Drug treatment: What works?
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People who use alcohol and other drugs differ in many ways:
These are all important issues to take into account when considering treatment for alcohol and other drug use. It is important to choose the treatment that is right for you. You may need a combination or sequence of services and because people change, you may need a different mix of services at different times.
There are a number of different treatment options for alcohol and other drug problems. Your health professional should be able to help you out with information about what treatments work best and what treatment is right for you right now.
People who have been using alcohol and other drugs for a short period and who are at low to moderate risk of health harms often benefit from 'early interventions' or brief therapies'. These focus on improving awareness of the risks and negative aspects of substance use, but also prompt the individual to explore the possible benefits of reducing or ceasing their use. The purpose of these interventions is to motivate people to take action and to consider treatment. A range of public and private services provide such interventions.
People who are using alcohol and other drugs in ways that place them at high risk of harms, or who are experiencing problems associated with their use, may be dependent. Dependence is when alcohol or other drugs cause physical and psychological changes in a person, leading to them spending a lot of time thinking about, obtaining, using and recovering from the effects. People who are dependent are likely to need structured and more intensive interventions to help them change their alcohol and other drug use behaviour.
Many people who are dependent on drugs or alcohol, experience physical withdrawal when they attempt to abruptly stop using them. This is not only unpleasant, and increases the risk of relapse to use, but can also be dangerous or event life threatening. A treatment service can help someone get alcohol or drugs out of their system with safety and some level of comfort. Withdrawal or detoxification treatment can involve rest, counselling, good nutrition and medications. A range of public and private services provide withdrawal programs. These can be inpatient or outpatient based.
Copleting a withdrawal process is not a cure for dependence and, without follow-up treatment, a person is likely to relapse to using alcohol or other drugs again. This is because their brain chemistry has changed in response to the alcohol or other drug being constantly present. Therefore, it is a good idea to try to follow up withdrawal treatment with counselling, residential rehabilitation, or medication assisted treatment.
A residential rehabilitation facility is a place where a person can stay and receive counselling and support to recover from alcohol or other drug dependence. There is a range of residential rehabilitation facilities in South Australia, including the Woolshed Therapeutic Community, which is run by Drug and Alcohol Services South Australia.
Most residential rehabilitation programs are abstinence based. That means the person stops the use of all alcohol and other drugs (often including smoking) that are not prescribed for medical purposes.
However, some programs do accept clients who are on a medication assisted treatment program; sometimes called pharmacotherapy or, in the case of treatment for opioid use, opioid substitution therapy.
A large focus of residential rehabilitation is assisting the development of constructive coping strategies. Residential rehabilitation addresses the behaviours of addiction, and is not specific to any particular drug or drug type. That is why clients who choose abstinence and clients who choose medication assisted treatment can all benefit from residential rehabilitation programs. There is usually lots of professional support and therapy to build life skills.
Residential rehabilitation programs are either staff run or are designed so staff and clients participate together as members of a social and learning community called a therapeutic community.
The length of a client stay in a residential rehabilitation program varies depending on the program, but most offer at least a 12-week stay.
After time in residential rehabilitation, people need to adjust to living in the general community again. Support is provided to help with this adjustment. This may include daily visits to a health professional or counsellor or spending time living in a half-way house. Half-way houses are regular houses in regular suburbs where several people who have been through residential rehabilitation live together while they adjust to the responsibilities and realities of regular life, without relapsing to alcohol or other drug use.
In medication-assisted treatment, medication is prescribed to reduce withdrawal symptoms, control craving, and block or change the effects of alcohol and other drugs. Medication alone is not enough to achieve lasting recovery from dependence on alcohol or drugs. At the same time psychosocial support is usually provided to address the psychological, social and environmental factors that contribute to drug and alcohol use.
In the case of opioid and nicotine dependence, the medications prescribed may be ‘substitutes’. This means the medications are similar to the drug upon which the person is dependent, but they can be used with less risks and with less intoxicating effects.
Nicotine replacement therapy is provided as patches, gums or inhalers that deliver nicotine without the harmful tars and carbon monoxide that comes with smoking tobacco. Similarly, methadone and buprenorphine can be provided to people who are dependent on heroin or other opioids with less risk of overdose and without the risks associated with injecting drug use.
Other medications for relapse prevention may work by; 1) reducing cravings 2) altering the response the body has to alcohol or drugs to make their use less pleasurable, or 3) reducing symptoms of withdrawal to make abstinence more comfortable and achievable.
In the case of alcohol, there are several medications that may be used to support relapse prevention, including naltrexone, acamprosate and disulfiram (Antabuse). Naltrexone can also be used in relapse prevention treatment of opioid dependence, as it blocks the effects of opioid drugs such as heroin.
Dependence on stimulants like amphetamine, and other drugs like cannabis have fewer medication based treatments supported by evidence. However, there are medications that can be helpful in some cases.
The above information provides only a small snap shot of the range of treatments for drug or alcohol issues and how they work.
The Know Your Options website also provides a directory of services for people who experience problems with alcohol or drug problems.