriety, including:
- Naltrexone, as listed above, blocks the reward receptors in the brain responsible for alcohol cravings. Naltrexone is proven to reduce relapse for those recovering from alcoholism.
- Acamprosate, or Campral, controls the neurotransmitter systems in the brain that cause certain alcohol withdrawal symptoms. Insomnia, anxiety, and depression can be better managed during the recovery process, and it is proven to improve the outlook for those in recovery.
- Disulfiram is a medication intended to deter someone from drinking. If alcohol is consumed while taking Disulfiram, an intense adverse reaction occurs. This is most effective in motivated individuals seeking recovery.
The use of MAT is not always necessary for rehabilitation, but has been shown to effectively help those in recovery manage sobriety by curbing cravings and easing discomfort.
Evidence suggests that healing the mind is as important as healing the body in recovery. The ability to cope with stressful situations can significantly improve the outcome of a treatment plan and lessen the likelihood of relapse. NIDA suggest the following research-based behavioral therapies:
NIDA suggest the following research-based behavioral therapies, in parentheses follows the drugs of abuse they suggest as particularly benefiting from these modalities (continuing research illustrates that some of these are effective for other drugs of abuse as well):
- Behavioral therapies primarily for adolescents: The Multisystemic Therapy (MST), involves the adolescent’s family and delivers treatment within “natural environments,” such as the home, school, or neighborhood. It “addresses the factors associated with serious antisocial behavior in children and adolescents who abuse alcohol and other drugs.”
- Cognitive behavioral therapy (CBT): (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine) This therapy is based on the principle that certain maladaptive behavioral patterns, such as substance abuse, are based on the way a person learns. Because of this, CBT seeks to teach a person constructive ways of thinking and feeling as a way of creating more positive behaviors. Additionally, CBT aids a person in developing coping skills, so that they can more effectively deal with cravings or situations that may trigger them.
- Community reinforcement approach plus vouchers: (Alcohol, cocaine, opioids) This 24-week outpatient therapy uses familial, recreational, social, and vocational reinforcers as a way of creating a sober life that is more fulfilling than one steeped in substance abuse. Material reinforcements, or vouchers, are also used to recognize, and encourage, positive and abstinent behaviors. This program seeks to create an abstinent state which allows clients to begin learning, and nurturing, essential life skills, while also decreasing any drinking which is linked to a client’s cocaine abuse.
- Contingency management interventions (CM)/motivational incentives: (Alcohol, Stimulants, Opioids, Marijuana, Nicotine) This incentive-based intervention affirms a client’s healthy behaviors with a reward. One example are voucher-based reinforcements (used mainly for opioids or stimulants) which work by a client receiving a voucher for each drug-free urine sample, that can be traded for positive items or services. A second is prize incentives CM—a client is able to enter a drawing for cash, when rewarded for clean drug tests, attending counseling, or other positive activities within treatment.
- Family behavior therapy (FBT): Effective with adults and adolescents alike, this method integrates a client’s family members and not only aids in treating substance use disorders, but also certain co-occurring conditions within the individual and/or family dynamic. A combination of behavioral contracting and contingency management, FBT works towards developing coping and interpersonal skills and positive-goal setting.
- The Matrix Model: (Stimulants) The therapist, as both a teacher and a coach, educates a client on the important concerns surrounding addiction and relapse, while aiding them in becoming more self-confident. “Treatment materials draw heavily on other tested treatment approaches and, thus, include…family education groups, early recovery skills groups, relapse prevention groups, combined sessions, urine tests, 12-step programs, relapse analysis, and social support groups.”
- Motivational enhancement therapy (MET): (Alcohol, Marijuana, Nicotine) This modality focuses on overcoming a person’s ambivalence towards change. “This approach aims to evoke rapid and internally motivated change, rather than guide the patient stepwise through the recovery process.” To create this change, MET aids a person in creating, and carrying out, a plan and developing coping skills.
- 12-Step facilitation therapy: (Alcohol, Stimulants, Opiates) The aim of this approach is to “increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence.” Within these goals, a person focuses on three things: acceptance, surrender, and involvement in 12-step meetings.
Mental health awareness is on the forefront of addiction research. Research shows a strong correlation between addictive behavior and mental health disorders, which is made evidenced by the prevalence of co-occurring disorders. While treating addiction in individuals, physicians and specialists are more inclined than ever to focus on the mental health aspects of patients. Over time, this process can increase the success rates of those seeking a lasting recovery.
Medical doctors, pharmaceutical scientists, and psychologists, among others, continue to work toward more effective means of rehabilitation. New trials are being utilized for medical management and studies are being conducted to track the progress of various treatment methods. This dedication to the well-being of those struggling with addiction will be observed in time and may perhaps lead to greater solutions for this growing problem.
We Can Help
Evidence-based addiction treatments are valuable tools for beating addiction. If you need help finding a solution for drug or alcohol addiction, the caring staff at RehabCenter.net is here. We can direct you to a rehabilitation facility, resources for follow-up care, and offer guidance in a treatment program. Contact us today.Article Sources
National Institute on Drug Abuse - Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)