Prescription and Illicit Drug Abuse
Treating Substance Abuse
Treatment Can Help Older Adults
Substance abuse and addiction are serious, but treatable, medical problems. Treatment helps reduce the powerful effects of drugs on the body and brain. In doing so, it helps people improve their physical health and everyday functioning and regain control of their lives. Once in treatment, older adults do just as well or better than younger adults.
Many Treatment Approaches
There are many ways to treat substance abuse and addiction. Depending on the substance(s) involved, treatment may include medications, behavioral treatments, or a combination of both. A doctor, substance abuse counselor, or other health professional can determine the right treatment for an individual.
Medications are available to treat addiction to opiates, nicotine, and alcohol, but none have yet been approved for treating addiction to marijuana, stimulants, or depressants. However, behavioral therapy can be helpful in these cases.
The First Step
The first step in a substance treatment program is often detoxification (“detox”), the process of allowing the body to get rid of the substance under supervised care. For some drugs, this may require a gradual reduction in the amount of drug taken (also known as a taper schedule). It is important to note that detoxificaton by itself is not treatment, and must be followed by behavioral therapy and/or medications.
Detoxification under medical care allows the physician to treat the symptoms of withdrawal. Withdrawal is the sick, sometimes unbearable feeling that people have when trying to stop or cut down on a substance they have become addicted to or have been taking for a long time. The type and length of withdrawal symptoms vary with the substance. For example, withdrawal from certain stimulants may lead to fatigue, depression, and sleep problems. Withdrawal from barbiturates and benzodiazepines can lead to rebound seizures and should be done only under a doctor’s supervision.
Medications Can Aid Treatment
Different types of medications may be useful at different stages of treatment -- to help a person stop abusing a substance, stay in treatment, focus on learning new behavioral skills, and avoid relapse. Medications for substance abuse help the brain adjust to the absence of the abused substance. These medications act slowly to quiet drug cravings and mental agitation. They can help people focus on counseling related to their treatment.
For example, buprenorphine, marketed as Subutex or Suboxone, can be prescribed by approved physicians, to treat patients addicted to opiate drugs, such as painkillers or heroin. Buprenorphine is useful in the short-term detoxification process by helping ease withdrawal symptoms and in the long-term by staving off cravings and helping prevent relapse.
Behavioral Therapies Can Help
Behavioral therapies can make treatment medications more effective and can help people stay in treatment longer and avoid relapse. Behavioral therapies help people learn how to change the way they think and cope with cravings and other “triggers” that may prompt them to relapse. Returning to a place or seeing a person associated with former drug abuse can bring about strong cravings for a drug without the person even being aware of it. Stress is also a frequent trigger of relapse.
Types of Behavioral Treatments
There are four main types of behavioral treatments.
- Cognitive behavioral therapy seeks to help people recognize, avoid, and cope with situations in which they are most likely to abuse substances.
- Motivational incentives offer rewards or privileges for attending counseling sessions, taking treatment medications, and not abusing substances.
- Motivational interviewing is typically conducted by a treatment counselor and occurs when a person first enters a drug treatment program. It aims to get people to recognize their need for treatment so they can take an active role in their recovery.
- Group therapy, preferably with one’s own age group, (and sometimes one’s gender), helps people face their substance abuse problems and the harm it causes. It teaches ways to solve personal problems without abusing medications or drugs.
Treatment Is Often Long Term
Addiction is a chronic illness, and people who are addicted to prescription medications or illegal drugs can face a long recovery. Treatment is ongoing and changes over time as patients’ needs change. Treatment must be tailored to each patient, including medical, mental, and social problems that are related to the substance abuse problem.
Relapse is Possible
As with most chronic diseases (e.g., diabetes, hypertension), relapse or the recurrence of symptoms (in this case, drug taking) is an expected part of the treatment cycle. In other words, relapse does not mean that treatment has failed. Instead, it means that treatment should be restarted or adjusted, or that a different treatment should be tried. It takes time to recover from drug abuse or addiction. Sometimes things go well, and sometimes they don’t. For older adults, the process can be complicated by other illnesses and life changes.
For more on treating opioid addiction, see “Treating Addiction to Prescription Opioids.”
For information on treating addiction to depressants, see Treating Addiction to CNS Depressants."
For information on treating addiction to stimulants, see “Treating Addiction to Prescription Stimulants."
If You Suspect a Problem
If you or someone you know has a substance abuse problem, see a doctor or substance abuse treatment specialist. To find a substance abuse treatment facility, call 1-800-662-4357 or visit www.findtreatment.samhsa.gov. A “12-step group” such as Narcotics Anonymous can provide ongoing support. For general information about substance abuse, see www.drugabuse.gov.