Seeking
Treatment for Substance Abuse Disorders
While each individual in treatment will have
specific long- and short-term goals, all specialized substance abuse
treatment programs have three similar generalized goals
(Schuckit, 1994;
American Psychiatric Association, 1995):
- Reducing substance abuse or
achieving a substance-free life
- Maximizing multiple aspects of
life functioning
- Preventing or reducing the
frequency and severity of relapse
For most persons, the primary goal of treatment
is attainment and maintenance of abstinence (with the exception of
methadone-maintained patients), but this may take numerous attempts and
failures at "controlled" use before sufficient motivation is mobilized.
Until the person accepts that abstinence is necessary, the treatment program
usually tries to minimize the effects of continuing use and abuse through
education, counseling, and self-help groups that stress reducing risky
behavior, building new relationships with drug-free friends, changing
recreational activities and lifestyle patterns, substituting substances used
with less risky ones, and reducing the amount and frequency of consumption,
with a goal of convincing the person of his/her individual responsibility
for becoming abstinent
(American Psychiatric Association, 1995). Total abstinence is strongly
associated with a positive long-term prognosis. Persons who have both
substance abuse disorders and mental must have treatment for provided at the
same time that addresses both the substance abuse disorder and the mental
illness. Persons with both issues are said to have a co-occurring disorder.
The initial stage of treatment is often
detoxification. This process involves an evaluation, stabilization and a
fostering of readiness for the person to participate in a Substance Abuse
Treatment Program. Detoxification in a medical setting with 24 hour
supervision is recommended by the Substance Abuse and Mental Health Agency (SAMHSA)
for persons addicted to alcohol, sedative-hypnotic and opiods. Often
withdrawal from these substances can create medical complications for the
individual requiring this type of monitoring.
Becoming alcohol- or drug-free, however, is only
a beginning. Most persons in substance abuse treatment have multiple and
complex problems in many aspects of living, including medical and mental
illnesses, disrupted relationships, underdeveloped or deteriorated social
and vocational skills, impaired performance at work or in school, and legal
or financial troubles. These conditions may have contributed to the initial
development of a substance use problem or resulted from the disorder.
Substantial efforts must be made by treatment programs to assist patients in
ameliorating these problems so that they can assume appropriate and
responsible roles in society. This entails maximizing physical health,
treating independent psychiatric disorders, improving psychological
functioning, addressing marital or other family and relationship issues,
resolving financial and legal problems, and improving or developing
necessary educational and vocational skills. Many programs also help
participants explore spiritual issues and find appropriate recreational
activities.
Increasingly, treatment programs are also
preparing persons for the possibility of relapse and helping them understand
and avoid dangerous "triggers" of resumed drinking or drug use. Persons are
taught how to recognize cues, how to handle craving, how to develop
contingency plans for handling stressful situations, and what to do if there
is a "slip." (Substance Abuse and Mental Health Agency website 01/04/08)
