Substance Abuse Programs
Definition of Addiction
Addiction is defined by signs of tolerance, withdrawal, and compulsive “out of control” use.
Tolerance – person exhibits a need for increased amount of substance to achieve intoxication or desired effects.
Withdrawal – person develops painful symptoms following cessation or reduction of substance use.
Compulsive use – person often uses substance in larger amounts or over a longer period of time than was intended; exhibits unsuccessful efforts to cut down, stop, or control substance use; spends a great deal of time in activities necessary to obtain substance and recover from its effects; substance use continues despite significant social, occupational, or educational consequence or knowledge of having persistent psychological problems that are likely to have been caused or exacerbated by use.
Substance use often begins as a voluntary choice. With continued use, the person experiences biological and psychological changes, progressively, that impair judgment, free will and choice, and life-social-occupational functioning. Prolonged (chronic) use and heavy use significantly changed the person’s biology and brain chemistry, where now more substance use was needed to experience the same therapeutic effects. (Tolerance) After a period of prolong or heavy use, the person enters a state of deprivation, where the body and brain are not functioning normally. When stopping use, even for one day, the person does not feel much pleasure or excitement, experiences nausea/sickness and insomnia, lacks interest in things, and feels anxious and depressed. (Withdrawal.) When in that state, the person experiences very strong urges to seek and use the substances – to feel better, to feel pleasure, to feel normal. The person is triggered by internal-biological and external-environmental cues. The person becomes desperate and myopic – steal, lie, con, committing shameful acts, or whatever it takes to obtain the substance. (Compulsive Use) The person begins using, sometimes desperately so, despite severe and sometimes catastrophic consequences including potential recurrent legal problems, severe harm to self and others, declining health, work or academic problems, loss of marriage and children, multiple overdoses, or threat of death.
Addiction is defined by signs of tolerance, withdrawal, and compulsive “out of control” use.
Poly Substance Addiction
According to the American Psychiatric Association (APA 2014), a diagnosis of polysubstance dependence must include a person who has used at least three different substances (not including caffeine or nicotine) indiscriminately, but does not have a preference to any specific one. There is a distinct difference between a person having three separate dependence issues and having Polysubstance dependence, the main difference is polysubstance dependence means that they are not specifically addicted to one particular substance. This is often confused with multiple specific dependences present at the same time. To elaborate, if a person is addicted to three separate substance such as cocaine, methamphetamines and alcohol and is dependent on all three then they would be diagnosed with three separate dependence disorders existing together (cocaine dependence, methamphetamine dependence and alcohol dependence,) not polysubstance dependence. In addition to using three different substances without a preference to one, there has to be a certain level of dysfunction in a person’s life to qualify for a diagnosis of polysubstance dependence.
Dual Diagnosis refers to a condition when two (or more) disorders occur in the same person, simultaneously or sequentially. Dual diagnosis also implies interactions between the disorders that affect the course and prognosis of both. Research data show that many persons with alcoholism and or drug addiction also have depressive or mood disorders, anxiety disorders, psychotic disorders, eating disorders, and or conduct disorder (among children/adolescents) or personality pathology (such as Antisocial Personality Disorder, Borderline Personality Disorder). The rates of psychiatric disorder in persons with severe alcoholism and or drug addiction are very high.
Causes of dual diagnosis:
- Drugs of abuse can cause persons to experience one or more symptoms of another mental illness.
- Mental illnesses can lead to alcohol or drug abuse. Individuals with overt, mild, or even subclinical mental disorders may abuse drugs as a form of self-medication.
- Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress (chaotic environment), alcohol and drugs, and or trauma.
- The high rate of comorbidity between drug abuse and addiction and other mental disorders argues for a comprehensive approach to intervention that identifies and evaluates each disorder concurrently, providing treatment as needed.
Our Substance Abuse Program
Our substance abuse program provides treatment at three levels: outpatient, intensive outpatient, and long-term residential.
Outpatient and Intensive Outpatient Programs
Outpatient treatment includes standard (once weekly) and intensive formats (three times weekly). Standard outpatient treatment typically consists individual therapy, 1-2 weekly sessions, 45 to 60 minutes in duration per session. Intensive outpatient treatment consists of group therapy or mixture of individual and group therapy, 3-4 weekly sessions, 90 to 180 minutes in duration per session. Most people who seek standard outpatient treatment usually become concerned about their use or consequences of use for the first time or may be court ordered. Other people who seek standard outpatient treatment are stepping down from a higher level of care, typically intensive outpatient treatment. Persons who seek intensive outpatient treatment are either stepping down from a higher level of care, typically inpatient detox or acute treatment, or are not able to establish abstinence or appreciable gains from standard outpatient treatment.
Treatment begins with a thorough intake evaluation. The initial evaluation includes review of any prior medical records (if obtained), personal background, thorough history of alcohol and drug use and treatments, psychiatric history, medical history, psychosocial and developmental histories, and mental status examination. In some cases, psychological and or neuropsychological testing are conducted.
After initial evaluation, persons will receive psychotherapy or combination of psychotherapy and medications. Individual and group therapies are conducted using combination of cognitive behavioral strategies, motivational interviewing, and psycho-education. Marital and family therapy is often utilized as needed. Some persons, typically those seeking substance abuse treatment for the first time, are assigned to a recovery mentor. A recovery mentor is a person who has a history of alcohol or drug dependence and has successfully achieved sustained recovery (for at least 2 years) and received formal training on guiding and orienting others in recovery. Contact with a recovery mentor is often outside of the clinical office, typically a combination of phone or other telecommunication method and in person. Aftercare support is provided for persons who have completed treatment but are in need of additional assistance on an as needed basis.
Residential program: Sober Living – a place, a new lifestyle
Our residential substance abuse program is provided in a halfway house recovery residence, called Sober Living, located in Macomb County, Michigan. The residence is spacious and well maintained.
Sober Living is a highly structured program in which persons typically remains in treatment for 4 to 12 months. The Sober Living program is based on the Psychosocial and Biosocial Models, with targeted treatment focused on psychological, social, and environmental changes. The Medical Model, although highly effective in initial medical stability and during relapses, does not work well for long term recovery as a sole or primary model. Aspects of the Medical Model are certainly used, but only as an adjunctive component.
Persons admitted to Sober Living have a history of social, educational and or vocational functioning and positive community and family ties that have been eroded by substance abuse or dependency. For them, recovery involves relearning or reestablishing healthy functioning, skills, and values as well as regaining physical and emotional health. However, some persons do not have a reference point of health, as disorder and dysfunction occur very early in life. Recovery for them involves learning for the first time skills, attitudes, and values associated with socialized living and physical and emotional health.
Recovery, living a sober lifestyle, often requires change in several life domains. Sober Living is designed to provide persons with quality, long-term supportive living and network of resources designed to nurture stability, growth, and a more self-determined and independent life.
Sober Living provides an array of therapeutic and social resources:
- Evaluation and assessment. Includes biopsychosocial, diagnostic, and mental status evaluations and personality and or neuropsychological testing. After evaluation and assessment, results are discussed with the person and family (when agreed).
- Community and peer influences. Peer influence, mediated through a variety of group processes, is used to help persons learn and assimilate social norms and develop social responsibility and more effective social skills.
- Self-Help. Self-Help implies the persons in recovery are the main contributors to the change process. “Mutual self-help” means that persons also assume partial responsibility for the recovery of peers, an important aspect of a person’s own success.
- Clinical services. Persons shall have access to and receive individual and family therapy, group therapy, psychiatry, and addiction medicine. All professionals are licensed and credentials.
- Linking and coordinating. Assistance in finding work, coordinating enrollment into school or college, completing disability paperwork, etc.
Additional Information About Substance Abuse Treatment
Phases of Treatment
A person in severe active alcohol or drug addiction is often medically, cognitively, psychiatrically unstable and experiencing irresistible urges to use and suffering from painful and potentially harmful withdrawal symptoms. Medically assisted detoxification/acute care is an important initiation or first phase in the treatment process for persons significantly medically unstable and impaired by severe alcohol or drug addiction. Many people receive detoxification in an inpatient treatment center. Medications, nursing services, 24-hour supervision and monitoring, and brief psycho-education and counseling are provided. Treatment and care is based on the Disease-Medical Model. In residential detoxification/acute care, the person is taken out of a state of deprivation and instability, and immediate compulsive use is ceased, severely distressing secondary anxiety and mood symptoms are alleviated and health and healing begin.
However, detoxification/acute inpatient care is not “treatment,” but rather only a brief initiation of treatment. Persons who go through detoxification/acute care treatment but do not receive any further treatment, often relapse – with most going back to pre-detox patterns of use.
Some persons who experience a milder severity alcoholism or drug addiction may not need detoxification/acute inpatient treatment. This decision should be determined by a professional and the person seeking services, and based on screening or assessment.
We do not provide detoxification services. However, we do assist persons in selecting an appropriate detoxification/acute intensive inpatient treatment center.
Now detoxification is done, alcohol or drug use has initially ceased, and physiological stability is achieved. Or, for those who did not require or did not receive detoxification and have achieved initial abstinence from alcohol and or drug use, there is often an initial feeling of well-being and determination. But what has changed? Detoxification only rarely has lasting effects; and persons trying to remain abstinence on their own, without treatment, almost always return to use. Why? Because nothing has changed. The person still exhibits ingrained unhealthy patterns of behavior, lack of insight and flawed thinking, impulsivity, anxiety and mood, and or other negative enduring characteristics or impairments. Further treatment is needed.
Some persons are stepped down into intensive outpatient treatment from detoxification/acute treatment OR begin intensive outpatient treatment is an appropriate first phase if detoxification/acute treatment was not available or required. Then standard outpatient is the next step down treatment. Some persons, especially those who with a history of multiple hospitalizations into detoxification/acute care treatment, may need ongoing structure and monitoring, where outpatient treatment at any level or intensity will likely prove inadequate. These persons often cannot resist urges that will arise, as they do not have requisite insight, foresight, and coping skills to refrain and abstain from alcohol or drug use. For most persons, there are no short cuts to recovery. Sustained recovery requires significant, sometime profound changes in personality, environment, and lifestyle, and ongoing psychiatric stability. Long-term residential is needed, and can be highly effective.
Preventing relapse (at any level or phase of care) is necessary for maintaining the positive effects of treatment. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen, addressing all aspects of a person’s life, including medical and mental health services, and follow–up options can be crucial to a person’s success in achieving and maintaining a sober living lifestyle.
Some persons are in the early stages of substance abuse or dependence. Outpatient treatment may be an appropriate first choice in treatment. Detoxification/acute care as first line treatment is often not indicated for these persons. Triage decision should be discussed with a professional, after a thorough evaluation.
Key Principles of an Effective Treatment Program
Treatments have been developed to help people stop using alcohol and or drugs, avoid relapse, and successfully recover (or discover for the first) their healthy lives. Key principles form the basis of any effective treatment program (adapted from NIDA, with modifications based on clinical wisdom, expert consensus, and treatment outcome data):
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available. (Persons with severe addiction cannot wait weeks or months, and often even days.)
- Effective treatment attends to multiple needs of the person, not just drug abuse.
- Remaining in treatment for an adequate period of time is critical. (Longer treatment is often better and needed.)
- Individual psychotherapy and group therapy are the most commonly used forms of alcohol and drug abuse/dependence treatment. (Psychotherapies are core to any effective treatment, especially critical to long-term recovery.)
- Medications are an important element of treatment for many people, especially when combined with psychotherapy. (Medications help ease painful withdrawal symptoms and reduce powerful urges to use, and medically stabilize the addicted person. Medications also target severe psychiatric symptoms. A combination of medication and psychotherapy is critical for many people suffering from alcoholism and drug addiction. )
- A person’s treatment plan must be assessed continually and modified as necessary to ensure that it meets changing needs.
- Many people addicted to alcohol or drugs also have other mental disorders. (Most people with alcoholism and drug addiction have another mental health disorder such as anxiety, depression, eating disorders, and or personality disorders.)
- Medically assisted detoxification is only the first stages of addiction treatment and by itself does little to change long-term alcohol and drug abuse. (Medically assisted detoxification is not “treatment”; it is only the first step in the treatment process. Short-term (7- to 21-day) inpatient detox/treatment center programs are not enough for long-term change and recovery, but rather only the first phase in the treatment of severe addiction. There is much more work to be done. This assertion/statement cannot be stressed enough.)
- Treatment does not need to be voluntary to be effective. (Treatment can be effective when court-ordered, or insisted upon by family or employer. In fact, treatment can be highly effective when court, family, and or employer are involved as directed by professionals.)
- Drug use during treatment must be monitored (urine screens, breath tests, and or blood tests) continuously, as lapses during treatment do occur. (Relapse of alcohol and drug use can occur in all levels of care, even treatment centers with 24-hour supervision. A person in a state of chemical deprivation is often desperate, and can and will find very clever ways to use and or conceal use.)
- Treatment should assess people for infectious diseases (HIV/AIDS, hepatitis B and C, tuberculosis) as well as provide targeted risk–reduction counseling to help these people modify or change behaviors that place them at risk of spreading infectious diseases. (This information is often highly sensitive and personal. Many people do not disclose, or even seek an evaluation or treatment. IV drug users are at high risk for contracting and spreading infections.)