Question

Describe treatment options for patients with substance-related disorders

Answer 1

Treatment for substance use disorders can take many different forms and may be delivered in a range of settings varying in intensity. In all cases, though, the goals of treatment for substance use disorders are similar to treatment for any medical condition: to reduce the major symptoms of the illness and return the patient to a state of full functioning.

Treatment must be provided for an adequate length of time and should address the patient’s substance use as well as related health and social consequences that could contribute to the risk of relapse, including connecting the patient to social support, housing, employment, and other wrap-around services.

a) Screening and brief intervention for alcohol in adults has been shown to be effective; and screening for substance use and mental health problems is recommended by major health organizations for both adults and adolescents

b) Treatment for all substance use disorders—including alcohol, marijuana, cocaine, heroin or other opioid use disorders, among others—should include one or more types of behavioral interventions delivered in individual, group, and sometimes family settings.

c) Motivational Interviewing ( MI): it is an intentionally goal-directed, collaborative, and empathetic communication technique therapists can use to leverage clients’ motivation for behavior change. It evokes clients’ internal motivation for changing problematic patterns in their life, while highlighting their intrinsic strengths and resources. It is usually practiced in a face-to-face format with client and therapist.

d) Motivational Enhancement Therapy (MET) is ideal for individuals who are not yet ready for making changes in their lives. It merges the strategic communication style of MI with psychological counseling.

e) Prize-Based Contingency Management (CM) : frequently monitoring of the clients’ behavior, and (2) reinforcing positive behavior using monetary or other tangible rewards.Usually, CM treatments are in effect for 8-24 weeks, and CM is typically provided as an add on to other treatment, such as cognitive behavioral therapy or 12-step meetings. CM is especially encouraged for cocaine use disorder patients.

f) Friend Care is a post-care program that capitalizes on the beneficial impact of community support on substance use recovery. Patients meet for 6 months with facility staff as outpatients, where they receive counseling, information on community resources, and other as-needed services for optimizing their social, emotional, and occupational functioning in daily life.

g) Guided Self-Change (GSC) is an integrative treatment, combining cognitive behavioral therapy (CBT) with motivational counseling.CBT involves patient “self-monitoring” or tracking their current substance use habits and “high-risk” circumstances for use. With this increased awareness, patients strategize in therapy ways they can alter certain thoughts and behaviors that lead to problematic patterns. It is ideal for mild or low-severity patients.

h) The intensity of substance use disorder treatment services falls along a continuum. For people with mild substance use disorders, counseling services provided through primary care or other outpatient settings with an intensity of one or two counseling sessions per week may be sufficient while residential treatment may be necessary for people with a severe substance use disorder.

i) People who receive treatment in residential settings participate in step-down services following the residential stay that includes intensive outpatient or other outpatient counseling and recovery support services (RSS) to promote and encourage patients to independently manage their condition.

j) Medications are also available to help treat people addicted to alcohol or opioids.The available medications do not by themselves restore the addicted brain to health, but they can support an individual’s treatment process and recovery by preventing the substance from having pleasurable effects in the brain, by causing an unpleasant reaction when the substance is used, or by controlling symptoms of withdrawal and craving. Widening access to highly effective medications for treating opioid addiction—methadone, buprenorphine, and naltrexone—has been identified as essential part in tackling opioid and heroin crisis.