In the medical profession, addiction to drugs or alcohol has for decades been viewed chiefly as a brain disease, a mental health disorder, in which the addictive substance alters the brain’s chemistry. Increasingly, however, there’s been recognition of genetic, environmental and other factors that can make initial drug use more likely and/or help solidify an addiction. Regardless of the possible causes, though, if drug use increases, addiction becomes more likely, because the brain essentially rewires itself so it compulsively demands drug use and the resulting high that users crave. The good news is that the brain can be made to re-adapt to life without addiction. But coming clean can require extraordinary patience and perseverance on the part of the drug user, as well as support, accountability and medical intervention for the person addicted. Many addiction treatment options are available, so even though addictions can range across a broad spectrum of severity, many users can—if they’re committed—regain control of their lives.
Perhaps the most crucial fact about treatment choices is that there’s no one-size-fits-all strategy, according to Rick Gressard, Ph.D., a professor of addictions counseling at The College of William & Mary and faculty director of the college’s New Leaf Clinic. The ideal treatment depends on the person, Gressard says, and successful treatment (regardless of the addictive substance) typically involves:
- Helping to provide motivation for the drug user to make changes, and
- A long-term strategy to help the user keep making those changes.
John Colaluca, M.D., medical director at The Farley Center at Williamsburg Place, which runs both outpatient and residential programs for drug and alcohol abusers in the Williamsburg area, concurs that whichever substance causes an addiction does not make a dramatic difference in the treatment process. “The lines of distinction start becoming blurred,” he says, adding that many different substances can “result in the same chaos and destructive behavior and impact on interpersonal relationships.”
The treatment best suited for an addict can vary depending on factors such as the age of the user, the degree of addiction and the severity of withdrawal symptoms that may be expected, the individual’s emotional as well as financial ability to commit fully to treatment, and the extent of the individual’s support system.
Recovery options can range from outpatient programs with individual or small-group meetings once or more weekly to long-term residential programs lasting up to a year, and any treatment will begin with a process of detoxification (clearing the body of drugs). Often
known as “medically managed withdrawal,” this is typically overseen by a physician and sometimes involves using less-addictive narcotics in diminishing amounts. (While aimed at reducing the craving for the primary drug, using narcotics to achieve withdrawal is not without controversy).
For those struggling with alcoholism, the first-choice recovery program for decades has been Alcoholics Anonymous (AA). Founded in the U.S. in the 1930s and open to anyone who wishes to address their drinking problem, AA offers a 12-step spiritual path that can, according to aa.org, “expel the obsession to drink and enable the sufferer to become happily and usefully whole.” While the scientific validity of the program’s effectiveness is not universally accepted, countless recovering alcoholics credit it with their sobriety.
The 12-step tradition of AA, which led to the creation of other 12-step programs such as the drug recovery program Narcotics Anonymous, strongly influenced the disease model that for many years has dominated thinking about addiction. But even though “treatment for adults is almost all 12-step based,” according to Ben Newman, clinical director at Newport News Behavioral Health Center, such programs may not be most appropriate for the ways substance abuse is manifested in many teens. Twelve-step programs tend to define addiction as a disease that is progressive, chronic, and fatal, but often teens’ substance abuse has not reached that extreme and does not seem like a disease, Newman says. Rather, it often manifests itself across a broad spectrum of experimental use, heavily influenced by peer involvement and/or in response to environmental stresses. He notes also that the typical 12-step program’s requirement of abstinence may not be realistic for teens, who are frequently surrounded by temptation.
Whether recovery programs are 12-step or not, a cornerstone of many is one-on-one or small-group counseling, aimed at helping addicts to examine their behavior, develop a sense of personal accountability, and perhaps most important, creating for them a supportive community. “Addiction is a disease of isolation,” says Colaluca, “and recovery is not possible as a solitary endeavor.”
