The descriptions above constitute a good general introduction to what a treatment program for drug or alcohol dependence might look like. The exact nature of treatment will be different for different sorts of substances being abused. In the discussion below, we've outlined some of the substance-specific issues in treatment.
Alcohol and CNS Depressant Drugs
- Detoxification from alcohol or other depressant drugs should not be done cold turkey - the risk of seizures and even death is too high. Rather, detoxification should take place under the supervision of a physician, who can help the addicted individual to detoxify gradually over a period of days via the administration of increasingly lower doses of benzodaizapine or related medicines.
- Teaching the disease model of addiction is a good idea: The patient and the family should be educated that addiction is an medical illness - not a moral failing. An alcoholic can never go back to drinking. In general, controlled drinking (e.g., one drink per weekend) carries a high risk of relapse. Any treatment for alcoholism must be based on total abstinence. Likewise, ALL addictive drugs should be avoided (unless they are clearly indicated for acute pain or time-limited acute anxiety).
- Antabuse or Naltrexone may be helpful medicines to keep the alcoholic from relapsing.
- Underlying psychiatric/psychological disorders should be treated in their own right. Depression and anxiety are common conditions.
- If an alcoholic is to remain alcohol-free, follow-up treatment, usually with psychiatric help and resort to community resources, is often vital. The patient must be seen regularly to monitor continued abstinence and adjustment. Research is showing that patient factors such as having a stable family, stable job, less sociopathy, less psychopathology, and a negative family history for alcoholism are more powerful predictors of positive outcome that is the type of treatment (Frances et al. 1984). This research could be interpreted to mean that follow-up treatment is most needed for alcoholic patients with an unstable family, unstable job, more sociopathy, more psychopathology, and a positive family history for alcoholism.
- The best way to confront the patient's denial of addiction is to challenge him to "prove" that he's not addicted by going on a one month trial period of abstinence. A successful trial period of abstinence may help the patient feel so much better that continued abstinence becomes easier. An unsuccessful trail period of abstinence proves that the alcohol use is out of control, and the therapist must then confront the patient's denial more vigorously.
- Focus psychotherapy on the patient's addiction: Psychotherapy is most successful when it focuses on the alcoholic's drinking. The drinking itself - past, present, and future consequences - must be given firm emphasis. Patients who insist that they need to solve their emotional problems before they stop using alcohol must be told that the alcohol is the main problem, and that other emotional problems can not be adequately treated until they first stop using alcohol.
- Involve family and friends: The therapist must involve the patient's family or friends as allies in the patient's treatment. Family and friends are often aware of relapses that are concealed by the patient. Research has shown that patients that are encouraged or even coerced into treatment by family or friends are more likely to remain in treatment and have a better outcome than those who are not so pressured.
- Therapists should routinely refer alcoholics to A.A. as part of a multiple treatment approach.
