Addiction Treatment: Types, Medications, and Help for Families

Addiction kills tens of thousands of people every year, including almost 200,000 people in 2021.¹˒² If you are living with addiction to drugs (including nicotine) or alcohol, there are plenty of resources available to help you (or a loved one) break free of dependency, reconnect with your loved ones, and reclaim your life.

Addiction is a chronic disease and it's very common. “Almost 1 in 11 people in this country have a substance abuse problem,” says Leonard Jason, PhD, professor of psychology at DePaul University and director of DePaul’s Center for Community Research in Chicago. "The addiction could be to alcohol or to drugs. Addiction to alcohol is more common, but opioids are more lethal. Deaths due to an overdose of opioids rose [by 28.5%] to 75,673 in 2021."

While the statistics are grim, the good news is there are a variety of addiction treatment options—that don't look anything like Alcoholics Anonymous (AA)—but are just as effective.

It bears repeating—addiction is an illness (not a moral failing or a lack of will power). “There is still so much shame attached to admitting you have a problem or engaging in treatment. Even though it's been well documented that addiction is a disease, society implicates the individual, rather than the addiction," explains Elie G. Aoun, MD, MRO, FAPA, assistant professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York.

Stigma like this is a barrier to treatment, Dr. Aoun says, and may explain why so few people struggling with this heartbreaking problem get treated for it. (In 2018, just 11% of people with addiction received treatment. For gambling, the numbers are even lower.) People with addiction face stigma from healthcare providers, too.

Before someone can get help for a substance use disorder, they have to recognize they have a problem. It can be an extremely difficult task, says Cheryl Brown Merriwether, SHRM-SCP, SPHR, CPRC, vice president and executive director at the ICare International Center for Addiction and Recovery Education in Orlando, Florida. "This is often due to a lack of awareness about their illness or an ambivalence about getting sober."

While forcing someone into treatment isn't typically the best option, sometimes court-ordered rehab is required. The District of Columbia and 37 states allow for involuntary commitment to a drug or alcohol treatment facility, but with a host of caveats, including whether there is proof the person has harmed or has threatened to harm themselves or others.

People often begin misusing drugs and alcohol to cope with anxiety, depression, loneliness, and hopelessness, Dr. Aoun says. "It’s hard to stop engaging in a habit that makes a person feel better, at least temporarily." Addiction is highly comorbid with other mental illnesses, especially anxiety and depression.

Loved ones can be an enormous source of influence. Successful treatment is often the result of family members, other relatives, and friends getting a loved one into treatment. They are often an important component of recovery and sobriety, as well," says Michael McGee, MD, DLFAPA, staff psychiatrist at Atascadero State Hospital in Atascadero, California, and an editorial board member.

Yet, despite the negative impact on families, addiction treatment has primarily focused on the individual. Family-focused services have been described by addiction researchers as the ‘neglected aspect of addiction treatment’. (Dr. McGee often recommends CRAFT—Community Reinforcement and Family Training—a non-confrontational approach that trains families how to communicate effectively with loved ones living with addiction.)

Misconceptions about treatment options can be another barrier to treatment. Many people wrongly believe there are only two forms of treatment—AA or inpatient rehab. This could not be further from the truth.

Once you decide to get help, there are a variety of options and many are low-cost or free. If you are ready to embrace sobriety, Dr. McGee recommends confiding in a close, trusted friend. "Having support is essential. Once you have it, finding an addiction treatment provider may feel easier," he says.

Another underutilized source of help is the workplace. Ask your human resources department if your company offers an employee assistant program, or EAP. EAPs are completely confidential and connect you with help immediately. You can also find options online. Search addiction treatment near me to see what options are close by.

Experts say the most effective way to treat an addiction is an individualized approach. Needs will vary depending on the person's degree of impairment and distress. The goal is to match the interventions and supports to the needs of each person.

"An attorney with an opioid use disorder may do well with buprenorphine to help with withdrawal symptoms and prevent re-addiction; a homeless person with schizophrenia, a meth addiction, and hepatitis will need many more services to address the physical and mental complications," Dr. McGee explains. "For some recovery literally happens overnight— such as someone who decides to quit smoking cold turkey—for others recovery is a long process and occurs over several years, such as someone with alcohol use disorder and severe PTSD from years of combat or serial rape."

"Good treatment focuses on a mix of interventions, modalities, and settings (outpatient, partial hospital, day treatment, residential, and inpatient rehab—the most intensive level of care," Dr. McGee says.

Psychotherapies, sponsors and/or recovery coaches, mutual help groups (like AA), medications, housing (sober living communities) and social service recommendations should be based on an assessment using American Society of Addiction Medicine (ASAM) criteria.

ASAM criteria gives the provider a clinical understanding of the addicition to best inform which services would be most effective. (The assessment is holistic and provides important feedback on things including the person's living environment, their readiness to change, and the potential for re-addiction.)

“If there are immediate [severe] medical concerns or a history of severe withdrawal symptoms, inpatient [or residential] care would be indicated,” says Bruce Goldman, LCSW, senior director of behavioral health at Zucker Hillside Hospital in Queens, New York. "Those who have not reached their goals despite multiple efforts with outpatient care may also need residential services at some type of specialized hospital or facility".

Several local, state, and federal toll-free numbers link patients with resources. An organization called Shatterproof also has a treatment finder application, Goldman says.

“When assessing a program, be sure it provides evidence-based care and the most current medications for addiction treatment. It's a good idea to ask about the credentials of the team and find out if there are physicians on the staff," Goldman says.

See overview of the various forms of treatment, below.

Outpatient Treatment

If you have a safe and supportive sober living environment, you may be able to avoid residential treatment and instead participate in an intensive outpatient program (IOP). Outpatient treatment is ideal for people who are motivated to stop using their substance of choice but need a flexible program option that will work with their schedule. They typically involve regular meetings with a behavioral health counselor. Recovery work may take place one-on-one (with a drug counselor) as well as participating in a support group.³

Thanks to the widening of telehealth during the COVID-19 pandemic, more outpatient groups are now held virtually.

“We now can provide group and individual therapy on a virtual platform,” says Mercedes Kent, LCSW, CADC, addiction counselor at the Gateway Foundation, a nonprofit treatment provider based in Illinois. “And this gives more people access to treatment because even if they do not live physically close to a treatment center, they can still receive treatment.”

Residential Programs

Residential treatment can be highly effective but is very expensive (costing tens of thousands of dollars) and often long-term.

Residential treatment facilities are licensed and provide 24-hour structured and intensive care, using various therapeutic approaches. Besides the long-term therapeutic communities, there are short-term residential treatment options that focus on detoxification and provide intensive counseling and prepare a person to continue care in a community-based, outpatient format.³

“Recovery is not a 30-day process,” Jason says. “It can take years. But you have to be a good detective to find the best care for yourself.”

Inpatient programs are not a panacea. Merriwether says: “Re-addiction is real and it happens. Addiction is a chronic condition and a person struggling with it may require multiple times in rehab before being successful. People can complete a 60 or 90-day inpatient program and re-addict again. This is where continuing care programs become so important.”

Detoxification

Detoxification is the practice of safely having a person withdraw (under 24/7 supervision) from physiologically addicting substances like alcohol, and cocaine, explains Goldman. Today, most detox happens in residential or outpatient programs, says Dr. McGee.

"It's important to understand that withdrawal management does little to change long-term addictive substance use," he says. "It needs to be followed by long-term recovery support treatment."

Sober Living Homes

Each year, about 250,000 people around the country take advantage of recovery homes (also known as sober living homes), Jason says. Each sober living home works a little differently, but in general, there are rules about staying sober, participating in group meetings, and paying your fair share of the expenses to keep things going.

“Recovery is a challenge and if you can spend several months in a sober house, surrounded by people who are employed and who are not using alcohol and drugs, you may have a better chance at sobriety,” he says.

These can be helpful for someone in recovery who is being discharged from treatment but who doesn’t have a good living situation.

“A sober living house can be a good alternative,” Kent says. “We want to set up a person for success before they leave treatment.”

Counseling and behavioral therapies are an important component of recovery. Therapeutic strategies can help someone with a substance use disorder build healthy life skills, change their attitudes and behaviors where drug (or alcohol) use is concerned, and stay compliant with treatment that includes medications.³

Therapy can also be used to address motivation, recruit support, help with cravings, and trigger management, too. "Therapy teaches coping skills, drug refusal skills, provides support for dealing with toxic relationships, 12-step work, family treatment, and can help with commonly co-occurring psychiatric issues such as depression and anxiety," says Dr. McGee.

A few of the common therapies used in addiction are:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) helps a person in treatment to recognize, avoid, and deal with the situations in which they may find themselves losing their resolve not to use drugs or alcohol.³ CBT is one of the more successful therapies when it comes to treating addiction and can be especially effective for cannabis-use disorder, too, says Dr. Aoun.

Dr. McGee points out that good treatment is usually eclectic, so CBT wouldn't be an effective treatment on its own.

Motivational Enhancement Therapy

The goal of motivational enhancement therapy (MET) is to help a person become motivated to make the necessary changes in their lives by using past experiences, explains Kent. “We explore barriers to behavior change and how to make the changes,” she says. “Motivational enhancement therapy can be life changing.”

Often, positive reinforcement is used to encourage the person to abstain from the substances they are misusing.³ Through motivational enhancement therapy, they identify their own reasons for wanting to quit. “Very often people entering treatment, lack motivation to quit. This type of therapy helps them find it,” Dr. Aoun explains.

Group Therapy

Many people with addictions have attachment disorders, says Dr. McGee. Group therapy can be a place to practice healthy, loving relationships for those wounded emotionally in this way.

Therapeutic groups can include:

• Psychoeducational groups, which teach about substance misuse.

• Skills development groups, with the aim of breaking free of addictions.

• Cognitive-behavioral groups, which rearrange patterns of thinking and action that lead to addiction.

• Mutual-support groups, where members can debunk each other's excuses and support constructive change.

Medication can be key in helping some people succeed in staying sober. They can be used to treat addiction to alcohol, nicotine, opioids and more.

Methadone (Dolophine, Methadose), buprenorphine (Suboxone, Subutex, Probuphine, Sublocade), and naltrexone (Vivitrol) are currently in use.³ Both methadone and buprenorphine suppress withdrawal symptoms and relieve cravings, while naltrexone works to block the effect of opioids in the brain. Naltrexone is only for people who have already been detoxified. It is a non-opioid replacement that's delivered as a long-acting injectable.

While medications to treat other drugs that are frequently abused, like cocaine and marijuana, are still in the works, those with an alcohol use disorder may be helped by naltrexone. The medication blocks the opioid receptors that are involved in the feel-good effects of drinking and can reduce re-addiction in heavy drinkers. Two other medications are also available for those who have an alcohol use disorder: acamprosate (Campral) and disulfiram (Antabuse).³

Medications for tobacco use disorder include nicotine replacement therapy (NRT) such as over-the-counter transdermal patches, sprays, gums, and lozenges. These products stimulate the brain receptors targeted by nicotine, helping relieve nicotine withdrawal symptoms and cravings. Prescription drugs that work similarly include bupropion (Wellbutrin XL, Wellbutrin SR, Forfivo XL)—originally approved as an antidepressant—and varenicline (Chantix). Combinations of NRT and other medications have also been found effective.

Medications for Addiction Treatment (MAT) for substance-use-disorders can be lifesaving and used for long periods of time, explains Shannon Robinson, MSN, chief nursing officer at Aspire, an Orlando-based integrated behavioral health system serving the Southeast. “For those with an opioid use disorder, MAT is best practice. Medication significantly reduces risk of overdose and allows people with an opioid addiction to get back to their normal life.”

“Recovery can be a lifelong process,” Robinson explains. “And being on medication long-term can mean the difference between being engaged with family and holding down a job and being in and out of the judicial system.”

For more information about MAT and to search for providers, access the finder's tool on the Substance Abuse and Mental Health Services Administration (SAMHSA) website. (Editor's note: This tool was most recently updated January 25, 2023.)

Mutual support groups are usually free and can be very helpful. “They provide a sense of belonging, decrease stigma, and offer strong support and tools to lead a life without alcohol and drugs,” Goldman says.

In addition to well-known groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), there are others worth looking into, Dr. Aoun explains. Smart Recovery, is an international nonprofit and totally free organization with tools, exercises, videos, podcasts and other resources you can apply to your life immediately. Use their directory to find a free meeting.

Life Ring, whose motto is “Sobriety, Secularity, and Self-Help,” and Recovery Dharma, a Buddhist-based program are other mutual-help group options.

The National Institutes of Health (NIH) and several related government agencies are excellent sources of online treatment service information:

• For publicly-funded addiction treatment centers in your state, visit call 1-800-622-HELP, or visit Find Treatment.gov.

• To learn more about substance use and mental health treatment, and to access related services visit the Substance Abuse and Mental Health Services Administration (SAMHSA).

• To find general information about drug use and addiction treatment, visit NIH's National Library of Medicine.

• For research updates related to opioid addiction, visit NIH's Helping to End Addiction Long-term® Initiative (HEAL).

• Find comprehensive information about treatment for alcohol use disorder at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

According to the National Institute on Drug Abuse (NIDA) there is no cure for addiction but many new treatment options are in the pipeline.

Given the scope of the opioid epidemic, the FDA says it is committed to supporting the development of novel treatments—both mediations and medically-assisted devices—that help with uncomfortable withdrawal symptoms and used to address opioid dependence or addiction, as well as new, non-addictive treatments for pain that can serve as alternatives to opioids.

Dr. McGee says addiction is a chronic, psychiatric illness like depression [and other serious mental illnesses]. "It can be kept in remission with good treatment and recovery practices. The best treatment is an individualized, multi-faceted approach based on a thorough assessment conducted by a qualified clinician."

While recovery from addiction can be a cycle of undergoing treatment, returning to the addictive behavior, and seeking treatment again some people with addiction go into remission without treatment.

Dr. McGee says getting sober isn't easy. "There is clear and consistent evidence that while recovery requires personal commitment, determination, and courage, it is usually not something that happens in isolation," says Dr. McGee. "It can be painful and arduous work but also richly rewarding."

Addiction hurts many more than the person with the problem. Families and communities are negatively affected as well. Living with a person who has a drinking problem or a substance use disorder can mean daily routines that are constantly disrupted, tiptoeing around to avoid painful confrontations, and being in constant fear that the person will end up in jail, or worse.

Many addiction programs offer services specifically for family members, Goldman says. “Additionally, self-help groups such as Al-Anon and Nar-Anon provide support and guidance to family members who are impacted by a loved one’s illness.”

One (previously-mentioned) approach called Community Reinforcement and Family Training (CRAFT) does not involve an intervention. Unlike family therapy which includes the loved one who is struggling, CRAFT is just for the friends and family members.

It works by giving the friends and families the tools they need—communication skills, motivation building, safety training and more—to reward and reinforce behaviors that contribute to and encourage a loved one's sobriety while taking care of themselves in the process," says Dr. McGee.

To find a CRAFT-trained practitioner visit Helping Families Help directory of providers.