Treatment Q&A

How can I get someone to stop using?
Although you probably want the substance use to stop as soon as possible, immediate abstinence has certain risks, including withdrawal symptoms with serious medical consequences. Many people need to be admitted to a detoxification center to help them physically withdraw.
Even if detoxification is not necessary, a formal, structured treatment program is often vital for sustained abstinence. A health care professional or substance use counselor can help you and person in need assess your options.
To encourage the person to stop, you might want to tell them ways you would be willing to help make it easier for example, going to counseling together, or providing transportation or childcare.

Why can’t people with addictions quit on their own?
Nearly all people with addictions believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the person stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences the defining characteristic of addiction.
Understanding that addiction has such an important biological component may help explain a person’s difficulty in achieving and maintaining abstinence without treatment. Psychological stress from work or family problems, social cues (such as meeting people from one’s drug-using past), or the environment (such as encountering streets, objects, or even smells associated with drug use) can interact with biological factors to hinder attainment of sustained abstinence and make relapse more likely. Research studies indicate that even the most severely addicted people can participate actively in treatment and that active participation is essential to good outcomes.

What should I do if I have to choose treatment for my family member?
Family members often have to make decisions about when and where someone should seek treatment. The person needing help may be confused or unable to make decisions. Or, crises may have reached a peak and the family decides it’s time to do something.
It’s a big responsibility, and it may seem frightening. You first have to trust yourself to know that treatment is necessary, and that you know the person well enough to make important decisions on his or her behalf.
Some factors influencing your choice of a treatment program may be beyond your control, like the financial situation, insurance coverage, and availability of the type of program you need.
Always remember that your physician or employee assistance provider can help you.

How can I locate drug and alcohol treatment programs?
If someone you know needs help for substance abuse addiction or problems with alcohol, where do you turn to find treatment? One good place to turn is the Substance Abuse Treatment Facility Locator. It is a searchable directory of more than 11,500 addiction treatment programs around the country that treat alcoholism, alcohol abuse, and drug abuse problems.
The Locator includes outpatient treatment programs, residential treatment programs, hospital inpatient programs, and partial hospitalization/day treatment programs for drug addiction and alcoholism in all 50 states, the District of Columbia, the Federated States of Micronesia, Guam, Puerto Rico, the Republic of Palau, and the Virgin Islands.
The Locator is maintained by the Substance Abuse and Mental Health Service Administration (SAMHSA). All information in the Locator is updated annually based on facility responses to SAMHSA’s National Survey of Substance Abuse Treatment Services. New facilities are added monthly.

Should I choose a place where no one will know our family?
Some families fear embarrassment if they seek treatment in their community a reasonable (and perhaps sometimes appropriate) concern, but in the long run, it might make less sense than you think.
Treatment programs are bound by law to protect the privacy of the people who participate, so attending a local program should not mean that your family member’s participation becomes widely known.
You and the person you’re concerned about should choose who you want to tell. In turn, those people can become huge assets during recovery. Many people who enter treatment drop out before their treatment is done. Family and friends can motivate people to enter and stay in treatment by providing emotional support and expressing their confidence that success is possible. They can continue that support right into recovery.
Family therapy is also an important method of treatment, especially for adolescents. Research shows that family involvement strengthens the benefits of treatment.

How can I judge the quality of the treatment? What makes treatment effective?
Certain characteristics increase the chances that a treatment program is of good quality:

* Is the program accredited or licensed?
* Are treatment services delivered by licensed or certified staff?
* Is the method of treatment based on an assessment of the severity of the problem, as well as the person’s other psychiatric, medical and social needs?
* Is the type of treatment appropriate for the person’s age, gender, and substance of choice?

If the person didn’t want to stay in treatment, consider asking the following questions:

* Was a treatment plan developed for the person’s specific needs?
* Did it address all of their issues (including medical and social)?
* Was the plan modified as the person changed?
* Is there another problem, such as depression, that needs to be addressed simultaneously?
* Was the facility safe and clean? Did the person feel comfortable there?
* Did the person fit with the staff members and other treatment participants?

How the person and family participate in the program also increase the chance of success:

* Was the person in treatment for a long enough period of time?
* Did the person attend all scheduled appointments?
* Did they receive the right medications?
* Did the person complete the program as outlined by the staff?
* Was the person involved in aftercare following the initial treatment experience?
* Were one or more family members willing to participate?
* Did the person receive any pressure or mandates to attend treatment?

How long should someone stay in treatment?
The treatment duration will depend on a person’s problems and needs. According to the National Institute on Drug Abuse, most people achieve significant improvement at about three months, or 90 days, of treatment. Sometimes, insurance companies will not pay for 90 days of treatment. If that happens, try to work with what you get; or, ask for 90 days of a different type of program (e.g., outpatient instead of inpatient).
Many people who enter treatment drop out before receiving all the benefits that treatment can provide. Successful outcomes may require more than one treatment experience. Many people with addictions have multiple episodes of treatment, often with a cumulative impact.

How can I get someone to accept treatment?
If you have already tried many strategies for helping the substance user see the problem and take action, there are additional actions that may be helpful:

* Involve other family members or friends. People who have been in treatment and are in recovery can also be particularly helpful.
* Tell the person what behaviors you will and will not tolerate and that you will accept no excuses.
* Give the person an ultimatum: either establish a lengthy period (for example, three months) of abstinence from all alcohol and other drugs or move out. Let them know that very few people with substance use disorders are able to do so without treatment, which will provide support and specific guidelines to make stopping easier.
* Hold an intervention.
* If all else fails, consider withdrawing all financial and emotional support, and terminating contact.

What helps people stay in treatment?
Since successful outcomes often depend upon retaining the person long enough to gain the full benefits of treatment, strategies for keeping someone in the program are critical. Whether a patient stays in treatment depends on factors associated with both the individual and the program. Individual factors related to engagement and retention include motivation to change drug-using behavior, degree of support from family and friends, and whether there is pressure to stay in treatment from the criminal justice system, child protection services, employers, or the family. Within the program, successful counselors are able to establish a positive, therapeutic relationship with the patient. The counselor should ensure that a treatment plan is established and followed so that the person knows what to expect during treatment. Medical, psychiatric, and social services should be available.
Since some individual problems (such as serious mental illness, severe cocaine or crack use, and criminal involvement) increase the likelihood of a patient dropping out, intensive treatment with a range of components may be required to retain patients who have these problems. The provider then should ensure a transition to continuing care or “aftercare” following the patient’s completion of formal treatment.

How can I pay for treatment?
There are several options for paying for substance abuse treatment but these options do not cover all people.

* Most private health insurance plans provide coverage for treatment. If you have private health insurance, call the toll-free number on the back of your card and ask about your treatment benefits, or talk to your employer’s human resources professional. Make sure you know exactly what you’re getting before making any arrangements. You don’t want to be blindsided by hidden costs. In the event your insurance denies a claim, refer to your benefits plan for instructions on how to appeal. The appeal process may be different in every state, and there is often a time limit for you to file. The Henry Kaiser Family Foundation provides guidelines for the 44 states that have independent state review of insurance disputes.
* Medicaid is an insurance program for people who lack health insurance and meet certain financial thresholds. Individuals must apply for coverage in their state, and benefits are administered differently in various states. To find out if you’re eligible, visit: http://cms.hhs.gov/medicaid/statemap.asp
* Medicare is an insurance program for people over 65 and for people with disabilities. People who receive Medicare benefits can access Medicare benefits enrollment at: http://www.medicare.gov/Basics/HowToEnroll.asp
* Veterans Administration benefits are available to veterans and their families. To learn more, visit: http://www.va.gov/health_benefits/ or call 1-877-222-VETS.
* Some companies have employee assistance professionals available for employed individuals. Services may be provided on-site, or you may receive a list of substance use professionals in your area. Contact your company’s human resources office to learn more about this option.
* For college students, student health services often provide group and individual counseling for people with substance use problems. Contact the health or counseling center.
* Clinical trials are services provided by researchers studying the effectiveness of a range of treatment methods, including counseling and medications. Often these services are provided free of charge because they are part of large research studies. To find a clinical trial, visit the National Institute on Drug Abuse Clinical Trial Network: http://www.drugabuse.gov/Funding/CTI.html
* Many private treatment centers have financial aid that helps defray the expense. Contact treatment facilities directly about the availability of these funds.
* Family members who need to pay for treatment out of their own resources can work with treatment centers to create payment plans so that the entire sum does not need to be paid at the beginning.

Treatment didn’t work. What do I do now?

* Help the person try again. Treatment often requires more than one attempt. As with other chronic diseases such as asthma or diabetes, the type of treatment may need to be adjusted before it works. Also, the person needs to learn how to make the best use of treatment, and the treatment staff needs time to learn about the needs of the patient.
* Examine what worked well (and what didn’t work.) Family members can help the person identify what parts of treatment were most effective. Perhaps group sessions worked well, but individual counseling was difficult. Maybe the person got confused and fatigued when given medication, or maybe medications were not used for long enough. Building on the positive aspects of past treatment can make the next treatment effort more worthwhile.
* Get advice from the professional staff. The professional staff from the treatment program can offer advice about whether the type of treatment was a good fit or whether another type would be better.
* Maintain a hopeful attitude. Many people do recover. With sufficient help and personal commitment, virtually anyone can recover. But it may require repeated efforts by both the addicted person and the family, and outside help as well.

Where can the rest of the family get help?
There are a number of resources available. Al-Anon, a Twelve Step program whose meetings are readily available in most communities across the country, provides support and guidance for family members, whether their loved one accepts treatment or refuses to get help.
Many human service agencies provide help, including counseling and guidance centers, mental health clinics, and substance use treatment programs. Your family physician may be able to provide a referral. Employee assistance programs are also very experienced with addiction. Ask your human resources department for assistance.

What role can the criminal justice system play in the treatment of drug addiction?
Increasingly, research is demonstrating that treatment for drug-addicted offenders during and after incarceration can have a significant beneficial effect upon future drug use, criminal behavior, and social functioning. The case for integrating drug addiction treatment approaches with the criminal justice system is compelling. Combining prison- and community-based treatment for drug-addicted offenders reduces the risk of both recidivism to drug-related criminal behavior and relapse to drug use. For example, a recent study found that prisoners who participated in a therapeutic treatment program in the Delaware State Prison and continued to receive treatment in a work-release program after prison were 70 percent less likely than nonparticipants to return to drug use and incur rearrest.
The majority of offenders involved with the criminal justice system are not in prison but are under community supervision. For those with known drug problems, drug addiction treatment may be recommended or mandated as a condition of probation. Research has demonstrated that people who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily.
The criminal justice system refers drug offenders into treatment through a variety of mechanisms, such as diverting nonviolent offenders to treatment, stipulating treatment as a condition of probation or pretrial release, and convening specialized courts that handle cases for offenses involving drugs. Drug courts, another model, are dedicated to drug offender cases. They mandate and arrange for treatment as an alternative to incarceration, actively monitor progress in treatment, and arrange for other services to drug-involved offenders.
The most effective models integrate criminal justice and drug treatment systems and services. Treatment and criminal justice personnel work together on plans and implementation of screening, placement, testing, monitoring, and supervision, as well as on the systematic use of sanctions and rewards for drug abusers in the criminal justice system. Treatment for incarcerated drug abusers must include continuing care, monitoring, and supervision after release and during parole.

How does drug addiction treatment help reduce the spread of HIV/AIDS and other infectious diseases?
Many drug addicts, such as heroin or cocaine addicts and particularly injection drug users, are at increased risk for HIV/AIDS as well as other infectious diseases like hepatitis, tuberculosis, and sexually transmitted infections. For these people and the community at large, drug addiction treatment is disease prevention.
Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. Drug users who enter and continue in treatment reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Participation in treatment also presents opportunities for screening, counseling, and referral for additional services. The best drug abuse treatment programs provide HIV counseling and offer HIV testing to their patients.

Where do 12-Step or self-help programs fit into drug addiction treatment?
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model, and Smart Recovery®. Most drug addiction treatment programs encourage patients to participate in a self-help group during and after formal treatment.

How can families and friends make a difference in the life of someone needing treatment?
Family and friends can play critical roles in motivating people with drug problems to enter and stay in treatment. Family therapy is important, especially for adolescents. Involvement of a family member in a person’s treatment program can strengthen and extend the benefits of the program.

Is drug addiction treatment worth its cost?
Drug addiction treatment is cost-effective in reducing drug use and its associated health and social costs. Treatment is less expensive than alternatives, such as not treating addicts or simply incarcerating addicts. For example, the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $18,400 per person.
According to several conservative estimates, every $1 invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.